Gastrointestinal Pathology Practice Questions

Q: A 25-year-old female presents with splenomegaly, leucopenia, and fever, and subsequently dies within a few days. Autopsy reveals longitudinal ulcers in the intestine. What is the probable diagnosis?

Enteric fever. ### Explanation The clinical presentation of fever, splenomegaly, and leucopenia, combined with the hallmark autopsy finding of **longitudinal ulcers** in the intestine, point directly to **Enteric Fever (Typhoid)** caused by *Salmonella Typhi*. **Why Enteric Fever is Correct:** In typhoid fever, the bacteria invade the **Peyer’s patches** of the terminal ileum. This leads to hyperplasia, followed by necrosis and sloughing of the overlying mucosa. Because Peyer’s patches are distributed along the long axis of the gut, the resulting ulcers are characteristically **longitudinal (oval)**. The systemic involvement explains the splenomegaly and the classic hematological finding of leucopenia (relative lymphocytosis). **Why Other Options are Incorrect:** * **Tuberculosis:** Intestinal TB typically presents with **transverse (circumferential)** ulcers because the bacilli spread via the lymphatics, which encircle the bowel wall. * **Amoebiasis:** Caused by *Entamoeba histolytica*, these ulcers are characteristically **flask-shaped** with narrow necks and broad bases, usually involving the colon rather than the ileum. * **Hemorrhagic Fever:** While it can cause systemic collapse and fever, it does not produce localized longitudinal intestinal ulceration. **High-Yield Clinical Pearls for NEET-PG:** * **Ulcer Orientation:** Typhoid = Longitudinal; Tuberculosis = Transverse. * **Complications:** Intestinal perforation (usually in the 3rd week) and hemorrhage are major causes of mortality. * **Diagnostic Tests:** Use the **ASU** mnemonic for timing: **A**ntigen/Blood culture (1st week), **S**erology/Widal (2nd week), **U**rine/Stool culture (3rd week). * **Pathology:** Look for "Typhoid nodules" (aggregates of macrophages/Kupffer cells) in the liver and bone marrow.

Q: Duodenal villous atrophy is seen in which of the following conditions?

Celiac disease. **Explanation:** **Celiac Disease (Correct Answer):** Celiac disease is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals (HLA-DQ2/DQ8) [1]. The hallmark histopathological finding on a duodenal biopsy is **villous atrophy**, accompanied by crypt hyperplasia and increased intraepithelial lymphocytes (Marsh Classification) [1]. This destruction of the villi reduces the surface area for absorption, leading to malabsorption syndromes. **Incorrect Options:** * **Crohn’s Disease:** While it can involve the duodenum, it is characterized by **transmural inflammation** and **non-caseating granulomas**. It typically presents with "skip lesions" and "cobblestoning" rather than diffuse villous atrophy. * **Ulcerative Colitis:** This condition is strictly limited to the **colon and rectum** (mucosal involvement). It does not affect the small intestine, except in cases of "backwash ileitis," and never involves the duodenum. * **Cystic Fibrosis:** This is a multisystem disorder affecting chloride channels (CFTR). In the GI tract, it primarily causes pancreatic insufficiency and inspissated secretions (meconium ileus), but it does not cause primary villous atrophy. **High-Yield NEET-PG Pearls:** * **Gold Standard Diagnosis:** Duodenal biopsy (showing villous atrophy) while on a gluten-containing diet. * **Serology:** Anti-tissue Transglutaminase (anti-tTG) IgA is the screening test of choice. Anti-Endomysial Antibody (EMA) is the most specific. * **Dermatitis Herpetiformis:** A pathognomonic skin manifestation (itchy vesicles on elbows/knees). * **Other causes of Villous Atrophy:** Tropical sprue (affects distal small bowel more), Whipple’s disease [2], and Common Variable Immunodeficiency (CVID).

Q: Erosive gastritis commonly occurs at which location?

Body and Antrum. **Explanation:** **Correct Answer: C. Body and Antrum** **Medical Concept:** Erosive gastritis (also known as acute hemorrhagic gastritis) is characterized by damage to the gastric mucosal barrier, leading to mucosal inflammation, erosions, and hemorrhage [1]. The most common triggers include NSAIDs, alcohol, and severe physiological stress (e.g., burns, trauma). [1] Pathologically, these erosions are typically **multifocal** and involve the **body and the antrum** of the stomach. While the antrum is frequently involved due to its role in acid regulation and proximity to ingested irritants (like NSAIDs), the body is equally affected because it contains the majority of the acid-secreting parietal cells, which exacerbate mucosal injury once the protective barrier is breached. **Analysis of Options:** * **A & B (Body and Fundus / Body):** While the body is a primary site, these options are incomplete. The fundus is less frequently involved compared to the antrum in typical erosive gastritis. * **D (Fundus and Antrum):** The fundus is the uppermost part of the stomach and is generally less susceptible to the pooling of irritants or the primary acid-insult seen in erosive patterns compared to the body. **NEET-PG High-Yield Pearls:** * **Curling Ulcer:** Stress ulcers occurring in the proximal duodenum, typically associated with **severe burns** [1]. * **Cushing Ulcer:** Gastric, duodenal, or esophageal ulcers associated with **increased intracranial pressure** (due to vagal stimulation leading to hypersecretion of gastric acid). * **Morphology:** Erosions are superficial (do not cross the muscularis mucosae), whereas ulcers are deep. * **Key Risk Factor:** NSAIDs inhibit COX-1, leading to decreased Prostaglandin $E_2$ and $I_2$, which are essential for mucus and bicarbonate secretion. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 767-768.

Question 1

A 25-year-old female presents with splenomegaly, leucopenia, and fever, and subsequently dies within a few days. Autopsy reveals longitudinal ulcers in the intestine. What is the probable diagnosis?

Accepted Answer

Enteric fever

Answer

Tuberculosis

Answer

Hemorrhagic fever

Answer

Amoebiasis

Question 2

Which of the following is not considered a precancerous lesion?

Accepted Answer

Verrucous carcinoma

Answer

Lichen planus

Answer

Submucous fibrosis

Answer

Leukoplakia

Question 3

A 30-year-old lady presents with features of malabsorption and iron deficiency anemia. Duodenal biopsy reveals complete villous atrophy. Which of the following antibodies is likely to be present?

Accepted Answer

Antiendomysial antibodies

Answer

Anti-goblet cell antibodies

Answer

Anti-saccharomyces cerevisiae antibodies

Answer

Antineutrophil cytoplasmic antibodies

Question 4

Duodenal villous atrophy is seen in which of the following conditions?

Accepted Answer

Celiac disease

Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Cystic fibrosis

Question 5

Erosive gastritis commonly occurs at which location?

Accepted Answer

Body and Antrum

Answer

Body and Fundus

Answer

Body

Answer

Fundus and Antrum

Question 6

Which of the following conditions causing malabsorption has no effect on villus architecture and no inflammatory reaction?

Accepted Answer

Abetalipoproteinemia

Answer

Giardiasis

Answer

Crohn's disease

Answer

Whipple's disease

Question 7

What staining is used for the diagnosis of Hirschsprung's disease?

Accepted Answer

AChE

Answer

Fontana stain

Answer

Trichrome stain

Answer

Auramine Rhodamine stain

Question 8

Which of the following is associated with rectal adenoma?

Accepted Answer

Hypokalemia

Answer

Familial polyposis coli

Answer

Intussusception

Answer

Hemorrhoids

Question 9

Which of the following is NOT true about Celiac disease?

Accepted Answer

Increased thickness of the mucosa

Answer

Crypt hyperplasia

Answer

Increased intraepithelial lymphocytes

Answer

Increased inflammatory cells in lamina propria

Question 10

H. pylori infection causes carcinoma by which mechanism?

Accepted Answer

Gastric metaplasia

Answer

Production of nitrosamines

Answer

Increasing acid secretion

Answer

Causing mutation

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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