Gastrointestinal Pathology Practice Questions

Q: Which of the following statements is false regarding familial polyposis colon cancer syndrome?

Autosomal recessive transmission. **Explanation:** **1. Why Option A is the correct (false) statement:** Familial Adenomatous Polyposis (FAP) is an **Autosomal Dominant** condition, not recessive. It is caused by a germline mutation in the **APC (Adenomatous Polyposis Coli) gene** located on chromosome **5q21** [1]. According to the "Knudson Two-Hit Hypothesis," an individual inherits one defective copy, and a somatic mutation in the second allele leads to the development of hundreds to thousands of adenomatous polyps [1]. **2. Analysis of other options:** * **Option B (Associated with fibromas and osteomas):** This describes **Gardner Syndrome**, a clinical variant of FAP. It includes intestinal polyps plus extra-colonic manifestations like osteomas (usually of the mandible/skull), epidermal cysts, and desmoid tumors (fibromas). * **Option C (Associated with brain tumors):** This describes **Turcot Syndrome**, another variant of FAP. It is characterized by the association of colonic polyposis with CNS tumors (classically **Medulloblastomas** in FAP-associated Turcot, or Glioblastomas in Lynch syndrome). * **Option D (100% chance of developing colon carcinoma):** This is a hallmark of FAP. If left untreated (without prophylactic colectomy), the progression from adenoma to adenocarcinoma is inevitable, usually by the age of 40-50 [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Minimum Requirement:** Diagnosis requires at least **100 polyps** [1]. * **Screening:** Start colonoscopy/sigmoidoscopy at age **10–12 years**. * **CHRPE:** Congenital Hypertrophy of Retinal Pigment Epithelium is a highly specific early extra-colonic sign of FAP. * **Molecular Pathway:** FAP follows the **APC-Wnt/β-catenin pathway** (the classic Adenoma-Carcinoma sequence). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 821-822.

Q: This is a specimen of which condition?

Familial adenomatous polyposis (FAP). ***Familial adenomatous polyposis (FAP)*** - Characterized by a **carpet-like appearance** of hundreds to thousands of small **adenomatous polyps** densely covering the colonic mucosa - The **uniform distribution** and **sheer number** of small polyps throughout the colon is pathognomonic for FAP *Ulcerative colitis* - Shows **diffuse mucosal inflammation** with superficial ulcerations and **pseudopolyps** formed by regenerating mucosa - Lacks the characteristic **carpet of true adenomatous polyps** seen in FAP; inflammation is limited to **mucosa and submucosa** *Crohn's disease* - Exhibits **skip lesions** with normal bowel between affected segments and **cobblestone appearance** due to deep ulcers - Shows **transmural inflammation** with thickened bowel wall, not the superficial carpet of polyps characteristic of FAP *Peutz-Jeghers syndrome* - Features **few large hamartomatous polyps** (typically 5-20) rather than hundreds of small adenomatous polyps - Associated with **mucocutaneous pigmentation** around lips and mouth, and polyps have a different histological appearance than adenomatous polyps

Question 1

Toxic megacolon is a complication of which of the following conditions?

Accepted Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Aganglionic megacolon

Answer

Ischemic colitis

Question 2

Which of the following statements is false regarding familial polyposis colon cancer syndrome?

Accepted Answer

Autosomal recessive transmission

Answer

Associated with fibromas and osteomas

Answer

Associated with brain tumors

Answer

100% chance of developing colon carcinoma

Question 3

Which of the following conditions shows the most specific change in a biopsy?

Accepted Answer

Abetalipoproteinemia

Answer

Tropical sprue

Answer

Giardiasis

Answer

Malnutrition

Question 4

Mixed tumors of the salivary glands are most commonly found in which location?

Accepted Answer

Parotid gland

Answer

Submandibular gland

Answer

Usually malignant

Answer

Associated with calculi

Question 5

Which of the following is NOT typically seen in Ulcerative colitis?

Accepted Answer

Skip lesions

Answer

Pseudopolyps

Answer

Rectum involvement

Answer

Malabsorption

Question 6

Biopsy of the lower esophagus in a patient with chronic reflux demonstrates epithelial metaplasia. Which of the following cell types was most likely observed in the involved areas?

Accepted Answer

Nonciliated columnar epithelium

Answer

Ciliated columnar epithelium

Answer

Ciliated columnar epithelium

Answer

Keratinizing squamous epithelium

Question 7

Which of the following polyps is not premalignant?

Accepted Answer

Ulcerative colitis

Answer

Juvenile polyposis syndrome

Answer

Peutz-Jeghers syndrome

Answer

Familial polyposis coli

Question 8

This is a specimen of which condition?

Accepted Answer

Familial adenomatous polyposis (FAP)

Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Peutz-Jeghers syndrome

Question 9

What is the most common tumor of the small intestine?

Accepted Answer

Leiomyoma

Answer

Lymphoma

Answer

Adenocarcinoma

Answer

Hemangioma

Question 10

Which of the following is NOT true regarding the intestinal type of gastric carcinoma?

Accepted Answer

Typically associated with extensive lymphatic spread.

Answer

Characterized by well-defined gland formation.

Answer

Most common site is the distal part of the stomach.

Answer

More common in the elderly population.

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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