MCQ: GASTROINTESTINAL PATHOLOGY — 60 MCQs (Redistributed Answers) – 60 MCQs | Kenya MBChB

60 Year 3: Gastrointestinal Pathology exam questions on MCQ: GASTROINTESTINAL PATHOLOGY — 60 MCQs (Redistributed Answers) for medical students. Includes MCQs, a

This MCQ set contains 60 questions on MCQ: GASTROINTESTINAL PATHOLOGY — 60 MCQs (Redistributed Answers) in the Year 3: Gastrointestinal Pathology unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: A 3-year-old presents with painful oral vesicles and ulcerations, high fever, and refusal to eat. His mother reports this began abruptly. Biopsy of the lesion edge reveals multinucleated polykaryons with eosinophilic intranuclear inclusions. What is the diagnosis?

  1. A. Primary oral candidiasis with pseudomembrane formation
  2. B. Aphthous ulcers triggered by stress in a toddler
  3. C. Acute herpetic gingivostomatitis from primary HSV-1 infection
  4. D. Herpangina from Coxsackievirus A infection

Correct answer: C – Acute herpetic gingivostomatitis from primary HSV-1 infection

Primary HSV-1 infection in 2–4 year olds presents as acute herpetic gingivostomatitis. The morphologic hallmarks are multinucleated polykaryons and eosinophilic intranuclear inclusions.

Q2: A 52-year-old male smoker has a white patch on his buccal mucosa that cannot be scraped off. Biopsy shows moderate epithelial dysplasia. What is the most accurate statement about this lesion?

  1. A. It must be considered precancerous until proved otherwise by histology
  2. B. It is definitively benign because it lacks erythroplakia features
  3. C. Malignant transformation occurs in more than 50% of such lesions
  4. D. It requires no treatment as most leukoplakias regress spontaneously

Correct answer: A – It must be considered precancerous until proved otherwise by histology

All leukoplakias must be considered precancerous regardless of clinical appearance. 5–25% are premalignant. 50% transformation rate applies to erythroplakia, not leukoplakia.

Q3: A 45-year-old woman develops a red, velvety slightly depressed lesion on the floor of her mouth. She is a non-smoker with no alcohol use. Which statement is most accurate regarding this lesion?

  1. A. It represents a reactive vascular lesion similar to a pyogenic granuloma
  2. B. It requires the same management as aphthous ulcers — watchful waiting
  3. C. Its malignant transformation risk is lower than leukoplakia due to absent tobacco history
  4. D. It has greater malignant transformation risk than leukoplakia with 50% of cases transforming

Correct answer: D – It has greater malignant transformation risk than leukoplakia with 50% of cases transforming

Erythroplakia carries a much greater malignant transformation risk than leukoplakia, with 50% of cases undergoing malignant transformation regardless of tobacco history.

Q4: A 35-year-old male has a rapidly growing pedunculated red-purple gingival mass. His wife is 7 months pregnant and has a similar lesion. Biopsy shows immature vessel proliferation resembling granulation tissue. What is this lesion and its behaviour?

  1. A. Oral SCC — requires urgent wide excision and cervical node dissection
  2. B. Pyogenic granuloma — may regress, fibrose, or become peripheral ossifying fibroma
  3. C. Kaposi sarcoma — requires investigation for immunodeficiency
  4. D. Fibroma — excise and remove the irritant source

Correct answer: B – Pyogenic granuloma — may regress, fibrose, or become peripheral ossifying fibroma

Pyogenic granulomas are richly vascular pedunculated gingival masses common in pregnant women and young adults. They can regress, mature into fibrous masses, or develop into peripheral ossifying fibroma.

Q5: An HPV-related oral SCC at the base of tongue is identified in a 40-year-old non-smoking male. Compared to tobacco-related oral SCC, this tumour is expected to show:

  1. A. Fewer mutations, overexpression of p16, and better prognosis
  2. B. Worse prognosis due to deeper invasion at diagnosis
  3. C. Higher incidence of field cancerisation affecting adjacent mucosa
  4. D. Overexpression of p53 due to direct viral inactivation

Correct answer: A – Fewer mutations, overexpression of p16, and better prognosis

HPV-related oral SCC (predominantly HPV-16) has fewer overall mutations, overexpresses p16 (cyclin-dependent kinase inhibitor), and carries a better prognosis than tobacco/alcohol-related SCC.

Q6: A 65-year-old woman complains of extreme dry mouth, difficulty swallowing, and recurrent dental caries. She is on multiple medications for hypertension and depression. What is the most common cause of her xerostomia?

  1. A. Bilateral parotid gland obstruction by sialolithiasis
  2. B. Sjögren syndrome with anti-Ro and anti-La antibodies
  3. C. Radiation therapy damage to parotid glands
  4. D. Medications — anticholinergic and antidepressant agents

Correct answer: D – Medications — anticholinergic and antidepressant agents

Medications are the most frequent cause of xerostomia, including anticholinergic, antidepressant, antihypertensive, and diuretic agents. Sjögren syndrome is the second most important cause.

Q7: A 25-year-old male presents with a fluctuant swelling of his lower lip that enlarges before meals and shrinks afterwards. What is the most likely diagnosis and its pathogenesis?

  1. A. Ranula — obstruction of the sublingual gland main duct
  2. B. Fibroma — reactive connective tissue hyperplasia from bite trauma
  3. C. Mucocele — blockage or rupture of a minor salivary gland duct with saliva leakage
  4. D. Pyogenic granuloma — vascular proliferation triggered by local infection

Correct answer: C – Mucocele — blockage or rupture of a minor salivary gland duct with saliva leakage

Mucocele is the most common inflammatory salivary gland lesion, resulting from duct blockage or rupture with saliva leakage into surrounding stroma. The fluctuant lower lip swelling that changes size around meals is characteristic.

Q8: A neonate presents with regurgitation during the first feeding, aspiration, and abdominal distention from gas below the diaphragm. What is the most likely oesophageal abnormality and its most common variant?

  1. A. Oesophageal stenosis from submucosal fibrosis — presents after weaning
  2. B. H-type tracheoesophageal fistula without atresia — most common in neonates
  3. C. Oesophageal atresia alone — blind-ended upper pouch with no fistula
  4. D. Oesophageal atresia with distal tracheoesophageal fistula — most common variant

Correct answer: D – Oesophageal atresia with distal tracheoesophageal fistula — most common variant

The most common variant is oesophageal atresia with a distal tracheoesophageal fistula. Gas below the diaphragm indicates a distal fistula allowing air into the GI tract.

Q9: A 38-year-old male presents with dysphagia to both solids and liquids, regurgitation of undigested food, and a barium swallow showing a "bird's beak" narrowing at the gastroesophageal junction. Manometry confirms aperistalsis. What is the primary pathogenesis of his condition?

  1. A. Oesophageal varices from portal hypertension obstructing the lumen
  2. B. Mucosal fibrosis from chronic reflux reducing luminal diameter
  3. C. Eosinophilic infiltration of oesophageal epithelium impairing peristalsis
  4. D. Loss of inhibitory neurons (nitric oxide, VIP) in the oesophageal wall

Correct answer: D – Loss of inhibitory neurons (nitric oxide, VIP) in the oesophageal wall

Primary achalasia results from loss of inhibitory neurons (secreting nitric oxide and VIP) in the oesophageal myenteric plexus, causing incomplete LES relaxation, increased LES tone, and aperistalsis.

Q10: A patient with advanced alcoholic cirrhosis develops sudden massive haematemesis. Emergency endoscopy reveals ruptured oesophageal varices. What is the mortality rate from this first bleeding episode?

  1. A. Approximately 70–80% without surgical ligation
  2. B. Approximately 25–30% with optimal medical management
  3. C. Approximately 50% despite intervention
  4. D. Approximately 10–15% even without treatment

Correct answer: C – Approximately 50% despite intervention

Approximately 50% of patients die from the first variceal bleeding episode from direct haemorrhage or hepatic coma from the protein load combined with hypovolaemic shock.

Q11: A 42-year-old male presents after a binge drinking episode with haematemesis. Endoscopy shows linear tears crossing the gastroesophageal junction without perforation into the mediastinum. What distinguishes this from Boerhaave syndrome?

  1. A. Mallory-Weiss tears are superficial/mucosal while Boerhaave involves transmural perforation and mediastinitis
  2. B. Mallory-Weiss tears occur in the stomach while Boerhaave occurs only in the oesophagus
  3. C. Mallory-Weiss tears are caused by alcohol while Boerhaave is caused by violent vomiting
  4. D. Mallory-Weiss requires surgical repair while Boerhaave heals spontaneously

Correct answer: A – Mallory-Weiss tears are superficial/mucosal while Boerhaave involves transmural perforation and mediastinitis

Mallory-Weiss tears are superficial mucosal lacerations that heal spontaneously. Boerhaave syndrome involves transmural perforation leading to mediastinitis — a life-threatening surgical emergency.

Q12: A 55-year-old woman with longstanding GERD undergoes endoscopy showing salmon-pink tongues of mucosa extending above the gastroesophageal junction. Biopsy confirms goblet cells. What is the significance of this finding?

  1. A. Indicates eosinophilic oesophagitis requiring dietary restriction
  2. B. Represents normal columnar metaplasia with no increased cancer risk
  3. C. Confirms gastric heterotopia (inlet patch) in the lower oesophagus — benign finding
  4. D. Represents Barrett oesophagus with 30–40 fold increased adenocarcinoma risk

Correct answer: D – Represents Barrett oesophagus with 30–40 fold increased adenocarcinoma risk

Barrett oesophagus is defined by intestinal metaplasia (goblet cells) replacing squamous oesophageal epithelium and confers a 30–40 fold increased risk of oesophageal adenocarcinoma compared to the general population.

Q13: A 28-year-old atopic male with allergic rhinitis and asthma presents with food impaction and dysphagia. Symptoms fail to improve on high-dose PPI. Endoscopic biopsies from the mid-oesophagus show dense eosinophilic infiltration superficially. What is the diagnosis?

  1. A. Eosinophilic oesophagitis — atopic background
  2. B. Gastroenteritis with eosinophilic gastritis
  3. C. Achalasia — failure of LES relaxation
  4. D. GERD with peptic stricture

Correct answer: A – Eosinophilic oesophagitis — atopic background

Eosinophilic oesophagitis is a chronic immune response characterised by eosinophilic infiltration of the oesophageal mucosa, often associated with atopy. It typically presents with dysphagia and food impaction and does not respond well to PPIs.

Q14: A 70-year-old male with long-standing pernicious anaemia is found to have a gastric polyp on endoscopy. Biopsy shows hyperplastic glands with mild dysplasia. What is the most likely outcome?

  1. A. The polyp will spontaneously regress with B12 supplementation
  2. B. It represents a benign adenoma with no malignant potential
  3. C. It is a precursor to gastric adenocarcinoma with increased surveillance required
  4. D. It requires immediate surgical resection due to high risk of perforation

Correct answer: C – It is a precursor to gastric adenocarcinoma with increased surveillance required

Patients with pernicious anaemia have an increased risk of gastric adenocarcinoma. Gastric polyps in this setting, especially those with dysplasia, are considered premalignant and require close monitoring and surveillance.

Q15: A 60-year-old female presents with postprandial epigastric pain, nausea, and vomiting, particularly after fatty meals. Abdominal ultrasound is normal. What is the most likely diagnosis?

  1. A. Peptic ulcer disease — H. pylori infection
  2. B. Cholelithiasis and biliary colic
  3. C. Chronic pancreatitis — pancreatic calcifications on CT
  4. D. Gastric cancer — gastric wall thickening on endoscopy

Correct answer: B – Cholelithiasis and biliary colic

Postprandial epigastric pain, nausea, and vomiting, especially after fatty meals, are classic symptoms of cholelithiasis and biliary colic. While ultrasound is the first-line investigation, it can miss small stones or non-obstructive stones. Further investigations like HIDA scan or MRCP might be needed.

Q16: A 40-year-old male with a history of heavy alcohol use develops severe epigastric pain radiating to the back, nausea, and vomiting. His amylase and lipase are elevated. What is the most likely diagnosis?

  1. A. Gastric ulcer disease
  2. B. Acute pancreatitis
  3. C. Hepatitis
  4. D. Biliary colic

Correct answer: B – Acute pancreatitis

Severe epigastric pain radiating to the back, nausea, vomiting, and elevated amylase and lipase levels are classic signs of acute pancreatitis, often precipitated by heavy alcohol use.

Q17: A 25-year-old male presents with fever, jaundice, and RUQ pain after eating raw oysters. AST and ALT are markedly elevated, and bilirubin is also high. What is the most likely infectious agent?

  1. A. Hepatitis A virus
  2. B. Hepatitis B virus
  3. C. Hepatitis C virus
  4. D. Vibrio vulnificus

Correct answer: D – Vibrio vulnificus

Eating raw oysters can expose individuals to Vibrio vulnificus, which can cause severe gastroenteritis, wound infections, and life-threatening sepsis, particularly in individuals with liver disease or immunocompromise. While Hepatitis A can also be transmitted via shellfish, the presentation with severe sepsis and rapid deterioration is more characteristic of V. vulnificus.

Q18: A 50-year-old obese female presents with intermittent RUQ pain after fatty meals. Ultrasound shows gallstones but no evidence of inflammation. What is the most appropriate management?

  1. A. Immediate cholecystectomy
  2. B. Ursodeoxycholic acid therapy
  3. C. Pain management and dietary advice
  4. D. Laparoscopic cholecystectomy once symptomatic episode resolves

Correct answer: C – Pain management and dietary advice

For asymptomatic or mildly symptomatic gallstones, observation with dietary advice and pain management is often appropriate. Elective cholecystectomy is considered for symptomatic patients or those with specific risk factors, but immediate surgery for uncomplicated biliary colic is not always necessary.

Q19: A 65-year-old male with a history of smoking develops painless jaundice, weight loss, and a palpable non-tender gallbladder (Courvoisier's sign). What is the most likely diagnosis?

  1. A. Gallstones
  2. B. Choledocholithiasis
  3. C. Pancreatic cancer
  4. D. Hepatitis

Correct answer: C – Pancreatic cancer

Painless jaundice, weight loss, and a palpable gallbladder (Courvoisier's sign) in an elderly male smoker are highly suggestive of pancreatic cancer obstructing the common bile duct. The painless nature is key. While gallstones can cause jaundice, it's usually associated with pain (biliary colic), and Courvoisier's sign is less common. Hepatitis typically presents with constitutional symptoms and

Q20: A 30-year-old male develops acute hepatitis with elevated transaminases and jaundice. He reports multiple sexual partners and recent unprotected sex. Serological tests reveal HBsAg positive, anti-HBc IgM positive, and anti-HBs negative. What is the most likely diagnosis?

  1. A. Past Hepatitis B infection
  2. B. Chronic Hepatitis B infection
  3. C. Acute Hepatitis B infection
  4. D. Hepatitis B carrier state

Correct answer: C – Acute Hepatitis B infection

The presence of HBsAg, anti-HBc IgM, and the absence of anti-HBs indicates an acute Hepatitis B infection. Anti-HBc IgM is a marker for recent infection.

Q21: A 50-year-old female with a history of chronic hepatitis C develops ascites and esophageal varices. Liver biopsy shows micronodular cirrhosis. What is the most likely complication leading to this advanced liver disease?

  1. A. Hepatitis B co-infection
  2. B. Alcoholic liver disease
  3. C. Non-alcoholic fatty liver disease (NAFLD)
  4. D. Hepatocellular carcinoma

Correct answer: A – Hepatitis B co-infection

While chronic Hepatitis C is a direct cause of cirrhosis, co-infection with Hepatitis B can accelerate the progression to cirrhosis and hepatocellular carcinoma. In the context of already advanced disease, it's a significant factor that would have contributed to the severity and progression.

Q22: A 20-year-old male presents with anorexia, nausea, vomiting, and RUQ pain. He has a history of intravenous drug use and multiple sexual partners. Serological tests are negative for Hepatitis A, B, and C. What is the most likely cause of his symptoms?

  1. A. Acute Hepatitis E
  2. B. Drug-induced liver injury
  3. C. Autoimmune hepatitis
  4. D. Budd-Chiari syndrome

Correct answer: B – Drug-induced liver injury

Given the history of intravenous drug use and multiple sexual partners, drug-induced liver injury (DILI) is a strong possibility. While Hepatitis E can cause acute hepatitis, it's typically acquired through contaminated water or food and less common in this demographic. Autoimmune hepatitis is a possibility but less likely without specific autoantibodies. Budd-Chiari syndrome involves hepatic vein

Q23: A 60-year-old male with known cirrhosis develops altered mental status, asterixis, and a musty odor to his breath. Lab results show elevated ammonia. What is the most likely diagnosis?

  1. A. Hepatic encephalopathy
  2. B. Intracranial hemorrhage
  3. C. Uremic encephalopathy
  4. D. Wernicke's encephalopathy

Correct answer: A – Hepatic encephalopathy

Hepatic encephalopathy is a complication of advanced liver disease characterized by neurological dysfunction due to the accumulation of toxins, such as ammonia, in the brain. Asterixis (flapping tremor) and a musty breath odor are classic signs.

Q24: A 45-year-old male with chronic pancreatitis experiences steatorrhea (fatty stools) and weight loss. What is the most likely cause of these symptoms?

  1. A. Malabsorption due to exocrine pancreatic insufficiency
  2. B. Bacterial overgrowth in the small intestine
  3. C. Celiac disease
  4. D. Short bowel syndrome

Correct answer: A – Malabsorption due to exocrine pancreatic insufficiency

Chronic pancreatitis leads to destruction of the exocrine pancreas, impairing the production of digestive enzymes. This results in malabsorption of fats, proteins, and carbohydrates, leading to steatorrhea and weight loss.

Q25: A 70-year-old female with a history of constipation presents with LLQ pain, fever, and leukocytosis. CT scan shows a thickened segment of the colon with pericolic fat stranding. What is the most likely diagnosis?

  1. A. Crohn's disease
  2. B. Ischemic colitis
  3. C. Diverticulitis
  4. D. Colon cancer

Correct answer: C – Diverticulitis

Left lower quadrant pain, fever, leukocytosis, and CT findings of a thickened colon segment with pericolic fat stranding are classic for acute diverticulitis, a common condition in the elderly, especially those with a history of constipation.

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