Gastrointestinal Pathology Practice Questions

Q: Test tube rete pegs are a characteristic feature of:

Dilantin hyperplasia. **Explanation:** The term **"test tube rete pegs"** refers to a specific histopathological pattern where the epithelial rete ridges become elongated, slender, and uniform in shape, resembling test tubes lined up in a rack. **1. Why Dilantin Hyperplasia is correct:** Dilantin (Phenytoin) is an anticonvulsant known to cause **gingival hyperplasia**. Histologically, this condition is characterized by significant epithelial hyperplasia with long, thin, and slender rete pegs extending deep into the underlying connective tissue. These are classically described as "test tube" or "finger-like" rete pegs. This is a result of increased fibroblast activity and collagen production induced by the drug. **2. Why other options are incorrect:** * **Lichen Planus:** Characterized by **"saw-tooth"** rete pegs due to the destruction of the basal cell layer (liquefactive degeneration) by a band-like lymphocytic infiltrate. * **Oral Submucous Fibrosis (OSMF):** Characterized by epithelial **atrophy** (thinning) and loss of rete pegs due to excessive collagen deposition and hyalinization in the subepithelial layers. * **Psoriasis (Comparison):** While Psoriasis also features elongated rete pegs, they are typically described as **"club-shaped"** or "regularly elongated" with thinning of the suprapapillary epithelium. **3. NEET-PG High-Yield Pearls:** * **Phenytoin (Dilantin):** Causes gingival enlargement in ~50% of users. Other drugs causing this include **Cyclosporine** and **Calcium Channel Blockers (Nifedipine)**. * **Auspitz Sign:** Bleeding when psoriasis scales are removed, due to thinning of the epithelium over dilated capillaries in the dermal papillae. * **Munro’s Microabscess:** Neutrophils in the stratum corneum (seen in Psoriasis). * **Kogoj’s Pustule:** Neutrophils in the stratum spinosum (seen in Psoriasis).

Q: A 95-year-old man has noted swelling of his lower lip for the past month. On examination, there is a fluctuant, 1-cm nodule with a blue, translucent hue just beneath the oral mucosa on the inside of his lip. The lesion is excised, and microscopic examination shows granulation tissue. What is the most likely etiology for this lesion?

Local trauma. **Explanation:** The clinical presentation describes a classic case of a **Mucocele** (Mucous extravasation cyst). This is the most common minor salivary gland lesion, typically occurring on the **lower lip**. **Why Local Trauma is Correct:** The underlying pathophysiology involves **local trauma** (such as accidental biting of the lip) that causes rupture of a minor salivary gland duct. This leads to the leakage (extravasation) of mucus into the surrounding submucosal soft tissues. The body responds by forming a wall of **granulation tissue** (pseudocyst) around the mucus, which explains the microscopic findings and the characteristic fluctuant, blue, translucent appearance. **Why Other Options are Incorrect:** * **A & B (Chili peppers/French kissing):** While these involve the oral cavity, they do not typically cause the specific ductal rupture required to form a mucocele. * **C (HIV infection):** HIV is associated with salivary gland issues like Benign Lymphoepithelial Lesions (BLEL), particularly in the parotid gland, but it is not a primary cause of lower lip mucoceles. **NEET-PG High-Yield Pearls:** * **Most common site:** Lower lip (due to frequent trauma). * **Pathology:** It is a **pseudocyst** because it lacks an epithelial lining (lined by granulation tissue). * **Ranula:** A mucocele occurring on the floor of the mouth, usually arising from the **sublingual gland**. A "Plunging Ranula" extends below the mylohyoid muscle into the neck. * **Treatment:** Complete surgical excision along with the involved minor salivary gland to prevent recurrence.

Question 1

Familial polyposis coli is associated with which genetic defect?

Accepted Answer

APC

Answer

MLH1

Answer

MSH2

Answer

RET

Question 2

Which of the following statements is incorrect?

Accepted Answer

Increased prostaglandin secretion is protective against stress ulcers.

Answer

Curling ulcers are associated with severe burns.

Answer

Stress ulcers can be caused by shock.

Answer

Central nervous system lesions can lead to the formation of stress ulcers.

Question 3

When carcinoma of the stomach develops secondarily to pernicious anemia, it is usually situated in which region?

Accepted Answer

Fundus

Answer

Pre-pyloric region

Answer

Pylorus

Answer

Body

Question 4

Squamous cell carcinoma of the lip is least likely to develop in which of the following individuals?

Accepted Answer

Brunette individual who constantly drinks tea

Answer

Scandinavian fisherman

Answer

Redheaded individual with a year-round tan

Answer

Man who smokes a clay pipe

Question 5

All of the following are features of early gastric carcinoma except?

Accepted Answer

Paradoxical aciduria

Answer

Mucosal involvement

Answer

Submucosal involvement

Answer

Muscularis propria not involved

Question 6

Test tube rete pegs are a characteristic feature of:

Accepted Answer

Dilantin hyperplasia

Answer

Lichen planus

Answer

Oral submucous fibrosis

Answer

All of the above

Question 7

A 70-year-old male, a chronic tobacco chewer for 50 years, presents with a six-month history of a large, fungating, soft papillary lesion in the oral cavity that has penetrated the mandible. Lymph nodes are not palpable. Biopsies show benign-appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. What is the most likely diagnosis?

Accepted Answer

Verrucous carcinoma

Answer

Squamous cell papilloma

Answer

Squamous cell carcinoma

Answer

Malignant mixed tumor

Question 8

Which of the following is associated with an increased risk of gastric carcinomas?

Accepted Answer

Intestinal metaplasia

Answer

Gastric polyp (hyperplastic or adenomatous)

Answer

Atrophic gastritis

Answer

Corrosive antral stricture

Question 9

A 95-year-old man has noted swelling of his lower lip for the past month. On examination, there is a fluctuant, 1-cm nodule with a blue, translucent hue just beneath the oral mucosa on the inside of his lip. The lesion is excised, and microscopic examination shows granulation tissue. What is the most likely etiology for this lesion?

Accepted Answer

Local trauma

Answer

Eating chili peppers

Answer

French kissing

Answer

HIV infection

Question 10

Tubular (Canalicular) adenoma most commonly occurs on which of the following locations?

Accepted Answer

Upper lip

Answer

Palate

Answer

Lower lip

Answer

Gingiva

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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