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GI Web Path Exam | QUESTIONS with 100% Solutions
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GI Web Path Exam | QUESTIONS with100% Solutions
Question 1
A 31-year-old woman has a 10 year history of intermittent, bloody diarrhea. She has
no other major medical problems. On physical examination there are no lesions
palpable on digital rectal examination, but a stool sample is positive for occult blood.
Colonoscopy reveals a friable, erythematous mucosa with focal ulceration that extends
from the rectum to the mid-transverse colon. Biopsies are taken and all reveal mucosal
acute and chronic inflammation with crypt distortion, occasional crypt abscesses, and
superficial mucosal ulceration. This patient is at greatest risk for development of which
of the following conditions?
A Acute pancreatitis
B Diverticulitis
C Sclerosing cholangitis
D Appendicitis
E Perirectal fistula
F Non-Hodgkin lymphoma - Ans (C) CORRECT. This patient has ulcerative colitis (UC).
One of the extraintestinal manifestations of this form of inflammatory bowel disease
is sclerosing cholangitis, which can still occur even after the colon is removed.
Question 2
A 39-year-old man is having a routine physical examination because of a history of colon
cancer in his family. He has no abdominal tenderness or masses, and active bowel
sounds are present. However, his stool is positive for occult blood. Colonoscopy is
performed. There are 7 polyps found in the ascending colon: three of these are small
0.5 cm pedunculated tubular adenomas, three are 1 cm tubulovillous adenomas, and
one is a 2 cm sessile villous adenoma in the cecum containing a focus of well
differentiated adenocarcinoma. Which of the following is the most likely diagnosis?
A Peutz-Jeghers syndrome
B Chronic ulcerative colitis
,C Hereditary non-polyposis colon carcinoma
D Familial polyposis coli
E Gardner syndrome - Ans (C) CORRECT. The number of polyps is not great in this case,
but a cancer at his age suggests an aggressive course for a polyp. Many polyps and
cancers of HNPCC involve the right (ascending) colon. This condition arises from
abnormal mismatch repair genes and accounts for perhaps 1 to 3% of all colon cancers.
Question 3
A 72-year-old woman notes increasing jaundice and nausea for the past month. On
physical examination she is afebrile, but scleral icterus is present. There is no abdominal
pain on palpation. She has active bowel sounds. A stool sample tested for occult blood
is negative. Laboratory findings include total protein 6.1 g/dL, albumin 3.3 g/dL, alkaline
phosphatase 210 U/L, AST 49 U/L, ALT 40 U/L, total bilirubin 7.2 mg/dL, and direct
bilirubin 6.3 mg/dL. Her serum lipase is 50 U/L. Which of the following conditions is
she most likely to have?
A Pancreatic adenocarcinoma
B Cystic fibrosis
C Chronic active hepatitis
D Primary biliary cirrhosis
E Chronic persistent hepatitis
F Autoimmune hemolytic anemia - Ans (A) CORRECT. Adenocarcinoma of the head of
pancreas produces extrahepatic biliary obstruction with an elevation predominantly
of the direct bilirubin along with an elevation in alkaline phosphatase. This results in
the classic finding of 'painless jaundice'.
A 45-year-old man has had a fever and a productive cough for the past 3 days. On
physical examination there is dullness to percussion over the right upper lung. His
temperature is 37.9 C. A chest radiograph reveals right upper lobe consolidation.
Laboratory findings include serum total protein of 6.0 g/dL, albumin 2.7 g/dL, AST
185 U/L, ALT 98 U/L, total bilirubin 1.0 mg/dL, alkaline phosphatase 31 U/L, and
prothrombin time 20 sec. He does not respond to antibiotic therapy and dies. He is
, found at autopsy to have a 2500 gm liver (normal for his size up to 1800 gm) that
microscopically shows most of the hepatocytes to be filled with large lipid droplets.
Which of the following conditions is the most likely underlying cause of death?
A Alpha-1-antitrypsin deficiency
B Wilson disease
C Acute hepatitis C
D Chronic alcoholism
E Biliary tract lithiasis - Ans (D) CORRECT. Big fatty livers are often seen in conjuction
with chronic alcoholism. In the absence of a history of chronic alcohol abuse, non-
alcoholic fatty liver (NAFL) is the likely cause, and NAFL can be associated with obesity
and diabetes mellitus. Microscopically, the pattern will be macrovesicular steatosis, with
large lipid vacuoles filling hepatocytes.
\
Question 5
A 60-year-old man has had anorexia, vomiting, and vague abdominal pain accompanied
by weight loss of 6 kg over the past 2 months. Physical examination reveals
supraclavicular non-tender lymphadenopathy. He becomes progressively cachectic and
dies. At autopsy the stomach is shrunken with the gastric wall thickened to 1 cm and
with extensive overlying mucosal erosions. Multiple tan umbilicated masses from 1 to
4 cm in size are scattered over the surface of the liver. Which of the following
conditions most likely preceded development of his terminal illness?
A Human immunodeficiency virus infection
B Diabetes mellitus, type I
C Chronic alcoholism
D Pernicious anemia
E A diet high in fresh fruits
F Use of NSAIDS - Ans (D) CORRECT. This is linitis plastica of the stomach, which
typically has a signet ring cell pattern of adenocarcinoma diffusely infiltrating the
stomach. Autoimmune gastritis is a risk factor for this condition.
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