Gastrointestinal Pathology Practice Questions

Q: What is true about Mallory-Weiss tear?

It presents with hematemesis.. **Explanation:** Mallory-Weiss syndrome is characterized by **longitudinal mucosal lacerations** at the gastroesophageal (GE) junction or the proximal gastric mucosa. **Why Option C is correct:** The hallmark clinical presentation is **painless hematemesis** (vomiting of bright red blood) following episodes of forceful vomiting, retching, or coughing. This occurs because the sudden increase in intra-abdominal pressure causes the gastric contents to overwhelm the GE junction, leading to mucosal stretching and tearing of the underlying plexus of arteries and veins. **Analysis of Incorrect Options:** * **Option A:** In reality, approximately **75% of tears occur in the stomach**, just below the GE junction, rather than above it. * **Option B:** Surgery is rarely required. About **80-90% of cases stop bleeding spontaneously** with supportive care (fluid resuscitation and PPIs). Endoscopic therapy (clipping or epinephrine injection) is used for active bleeds. * **Option D:** While it is a longitudinal tear, this option is technically less "true" as a standalone clinical fact compared to the classic presentation of hematemesis in exam patterns. (Note: In some contexts, D is considered a feature, but C is the definitive clinical hallmark). **High-Yield Clinical Pearls for NEET-PG:** * **Association:** Strongly associated with **chronic alcoholism** and eating disorders (bulimia). * **Location:** Most commonly located on the **lesser curvature** of the stomach. * **Diagnosis:** Gold standard is **Upper GI Endoscopy**, which reveals linear mucosal tears. * **Mallory-Weiss vs. Boerhaave:** Mallory-Weiss is a **mucosal/submucosal tear** (incomplete), whereas Boerhaave Syndrome is a **transmural rupture** (complete) of the esophagus, which is a surgical emergency.

Q: Cobble stoning of the intestine with the string sign of Twort is seen in which condition?

Crohn's disease. **Explanation:** **Crohn’s Disease (Correct Answer):** Crohn’s disease is a chronic, transmural inflammatory bowel disease that can affect any part of the GIT [1]. The **"Cobblestone appearance"** occurs due to deep, longitudinal, and transverse linear ulcers (fissures) intersecting with islands of edematous, intact mucosa [1]. The **"String sign of Kantor"** (often referred to in radiology/pathology contexts alongside the String sign of Twort) represents a terminal ileum that has become significantly narrowed due to transmural inflammation, edema, and subsequent fibrosis/cicatrization, appearing as a thin thread of contrast on imaging [1]. **Why other options are incorrect:** * **Ulcerative Colitis:** Characterized by superficial mucosal involvement, continuous lesions (starting from the rectum), and "Pseudopolyps." It lacks transmural fibrosis, so the "string sign" is absent. Lead-pipe appearance is the classic radiological finding. * **Ischemic Colitis:** Typically presents with "Thumbprinting" on imaging due to submucosal hemorrhage and edema, usually at splenic flexure (Griffith’s point). * **Amoebic Colitis:** Characterized by "Flask-shaped ulcers" with narrow necks and broad bases, primarily involving the cecum and ascending colon. **NEET-PG High-Yield Pearls:** * **Transmural inflammation** is the hallmark of Crohn’s (leads to fistulas and strictures) [1]. * **Non-caseating granulomas** are pathognomonic (seen in ~40-60% of cases) [1]. * **Creeping fat:** Mesenteric fat wraps around the serosal surface of the bowel. * **Skip lesions:** Areas of disease separated by normal-appearing "skip" segments [1]. * **ASCA (Anti-Saccharomyces cerevisiae antibodies)** is positive in Crohn’s, whereas **p-ANCA** is associated with Ulcerative Colitis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-367.

Question 1

All of the following are true about pleomorphic adenoma EXCEPT:

Accepted Answer

Malignant transformation risk is high

Answer

Mixed tumor

Answer

Benign tumor

Answer

Encapsulated

Question 2

Pseudopolyposis is seen in which of the following conditions?

Accepted Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Juvenile polyposis

Answer

Enteric fever

Question 3

Upper GI endoscopy and biopsy from the lower esophagus in a 48-year-old lady with chronic heartburn shows the presence of columnar epithelium with goblet cells. What is this feature most likely consistent with?

Accepted Answer

Metaplasia

Answer

Dysplasia

Answer

Hyperplasia

Answer

Carcinoma in-situ

Question 4

Which of the following are predisposing factors for Esophageal Carcinoma?

Accepted Answer

All of the above

Answer

Tylosis

Answer

Achalasia

Answer

Barrett's esophagus

Question 5

What is true about Mallory-Weiss tear?

Accepted Answer

It presents with hematemesis.

Answer

More than 90% occur above the gastroesophageal junction.

Answer

Surgery is the mainstay of treatment.

Answer

It is a longitudinal tear near the gastroesophageal junction.

Question 6

Linitis plastica is found in which of the following conditions?

Accepted Answer

Leiomyosarcoma

Answer

Syphilis

Answer

Carcinoma

Answer

Sarcoidosis

Question 7

Cobble stoning of the intestine with the string sign of Twort is seen in which condition?

Accepted Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Ischemic colitis

Answer

Amoebic colitis

Question 8

All of the following are inherited in an autosomal dominant pattern EXCEPT?

Accepted Answer

Cronkhite-Canada syndrome

Answer

Bannayan-Riley-Ruvalcaba syndrome

Answer

Peutz-Jeghers syndrome

Answer

Gardner's syndrome

Question 9

Which of the following conditions would most likely be associated with chronic gastritis (Type A) resulting from autoimmune destruction of parietal cells?

Accepted Answer

Increased production of macrocytic red blood cells

Answer

Decreased growth of luminal bacteria

Answer

Decreased likelihood of developing gastric carcinoma

Answer

Decreased plasma concentration of gastrin

Question 10

A 65-year-old male with a history of smoking and alcohol abuse complains of poor appetite and difficulty swallowing both solid and liquid foods over the course of the last 4 months. He has lost 10 kg and occasionally vomits blood. A mass is detected in his esophagus and is subsequently biopsied. What is the most likely histological appearance of the biopsy?

Accepted Answer

Squamous cell morphology

Answer

Glandular epithelium associated with desmoplasia

Answer

Malignant tumor of mesenchymal origin

Answer

Tumor derived from all three germ layers

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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