GI PATHOLOGY Flashcards by Harrison Wells

Patient has HBsAg −, Anti-HBs +, Anti-HBc +. Most likely?
a. Vaccination
b. Past infection with recovery
c. Acute infection
d. Window period

b. Past infection with recovery

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Patient has HBsAg −, Anti-HBs −, IgM anti-HBc +. Most likely stage?
a. Acute infection
b. Chronic infection
c. Window period
d. Past infection

c. Window period

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Patient has HBsAg −, Anti-HBs +, Anti-HBc −. What does it suggest?
a. Acute HBV
b. Chronic HBV
c. Vaccination
d. Past infection

c. Vaccination

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Patient has HBsAg +, IgM anti-HBc −, Anti-HBs −. Diagnosis?
a. Acute HBV
b. Chronic HBV
c. Window period
d. Vaccination

b. Chronic HBV

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Patient has HBsAg +, IgM anti-HBc +. Diagnosis?
a. Acute HBV
b. Chronic HBV
c. Past infection
d. Vaccination

a. Acute HBV

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Wilson’s disease inheritance pattern is:
A. Autosomal dominant
B. Autosomal recessive
C. X-linked recessive
D. Mitochondrial

B. Autosomal recessive

Inheritance: Autosomal recessive mutation in ATP7B gene (chromosome 13).

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Most specific diagnostic test for Wilson’s disease:
A. Serum ceruloplasmin
B. 24-hr urinary copper
C. Liver biopsy copper quantification
D. Slit lamp exam for KF rings

B. 24-hr urinary copper

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Which of the following is NOT a feature of Wilson’s disease?
A. Kayser–Fleischer rings
B. Coombs-positive hemolytic anemia
C. Hepatic cirrhosis
D. Neuropsychiatric symptoms

B. Coombs-positive hemolytic anemia

Hematology: Coombs-negative hemolytic anemia.

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Characteristic MRI finding in Wilson’s disease:
A. Butterfly glioma
B. Face of giant panda sign
C. Salt and pepper appearance
D. Ring-enhancing lesion

B. Face of giant panda sign

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First-line treatment for Wilson’s disease:
A. Zinc acetate
B. D-penicillamine
C. Prednisolone
D. Ursodeoxycholic acid

B. D-penicillamine

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Gold standard for Hepatolenticular degeneration:

Liver biopsy with copper quantification (>250 µg/g dry weight).

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NAFLD histology

Macrovesicular faaty change only

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NASH histology

Cellular ballooning and necrosis
Chicken wire fibrosis

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Alcoholic steatohepatits

Macrovesicular + microvesicular steatosis.
Ballooned hepatocytes.
Mallory bodies (classically prominent).
Neutrophilic infiltration around degenerating hepatocytes.
Perivenular (zone 3) and pericellular “chicken wire” fibrosis.

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Nutmeg liver =

chronic passive congestion of the liver due to right-sided heart failure or Budd–Chiari syndrome.

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patient presented with obstructive jaundice, now having bleeding cause is? A. vit K deficiency b. decrease clotting factor due to liver problem c. vitamin c d. decrease prothrombin

A. vit K deficiency

In obstructive jaundice, bile doesn’t reach the intestine → fat malabsorption → vitamin K deficiency → ↓ synthesis of clotting factors II, VII, IX, X → bleeding.

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Patient with obstructive jaundice develops bleeding gums. Which factor is primarily responsible?
A. Vitamin K deficiency
B. Thrombocytopenia
C. Factor V deficiency
D. Vitamin C deficiency

A. Vitamin K deficiency

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A patient with advanced cirrhosis develops prolonged PT and bleeding. Vitamin K injection is given but PT remains prolonged. Cause?
A. Malabsorption of fat
B. Failure of factor synthesis by liver
C. Warfarin toxicity
D. Platelet dysfunction

B. Failure of factor synthesis by liver

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Bleeding in a patient on warfarin resembles which condition?
A. Liver cirrhosis
B. Vitamin K deficiency
C. Thrombocytopenia
D. Hemophilia

B. Vitamin K deficiency

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________ → Autoimmune, Anti-mitochondrial, middle-aged women, intrahepatic ducts.

________ → Men, UC, p-ANCA, “beading” on ERCP, cholangiocarcinoma risk.

PBC → Autoimmune, Anti-mitochondrial, middle-aged women, intrahepatic ducts.

PSC → Men, UC, p-ANCA, “beading” on ERCP, cholangiocarcinoma risk.

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Which disease shows granulomatous destruction of intrahepatic bile ducts?
A. Primary sclerosing cholangitis
B. Primary biliary cholangitis
C. Choledocholithiasis
D. Secondary biliary cirrhosis

B. Primary biliary cholangitis

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Which of the following is a common complication of PSC?
A. Hepatocellular carcinoma
B. Cholangiocarcinoma
C. Pancreatic carcinoma
D. Gastric carcinoma

B. Cholangiocarcinoma

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A young man with ulcerative colitis develops fatigue and jaundice. Labs: ↑ ALP, p-ANCA positive. Imaging: beading of bile ducts. Likely diagnosis?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Alcoholic cirrhosis
D. Autoimmune hepatitis

B. Primary sclerosing cholangitis

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PBC is most strongly associated with:
A. Ulcerative colitis
B. Crohn’s disease
C. Rheumatoid arthritis
D. Sjögren’s syndrome

D. Sjögren’s syndrome

Strongest association (key answer): Sjögren’s ✅

Other associations (may appear as distractors): RA, autoimmune thyroid disease, systemic sclerosis, celiac.

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A middle-aged woman presents with fatigue, pruritus, and jaundice. Labs show ↑ ALP and ↑ cholesterol. Autoantibody most likely? A. Anti-mitochondrial antibody B. ANA C. Anti-smooth muscle antibody D. Anti-LKM antibody

A. Anti-mitochondrial antibody

Secondary biliary cirrhosis most commonly results from: A. Autoimmune destruction of intrahepatic bile ducts B. Extrahepatic biliary obstruction (e.g., gallstones, strictures, tumors) C. Association with ulcerative colitis D. Genetic defect in bile salt transport

B. Extrahepatic biliary obstruction (e.g., gallstones, strictures, tumors)

in liver cell injury, enzyme decreased is ALP, AST, GGT, ALT, 5-nucleotidase

5-nucleotidase

Which enzyme is most specific for hepatocellular injury? A. ALP B. AST C. ALT D. GGT

C. ALT

In alcoholic hepatitis, which pattern is typical? A. ALT > AST B. AST > ALT (ratio > 2:1) C. ALP markedly raised D. GGT normal

B. AST > ALT (ratio > 2:1)

A patient with jaundice has ↑ ALP, ↑ GGT, and ↑ 5′-nucleotidase but only mild elevation of ALT/AST. This pattern suggests: A. Viral hepatitis B. Alcoholic hepatitis C. Cholestatic/obstructive jaundice D. Ischemic hepatitis

C. Cholestatic/obstructive jaundice

Which of the following is NOT a reliable marker of hepatocellular injury? A. ALT B. AST C. GGT D. ALP

D. ALP

Piece meal necrosis is seen in

seen in chronic hepatitis (viral/ autoimmune)

Councilman bodies →

apoptotic hepatocytes in viral hepatitis

Onion skin bile duct fibrosis is seen in _______________--

PSC

Liver enzyme raised due to drug

ALT

Non alcoholic = ____________ Non alcoholic (cirrhosis/fibrosis) = _______________

ALT>AST AST>ALT

Zollinger–Ellison syndrome is most commonly due to a tumor in which site? A. Stomach B. Pancreas C. Duodenum D. Jejunum

C. Duodenum

A patient with multiple refractory peptic ulcers and diarrhea is suspected of having ZES. The most specific diagnostic test is: A. Serum amylase B. Serum gastrin level C. Secretin stimulation test D. Urea breath test

C. Secretin stimulation test

Zollinger–Ellison syndrome may be associated with which inherited condition? A. MEN 1 B. MEN 2A C. MEN 2B D. Von Hippel-Lindau disease

A. MEN 1

A 40-year-old man has recurrent, multiple duodenal ulcers and chronic diarrhea. Serum gastrin is markedly elevated. Likely diagnosis? A. Cushing ulcer B. Zollinger–Ellison syndrome C. Curling ulcer D. Stress ulcer

B. Zollinger–Ellison syndrome

Jaundice appearing after 24 hrs of birth, peaking at 3–5 days, resolving within 2 weeks is most likely: A. Pathological jaundice B. Physiological jaundice C. Biliary atresia D. Crigler–Najjar syndrome

B. Physiological jaundice

A 6-week-old infant presents with jaundice, yellow urine and pale stools. Most likely diagnosis: A. Gilbert syndrome B. Biliary atresia C. Physiological jaundice D. Breast milk jaundice

B. Biliary atresia

Which neonatal condition shows conjugated hyperbilirubinemia? A. Biliary atresia B. Crigler–Najjar syndrome C. Physiological jaundice D. Gilbert syndrome

A. Biliary atresia

Persistent jaundice beyond 2 weeks in a neonate should raise suspicion of: A. Breast milk jaundice only B. Pathological jaundice C. Gilbert syndrome D. Physiological jaundice

B. Pathological jaundice

Jaundice appearing in the first week of life due to decreased intake and dehydration is called: A. Breast milk jaundice B. Breastfeeding jaundice C. Physiological jaundice D. Pathological jaundice

B. Breastfeeding jaundice

Jaundice that appears after the first week and can persist up to 12 weeks, caused by substances in mother’s milk: A. Breastfeeding jaundice B. Breast milk jaundice C. Crigler–Najjar syndrome D. Biliary atresia

B. Breast milk jaundice

Which type of jaundice improves with increased frequency of feeds? A. Breast milk jaundice B. Breastfeeding jaundice C. Physiological jaundice D. Hemolytic jaundice

B. Breastfeeding jaundice

In which condition is it not recommended to stop breastfeeding because the baby is otherwise thriving? A. Breast milk jaundice B. Breastfeeding jaundice C. Pathological jaundice D. Physiological jaundice

A. Breast milk jaundice

Main mechanism of breastfeeding jaundice is: A. Inhibition of bilirubin conjugation by breast milk substances B. Increased enterohepatic circulation due to decreased feeding C. Genetic defect in UDP-GT enzyme D. Bile duct obstruction

B. Increased enterohepatic circulation due to decreased feeding

Breastfeeding jaundice Timing → Cause → Management → Key point →

Timing → 1st week of life Cause → ↓ Feeding → dehydration → ↑ enterohepatic circulation Management → Increase feeding frequency Key point → Prevented/treated by more breastfeeding

Breast milk jaundice Timing → Cause → Management → Key point →

Timing → After 1st week (peaks at 2 weeks, can last up to 12 weeks) Cause → Substances in breast milk (e.g., β-glucuronidase) inhibit bilirubin conjugation Management → Continue breastfeeding (baby otherwise healthy) Key point → Do NOT stop breastfeeding

Risk factors for diffuse type gastric carcinoma include: A. β-catenin mutation B. Loss of E-cadherin C. H. pylori-induced metaplasia D. Nitrosamine exposure

B. Loss of E-cadherin

Risk factors for intestinal type gastric carcinoma include: A. H. pylori, nitrosamines, smoking, chronic gastritis B. EBV, loss of E-cadherin, genetic mutations C. Alcohol, Crohn’s disease, ulcerative colitis D. Peutz-Jeghers syndrome

H. pylori, nitrosamines, smoking, chronic gastritis

Blumer’s shelf sign refers to: A. Palpable mass in umbilicus B. Metastatic nodule in the pouch of Douglas C. Bilateral ovarian metastasis D. Enlarged supraclavicular lymph node

B. Metastatic nodule in the pouch of Douglas

Sister Mary Joseph nodule indicates: A. Ovarian metastasis B. Umbilical metastasis from gastric cancer C. Rectovesical pouch metastasis D. Left supraclavicular node metastasis

B. Umbilical metastasis from gastric cancer

Virchow’s node is: A. Left supraclavicular lymph node metastasis B. Umbilical nodule metastasis C. Bilateral ovarian metastasis D. Rectovesical pouch metastasis

A. Left supraclavicular lymph node metastasis

Which of the following is true regarding metastasis in gastric cancer? A. Virchow’s node → left axillary lymph node B. Krukenberg tumor → ovarian metastasis, bilateral C. Sister Mary Joseph nodule → supraclavicular node metastasis D. Blumer’s shelf → inguinal lymph node metastasis

B. Krukenberg tumor → ovarian metastasis, bilateral

Diffuse type gastric carcinoma is characterized by: A. Gland-forming neoplastic cells B. Signet ring cells + loss of E-cadherin C. H. pylori-associated intestinal metaplasia D. Polyposis syndromes

B. Signet ring cells + loss of E-cadherin stomach wall grossly leathery and thickened (linitis plastica)

Intestinal type gastric carcinoma is associated with: A. FAP and β-catenin mutations B. E-cadherin mutations C. EBV infection D. Linitis plastica

A. FAP and β-catenin mutations

The most common site of gastric carcinoma is: A. Fundus B. Lesser curvature of antrum C. Greater curvature of fundus D. Cardia

B. Lesser curvature of antrum

Morphology of Menetrier disease shows: A. Hypertrophied gastric rugae that resemble cerebral gyri B. Thin atrophic rugae with ulcers C. Normal mucosa with patchy inflammation D. Loss of rugae with intestinal metaplasia

👉 Answer: A. Hypertrophied gastric rugae that resemble cerebral gyri

Which of the following is a typical sign/symptom of Menetrier disease? A. Severe epigastric pain + massive hematemesis B. Peripheral edema due to low albumin C. Constipation with intestinal obstruction D. Hyperpigmentation of oral mucosa

B. Peripheral edema due to low albumin

The main clinical manifestation of Menetrier disease is: A. Peptic ulcer disease B. Protein-losing gastropathy → hypoalbuminemia C. Pernicious anemia D. Hematemesis

B. Protein-losing gastropathy → hypoalbuminemia

The pathogenesis of Menetrier disease is due to overexpression of: A. VEGF B. TGF-α (Transforming growth factor alpha) C. IL-6 D. TNF-α

B. TGF-α (Transforming growth factor alpha)

Menetrier disease is characterized by: A. Hypertrophy of gastric rugae with ↑ parietal cells B. Hypertrophy of gastric rugae with ↑ mucus-secreting cells C. Atrophy of gastric mucosa with intestinal metaplasia D. Hypertrophy of lymphoid follicles in stomach

B. Hypertrophy of gastric rugae with ↑ mucus-secreting cells

Long-standing chronic gastritis increases the risk of: A. Peptic ulcer disease B. Gastric adenocarcinoma C. MALT lymphoma D. All of the above

D. All of the above

Morphological hallmark of H. pylori chronic gastritis is: A. Neutrophils in glands B. Lymphoid aggregates with germinal centers in lamina propria C. Granulomas with necrosis D. Eosinophilic infiltration

B. Lymphoid aggregates with germinal centers in lamina propria

Which vitamin deficiency is characteristic of autoimmune chronic gastritis? A. Vitamin B12 B. Vitamin B1 C. Vitamin B6 D. Vitamin K

A. Vitamin B12

Autoimmune chronic gastritis is associated with: A. Antibodies against parietal cells & intrinsic factor B. Antibodies against H. pylori C. Neutrophilic infiltration of gastric pits D. Alcohol abuse

A. Antibodies against parietal cells & intrinsic factor

The most common cause of chronic gastritis worldwide is: A. Autoimmune gastritis B. NSAIDs C. H. pylori infection D. Alcohol

C. H. pylori infection

Morphological hallmark of acute gastritis is: A. Neutrophils in the glandular epithelium B. Lymphocytes in lamina propria C. Granulomas with necrosis D. Eosinophilic infiltration

A. Neutrophils in the glandular epithelium

Alcohol and cigarette smoking cause acute gastritis primarily by: A. Direct mucosal irritation and ↑ acid secretion B. Decreasing H. pylori colonization C. Increasing mucus production D. Inhibiting vagal activity

A. Direct mucosal irritation and ↑ acid secretion

Which of the following is the most common cause of acute gastritis? A. NSAIDs B. Severe burns C. Alcohol D. Cigarette smoking

A. NSAIDs

Acute gastritis due to increased intracranial pressure is called: A. Curling’s ulcer B. Cushing’s ulcer C. Mallory-Weiss tear D. Stress ulcer

B. Cushing’s ulcer

Acute gastritis due to severe burns is called: A. Curling’s ulcer B. Cushing’s ulcer C. Peptic ulcer D. Stress ulcer

A. Curling’s ulcer

Chronic gastritis is of two types: Atrophic and non-atrophic Non-atrophic is caused by = Atrophic has further types Type A = Type B =

Non-atrophic is caused by = H. pylori Atrophic has further types Type A = autoimmune Type B = H. pylori

Gastric ulcer location: pain _______ with meal there is weight __________ h. pylori chance _______% Risk of CA = Complication =

lesser curvature increase loss 70% increased perforate

Duodenal ulcer location: pain _______ with meal there is weight __________ h. pylori chance _______% Risk of CA = Complication =

1st portion of duodenum decrease gain 90% benign bleed

PUD mc complication

bleed

Bleeding from PUD occurs more from _____________ (anterior/posterior)

posterior

____________ (anterior/posterior) wall of duodenum is likely to perforate

anterior>posterior

Difference between PUD and CA ulcer

CA = necrotic base and raised margins PUD = smooth base, non-elevated punch out margin

Only malignancy that can be treated with antibiotics

MALTOMA

GIST = ________________ tumor and are due to ___________________ cells. Tx is sx + Imatinib

mesenchymal tumor Pacemaker cells of Cajal

Lesar trelat sign is ________________- and seen in _____________

Rapid increase in no. of seborrheic keratosis Gastric cancer

Tumor in the tail of the pancreas is most likely to present with: A. Jaundice B. Painful gallbladder C. Diabetes mellitus D. Ascites

C. Diabetes mellitus

A patient with pancreatic cancer presents with migratory thrombophlebitis. This is called: A. Virchow’s node B. Trousseau’s syndrome C. Krukenberg tumor D. Sister Mary Joseph nodule

B. Trousseau’s syndrome

Which tumor marker is most commonly elevated in pancreatic adenocarcinoma? A. AFP B. CEA C. CA 19-9 D. CA-125

C. CA 19-9

Pancreatic carcinoma most often metastasizes to: A. Brain B. Bones C. Liver D. Lungs

C. Liver

Obstructive jaundice with a palpable, non-tender gallbladder is known as: A. Murphy’s sign B. Courvoisier’s sign/law C. Blumer’s shelf D. Trousseau’s sign

B. Courvoisier’s sign/law

The most common site of pancreatic carcinoma is: A. Body B. Tail C. Head D. Uncinate process

C. Head

Which of the following is more commonly associated with systemic complications (ARDS, DIC, shock)? A. Acute pancreatitis B. Chronic pancreatitis C. Both equally D. Neither

A. Acute pancreatitis

Calcifications seen on abdominal X-ray are most characteristic of: A. Acute pancreatitis B. Chronic pancreatitis C. Pancreatic cancer D. Duodenal ulcer

B. Chronic pancreatitis

Which is a hallmark feature of chronic pancreatitis but not acute? A. Steatorrhea and malabsorption B. Severe epigastric pain radiating to the back C. Hypocalcemia D. Grey-Turner sign

A. Steatorrhea and malabsorption

The most common cause of chronic pancreatitis is: A. Gallstones B. Alcohol abuse C. Trauma D. Hypertriglyceridemia

B. Alcohol abuse

The most common cause of acute pancreatitis is: A. Alcohol B. Gallstones C. Trauma D. Drugs

B. Gallstones

Grey-Turner sign in acute pancreatitis is: A. Periumbilical discoloration B. Flank ecchymosis C. Jaundice D. Umbilical metastasis

B. Flank ecchymosis Cullen sign is periumbilical discoloration

A patient with acute pancreatitis 4 weeks later develops a palpable abdominal mass. The most likely diagnosis is: A. Pancreatic carcinoma B. Pancreatic pseudocyst C. Hepatic abscess D. Gastric carcinoma

B. Pancreatic pseudocyst

Which pulmonary complication is commonly seen in severe acute pancreatitis? A. Pneumothorax B. Pulmonary embolism C. ARDS D. Pulmonary fibrosis

C. ARDS

A patient with acute pancreatitis develops hypocalcemia and tetany. The mechanism is: A. Vitamin D deficiency B. Fat necrosis binding calcium soaps C. Parathyroid suppression D. Excess urinary calcium loss

B. Fat necrosis binding calcium soaps

The most common complication of acute pancreatitis is: A. Pancreatic abscess B. Pseudocyst formation C. Hemorrhage D. ARDS

B. Pseudocyst formation

In “GET SMASHED”, the “T” stands for: A. Tumors B. Trauma C. Thrombosis D. Typhoid

B. Trauma

A patient developed acute pancreatitis after a course of azathioprine. Which cause from “GET SMASHED” applies? A. Drugs B. Steroids C. Gallstones D. Autoimmune

. Drugs

Hypercalcemia and hypertriglyceridemia can trigger acute pancreatitis by: A. Increasing bile salt secretion B. Activating trypsinogen inside pancreatic acini C. Inhibiting lipase secretion D. Enhancing insulin resistance

B. Activating trypsinogen inside pancreatic acini

A young alcoholic male presents with acute pancreatitis. Which cause from “GET SMASHED” is this? A. Gallstones B. Alcohol C. Steroids D. Drugs

B. Alcohol

Mutations in ___________ gene can cause chronic pancreatic insufficiency

CFTR gene (cystic fibrosis)

Angiosarcoma of liver is associated with exposure to: A. Arsenic and vinyl chloride B. Alcohol and smoking C. Gallstones D. Hepatitis C

A. Arsenic and vinyl chloride

Classical tumor marker for HCC: A. CA 19-9 B. AFP (α-fetoprotein) C. CEA D. CA-125

B. AFP (α-fetoprotein)

Hepatic adenoma is most strongly associated with: A. Hepatitis B B. Alcohol abuse C. Oral contraceptive pill use D. Wilson’s disease

C. Oral contraceptive pill use

Most common benign liver tumor: A. Focal nodular hyperplasia B. Hemangioma C. Hepatic adenoma D. Lipoma

B. Hemangioma

The most common malignant tumor in the liver overall is: A. HCC B. Hemangioma C. Metastasis D. Adenoma

C. Metastasis

The most common primary malignant tumor of the liver is: A. Cholangiocarcinoma B. Angiosarcoma C. Hepatocellular carcinoma (HCC) D. Hepatic adenoma

C. Hepatocellular carcinoma (HCC)

Courvoisier’s law is seen in: A. Gallbladder carcinoma B. Pancreatic head carcinoma C. Cholangiocarcinoma D. All of the above

D. All of the above

Risk factors for cholangiocarcinoma include all EXCEPT: A. Primary sclerosing cholangitis B. Clonorchis sinensis infection C. Ulcerative colitis D. Gallstones

D. Gallstones

A porcelain gallbladder is: A. Gallbladder filled with pus B. Calcified gallbladder wall C. Gallbladder with stones D. Gallbladder with fibrosis only

B. Calcified gallbladder wall

Gallbladder carcinoma is most strongly associated with: A. Alcohol B. Hepatitis B virus C. Gallstones D. Smoking

C. Gallstones

The most common type of gallbladder carcinoma is: A. Squamous cell carcinoma B. Adenocarcinoma C. Small cell carcinoma D. Sarcoma

B. Adenocarcinoma

The most common site of gallbladder carcinoma is: A. Fundus B. Body C. Neck D. Cystic duct

A. Fundus

Prophylactic cholecystectomy is done in porcelain gallbladder due to risk of

GB CA

The classic presentation of cholelithiasis is: A. Severe jaundice + pale stools B. Episodic right upper quadrant (RUQ) pain after fatty meals C. Fever + hypotension D. Dark urine + pruritus

B. Episodic right upper quadrant (RUQ) pain after fatty meals

The hallmark presentation of choledocholithiasis is: A. Colicky RUQ pain without jaundice B. RUQ pain + obstructive jaundice (dark urine, pale stools) C. Asymptomatic gallstones D. Nausea only

B. RUQ pain + obstructive jaundice (dark urine, pale stools)

Laboratory finding more characteristic of choledocholithiasis than simple cholelithiasis: A. Normal LFTs B. Mildly elevated AST/ALT C. Elevated ALP and bilirubin D. Low amylase

C. Elevated ALP and bilirubin

Imaging of choice to confirm choledocholithiasis: A. Plain X-ray B. Ultrasound C. MRCP or ERCP D. CT abdomen without contrast

C. MRCP or ERCP

Complications more likely with choledocholithiasis than cholelithiasis: A. Acute cholecystitis B. Obstructive jaundice, cholangitis, pancreatitis C. Gallbladder polyps D. Fatty liver

B. Obstructive jaundice, cholangitis, pancreatitis

True statements: A. Most patients with cholelithiasis are symptomatic. B. Choledocholithiasis can be asymptomatic. C. Cholelithiasis often causes postprandial RUQ pain, while choledocholithiasis causes obstructive jaundice. D. Both A & C

C. Cholelithiasis often causes postprandial RUQ pain, while choledocholithiasis causes obstructive jaundice.

Microscopically, cardiac cirrhosis is distinguished by: A. Periportal fibrosis with lymphoid infiltrates B. Centrilobular congestion and necrosis C. Fatty change in zone 1 D. Diffuse bridging fibrosis with regenerative nodules

Which cirrhosis type is characterized by autoimmune destruction of intrahepatic bile ducts? A. Cardiac cirrhosis B. Alcoholic cirrhosis C. Primary biliary cirrhosis (PBC) D. Viral hepatitis-related cirrhosis

In cardiac cirrhosis, which area of the hepatic lobule is affected first? A. Periportal hepatocytes (zone 1) B. Midzonal hepatocytes (zone 2) C. Centrilobular hepatocytes (zone 3) D. Entire lobule uniformly

The classic gross appearance of the liver in chronic right heart failure is: A. Shrunken, nodular liver B. Nutmeg liver C. Cirrhosis with bile plugs D. Fatty liver

Which lab finding is most likely in Budd–Chiari syndrome? A. Elevated liver enzymes (AST, ALT) and bilirubin B. Severe leukopenia C. Isolated high amylase D. Low alkaline phosphatase only

Imaging modality of choice for Budd–Chiari syndrome: A. Ultrasound with Doppler B. Plain X-ray C. Non-contrast CT D. Endoscopy

Which population is at higher risk of Budd–Chiari syndrome due to hypercoagulable state? A. Pregnant women B. Elderly men C. Children under 5 D. Postmenopausal women

Budd–Chiari syndrome is commonly associated with: A. Myeloproliferative disorders (e.g., polycythemia vera) B. Chronic hepatitis B C. Alcoholic liver disease D. Wilson disease

Which of the following is a common complication of Budd–Chiari syndrome? A. Cirrhosis and liver failure B. Pancreatitis C. Hepatic adenoma D. Cholelithiasis

Classic triad of Budd–Chiari syndrome includes: A. Fever, jaundice, ascites B. Hepatomegaly, ascites, abdominal pain C. Splenomegaly, esophageal varices, hematemesis D. Dark urine, pruritus, jaundice

Budd–Chiari syndrome is defined as: A. Obstruction of hepatic veins or inferior vena cava B. Portal vein thrombosis C. Hepatic artery occlusion D. Biliary obstruction

Which organ involvement leads to skin hyperpigmentation in hereditary hemochromatosis? A. Liver (iron + melanin deposition) B. Pancreas C. Pituitary D. Heart

Which of the following is a classic hepatic manifestation of hemochromatosis? A. Fatty liver only B. Cirrhosis and increased risk of HCC C. Hepatitis A infection D. Wilson’s disease

A patient with hereditary hemochromatosis develops MCP joint pain and reduced hand mobility. This is due to: A. Gout B. Iron deposition in cartilage C. Osteoporosis D. Rheumatoid arthritis

Which organ is affected to cause “bronze diabetes” in hemochromatosis? A. Adrenal gland B. Liver C. Pancreatic beta cells D. Hypothalamus

A 45-year-old male presents with bronze-colored skin, fatigue, and impotence. Which organ is primarily responsible for his hypogonadism? A. Testes B. Pituitary C. Adrenal gland D. Thyroid

there is 200x increased risk of HCC in ___________________

Organs most commonly affected in hemosiderosis: A. Liver, spleen, bone marrow B. Brain and heart only C. Kidneys only D. Pancreas only

Histological stain used to identify iron in hemosiderosis: A. Prussian blue B. Congo red C. Hematoxylin & eosin D. PAS

In contrast to hemochromatosis, hemosiderosis: A. Always causes cirrhosis and diabetes B. Often spares organ function despite iron deposition C. Is hereditary D. Only affects the heart

Most common cause of secondary hemosiderosis is: A. Chronic blood transfusions B. HFE gene mutation C. Hemolytic anemia D. Iron-poor diet

Hemosiderosis is characterized by: A. Iron overload causing tissue damage B. Iron deposition without significant organ dysfunction C. Copper deposition in liver D. Fat accumulation in liver

Imaging useful to assess iron overload non-invasively: A. CT scan B. T2*-weighted MRI C. Ultrasound D. PET scan

Definitive diagnosis of hemochromatosis is made by: A. Liver biopsy with iron quantification B. Serum iron C. Ultrasound of liver D. MRI brain

Initial screening test for suspected hemochromatosis: A. Serum ferritin and transferrin saturation B. Serum iron only C. Liver function tests D. Bone marrow biopsy

Which of the following is a specific sign of hemochromatosis? A. Kayser-Fleischer rings B. Bronze skin C. Spider angiomas D. Gowers sign

Classic triad of hemochromatosis includes: A. Jaundice, hepatomegaly, ascites B. Skin pigmentation, diabetes mellitus, cirrhosis C. Anemia, fatigue, bleeding D. Pruritus, xanthomas, hepatomegaly

A patient with secondary hemochromatosis most likely has: A. Hereditary mutation B. Chronic transfusions or thalassemia C. Wilson disease D. Iron-poor diet

The most common primary (hereditary) cause of hemochromatosis is mutation in: A. HFE gene (C282Y) B. Transferrin gene C. Hepcidin gene D. Ferroportin gene

Hemochromatosis is characterized by: A. Iron deficiency leading to anemia B. Excessive iron deposition in tissues C. Copper accumulation in liver D. Fat accumulation in liver

Cause of hepatic encephalopathy is

cirrhosis = portosystemic shunt = high NH3 in the body as its not metabolized

Hepatic encephalopathy has neuropsychiatric s/s that are _____________

reversible

The mainstay of treatment for HE is: A. Reduce ammonia production (lactulose, rifaximin) B. Phlebotomy C. Iron chelation D. High-protein diet unrestricted

The characteristic physical sign of HE, especially in grades II–III, is: A. Asterixis (“flapping tremor”) B. Kayser-Fleischer rings C. Spider angiomas D. Gynecomastia

Common precipitating factors for HE include: A. GI bleeding, infection, constipation, sedatives B. Iron overload, obesity C. Diabetes mellitus only D. Vitamin C deficiency

Grade IV HE is: A. Mild confusion B. Lethargy C. Stupor D. Coma

Grade III HE is characterized by: A. Somnolence, confusion, incoherent speech B. Mild personality changes C. Deep coma D. Normal neurological exam

Grade II HE clinical features include: A. Obvious personality changes, disorientation, asterixis B. Mild confusion only C. Stupor or semi-coma D. Deep coma

Grade I HE is characterized by: A. Trivial lack of awareness, mild personality changes B. Lethargy, disorientation, asterixis C. Somnolence to stupor D. Coma

Hepatic encephalopathy is primarily caused by: A. Accumulation of bilirubin B. Accumulation of ammonia and other neurotoxins C. Iron overload D. Hypoglycemia

what are the triggers of hepatic encephalopathy?

Increased ammonia production and absorption = Infection, constipation, dietary protein, GI bleed) Decreased ammonia removal = renal failure, diuretics, bypassed hepatic blood flow post TIPS)

Grade 0 vs Grade 1 vs 2 vs 3 vs 4 of Hepatic encephalopathy

0 = minimal impairment 1 = mild confusion/ irritable 2 = obvious personality changes, lethargic, disoriented 3 = stupor, decreased consciousness but arousable 4 = deep coma

Cirrhosis is defined as: A. Fat accumulation in hepatocytes B. Diffuse hepatic fibrosis with nodular regeneration C. Acute liver inflammation D. Iron deposition in liver

Which of the following is a feature of decompensated cirrhosis? A. Asymptomatic liver enlargement B. Ascites, jaundice, variceal bleeding, encephalopathy C. Mild fatigue only D. Elevated transaminases without symptoms

Common signs of cirrhosis on physical exam include: A. Spider angiomas, palmar erythema, gynecomastia, jaundice B. Kayser-Fleischer rings C. Splinter hemorrhages D. Clubbing only

Which of the following is a complication of cirrhosis? A. Portal hypertension and variceal bleeding B. Hepatocellular carcinoma C. Hepatorenal syndrome D. All of the above

The most common cause of cirrhosis worldwide is: A. Chronic hepatitis B and C infection B. Hemochromatosis C. Wilson disease D. Alpha-1 antitrypsin deficiency

Decompensation in cirrhosis is indicated by: A. Mild hepatomegaly without symptoms B. Development of jaundice, ascites, variceal bleeding, or hepatic encephalopathy C. Elevated ALT only D. Weight loss alone

Physical findings suggestive of chronic liver disease include: A. Caput medusae, ascites, palmar erythema B. Kayser-Fleischer rings, tremors C. Splinter hemorrhages, petechiae D. Lymphadenopathy

Compensated cirrhosis is characterized by: A. Presence of jaundice, ascites, or encephalopathy B. Absence of significant clinical symptoms despite fibrosis C. Variceal bleeding D. Hepatocellular carcinoma

Which lab or clinical finding suggests decompensation rather than compensated cirrhosis? A. Mild fatigue, normal bilirubin B. Low albumin, prolonged PT, hyperbilirubinemia C. Mild hepatomegaly, normal PT D. Normal platelet count

Which of the following is more common in compensated cirrhosis? A. Ascites and spontaneous bacterial peritonitis B. Jaundice and hepatic encephalopathy C. Asymptomatic hepatomegaly and mild splenomegaly D. Variceal hemorrhage

Which statement is true? A. Compensated cirrhosis can suddenly decompensate with triggers like infection or GI bleed B. Decompensated cirrhosis rarely develops complications C. Compensated cirrhosis always has jaundice D. Decompensated cirrhosis has normal lab tests

SBP is defined as: A. Infection of ascitic fluid in patients without an intra-abdominal surgically treatable source B. Infection following perforated appendix C. Infection secondary to bowel obstruction D. Any abdominal infection in cirrhosis

SBP most commonly complicates: A. Hepatocellular carcinoma B. Cirrhotic ascites C. Pancreatic pseudocyst D. Hepatitis A infection

Patients at highest risk of developing SBP include: A. Patients with GI bleed B. Non-cirrhotic patients with portal hypertension C. Patients with viral hepatitis only D. Healthy individuals

Classic signs and symptoms of SBP include: A. Fever, abdominal pain/tenderness, altered mental status, diarrhea B. Jaundice only C. Fatigue without abdominal symptoms D. Cough and dyspnea

The most common causative organism of SBP is: A. Escherichia coli B. Staphylococcus aureus C. Streptococcus pneumoniae D. Pseudomonas aeruginosa

Other organisms that can cause SBP include: A. Klebsiella, Streptococcus species, Enterococcus B. Mycobacterium tuberculosis only C. Hepatitis B virus D. Candida only

Diagnostic criteria for SBP (ascitic fluid analysis) include: A. PMN count ≥250 cells/mm³ ± positive culture B. PMN count <50 cells/mm³ C. Any ascitic fluid with bilirubin >2 mg/dL D. Protein >3 g/dL

SBP is classified as primary vs secondary based on: A. Primary = no intra-abdominal source; Secondary = surgically treatable cause (e.g., perforation, abscess) B. Primary = caused by Staphylococcus; Secondary = caused by E. coli C. Primary = only in children; Secondary = only in adults D. Primary = community-acquired; Secondary = hospital-acquired

Which organism can cause portal hypertension

Schistosomiasis

Most common cause of cryptogenic cirrhosis is __________-

NAFLD

Immunization for Hep B is done at

0, 1 and 6 months and then a booster dose after 5 years

When to test for Anti-HBs

HCW Patients with CKD should be checked 1-4 months are primary immunization

A patient has Anti-HBs levels done and its 130 mIU/ml. What should be the next step?

get booster dose after 5 years

A patient has Anti-HBs levels done and its 40 mIU/ml. What should be the next step?

One additional vaccine given (if immunocompetent no further testing needed)

A patient has Anti-HBs levels done and its 3 mIU/ml. What should be the next step?

Test for current or past infection Give complete 3 doses again with testing. If still fails then HBIG would be required if exposed it virus

Anti HBs levels >100 = 10-100 = <10 =

>100 = adequate 10-100 = suboptimal (one dose needed) <10 = suboptimal, 3 doses needed)

All hepatits virus are RNA virus except ____________

Hepatitis B

Most lethal hepatitis = Most lethal hepatitis in pregnancy =

Hep D Hep E in pregnancy

Autoimmune hepatitis has increased _____________ and _____________ in blood

immunoglobulins anti-smooth muscle antibodies

Jaundice is detectable when plasma bilirubin exceeds ____________-

3 mg/dl

Causes of unconjugated billirubinemia

Hemolytic jaundice (SCD, HS, hemolytic disease of newborn) Congenital non hemolytic anemia (decreased uptake or conjugation of UCB)

Crigler-najjar I is autosomal ___________ It has ________________ enzyme absent It may lead to _____________

recessive UDP glucoronyl transferase kernicterus

Crigler-najjar II is autosomal ___________ It has ________________ enzyme decreased It may lead to _____________

dominant UDP glucoronyl transferase mild jaundice

CN II is treated with ______________

oral phenobarbital

jaundice that is Autosomal dominant, UDP GT enzyme is decreased and occurs in adults in response to any stress, fasting, alcohol is ________________

Gilbert syndrome

Causes of Conjugated bilirubinemia

Decreased intrahepatic bile flow (PBC/Autoimmune hep/Dubin johnson/Rotor) Decreased extrahepatic bile flow (Ca pancreas head, biliary strictures, choledocholithiasis)

Dubin johnson and rotor syndrome has defective ______________ but one of them has black liver due to pigment deposition

bilirubin transport Dubin johnson has black liver

Hepatocellular jaundice has ____________ type of jaundice

mixed

cheapest non invasive test for H pyloru

serology for antibodies but postive for upto 18 months

most accurate non invasive test for H pylori

Urea breath test/ Fecal antigen test (but not so much likable)

Gold standard for PUD diagnosis

Endoscopic biopsy

patient with refractory H. pylori. what to do?

Culture

Gastric CA is associated with blood group _______-

A and HNPCC

Which of the following is a predisposing factor for colorectal carcinoma? A. Familial adenomatous polyposis (FAP) B. Lynch syndrome (HNPCC) C. Long-standing ulcerative colitis D. All of the above

👉 Answer: D. All of the above

Right-sided colon cancer typically presents with: A. Obstructive symptoms, narrow stools B. Occult bleeding → iron deficiency anemia C. Tenesmus, rectal bleeding D. Early change in bowel habits

👉 Answer: B. Occult bleeding → iron deficiency anemia

Left-sided colon cancer typically presents with: A. Iron deficiency anemia B. Apple-core lesion on barium enema, obstruction, change in bowel habits C. Weight gain and constipation D. Hepatomegaly without other symptoms

👉 Answer: B. Apple-core lesion on barium enema, obstruction, change in bowel habits

Iron deficiency anemia in an older adult should raise suspicion of: A. Gastritis B. Hemorrhoids C. Colorectal cancer (especially right-sided) D. Diverticulosis

👉 Answer: C. Colorectal cancer (especially right-sided)

The tumor marker most commonly associated with colorectal carcinoma is: A. Alpha-fetoprotein (AFP) B. Carcinoembryonic antigen (CEA) C. CA-19-9 D. PSA

👉 Answer: B. Carcinoembryonic antigen (CEA)

Screening colonoscopy in average-risk adults should begin at: A. Age 30 B. Age 40 C. Age 45–50 D. Age 60

👉 Answer: C. Age 45–50

If a first-degree relative had colorectal cancer, colonoscopy should start: A. At age 40, or 10 years before the relative’s age at diagnosis (whichever comes first) B. At age 40 only C. At age 50 regardless of history D. Only if symptomatic

👉 Answer: A. At age 40, or 10 years before the relative’s age at diagnosis (whichever comes first)

According to Dukes staging of colorectal cancer: Stage A = Stage B = Stage C = Stage D =

Stage A = Limited to mucosa/submucosa = surgery Stage B = Into muscularis, no nodes = surgery + radiotherapy Stage C = Lymph node involvement = Surgery + chemotherapy + radiotherapy Stage D = Distant metastasis = Surgery for obstruction + Palliative chemo/radio

Unexplained IDA in men or non-menstruating women (<11 in men/<10 in women) raises suspicion for

Colorectal cancer

What are the alternatives for colonoscopy?

Flexible sigmoidoscopy Fecal occult blood testing CT colonography

___________ diet is a risk factor for Colon CA

low fiber diet

D-xylose test is abnormal in: A. Chronic pancreatitis B. Celiac disease C. Bile salt deficiency D. Pancreatic cancer

👉 **Answer: B (Celiac disease – mucosal defect)**

Steatorrhea with normal intestinal biopsy suggests: A. Tropical sprue B. Celiac disease C. Pancreatic insufficiency D. Whipple’s disease

👉 **Answer: C (Pancreatic insufficiency – intraluminal digestion defect)**

Which of the following is a disorder of mucosal absorption? A. Cholestasis B. Lactase deficiency C. Chronic pancreatitis D. Bile duct obstruction

👉 **Answer: B (Lactase deficiency – brush border enzyme, mucosal problem)**

Villous atrophy on biopsy with iron deficiency anemia is seen in: A. Pancreatic insufficiency B. Celiac disease C. Bile salt deficiency D. Zollinger–Ellison syndrome

👉 **Answer: B (Celiac disease – mucosal defect)**

Zollinger–Ellison syndrome causes malabsorption due to: A. Mucosal damage B. Excess acid inactivating pancreatic enzymes C. Loss of bile salts D. Brush border enzyme deficiency

👉 **Answer: B (Excess acid – intraluminal digestion problem)**

Which malabsorption disorder shows **villous atrophy, crypt hyperplasia, and improves with gluten withdrawal**? A. Tropical sprue B. Whipple’s disease C. Celiac disease D. Lactase deficiency

C. Celiac disease

Which condition is caused by **Tropheryma whipplei**, presenting with **malabsorption, arthralgia, lymphadenopathy, and hyperpigmentation**? A. Celiac disease B. Whipple’s disease C. Tropical sprue D. Crohn’s disease

👉 **Answer: B (Whipple’s disease)**

Which malabsorption disorder occurs in people returning from **tropical regions**, responds to **antibiotics**, and is associated with **folate & B12 deficiency**? A. Tropical sprue B. Celiac disease C. Whipple’s disease D. Lactose intolerance

👉 **Answer: A (Tropical sprue)**

Which disease shows **PAS-positive foamy macrophages in intestinal lamina propria**? A. Whipple’s disease B. Celiac disease C. Tropical sprue D. Giardiasis

👉 **Answer: A (Whipple’s disease)**

Which of the following is most strongly associated with **HLA-DQ2/DQ8** and **anti-tTG antibodies**? A. Tropical sprue B. Whipple’s disease C. Celiac disease D. Lactose intolerance

👉 **Answer: C (Celiac disease)**

⚡ **Quick differentiation memory tip:** * **Celiac** → Gluten sensitivity, autoimmune, ↑ anti-tTG, villous atrophy. * **Whipple** → PAS+ foamy macrophages, systemic (joints, CNS, nodes). * **Tropical sprue** → Infective, post-travel, folate/B12 deficiency, responds to antibiotics

Remember it

Lactose intolerance is due to deficiency of: A. Amylase B. Lactase C. Sucrase D. Maltase

👉 **Answer: B (Lactase)*

A patient develops **abdominal pain, bloating, and diarrhea** after drinking milk. Which of the following tests is most useful for diagnosis? A. Hydrogen breath test B. Stool culture C. Schilling test D. Colonoscopy

👉 **Answer: A (Hydrogen breath test)**

Stool in lactose intolerance is typically: A. Acidic with reducing substances B. Alkaline with bile salts C. Clay-colored D. Containing ova and parasites

👉 **Answer: A (Acidic with reducing substances)**

Which type of diarrhea occurs in lactose intolerance? A. Secretory B. Osmotic C. Exudative D. Inflammatory

👉 **Answer: B (Osmotic diarrhea)**

Secondary lactose intolerance can occur after: A. Viral gastroenteritis B. Celiac disease C. Giardiasis D. All of the above

👉 **Answer: D (All of the above)**

⚡ **Quick facts for exam:** * Defect: ↓ Lactase (brush border enzyme). * Symptoms: Bloating, cramps, diarrhea, flatulence after dairy. * Stool: Acidic, reducing sugars present. * Test: Hydrogen breath test. * Type of diarrhea: Osmotic.

Remember

Lactose intolerance test is positive if lactose is given and glucose rises only _____ =

<20 mg/dl

Lactose intolerance** → **acidic, watery, frothy diarrhea** (carb malabsorption, not fat). * **Pancreatic insufficiency** → **fatty, bulky, greasy stools** (fat + protein maldigestion).

Remember it

Whipple disease treatment is

IV penicillin + streptomycin for 2 weeks then Cotrimaxazole or tetracycline for 1 year

____________ are gliadin from wheat, hordein from barley, sccalins from rye

Prolamines

Rare complications of Celiac disease =

tetany, osteomalacia, malnutrition and edema

Small bowel biopsy for celiac disease is done from =

4-6 biopsy from 2nd part of duodenum)

AI conditions related to celiac =

DMI, Thyroid, Sjogren, IBD, PBC, ILD, Epilepsy, IgA deficiency

____________ is needed due to splenic atrophy in celiac disease

Pneumococcal vaccine

CBC in celiac disease will show =

Anemia (normocytic/microcytic/macrocytic), Howel jolly bodies d/t splenic atrophy)

_________ scan should be done due to osteomalacia in celiac disease

DEXA

______________ is similar to tropical sprue ____________ is affected in tropical sprue Morphology of TS = Mortality is due to _____________

Giardiasis Jejunum partial villious atrophy water and electrolytes imbalance in tropical sprue

Renal stones (calcium oxalate) are more common in:** A. Ulcerative colitis B. Crohn’s disease

➡ **Answer: B. Crohn’s disease

Perianal fistulae and abscesses are characteristic of:** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: A. Crohn’s disease**

Colonoscopy shows red, granular mucosa with broad-based ulcers. This is typical of:** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: B. Ulcerative colitis*

Severe ulcerative colitis is defined as:** A. >3 stools/day without systemic symptoms B. >6 stools/day with fever, tachycardia, anemia, ↑ESR, ↓albumin C. <4 stools/day with no systemic involvement D. >10 stools/day without systemic features

➡ **Answer: B. >6 stools/day with systemic features** albumin <30

Toxic megacolon in UC is defined as:** A. Colon dilation >4 cm B. Colon dilation >5 cm C. Colon dilation >6 cm

C. Colon dilation >6 cm

Fecal calprotectin is a marker of:** A. Infective colitis B. Inflammatory bowel disease activity C. Irritable bowel syndrome D. Pancreatitis

➡ **Answer: B. Inflammatory bowel disease activity** CD

Crohn’s disease of terminal ileum can mimic:** A. Appendicitis B. Cholecystitis C. Pancreatitis D. Diverticulitis

➡ **Answer: A. Appendicitis**

Antibodies in UC and CD respectively are:** A. ASCA in UC, pANCA in CD B. pANCA in UC, ASCA in CD C. ANA in UC, ASMA in CD D. Anti-dsDNA in UC, anti-Scl70 in CD

➡ **Answer: B. pANCA in UC, ASCA in CD**

Which feature is more characteristic of Crohn’s disease than ulcerative colitis?** A. Continuous mucosal involvement B. Skip lesions C. Limited to colon and rectum D. Superficial ulcerations

➡ **Answer: B. Skip lesions**

The most common type of anemia in IBD is:** A. Iron deficiency anemia B. Hemolytic anemia C. Sideroblastic anemia D. Pernicious anemia ➡

**Answer: A. Iron deficiency anemia**

Which disease shows transmural inflammation with risk of fistula formation?** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: A. Crohn’s disease**

Pseudopolyps are typically seen in:** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: B. Ulcerative colitis**

Cobblestone mucosa with creeping fat is a hallmark of:** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: A. Crohn’s disease**

Which disease is strongly associated with primary sclerosing cholangitis (PSC)?** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: B. Ulcerative colitis**

Non-caseating granulomas are diagnostic (when present) for:** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: A. Crohn’s disease**

Backwash ileitis occurs in:** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: B. Ulcerative colitis**

Increased risk of colorectal carcinoma is higher in:** A. Crohn’s disease B. Ulcerative colitis

➡ **Answer: B. Ulcerative colitis** (esp. pancolitis >10 years)

Which of the following extraintestinal features can occur in both Crohn’s and UC?** A. Uveitis B. Ankylosing spondylitis C. Erythema nodosum D. All of the above

➡ **Answer: D. All of the above**

Which is true for Crohn’s disease compared to UC?** A. Superficial mucosal ulcerations B. Continuous rectum-to-colon spread C. Transmural inflammation D. Rare small intestine involvement

➡ **Answer: C. Transmural inflammation**

Pseudomembranous colitis is morphologically characterized by:** A. Transmural inflammation with granulomas B. Superficial grayish mucosal exudates of necrotic debris C. Cobblestone mucosa with creeping fat D. Red granular mucosa with broad-based ulcers

➡ **Answer: B. Superficial grayish mucosal exudates of necrotic debris**

The most common cause of pseudomembranous colitis is:** A. Campylobacter jejuni B. Salmonella typhi C. Clostridium difficile exotoxin D. Staphylococcus aureus enterotoxin

➡ **Answer: C. Clostridium difficile exotoxin**

Pseudomembranous colitis most often develops in patients with:** A. HIV infection B. Prior appendectomy C. Broad-spectrum antibiotic therapy D. Chronic NSAID use

➡ **Answer: C. Broad-spectrum antibiotic therapy**

Clinical features of pseudomembranous colitis include all EXCEPT:** A. Diarrhea B. Fever C. Toxicity D. Constipation with abdominal distension

➡ **Answer: D. Constipation with abdominal distension**

Hirschsprung disease is due to:** A. Failure of neural crest migration → absence of ganglion cells in submucosal & myenteric plexus B. Overgrowth of Clostridium difficile C. Malrotation of the midgut D. Atresia of the ileum

➡ **Answer: A. Failure of neural crest migration → absence of ganglion cells**

The RET gene mutation is associated with which GI condition?** A. Ulcerative colitis B. Crohn’s disease C. Hirschsprung disease D. Celiac disease

➡ **Answer: C. Hirschsprung disease**

Classic neonatal presentation of Hirschsprung disease is:** A. Projectile non-bilious vomiting B. Bilious emesis, abdominal distention, and failure to pass meconium C. Bloody diarrhea with tenesmus D. Steatorrhea with growth failure

➡ **Answer: B. Bilious emesis, abdominal distention, and failure to pass meconium**

Hirschsprung disease is commonly associated with:** A. Turner syndrome B. Down syndrome C. Klinefelter syndrome D. Marfan syndrome

➡ **Answer: B. Down syndrome**

The gold standard diagnostic test for Hirschsprung disease is:** A. Barium enema B. Abdominal ultrasound C. Rectal suction biopsy D. Colonoscopy

➡ **Answer: C. Rectal suction biopsy**

⚡ Buzzwords to instantly recall: * **RET mutation + failure of neural crest migration** * **Aganglionosis (Meissner + Auerbach plexus)** * **Proximal dilation ("megacolon")** * **Assoc. with Down syndrome** * **Rectal suction biopsy = diagnosis**

Remember Damnit

1. Hyperplastic polyps are best described as:** A. Neoplastic polyps with high malignant potential B. Non-neoplastic polyps, usually benign C. Hamartomatous polyps with RET mutation D. Pseudopolyps seen in Crohn’s disease

➡ **Answer: B. Non-neoplastic polyps, usually benign**

Inflammatory pseudopolyps are most commonly associated with:** A. Familial adenomatous polyposis (FAP) B. Ulcerative colitis C. Crohn’s disease D. Peutz-Jeghers syndrome

➡ **Answer: B. Ulcerative colitis**

Hamartomatous polyps are associated with which condition?** A. Lynch syndrome B. Juvenile polyposis and Peutz-Jeghers syndrome C. Hyperplastic polyps D. Villous adenomas

➡ **Answer: B. Juvenile polyposis and Peutz-Jeghers syndrome**

The most common type of adenomatous (neoplastic) polyp is:** A. Villous adenoma B. Tubulovillous adenoma C. Tubular adenoma D. Hyperplastic polyp

➡ **Answer: C. Tubular adenoma (≈75%)**

Which adenomatous polyp carries the highest risk of malignancy?** A. Tubular adenoma B. Villous adenoma C. Hyperplastic polyp D. Juvenile polyp ➡ **Answer: B. Villous adenoma**

➡ **Answer: B. Villous adenoma**

⚡ Quick one-liners for FCPS: * **Hyperplastic polyps** → non-neoplastic, benign. * **Pseudopolyps** → inflammatory, seen in UC. * **Hamartomatous** → Peutz-Jeghers (mucocutaneous pigmentation), Juvenile polyposis. * **Tubular adenoma** = most common. * **Villous adenoma** = most malignant potential (“villous = villain”).

Remember. So so so Important

Familial adenomatous polyposis (FAP) is caused by a mutation in which gene?** A. KRAS B. APC gene on chromosome 5q C. p53 gene D. MLH1 gene

➡ **Answer: B. APC gene on chromosome 5q*

The risk of malignant transformation in untreated FAP is approximately:** A. 20% B. 50% C. 80%

D. \~100%

Which of the following is a variant of FAP characterized by adenomatous polyps plus osteomas and soft tissue tumors?** A. Turcot syndrome B. Gardner syndrome C. Lynch syndrome D. Peutz-Jeghers syndrome

B. Gardner syndrome

**4. Turcot syndrome is best described as:** A. FAP variant with osteomas and fibromas B. FAP variant with medulloblastoma or other CNS tumors C. Hamartomatous polyposis with mucocutaneous pigmentation D. Non-neoplastic hyperplastic polyps

B. FAP variant with medulloblastoma or other CNS tumors

⚡ Quick pearls: * **FAP** → APC mutation, hundreds–thousands of adenomas, 100% colon cancer risk. * **Gardner syndrome** → FAP + **osteomas** + soft tissue tumors. * **Turcot syndrome** → FAP + **CNS tumors (esp. medulloblastoma)**.

If you got even 1 mcq wrong from this topic, then, what can I say.

Peutz-Jeghers syndrome is inherited in which pattern?** A. Autosomal recessive B. Autosomal dominant C. X-linked dominant D. Sporadic only

➡ **Answer: B. Autosomal dominant**

The hallmark feature of Peutz-Jeghers syndrome is:** A. Villous adenomas of colon B. Hyperplastic polyps C. Hamartomatous polyps with mucocutaneous hyperpigmentation D. Sessile serrated adenomas

➡ **Answer: C. Hamartomatous polyps with mucocutaneous hyperpigmentation**

Which extra-GI findings are most characteristic of PJS?** A. Oral ulcers and glossitis B. Café-au-lait spots C. Pigmentation on lips, mouth, hands, and genitalia D. Spider angiomas

C. Pigmentation on lips, mouth, hands, and genitalia

Patients with Peutz-Jeghers syndrome are at increased risk of all the following cancers EXCEPT:** A. Pancreatic B. Stomach C. Breast D. Thyroid

➡ **Answer: D. Thyroid**

Colonoscopy surveillance in Peutz-Jeghers syndrome should begin at which age?** A. 15 years B. 20 years C. 25 years D. 40 years

➡ **Answer: C. 25 years (then every 2 years)**

⚡ Quick recall: * **PJS** = hamartomatous GI polyps + mucocutaneous pigmentation. * **AD inheritance**. * ↑ risk of **colorectal, breast, gastric, small bowel, pancreatic cancers**. * **Screening**: colonoscopy every 2 years after 25 yrs.

Pfffft

Juvenile polyposis syndrome is inherited as:** A. Autosomal recessive B. Autosomal dominant C. X-linked recessive D. Sporadic only

B. Autosomal dominant

Juvenile polyposis typically presents at what age?** A. Infancy (<1 year) B. Childhood (<5 years) C. Adolescence D. Adulthood ➡ **Answer: B. Childhood (<5 years)**

➡ **Answer: B. Childhood (<5 years)**

The type of polyps seen in juvenile polyposis are:** A. Adenomatous B. Hyperplastic C. Hamartomatous D. Villous

➡ **Answer: C. Hamartomatous**

Which part(s) of the GI tract are most affected in juvenile polyposis?** A. Colon only B. Colon, stomach, and small bowel C. Esophagus D. Duodenum only

➡ **Answer: B. Colon, stomach, and small bowel**

Juvenile polyposis carries an increased risk of developing:** A. Gastric ulcers B. Celiac disease C. Colorectal carcinoma D. IBS

➡ **Answer: C. Colorectal carcinoma**

HNPCC (Lynch syndrome) is inherited as:** A. Autosomal recessive B. Autosomal dominant C. X-linked recessive D. Sporadic

➡ **Answer: B. Autosomal dominant**

What percentage of HNPCC cases progress to colorectal cancer?** A. 20% B. 40% C. 60% D. 80%

➡ **Answer: D. 80%**

In Lynch syndrome, which part of the colon is always involved?** A. Distal colon B. Proximal colon C. Sigmoid colon D. Rectum

➡ **Answer: B. Proximal colon**

HNPCC is associated with all of the following EXCEPT:** A. Endometrial cancer B. Ovarian cancer C. Skin cancers D. Gastric ulcers

➡ **Answer: D. Gastric ulcers**

The Amsterdam “3-2-1” rule for diagnosing HNPCC refers to:** A. 3 relatives, 2 cancers, 1 decade B. 3 relatives with Lynch-associated cancers, across 2 generations, 1 diagnosed before age 50 C. 3 cancers, 2 generations, 1 site D. 3 siblings, 2 parents, 1 cousin affected

➡ **Answer: B. 3 relatives with Lynch-associated cancers, across 2 generations, 1 diagnosed before age 50**

Crypt abscess are found in _____________-

Left sided appendicitis is due to ______________ a. true diverticulum b. false diverticulum c. left sided appendix d. Crohn disease

b. false diverticulum

False diverticulum are so called because a. only mucosa and submucosa b. arise congenitally c. do not cause any symptom d. all 3 layers are present

a. only mucosa and submucosa

______________ is a true diverticulum because

Meckel diverticulum because has all 3 layers

A patient presented with pain that was relieved with defecation, with alternating history of constipation and diarrhea. His colonoscopy was normal. Stool DR/culture = normal. What is the diagnosis a. IBS b. Manifesting UC c. Yeast infection d. I can't think of more stuff

a. IBS

GI PATHOLOGY Flashcards

(311 cards)