Gastrointestinal Pathology Practice Questions

Q: Tylosis is associated with which of the following conditions?

Oesophageal Carcinoma. **Explanation:** **Tylosis** (also known as *Howel-Evans syndrome*) is a rare autosomal dominant genetic disorder characterized by focal hyperkeratosis of the palms and soles (palmoplantar keratoderma). **Why Oesophageal Carcinoma is Correct:** The association between Tylosis and **Squamous Cell Carcinoma (SCC) of the oesophagus** is one of the strongest genetic predispositions in gastrointestinal pathology. It is caused by a mutation in the **RHBDF2 gene** on chromosome 17q25. Individuals with this syndrome have a lifetime risk of developing oesophageal cancer approaching **90%** by age 70. This makes regular endoscopic surveillance mandatory for these patients. **Why Other Options are Incorrect:** * **B, C, and D:** While Uterine, Gastric, and Prostatic carcinomas have various genetic and environmental risk factors (e.g., *BRCA* mutations for prostate/uterine, *H. pylori* or *CDH1* for gastric), they have no established clinical or genetic link with palmoplantar keratoderma or the RHBDF2 mutation. **High-Yield Clinical Pearls for NEET-PG:** * **Type of Cancer:** Tylosis is specifically associated with **Squamous Cell Carcinoma**, not Adenocarcinoma. * **Triad:** Look for the triad of palmoplantar hyperkeratosis, oral leukoplakia, and oesophageal SCC in clinical vignettes. * **Other Oesophageal SCC Risk Factors:** Plummer-Vinson Syndrome (Iron deficiency anemia + glossitis + esophageal webs), Achalasia cardia, and corrosive injury (strictures). * **Genetic Locus:** Chromosome **17q25** (Tylosis Oesophageal Cancer locus).

Q: All of the following statements are true for telangiectasia of the colon EXCEPT:

50% involve the rectum. **Explanation:** **Telangiectasia of the colon**, also known as **Angiodysplasia**, is a common cause of lower gastrointestinal bleeding in the elderly. It consists of malformed, dilated submucosal and mucosal blood vessels [1]. **Why Option D is the Correct Answer (The False Statement):** Angiodysplasia is characteristically located in the **right colon**, specifically the **cecum and ascending colon** (approx. 75-80% of cases) [1]. It is rarely found in the rectum. Therefore, the statement that 50% involve the rectum is factually incorrect. **Analysis of Other Options:** * **Options A & B:** While angiodysplasia is most common in patients **over the age of 60** (due to degenerative changes in vessel walls over time), it can occasionally be seen in younger individuals (less than 40 years), often associated with systemic conditions or congenital predispositions [1]. * **Option C:** The **cecum** is indeed the most common site. This is attributed to Laplace’s Law; the cecum has the largest diameter of the colon, resulting in the highest wall tension, which leads to chronic intermittent venous obstruction and subsequent vessel dilation [1]. **Clinical Pearls for NEET-PG:** * **Association:** Frequently associated with **Aortic Stenosis** (Heyde’s Syndrome) and Chronic Kidney Disease. * **Presentation:** Usually presents as painless, chronic, or episodic hematochezia or iron deficiency anemia [1]. * **Diagnosis:** Gold standard is **Colonoscopy** (appears as bright red, stellate/fern-like vascular lesions). Angiography is used if colonoscopy is inconclusive. * **Pathogenesis:** Attributed to chronic, intermittent occlusion of submucosal veins as they pierce the muscularis propria [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 787-789.

Q: Macrophages containing PAS-positive granules and rod-shaped bacilli are found in which condition affecting the small intestinal mucosa?

Whipple's disease. **Explanation:** **Whipple’s Disease (Correct Answer):** Whipple’s disease is a systemic infectious process caused by the gram-positive actinomycete **_Tropheryma whipplei_**. The hallmark histological finding is the infiltration of the small intestinal lamina propria by **foamy macrophages** [1]. These macrophages contain large cytoplasmic granules that are **PAS-positive** and diastase-resistant [1]. These granules represent partially digested bacterial cell walls. Electron microscopy reveals the characteristic **rod-shaped bacilli** (the causative organism) within these macrophages [1]. **Why the other options are incorrect:** * **Agammaglobulinemia:** This immunodeficiency typically shows a lack of plasma cells in the lamina propria and may be associated with *Giardia lamblia* infections, but not PAS-positive macrophage infiltration. * **Tropical Sprue:** Characterized by total or subtotal villous atrophy and increased intraepithelial lymphocytes, similar to Celiac disease, but lacks specific PAS-positive inclusions. * **Celiac Sprue:** Histology shows villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes (IELs). It is an immune-mediated response to gluten, not a bacterial infiltration of macrophages. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Tetrad:** Malabsorption (diarrhea/weight loss), migratory large-joint arthritis, hyperpigmentation, and lymphadenopathy [1]. * **CNS Involvement:** Can present with "Oculomasticatory myorhythmia" (pathognomonic). * **Mnemonic:** **W**hipple’s = **W**eight loss, **W**ide (foamy) macrophages, **W**orking (PAS) stain, and **W**heel-shaped (rod) bacilli. * **Treatment:** Long-term antibiotics (usually Ceftriaxone followed by Trimethoprim-sulfamethoxazole). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 798-799.

Question 1

All of the following are benign mesenchymal tumors of the stomach EXCEPT?

Accepted Answer

Adenoma

Answer

Leiomyoma

Answer

Fibroma

Answer

Lipoma

Question 2

Which of the following gastric polyps does not undergo malignant transformation?

Accepted Answer

Hyperplastic polyps

Answer

Tubular adenoma

Answer

Villous adenoma

Answer

Multiple polyposis

Question 3

Tylosis is associated with which of the following conditions?

Accepted Answer

Oesophageal Carcinoma

Answer

Uterine Carcinoma

Answer

Gastric Carcinoma

Answer

Prostatic Carcinoma

Question 4

All of the following statements are true for telangiectasia of the colon EXCEPT:

Accepted Answer

50% involve the rectum

Answer

May be seen in persons less than 40 years of age

Answer

May be seen in persons more than 60 years of age

Answer

Common site is the cecum

Question 5

Macrophages containing PAS-positive granules and rod-shaped bacilli are found in which condition affecting the small intestinal mucosa?

Accepted Answer

Whipple's disease

Answer

Agammaglobulinemia

Answer

Tropical Sprue

Answer

Celiac sprue

Question 6

What is the most common stomach tumor that causes bleeding?

Accepted Answer

Leiomyosarcoma

Answer

Adenocarcinoma

Answer

Squamous carcinoma

Answer

Fibrosarcoma

Question 7

Early gastric cancer generally indicates?

Accepted Answer

Gastric adenocarcinoma confined to the mucosa and submucosa

Answer

Gastric adenocarcinoma detected early

Answer

Gastric adenocarcinoma confined to the mucosa

Answer

Gastric adenocarcinoma less than 1 cm in size

Question 8

Gastric carcinoma is associated with all EXCEPT:

Accepted Answer

Circulating autoimmune antibodies

Answer

Inactivation of p53

Answer

Overexpression of c-erbB2

Answer

Overexpression of c-met

Question 9

Which condition is a known cause of colonic carcinoma?

Accepted Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Erythema multiforme

Answer

Bullous pemphigoid

Question 10

Which of the following is the most aggressive type of rectal carcinoma?

Accepted Answer

Secondary mucoid carcinoma

Answer

Adenocarcinoma

Answer

Signet ring carcinoma

Answer

Squamous cell carcinoma

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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