GIT MCQs

1. Upper GI endoscopy and biopsy from lower esophagus in a 48 years

old lady with chronic heart burn shows presence of columnar
epithelium with goblet cells. The feature is most likely consistent with:
A) Dysplasia
B) Hyperplasia
C) Carcinoma in-situ
D) Metaplasia

2. The distance from incisor teeth to the gastro-oesophageal junction is:

A) 25 cm
B) 30 cm
C) 35 cm
D) 40 cm

3. Some common conditions predisposing to reflux oesophagitis are as

follows except:
A) Hiatus hernia
B) Mallory-Weiss syndrome
C) Peptic ulcers
D) Persistent vomiting

4. The nature of lesion in Barrett’s oesophagus is:

A) Congenital anomaly
B) Inflammatory disease
C) Metaplastic process
D) Neoplastic lesion

5. Barret’s oesophagus predisposes to development of:

A) Reflux oesophagitis
B) Oesophageal varices
C) Squamous cell carcinoma
D) Adenocarcinoma

6. The most frequent anatomic site for squamous cell carcinoma of the
oesophagus is:
A) Upper third
B) Middle third
 C) Lower third
D) Gastro-oesophageal junction

7. Duodenal ulcers are found most commonly at:

A) First part, anterior surface
B) First part, posterior surface
C) Second part, anterior surface
D) Second part, posterior surface
8. The most common location of gastric colloid carcinoma is:
A) Cardia
B) Fundus
C) Body
D) Pylorus

9. The most common growth pattern of gastric carcinoma is:

A) Scirrhous
B) Fungating
C) Ulcerative
D) colloid

10. Following humoral factors are implicated in the etiology of

Inflammatory bowel disease:
A) anti-colon antibodies to E. coli
B) Decreased synthesis of IgG
C) IgE mediated hypersensitivity
D) Circulating immune complexes

11. Crohn’s disease is characterized by the following histopathological

features except:
A) Non caseating sarcoid like granulomas
B) Superficial mucosal ulceration
C) Stricture formation
D) Widening of submucosa due to edema

12. The following features characterize ulcerative colitis except:

A) Formation of crypt abscess and cryptitis
B) Superficial mucosal ulceration
C) Depletion of goblet cells and mucus
D) Stricture formation in chronic cases
13. Long standing cases of Crohn’s disease may develop the following
complications except:
A) Malabsorption
B) Toxic megacolon
C) Fistula formation
D) Stricture formation

14. Tuberculous ulcers in bowel have the following features except:

A) They begin in Peyer’s patches
B) They are transverse to the long axis
C) Advanced cases may cause intestinal obstruction
D) Tuberculous ulcers often cause intestinal perforation

15. The major complication of typhoid ulcers is:

A) Intestinal obstruction
B) Intestinal perforation
C) Malabsorption
D) Fistula formation

16. The histologic hallmark of diagnosis of acute appendicitis is:

A) Mucosal ulceration
B) Impacted foreign body
C) Neutrophilic infiltrate in muscularis
D) Thrombosed blood vessels

17. The most common location of carcinoid tumor is:

A) Foregut
B) Midgut
C) Hindgut
D) Equal at all these three sites

18. The following type of colorectal polyps has the highest malignant
potential:
A) Hyperplastic polyp
B) Adenomatous polyp
C) Villous adenoma
D) Tubulovillous adenoma

19. The most common location for primary colorectal carcinoma is:
 A) Rectum
B) Sigmoid and descending colon
C) Caecum and ileocaecal valve
D) Ascending colon

20. The significant genetic mutation in adenoma-carcinoma sequence are

all of the following except:
A) Loss of APC gene
B) Deletion of DCC gene
C) Mutated Rb gene
D) Mutated K-RAS gene

21. H. pylori colonization of gastric mucosa is implicated in the following

diseases except:
A) Gastritis
B) Gastric carcinoma
C) MALT lymphoma
D) Intestinal metaplasia

22. Which of the following is not implicated in oesophageal carcinoma:

A) HPV infection
B) Mallory weiss syndrome
C) Plummer vinson syndrome
D) Heavy smoking

23. All are hamartomatous polyps except:

A) Juvenile polyps
B) Peutz-Jegher’s polyps
C) retention polyps
D) Metaplastic polyps

24. Which of the following is not familial polyposis syndrome:

A) Cronkhite Canada syndrome
B) Gardener’s syndrome
C) Turcot’s syndrome
D) Juvenile polyposis syndrome

25. Early gastric cancer generally indicates:

A) Gastric adenocarcinoma detected early
B) Gastric adenocarcinoma confined to the mucosa
 C) Gastric adenocarcinoma confined to the mucosa and submucosa
D) Gastric adenocarcinoma less than 1 cm in size

26. Toxic megacolon is most commonly associated with:

A) Ulcerative colitis
B) Crohn’s disease
C) Whipple’s disease
D) Reiter’s disease

27. Skip granulomatous lesions are seen in:

A) Ulcerative colitis
B) Crohn’s disease
C) Whipple’s disease
D) Reiter’s disease

28. Pseudopolyps are features of:

A) Crohn’s disease
B) Ulcerative colitis
C) Celiac sprue
D) Whipple’s disease

29. Following is true for Lynch syndrome except

A) Occurs in < 50 years
B) location is right colon
C) mutations in mismatch repair genes
D) worse prognosis

30. Which of the following genes is commonly affected by Microsatellite

instability mechanism in pathogenesis of Carcinoma Colon?
A) APC
B) K-RAS
C) TGFBR2
D) TP53

31. All are true for right sided colon carcinoma except:
A) Fungating, polypoid growth
B) bleeding per rectum, anemia and weakness
C) Most common site is Sigmoid Colon
D) Late symptoms
32. Which of the following disease has the highest malignant
transformation rate?
A) Leukoplakia
B) Erythroplakia
C) Oral Lichen planus
D) Oral Sub-mucosal fibrosis

33. Which of the following is true for HPV associated SCC?

A) Large primary lesion with variable nodal disease
B) Oral cavity
C) Tobacco, alcohol
D) Nonkeratinizing SCC

34. Malignant transformation rate of oral Leukoplakia globally is:

A) 18-20%
B) 3-6%
C) 0-1%
D) 0.5-1%

35. All of the following statements are true for Barrett’s Esophagus except
A) Affected esophagus appears red and velvety
B) develop into adenocarcinoma
C) Long segment Barrett esophagous - > 5 cm of esophagus involved
D) Metaplastic process

36. The most characteristic microscopic finding of Barrett’s esophagus is:

A) Metaplastic columnar epithelium
B) Goblet cells
C) Inflammatory infiltrate
D) Dysplasia

37. Special stain used for demonstration of H. Pylori:

A) May Grunwald Giemsa
B) Congo Red stain
C) Reticulin stain
D) Warthin starry silver stain

38. Which of the following microscopic feature is not seen in peptic ulcer:
A) Hyperplasia of foveolar epithelium
 B) Neutrophilic inflammatory exudate
C) Granulation tissue + mononuclear leucocytes
D) Fibro collagenous scar + thick walled congested blood vessels

39. All are features od duodenal ulcer except:

A) Night pain
B) Vomiting
C) Malena
D) Seasonal variation

40. Extensive desmoplasia is seen in

A) Scirrhous carcinoma
B) Colloid (Mucoid) carcinoma
C) Ulcerative carcinoma
D) Fungating (polypoid) carcinoma

ANSWER KEY:
1. D; metaplasia
2. D; 40 cm
3. C; peptic ulcers
4. C; metaplastic process
5. D; adenocarcinoma
6. B; middle third
7. A; first part, anterior surface
8. B; fundus
9. C; ulcerative
10. B; decrease synthesis of IgG
11. B; superficial mucosal ulceration
12. D; stricture formation
13. B; toxic megacolon
14. D; TB ulcers often cause int perforation
15. B; intestinal perforation
16. C; neutrophilic infiltrate in muscularis
17. B; midgut
18. C; villous adenomas
19. A; rectum
20. C; mutated Rb gene
21. D; intestinal metaplasia
22. B; Mallory weiss syndrome
23. D; metaplastic polyps
24. A; Cronchite Canada syndrome
25. C; carcinoma confined to mucosa and submucosa
26. A; Ulcerative colitis
27. B; Crohn’s disease
28. B; UC
29. D; worse prognosis
30. TGFBR2
31. C; Sigmoid Colon
32. B; Erythroplakia
33. D; Non-keratinizing
34. B; 3-6%
35. C; long segment Barrett’s esophagus> 5 cm
36. B; Goblet cell
37. D; Warthin starry silver stain
38. A; Hyperplasia of foveolar epithelium
39. B; Vomiting
40. A; Scirrhous Carcinoma