MCQ-Lower GI

FRCPath Part1 Course

Lower Gastrointestinal System EMQ 1 A. B. C. D. F. G.

Infective colitis Pseudomembranous colitis Ulcerative colitis Crohn’s disease E. Lymphocytic colitis Collagenous colitis Ishcaemic colitis

Select the appropriate condition from the list of options for each of the clinicopathological descriptions.

1. A 64 year old male admitted in ITU for sepsis develops acute onset diarrhoea.

Colonic biopsies show a luminal spray of mucus and neutrophils. The background mucosa shows minimal inflammatory changes.

2. A 55 year old female with watery diarrhoea and normal colonoscopy. The colonic biopsies show increased intraepithelial lymphocytes with a thickened sub epithelial collagen plate 3. A 28 year old male with bloody diarrhaoea and abdominal pain. A colonscopy shows patchy inflammation affecting the right side colon with apthous ulcers.

The colonic biopsies show mild crypt distortion with patchy discontinuous inflammation with cryptitis 4. A 42 year old female with acute onset bloody diarrhoea and granular and congested rectum on endoscopy. The rectal biopsy shows oedematous mucosa with dispersed ‘sprinkled salt’ inflammatory cells, cryptitis and dilatation and withering of crypts 5. A 72 year old male with abdominal pain and bloody diarrhoea. Sigmoidoscopy shows inflammation in the left side of the colon, most prominent in the sigmoid colon. Biopsies show extensive ulceration with preservation of basal crypts and active inflammation. There is no crypt distortion or crypt abscess formation

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FRCPath Part1 Course EMQ 2 A. B. C. D. E. F. G.

Gardner’s syndrome Turcot syndrome Peutz-Jeghers syndrome Cowden syndrome Cronkhite-Canada syndrome Carney triad Muir Torre syndrome

Select the appropriate syndrome from the list of options for each of the conditions described. Each of the options may be used once, more than once or not at all.

Autosomal dominant disorder characterised by intestinal hamartomatous polyps, facial trichilemmomas, acral keratosis and oral papillomas Non hereditary condition characterised by gastrointestinal hamartomatous polyps, nail atrophy and alopecia Familial disorder with intestinal adenomatous polyps, osteomas, epidermal cysts and fibromatosis Autosomal dominant condition with microsatellite instability, gastrointestinal malignancy and sebaceous neoplasms Condition characterised by colonic adenomatous polyposis and CNS tumours

NOTES

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FRCPath Part1 Course EMQ 3 A. B. C. D. E. F. G. H. I.

Tubulovillous adenoma Tubular adenoma Villous adenoma Serrated adenoma Sessile serrated polyp Mixed hyperplastic polyp – serrated adenoma Juvenile polyp Hamartomatous polyp Hyperplastic polyp

Select the appropriate term from the list of options for each of the polyps described.

1. Polyp with low grade dysplasia and approximately 10% villous architecture 2. Polyp with high grade dysplasia and approximately 60% villous architecture 3. A 3 mm polyp in the rectum with a serrated architecture and no dysplasia 4. A 25 mm polyp in the ascending colon with a serrated architecture and no dysplasia.

The bases of the crypts show dilatation and branching.

5. A 30 mm polyp in the rectum with oedematous lamina propria, ulcerated surface and many cystically dilated glands 6. A 14 mm polyp is the transverse colon with a serrated architecture and low grade dysplasia

MCQ 4 Sections from a pedunculated polyp received through the bowel cancer screening programme show an invasive carcinoma arising within a tubulovillous adenoma. The carcinoma infiltrates into and appears limited to the stalk of the polyp. No vascular invasion is seen. The deep margin is 3 mm away. Which of the following best describes the level of submucosal infiltration?

A. Kikuchi level sm1 B. Kikuchi level sm2 C. Kikuchi level sm3 D. Haggit level 1 E. Haggit level 2 F. Haggit level 3

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FRCPath Part1 Course EMQ 5 A. B. C. D. E. F. G. H.

pT3N2, Dukes C2 pT1N0, Dukes A ypT2yN1, Dukes C1 pT4N0, Dukes B pT3N1, Dukes C1 pT4N1, Dukes C1 ypT2yN2, Dukes C1 pT4N0, Dukes B

Select the appropriate pathological tumour and nodal stage from the options for each of the colorectal tumours described. Each option may be used once, more than once or not at all.

Caecal adenocarcinoma with intramural extension into terminal ileum and infiltration into subserosal fat; 3/22 lymph nodes involved, apical node clear.

Low rectal adenocarcinoma infiltrating into the levator muscles; lymph nodes free of tumour.

Large rectal adenocarcinoma with macroscopic tumour perforation through the mesorectal fat into the retroperitoneum, 2/13 nodes involved, apical node clear Rectal adenocarcinoma with preoperative long course chemoradiation. Residual tumour infiltrating into but not beyond muscularis propria. A total of 7 lymph nodes retrieved of which 3 show carcinoma and one contains mucin lakes with no demonstrable tumour cells.

Apical node clear Polypoid adenocarcinoma infiltrating into the submucosa. No lymph nodes involved

MCQ 6 A 52 year old female is found to have a pelvic mass arising from the rectum, which is resected. The mass measures 12 cm in maximum dimension and has a uniform solid cut surface. On histological examination, this is a predominantly spindle cell lesion, with the cells showing minimal nuclear pleomorphism, no necrosis and up to 3 mitoses per 50 hpf. The cells have the following immunoprofile: AE1/AE3 negative, SMA focally positive, desmin negative, S100 negative, CD117 negative, CD34 positive and DOG-1 positive. What is the risk of progressive disease for this tumour?

A. B. C. D. E.

None Low Intermediate High Very high

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