Gastrointestinal Pathology Practice Questions

Q: Whipple's disease is characterized by which of the following findings?

Foamy macrophages. **Explanation:** **Whipple’s Disease** is a rare systemic infectious disease caused by the Gram-positive actinomycete **_Tropheryma whipplei_** [1]. **Why Option A is Correct:** The hallmark histological finding in the small intestine is the infiltration of the **lamina propria** by numerous **foamy macrophages** [1]. These macrophages contain large amounts of indigestible bacterial cell wall material, which stains intensely positive with **Periodic Acid-Schiff (PAS)** and is **diastase-resistant**. This infiltration causes lymphatic obstruction, leading to malabsorption and steatorrhea [1]. **Analysis of Incorrect Options:** * **Option B (AFB positive):** While the macrophages in Whipple’s disease are PAS-positive, they are **AFB-negative** [1]. This is a crucial diagnostic distinction from *Mycobacterium avium-intracellulare* (MAI) infection, which also presents with foamy PAS-positive macrophages but is acid-fast. * **Option C (Papillary projections):** These are characteristic of certain malignancies (e.g., Papillary Thyroid Carcinoma) or inflammatory conditions, but not Whipple’s disease. * **Option D (Villous atrophy):** While the villi may appear widened or "blunted" due to macrophage infiltration, total villous atrophy is the classic feature of **Celiac Disease**, not Whipple’s. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Tetrad:** Malabsorption (weight loss/diarrhea), Hyperpigmentation, Lymphadenopathy, and Polyarthritis (often the earliest symptom) [1]. * **Electron Microscopy:** Shows characteristic **"bacilliform bodies"** (the causative organism). * **Mnemonic:** **PAS** the **Whipped** cream (PAS-positive macrophages in Whipple’s). * **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.

Q: Turcot’s syndrome is not associated with which of the following?

Odontoma. **Explanation:** **Turcot’s Syndrome** is a rare variant of Familial Adenomatous Polyposis (FAP) characterized by the association of **colonic polyposis** and **central nervous system (CNS) tumors**. 1. **Why Odontoma is the correct answer:** Odontomas (benign dental tumors) are a classic feature of **Gardner’s Syndrome**, not Turcot’s Syndrome. While both are variants of FAP, Gardner’s is characterized by the triad of colonic polyposis, soft tissue tumors (desmoid tumors, sebaceous cysts), and skeletal abnormalities (osteomas of the mandible, odontomas). 2. **Analysis of Incorrect Options:** * **Polyps (A):** As a variant of FAP, Turcot’s syndrome is fundamentally defined by the presence of hundreds to thousands of adenomatous polyps in the colon, which have a 100% risk of progressing to adenocarcinoma [1]. * **CHRPE (B):** Congenital Hypertrophy of the Retinal Pigment Epithelium is a common extracolonic manifestation found in various FAP variants, including Turcot’s. It serves as a useful clinical screening marker. * **Brain Tumors (C):** This is the hallmark of Turcot’s [1]. There are two distinct genetic patterns: * *Type 1:* Associated with HNPCC/Lynch Syndrome (mismatch repair genes); typically presents with **Glioblastoma Multiforme** [1]. * *Type 2:* Associated with FAP (APC gene mutation); typically presents with **Medulloblastoma**. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Turcot’s:** "Turban" (Turcot = Brain tumors). * **Mnemonic for Gardner’s:** "SOD" (Sebaceous cysts, Osteomas/Odontomas, Desmoid tumors). * **Most common CNS tumor in Turcot (FAP-associated):** Medulloblastoma. * **Most common CNS tumor in Turcot (Lynch-associated):** Glioblastoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 813.

Question 1

Whipple's disease is characterized by which of the following findings?

Accepted Answer

Foamy macrophages

Answer

Acid-fast bacilli (AFB) positive

Answer

Papillary projections

Answer

Villous atrophy

Question 2

Which of the following is a feature of Barrett's esophagus?

Accepted Answer

Intestinal metaplasia

Answer

Always gastric type of epithelium

Answer

Squamous cell carcinoma is more common

Answer

Present as patchy or ring involvement

Question 3

Which is the most specific marker for gastrointestinal stromal tumors (GIST)?

Accepted Answer

DOG 1

Answer

CD 117

Answer

CD 34

Answer

PDGFRA mutation

Question 4

All of the following predispose to carcinoma of the esophagus except?

Accepted Answer

Zenker's diverticulum

Answer

Achalasia

Answer

Barrett's esophagus

Answer

Plummer-Vinson disease

Question 5

Which of the following is not a pre-malignant condition?

Accepted Answer

Juvenile polyp

Answer

Familial adenomatous polyposis (FAP)

Answer

Peutz-Jeghers (PZ) syndrome

Answer

Juvenile polyposis syndrome

Question 6

Incidence of malignancy is maximum in which of the following polyp types?

Accepted Answer

Villous adenoma

Answer

Juvenile polyps

Answer

Hyperplastic polyps

Answer

Tubular adenoma

Question 7

Turcot’s syndrome is not associated with which of the following?

Accepted Answer

Odontoma

Answer

Polyps

Answer

Congenital hypertrophy of the retinal pigment epithelium (CHRPE)

Answer

Brain tumors

Question 8

Which type of polyp has the least malignant potential?

Accepted Answer

Hyperplastic polyp

Answer

Pseudoadenoma

Answer

Villous adenoma

Answer

Tubular adenoma

Question 9

Longitudinal ulcers in the intestine are seen in:

Accepted Answer

Typhoid

Answer

Tuberculosis

Answer

Amoebiasis

Answer

Yersinia

Question 10

A 23-year-old female presents with prolonged diarrhea, flatus, and abdominal pain. Her appetite is preserved, yet she is experiencing weight loss. Physical examination is within normal limits. Small intestinal biopsy reveals villous atrophy, lymphocytic infiltration of the lamina propria, and crypt hyperplasia. She improved after dietary changes. How can this condition be differentiated from Whipple disease?

Accepted Answer

Histopathology

Answer

Physical examination

Answer

Clinical symptoms

Answer

Imaging

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?