Gastrointestinal Pathology Practice Questions

Q: A 45-year-old HIV-positive male presented with dysphagia. Endoscopy and biopsy were performed. What is the most likely diagnosis based on the endoscopic and histological findings?

Cytomegalovirus (CMV) esophagitis. ***Cytomegalovirus (CMV) esophagitis*** - Characterized by **large linear ulcerations** on endoscopy, typically seen in severely immunocompromised HIV patients with **CD4+ count <50 cells/μL**. - Histologically shows pathognomonic **owl-eye nuclear inclusions** (large eosinophilic intranuclear inclusions with surrounding halo) in infected cells. *Herpes esophagitis* - Endoscopically presents with **small, punched-out ulcers** rather than large linear ulcerations seen in CMV. - Histologically shows **multinucleated giant cells** with **Cowdry A inclusions**, not the characteristic owl-eye inclusions of CMV. *Candida esophagitis* - Endoscopically appears as **white plaques** or **pseudomembranes** that can be wiped off, revealing erythematous mucosa underneath. - Histologically shows **pseudohyphae and budding yeasts** on PAS or GMS staining, without the viral inclusions described. *Pseudomonas esophagitis* - Extremely rare cause of esophagitis, typically occurring only in **severely neutropenic patients** or those with extensive burns. - Would show **gram-negative rod bacteria** on histology and **necrotizing inflammation**, not the viral cytopathic effects described.

Q: Which of the following conditions is NOT typically associated with the formation of a small intestinal stricture?

Typhoid fever. The formation of a small intestinal stricture depends on the nature of the inflammatory or neoplastic process. **Typhoid fever (Enteric fever)**, caused by *Salmonella typhi*, primarily affects the Peyer’s patches in the terminal ileum. The characteristic pathology involves longitudinal ulceration. Because these ulcers are longitudinal (parallel to the long axis of the gut) and heal without significant fibrosis or circumferential scarring, they **do not result in stricture formation**. Instead, the most feared complications of typhoid ulcers are perforation and hemorrhage. **Analysis of other options:** * **Tuberculosis (TB):** Intestinal TB is the most common cause of benign small bowel strictures in developing countries. The ulcers are typically **transverse** (circumferential), leading to significant fibrosis and "napkin-ring" narrowing during healing. * **Malignant Tumors (e.g., Adenocarcinoma):** These lesions grow circumferentially and infiltrate the bowel wall, leading to progressive luminal narrowing and "apple-core" appearances. * **Lymphoma:** While primary intestinal lymphoma often causes aneurysmal dilatation of the bowel wall, it can also present with obstructive symptoms due to bulky masses or associated desmoplastic reactions that lead to strictures [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Typhoid Ulcers:** Longitudinal, along the long axis; lead to **perforation**, not strictures. * **Tubercular Ulcers:** Transverse/Circumferential; lead to **strictures**, not usually perforation. * **Crohn’s Disease:** Characterized by transmural inflammation and "string sign of Kantor" due to terminal ileal strictures. * **Aneurysmal Dilatation:** Classically associated with **Small Bowel Lymphoma** due to destruction of the myenteric plexus.

Q: Turcot's syndrome is associated with which of the following conditions?

Brain tumors. Explanation: Turcot’s Syndrome is a rare genetic disorder characterized by the association of Familial Adenomatous Polyposis (FAP) or Lynch syndrome with primary tumors of the Central Nervous System (CNS) [1]. 1. Why Option C is correct: The hallmark of Turcot’s syndrome is the development of brain tumors in patients with hereditary colorectal polyposis [1]. There are two distinct genetic patterns: * Type 1: Associated with Lynch Syndrome (HNPCC); typically presents with Glioblastoma Multiforme [1]. * Type 2: Associated with FAP (APC gene mutation); typically presents with Medulloblastoma [1]. 2. Why other options are incorrect: * Option A & D: While duodenal polyps and villous adenomas can occur in patients with FAP, they are not the defining extra-colonic feature that characterizes Turcot’s syndrome specifically [1]. * Option B: FAP is a *component* of Turcot’s syndrome, but the question asks what the syndrome is *associated* with (i.e., the additional clinical feature that differentiates it from simple FAP) [1]. High-Yield Clinical Pearls for NEET-PG: * Mnemonic: "Turcot = Turban" (Brain involvement). * Gardner’s Syndrome: Another FAP variant characterized by the triad of Colonic polyposis, Osteomas (usually of the mandible), and Soft tissue tumors (Desmoid tumors, sebaceous cysts) [1]. * Inheritance: Most cases follow an Autosomal Recessive or Autosomal Dominant pattern depending on the underlying mutation (MLH1/PMS2 vs. APC). * Screening: Patients with known FAP or family history of Turcot’s require periodic neurological examinations and potentially brain imaging in addition to colonoscopies.

Question 1

A 45-year-old HIV-positive male presented with dysphagia. Endoscopy and biopsy were performed. What is the most likely diagnosis based on the endoscopic and histological findings?

Accepted Answer

Cytomegalovirus (CMV) esophagitis

Answer

Herpes esophagitis

Answer

Candida esophagitis

Answer

Pseudomonas esophagitis

Question 2

Which of the following is NOT a gene involved in the pathogenesis of gastric cancer?

Accepted Answer

C-kit mutation

Answer

Suppression of p53 gene

Answer

APC gene

Answer

k-ras mutation

Question 3

A patient with intestinal malabsorption shows marked improvement when flour products are removed from the diet. At the height of the disease, what histologic changes would be seen at which of the following sites?

Accepted Answer

Proximal small bowel

Answer

Distal large bowel

Answer

Distal small bowel

Answer

Entire large bowel

Question 4

Malignant gastric ulcers are characterized by which of the following?

Accepted Answer

The question is about the characteristics of malignant gastric ulcers.

Answer

Mucosal rugae stop far from the ulcers.

Answer

Eccentric crater.

Answer

Margins are raised.

Question 5

Which of the following is NOT a pathologic feature of H. pylori chronic gastritis?

Accepted Answer

Eosinophilic infiltrates

Answer

Intraepithelial neutrophil deposits

Answer

Affects intestinal gland formation in the stomach

Answer

Subepithelial plasma cell deposits

Question 6

Which statement is false regarding familial adenomatous polyposis?

Accepted Answer

Males are usually carriers.

Answer

Autosomal dominant inheritance.

Answer

If not treated, progresses to malignancy in 100% of cases.

Answer

Males and females are affected equally.

Question 7

A 45-year-old woman presents with increasing abdominal girth over the past 2 years. Physical examination reveals abdominal distension. A CT scan shows multiple nodules on peritoneal surfaces along with low-attenuation mucinous ascites. Cytological examination after paracentesis showed well-differentiated columnar cells with minimal nuclear atypia. From which site did this pathology most likely originate?

Accepted Answer

Appendix

Answer

Pancreas

Answer

Ileum

Answer

Jejunum

Question 8

Which of the following conditions is NOT typically associated with the formation of a small intestinal stricture?

Accepted Answer

Typhoid fever

Answer

Lymphoma

Answer

Malignant tumor

Answer

Tuberculosis

Question 9

Turcot's syndrome is associated with which of the following conditions?

Accepted Answer

Brain tumors

Answer

Duodenal polyps

Answer

Familial adenomatous polyposis

Answer

Villous adenoma

Question 10

A segment of jejunum shows a nodular lesion in the submucosa. Histological examination reveals a tumor composed of uniform round cells arranged in trabeculae, with a "salt-and-pepper" chromatin pattern. Electron microscopy shows secretory granules, and immunohistochemistry is positive for serotonin. Which of the following parameters best correlates with the metastatic potential of this tumor?

Accepted Answer

Site and size

Answer

Architectural pattern

Answer

Cell pleomorphism

Answer

Hormonal production

Gastrointestinal Pathology — MCQs

Gastrointestinal Pathology — MCQs

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