FRCPath Part1 Course
Upper Gastrointestinal System MCQ 1 The commonest disease associated with lymphocytic gastritis is: A. Crohn’s disease. B. Common variable immunodeficiency. C. Collagenous colitis. D. Coeliac disease. E. CMV infection MCQ 2 A common complication of chronic gastroesophageal reflux is: A. Eosinophilic oesophagitis. B. Barrett’s oesophagus. C. Candida oesophagitis. D. MALT lymphoma. E. Squamous cell carcinoma MCQ 3 An oesophagogastrectomy specimen reveals an adenocarcinoma at the gastrooesophageal junction, about 80% of which lies in the stomach with the background oesophageal mucosa showing no evidence of Barrett’s change. The tumour invades just beyond the muscularis propria into the subserosa and involves two out of fifteen perigastric lymph nodes. The pathological stage is: A. pT1, pN1, pMx. B. pT2, pN1, pMx. C. pT3, pN1, pMx. D. pT1, pN0. pMx. E. pT2, pN0. pMx. MCQ 4 A common association of gastric endocrine neoplasms is: A. Helicobacter gastritis. B. Familial adenomatous polyposis C. Pernicious anaemia D. Peptic ulcer disease. D. NSAID use. MCQ 5 Imatinib (Glivec) is a drug used for the treatment of: A. Intestinal carcinoids. B. Gastric MALT lymphoma. C. H. Pylori gastritis D. Metastatic GIST. E. Gastric adenocarcinomas.
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FRCPath Part1 Course
MCQ 6 A well-known association/complication of Helicobacter pylori gastritis is: A. Gastric MALT lymphoma. B. Inflammatory fibroid polyp. C. Gastric GIST. D. Fundic gland polyp. E. Mantle cell lymphoma. EMQ 7 A. Eosinophilic oesophagitis. B. Herpes simplex infection C. Barrett’s oesophagus D. Reflux oesophagitis E. Chronic radiation damage F. Cytomegalovirus infection G. Adenocarcinoma H. Malignant melanoma I. Chronic graft versus Host disease J. Crohn’s disease K. Granular cell tumour Select one of the above oesophageal abnormalities which fits best for the following histological features seen in an oesophageal biopsy: Ulceration, large intranuclear eosinophilic inclusions surrounded by a clear halo with cellular enlargement in the stromal and endothelial cells of the ulcer base Basal zone hyperplasia, papillary elongation, vascular dilatation, intraepithelial infiltration by a few neutrophils and occasional eosinophils Apoptosis of individual squamous cells, necrosis and focal lymphocytic infiltration in a patient with history of bone marrow transplant Pseudoepitheliomatous hyperplasia of the squamous epithelium, well circumscribed lesion in the lamina propria composed of sheets of polygonal cells with bland nuclei and abundant eosinophilic cytoplasm showing PAS positivity Ulceration, dyscohesive and multinucleated squamous cells at the margin of the ulcer, ground glass inclusions filling the nucleus
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FRCPath Part1 Course EMQ 8 A. Helicobacter pylori gastritis. B. Whipple’s disease. C. Mantle cell lymphoma. D. Eosinophilic gastritis. E. Bile reflux/chemical gastritis. F. Xanthelasma. G. Chronic radiation gastritis. H. Mycobacterium avium-intracellulare. I. Gastro-intestinal stromal tumour J. MALT lymphoma. K. Diffuse signet ring cell carcinoma. L. Lymphocytic gastritis. Each of the following subjects has a gastric biopsy. For each one select the most likely condition from the option list above. A 52 year old male with multiple cream coloured plaques in the antrum, ranging in size from 1mm to 4mm: The biopsy shows loosely organised aggregates of foamy histiocytes in the upper lamina propria with bland inconspicuous nuclei. The cytoplasm is PAS and ZN negative A 64 year old female with antral ulceration and thickening: The biopsy shows individual and small clusters of atypical cells in the lamina propria. The cells have abundant vacuolated cytoplasm with peripheral enlarged nuclei. The cytoplasm is Alcian blue - PAS positive A 40 year old male with dyspepsia: The biopsy shows a chronic inflammatory infiltrate and occasional lymphoid follicles with germinal centres in the lamina propria, and several neutrophils infiltrating the foveolar epithelium A 54 year old woman with multiple antral erosions: The biopsy shows a dense and diffuse lymphoid infiltrate in the lamina propria with infiltration of the glands by several aggregates of lymphocytes (lymphoepithelial lesions) A 61 year old male with dyspepsia: The antral biopsy shows foveolar hyperplasia and congestion of the lamina propria associated with smooth muscle proliferation
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FRCPath Part1 Course EMQ 9 A. Ziehl-Neelsen’s stain. B. Von Kossa. C. PAS. D. Gomori’s methenamine sliver. E. Orcein. F. Hale’s colloidal iron. G. Masson’s trichrome. H. Gram’s stain. I. Congo red. J. Perl’s Prussian blue. K. Modified Giemsa. L. Reticulin. One of the above special stains is most helpful in the diagnosis of each of the following upper gastrointestinal conditions. Select the most appropriate option for each. Collagenous gastritis Whipple’s disease Helicobacter associated chronic gastritis Mycobacterium avium-intracellulare infection Tablet induced gastric erosion (? Iron tablet) EMQ 10 A. CD3. B. Chromogranin. C. CD34 D. CK20. E. HMB45. F. Alk-1 G. CD117. H. TTF-1. I. S100. J. Desmin. K. Cyclin D1. One of the above immunohistochemical stains is the most useful in the diagnosis of the following upper gastrointestinal conditions: Gastric Schwannoma Carcinoid (neuroendocrine tumour) of the duodenum Granular cell tumour of the oesophagus Gastrointestinal stromal tumour of the stomach Mantle cell lymphoma of the stomach
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