SMARTVI

SIONI
NSTI
TUTE

MCQS

GASTROI
NTESTI
NALTRACT
GIT MCQS PATHOLOGY DR,ELNEMR

GIT MCQS
1- All of the following are true about oral leukoplakia except:
a) It appears as whitish mucosal patch
b) It occurs due to chronic irritation
c) Common sites are lips, tongue and cheek
d) Malignant transformation into adenocarcinoma is a major complication

2- Predisposing factors of squamous cell carcinoma of the tongue include all of

the following except:
a) WV 16 & 18
b) TB ulcer
c) 3ry syphilis (gumma)
d) Tobacco chewing

3- The etiology of sialadenitis in Sjogren's syndrome is:

a) Autoimmune
b) Traumatic
c) Viral infection
d) Bacterial infection

4- The most common virus causing sialadenitis is:

a) CMV
b) EPV
c) Mumps
d) HSV

5- Most of salivary gland tumors occur in:

a) Parotid glands
b) Submandibular glands
c) Sublingual glands
d) Minor salivary glands

6- The most common primary malignant salivary gland tumor is:

a) Adenoid cystic carcinoma
b) Adenolymphoma
c) Adenocarcinoma
d) Mucoepoidermoid carcinoma

solving is the solve 1

GIT MCQS PATHOLOGY DR,ELNEMR

7- Achalasia means:
a) Failure of canalization of the esophagus
b) An outpouching of part of the wall of the esophagus
c) Loss of the contractility of the esophagus and failure of relaxation of
the lower esophageal sphincter
d) Protrusion of the upper part of the esophagus into the neck

8- All of the following are true about hiatus hernia except:

a) Protrusion of the upper part of the stomach into the thorax
b) Predisposing factors include obesity, lifting heavy loads & frequent coughing fits
c) It is due to increased intrathoracic pressure and increased diaphragmatic tone
d) It results in regurgitation of gastric contents and GERD

9- Define esophageal varices and list 2 possible complications.

10-Common causes of acute esophagitis include all of the following except:
a) HSVI
b) CMV
c) Candida albicans
d) HPV

11-A 40-year-old smoker, obese and alcoholic male with a 10-year history of acid reflux
presents to his primary care provider with concern due to the increasing severity and
frequency of his acid reflux symptoms. The patient describes these symptoms as
a burning in his upper and middle chest, as well as the development of a sour taste
in his mouth over the last several months. Endoscopy is done and revealed
hyperemic tongue like projections replacing the normal whitish mucosa of the
esophagus. Answer the following questions.
a) What is your diagnosis?
b) Mention the possible risk factors for this disease in this case.
c) Mention the most important complication in this condition.
d) If a biopsy is taken, what will you see histologically?

12- The benign esophageal tumor which may be linked to HPV infection is:
a) Hemangioma
b) Squamous cell papilloma
c) Leiomyoma
d) Lipoma

solving is the solve 2

GIT MCQS PATHOLOGY DR,ELNEMR

13- Common causes of acute gastritis include all of the following except:
a) Alcohol
b) Aspirin and NSAIDs
c) Autoimmune
d) Cortisone & cytotoxic drugs

14- Pathogenesis of acute gastritis include all of the following except:

a) Damage of epithelial cells
b) Diminished secretion of mucous
c) Parietal cell destruction leading to diminished acid secretion
d) Inhibition of prostaglandin secretion by mucosal cells

15- The most common cause of acute gastritis is:

a) Alcohol
b) Autoimmune gastritis
c) H-pylori infection
d) NSAIDs

16- Pathogenesis of H-pylori gastritis include all of the following except:

a) The organism is found in the mucous layer of gastric epithelium
b) High acid production occurs almost in all cases
c) The acute inflammatory response is mediated by complement
d) Neutrophils release proteases and ROS

17- A 66-year-old woman was admitted because of severe epigastric pain, dyspepsia,
atrophic glossitis and peripheral neuropathy. The patient had no previous disease
history and does not take any medications. Laboratory testing revealed anemia
and decreased levels of vitamin B12. Endoscopy revealed thin paper-like
gastric mucosa with loss of rugae and biopsy is taken.
a) What is your diagnosis?
b) Which parts of the stomach commonly affected by this condition?
c) Describe the microscopic picture?
d) Mention 2 possible complications.
18- Causes of acute gastric ulceration include all of the following except:
a) Stress ulcers
b) Zollinger Ellison syndrome
c) Curling ulcers
d) Cushing ulcers

solving is the solve 3

GIT MCQS PATHOLOGY DR,ELNEMR

19- One of the gross features of peptic ulcer disease is:

a) Peptic ulcers are more common in the stomach than the duodenum
b) Duodenal ulcers occur in the first few centimeters of the duodenum on the anterior wall
c) Gastric ulcers are predominately located at the junction between the fundus & the body
more on the greater curvature
d) Peptic ulcers are usually multiple

20- All of the following are benign mesenchymal gastric tumors except:
a) Adenomatous polyp
b) GIST
c) Leiomyoma
d) Schwannoma

21- Risk of development of adenocarcinoma is high with:

a) Inflammatory polyp
b) Hyperplastic polyp
c) Adenomatous polyp
d) Fundic polyp

22- One of the predisposing factors of gastric carcinoma is:

a) Hyperchlorhydria favors the growth of bacteria that catalyse the formation of nitrosamines
b) Autoimmune gastritis type A
c) Increased expression of E cadherins in diffuse gastric cancer
d) Blood group O
23- The most common mesenchymal tumor of the abdomen is:
a) GIST
b) Fibroma
c) Lipoma
d) Leiomyoma

24- GIST is frequently associated with:

a) Bc12 mutation
b) P53 mutation
c) Her2Neu mutation
d) c-KIT mutation

25- Regarding gastric lymphoma, its risk significantly increases with:

a) Peptic ulcer
b) H-pylori gastritis
c) Adenomatous polyp
d) Autoimmune gastritis
solving is the solve 4
GIT MCQS PATHOLOGY DR,ELNEMR

26- What are the main types of gastric carcinoma and differentiate between them in the
following table?

Precursor lesions

Gross picture
Microscopic picture

27- Define hematemesis & enumerate 4 possible causes.

28- The following feature is not true about Meckel's diverticulum:

a) It is a remnant of the vitello-intestinal duct
b) It is a blind pouch present on the mesenteric border of the small intestine
c) Located 2-3 feet from the ilieocecal junction
d) May get inflamed and present as acute abdomen

29- Features of Hirschsprung disease include all of the following except:

a) It is a disease of children less than one year
b) Due to congenital absence of the ganglionic cells in the mesenteric plexus
c) Manifested by severe diarrhea & abdominal distension
d) The aganglionic segment is narrow & the segment proximal to it is markedly dilated

30- One of the functional causes of acute intestinal obstruction is:

a) Adhesions
b) Strangulated hernia
c) Paralytic ileus
d) Thrombosis or embolism of mesenteric artery

31- All of the following are causes of chronic intestinal obstruction except:
a) Fibrous stricture following Crohn's disease
b) Annular stricture carcinoma
c) Hirschsprung disease
d) Strangulated hernia

32- Pathological features of chronic intestinal obstruction include:

a) There is collapse of the proximal segment
b) The distal segment is dilated
c) The lumen contains liquefied food & gases by the action of the bacteria
d) Hypertrophy and thickening of the wall of the distal segment

solving is the solve 5

GIT MCQS PATHOLOGY DR,ELNEMR

33- Bacillary dysentery is caused by:

a) Salmonella organism
b) Shigella organism
c) Clostridium difficle
d) Treponema pallidum

34- Bacillary dysentery is:

a) Acute suppurative inflammation
b) Acute fibrinous inflammation
c) Acute pseudomembranous inflammation
d) Acute necrotizing inflammation

35- A previously healthy 21-year-old woman presented to the hospital with fever,
fatigue, myalgia, and non-bloody, watery diarrhea, occurring three to five times a
day. Physical examination was remarkable for dry mucous membranes, mild
muscle tenderness and splenomegaly.
a) What is the most probable diagnosis?
b) What is the causative agent?
c) Explain the cause of spleen enlargement in this case
d) List 3 possible complications

36- A 53-year-old woman presented to the hospital with severe

abdominal pain, persistent vomiting and abdominal distension
with no passage of stools or flatus. She had a history of appendectomy 3
weeks ago. On examination, her abdomen was distended and she was
tender on palpation of the central abdomen. CT of the abdomen and pelvis
with contrast showed distended loops of fluid-filled small bowel.
a) What is your diagnosis?

b) What is the most probable cause of your diagnosis in this case?

c) List 2 possible complications.

37- A 42-year-old woman developed a temperature of 38.90 C sweats, shaking chills, headache, liquid
stools containing bloody mucus and abdominal cramps. On the night the patient was admitted to
the hospital, her temperature became elevated to 39.40 C, and she reported increasing tenderness
in the right upper quadrant, Ultrasound examination of the right upper quadrant and computed
tomographic (CT) scanning of the abdomen revealed one large abscess in the right lobe of the
patient's liver.
a) What is the most probable diagnosis?
b) Mention one simple test to confirm your diagnosis?
c) Enumerate 3 possible complications

solving is the solve 6

GIT MCQS PATHOLOGY DR,ELNEMR

38-One of the following features is not true about inflammatory bowel disease:
a) It is a chronic condition resulting from abnormal mucosal immune responses
b) It embraces 2 conditions; crohns disease & ulcerative colitis
c) Crohns disease commonly affects the large intestine
d) Ulcerative colitis commonly affects the rectosigmoid region

39- Multiple small flask shaped ulcers in the intestine is a feature of:
a) Amoebic dysentery
b) Bacillary dysentery
c) Bilharzial ulcers
d) Typhoid fever

40- A 12 years old girl was admitted to the hospital with frequent passage of blood mixed
stool for 2 weeks. The frequency was about 8-10 times per day, associated with low grade
intermittent fever. Additional symptoms include anorexia, tenesmus and lower abdominal
pain. The patient also reported similar repeated attacks with periods of no symptoms in
between. Colonoscopy showed edema, erythema, multiple ulcerative lesions throughout the
length of the colon in a patchy distribution and biopsy had been taken for histopathology.

a) What is the most probable diagnosis?

b) What do you expect to find in the biopsy?
c) Enumerate 3 possible complications

41- All of the following are true about diverticular disease of the colon except:
a) It is a disease of young infants
b) It occurs due to weakness in the intestinal wall
c) Chronic constipation may be a cause
d) The condition remains silent until inflammation develops
42- Diverticular disease of the colon commonly affects:
a) Rectum
b) Sigmoid colon
c) Transverse colon
d) Ascending colon
43- One of the pathological features of diverticular disease of the colon:
a) It is most common in the rectum
b) Commonly occurs as single lesion
c) The pouch is formed of mucosa & submucosa only
d) The pouch protrude on the mesenteric border

solving is the solve 7

GIT MCQS PATHOLOGY DR,ELNEMR

44- All of the following are types of non-neoplastic colonic polyps except:
a) Bilharzial polyp
b) Hyperplastic polyp
c) Adenomatous polyp
d) Hamartomatous polyp

45- Features of juvenile polyps include all of the following except:

a) They are types of hamartomatous polyps
b) The most common types in children
c) Consist of cystically dilated hyperplastic mucosal glands filled with secretions
d) Commonly associated with intestinal & extraintestinal manifestations

46- The following statement is not true about adenomas:

a) Their incidence increases with age
b) They are probably the precursor of most colorectal cancers
c) Most of adenomas progress to cancer
d) Risk of malignancy is related to size

47- The commonest site of carcinoid tumor:

a) Stomach
b) Small intestine
c) Appendix
d) Cecum

48- Regarding the lymphomas of the GIT, which of the following is incorrect:
a) More common in colon than the small intestine
b) Commonly B cell lymphoma
c) May occur as multiple lesions
d) May cause intestinal obstruction

49- The following are known predisposing factors of acute appendicitis except:
a) Fecolith
b) Food residues
c) Senility
d) Lymphoid hyperplasia
50- Familial adenosis polyposis (FAP) is an autosomal dominant disease caused by
mutation of:
a) B-catenin gene
b) E- cadherine gene
c) APC gene
d) Bc12 gene

solving is the solve 8

GIT MCQS PATHOLOGY DR,ELNEMR

51- The affected gene in FAP is a member of:

a) Oncogenes
b) Tumor suppressor genes
c) Genes involved in DNA repair
d) Genes controlling apoptosis

52- What is the suspected modified Dukes stage of a case of colonic carcinoma extending
into the muscularis propria with positive metastatic lymph node?

53- A 57-year-old male patient presented with altered bowel habit, abdominal pain,
anorexia & weight loss one month ago. Computed tomography (CT) scan revealed
multiple liver and peritoneal masses. Colonoscopy revealed descending colon mass.
a) What is your diagnosis?
b) Mention 3 possible risk factors for this lesion
c) Enumerate 2 possible complications

54- Compare in a table between Crohn's disease & Ulcerative colitis using the following
items:

Crohn's disease Ulcerative colitis

Commonest location
extension of inflammation
skip lesions
presence of granuloma
Pseudopolyps

55- Define the followings:

(Amoeboma, Volvulus, Zollinger Ellison syndrome)

56- A 33-year-old male, smoker & alcoholic presented with a 1-month history
of intermittent, burning epigastric abdominal pain that was moderately severe in intensity. He also
noted nausea and vomited once. Upon physical exam, there was a significant pain in the epigastric
region. Endoscopy revealed 2 clean-based antral ulcers. Biopsies also were taken for Helicobacter
pylori, the results of which were positive.
a) What is the most probable diagnosis?
b) What is your differential diagnosis?
c) What are the risk factors of this lesion present in the case?
d) Enumerate 3 possible complications
solving is the solve 9
GIT MCQS PATHOLOGY DR,ELNEMR

57- Which of the following is not true about pathogenesis of peptic ulcer disease?
a) A mucous-bicarbonate barrier is one of the defensive mechanisms
b) Prostaglandin E increases blood flow & increases mucosal regeneration
c) High dose of corticosteroids suppress prostaglandin synthesis
d) In peptic ulcer of the stomach, hyperacidity is more important than breakdown
of mucosal defense

58- Common sites of peptic ulcer disease include all of the following except:
a) First part of the duodenum

b) Pyloric antrum of the stomach

c) Ileocecal valve

d) Meckels diverticulum

59- The following image of an ulcer in the tongue. Answer the following questions.
a) Describe the lesion
b) What is the nature of this lesion?
c) What is the commonest microscopic type of this lesion?
d) Enumerate 2 possible complications.

60- The following images of a patient with painless slowly growing parotid gland swelling. Answer the
following questions.
a) Describe the gross image
b) Describe the microscopic image
c) What is your diagnosis?
d) what is the behavior of this lesion?

61- The following image is a tissue biopsy of a patient with gastric wall
thickening. Answer the following questions.
a) Describe this image
b) Describe the gross picture of this lesion
c) What is your diagnosis?
d) List 2 possible complications

solving is the solve 10

GIT MCQS PATHOLOGY DR,ELNEMR

62- A 51-year-old man was admitted to the hospital with a four-week

history of dysphagia, weight loss and nausea. He is smoker and hypertensive.
Upper endoscopy & biopsy were done. Answer the following questions.
a) Describe image A
b) Describe image b
c) What is your diagnosis?
d) Name 3 possible risk factors
e) What is the other histologic types of this lesion and what is its main risk factor?

63- The following images of a patient with symptoms of chronic gastritis.

Answer the following questions.
a) Describe both images.
b) What is your diagnosis?
c) How to confirm your diagnosis?
d) Enumerate 2 possible complications

64- Which of the following statements is true about duodenal peptic ulcer?
a) It is precancerous
b) It has undermined edges
c) It is more common in females
d) It may be related to Gastrinoma.
65- All of the following conditions may be associated with melena except:
a) Piles
b) Duodenal peptic ulcer
c) Oesophageal varices
d) Gastric

solving is the solve 11

GIT MCQS PATHOLOGY DR,ELNEMR

66- This is an image of part of the intestine.

Answer the following questions.
a) Describe the image.
b) What is your diagnosis?
c) List 2 possible causes of this conditions.
d) Enumerate 2 possible complications.

67- This is an image of a patient with high fever, severe diarrhea, tenesmus, blood and

mucous in stool.

a) Describe this image

b) What is your diagnosis?

C) Enumerate 2 possible complications

68- The following image of a part of colon of a 25 years old male complaining of nonspecific
abdominal pain & bloody stool.

a) Describe this image

b) What is your diagnosis?
c) What is the most dangerous complication
of this condition & how to avoid?

69- This is a colonic biopsy of a female patient,

answer the following questions.
a) What is your diagnosis?
b) What are the microscopic types of this lesion?

solving is the solve 12

GIT MCQS PATHOLOGY DR,ELNEMR

ANSWERS
1) D 15) C 30) C 46) C

2) B 16) B 31) D 47) C

3) A 18) B 32) C 48) A

4) C 19) B 33) B 49) C

5) A 20) A 34) C 50) C

6) D 21) C 38) C 51) B

7) C 22) B 39) A 52) C

8) C 23) A 41) A 57) D

10) D 24) D 42) B 58) C

12) B 25) B 43) C 64) D

13) C 28) B 44) C 65) A

14) C 29) C 45) D

solving is the solve 13

GIT MCQS PATHOLOGY DR,ELNEMR

9) Dilated congested tortous submucosal veins in the lower end of the esophagus due to
portal hypertension.
complications: ulceration and hematemesis

11) A-Barrett's esophagus on top of GERD.

B- Smoking, obesity & alcohol are risk factors for GERD and long standing
GERD may lead to barrets esophagus.
C- This patient has a higher risk of esophageal adenocarcinoma.
D- Biopsy will revealed superficial mucosal erosions, areas of intestinal metaplasia &
neutrophilic infiltration.
17) A-Autoimmune gastritis.
B- Fundus & body (typically spares the antrum).
C- Marked glandular atrophy. The lamina propria showed chronic inflammatory
cells and lymphoid aggregates can be present.
D- Intestinal metaplasia & carcinoma

26)

Intestinal type adenocarcinoma Diffuse gastric cancer (Signet ring carcinoma)

Dysplasia & adenoma No definite precursor lesions
Bulky, exophytic mass or ulcerated mass b-The gastric wall is diffusely thickened with flattening
of gastric rugae giving the stomach a leather bottle
appearance (linitis plastica)

Composed of malignant lands with Formed of discohesive cells having signet

variable degrees of differentiation. the ring appearance. The cells have intracytoplasmic mucin
glands are lined by malignant cells vacuoles that push the nucleus to one side. The nuclei
exhibiting the malignant citeria are pleomorphic, enlarged and hyperchromatic

solving is the solve 14

GIT MCQS PATHOLOGY DR,ELNEMR

27) Def: vomiting of blood.

Causes: esophageal causes (varicose veins, esophagitis, tumors infiltrating the esophagus)/
gastric causes (gastritis, acute ulcer, peptic ulcer, gastric tumors)/
general causes (hemophilia, purpura, vitamin C & K deficiency).

35) A-Typhoid fever.

B- Salmonella typhi.
C- The organism invades the intestinal wall, engulfed by macrophages which go to Peyers
patches. The organism then reach the lymphatics and the blood. The organisms are finally
taken by RECS in the liver & spleen and causing their enlargement.
D- Toxemia leading to heart failure, meningitis, encephalitis, intestinal perforation &
septic peritonitis

36) A- Acute intestinal obstruction.

B- Possibly due to adhesions following her appendectomy operation.

C- Infarction and gangrene of the affected loop & peritonitis and septic shock.

37) A- Amoebic dysentery complicated by amoebic liver abscess.

B- Stool analysis would be positive for Entameba histolytica parasite.

C- Hemorrhage, perforation, fibrosis & stricture, amoeboma & spread of infection

40) A-Ulcerative colitis (acute phase).

B- Mucosal edema, congestion & ulcers, inflammation limited to mucosa & submucosa, crypt
abcess formation, degenerative changes & no granuloma.
C- Perforation & septic peritonitis, hemorrhage, dysplasia& adenocarcinoma & amyloidosis

53) A-adenocarcinoma, colon with metastatic liver nodules.

B- adenomas, high fat & low fiber diet, ulcerative colitis with dysplasia.
C- intestinal obstruction, hemorrhage, perforation & septic peritonitis, spread.

54)
Chrons disease Ulcerative colitis
Terminal ilieum Rectosigmoid
Transmural Limited to mucosa & submucosa
present No skip lesions
present -----------
-------- present

solving is the solve 15

GIT MCQS PATHOLOGY DR,ELNEMR

55) Amoeboma: amoebic granuloma forming a mass in the wall of the intestine, as a complication

of amoebic dysentery.
Volvolus: complete twisting of a bowel loop around its vascular base leading to vascular &
luminal obstruction.
Zollinger Ellison syndrome: syndrome in which there are gastrinoma & multiple peptic ulcers

56) A- peptic ulcer disease.

B- other causes of gastric ulcers as malignant ulcer, stress ulcers, curling ulcers.
C- H- pylori infection, alcoholism & smoking.
D- bleeding, perforation, pyloric obstruction, penetration into adjacent organs

59) A- It is an ulcer with irregular margin, rough necrotic hemorrhagic floor and

raised everted edges. B- Malignant ulcer.

C- Squamous cell carcinoma. D- Infection, bleeding and spread (direct, Iymphatic & spread)

60) A- Single oval mass, well defined, capsulated, whitish in color, soft gelatinous cut section with

no hemorrhage and necrosis.

B- Section in a benign tumor showin mixed epithelial & mesenchymal differentiation. There are
epithelial glands, myoepithelial cells and myxoid (chondroid) stroma.
C- Pleomorphic adenoma.
D- It is a benign tumor but recurrence rate approaches 25% if not well excised. The tumor also
may turn malignant (malignant mixed salivary gland tumor)

61) A- It is a malignant tumor formed of discohesive cells having signet ring appearance.

The cells have intracytoplasmic mucin vacuoles that push the nucleus to one side.
The nuclei are pleomorphic, enlarged and hyperchromatic.
B- The gastric wall is diffusely thickened with flattening of gastric rugae giving the stomach a
leather bottle appearance (linitis plastic).
C- Signet ring carcinoma, stomach.
D- Hematemesis & melena/ pyloric obstruction with severe vomiting & dehydration/ spread

62) A- It is an ill-defined non capsulated irregular fungating mass with heterogenous cut section
and hemorrhage & necrosis.
B- Malignant tumor formed of malignant squamous cells arranged in groups & cell nests.
Malignant cells exhibit malignant criteria (pleomorphism, hyperchromatism, increased N/C
ratio, prominent neocleoli & abnormal mitosis).
C- Squamous cell carcinoma, esophagus.
D- Alcohol, tobacco, nitrosamine in pickled food, HPV & dysplastic changes.
E- Adenocarcinoma. GERD & Barret esophagus are the main risk factors.

solving is the solve 16

GIT MCQS PATHOLOGY DR,ELNEMR

63) A- A variable number of neutrophils are present intraepithelial, the lamina propria contains

plasma cells, macrophages & lymphocytes with prominent lymphoid aggregates, long
standing cases are associated with diffuse mucosal atrophy and there are H-pylori organisms
seen in the mucous layer as slender curved rods.
B- H-pylori gastritis.
C- Serologic test, urea breath test, bacterial culture & special stain (GIEMSA stain) in gastric biopsy.
D- *Atrophy with intestinal metaplasia & adenocarcinoma, increased risk of peptic ulcer disease &
gastric lymphoma

64) A-Part of the intestine (intussusceptum) is invaginated into another segment (intussuscepient)

drawing with it its mesentery resulting in lumen obstruction, vessel compression & infarction.
B- Intussusception.
C- Due to abnormal peristalsis caused by benign tumor, bilharzial polyp or parasitic irritation.
D- Infarction, gangrene, perforation & septic peritonitis and septicemia.

65) A-The mucosa is diffusely inflamed, congested, with patches of dirty yellow pseudomembrane.

B- Bacillary dysentery.
C- Local (hemorrhage, perforation, fibrosis with stricture formation)/
general (myocarditis, arthritis).

66) A- multiple variable sized sessile & pedunculated polyps.

B- familial adenosois polyps.

C- prophylactic colectomy.

67) A-adenomatous polyp.

B- tubular, villous & tubulovillous.

solving is the solve 17

Liver MCQs Pathology DR ELNEMR

Liver, GB & Pancreas MCQs

1.The most liver zone susceptible to injury from vascular insufficiency is:
a) Zone 1
b) Zone 2
c) Zone 3
d) None of the above

2. Which of the following hepatic viruses produce concomitant infection (co-

infection):
a) HBV-HAV
b) HBV-HCV
c) HBV-HDV
d) HBV-HEV

3. Hepatitis E virus (HEV) is commonly transmitted by:

a) Blood and blood components
b) Sexual route
c) Transplacentally
d) Enterically

4. Which of the following hepatic viruses can cause fatal fulminant hepatitis in
pregnant women:
a) HBV
b) HCV
c) HDV
d) HEV

5. Clinicopathological syndromes of viral hepatitis include all of the following

except:
a) HAV & HBV infections are frequently subclinical
b) HAV& HDV do not cause chronic disease
c) The carrier state is commonly caused by HBV or HCV
d) Acute symptomatic cases are all similar with a variable incubation period

6. Fulfill the following table about the various hepatic viruses.

HAV HBV HCV
DNA/RNA
Mode of
transmission
Clinical
presentation

Solving is the solve 1

Liver MCQs Pathology DR ELNEMR

7. Metabolic causes of chronic hepatitis include all of the following except:

a) Alpha-l antitrypsin deficiency
b) Cryptogenic
c) Hemochromatosis
d) Wilson disease

8. The most common cause of chronic hepatitis is:

a) Viral hepatitis
b) Autoimmune hepatitis
c) Drug-induced hepatitis
d) Metabolic hepatitis

9. One of the causes of multiple liver abscesses is:

a) Infected hydatid cyst
b) Traumatic
c) Pyaemic
d) Complicating cholecystitis

10. One of the following is not a granulomatous liver disease:

a) Tuberculosis
b) Non-alcoholic steatohepatitis (NASH)
c) Primary biliary cirrhosis
d) Sarcoidosis

11. One of the following is incorrect regarding acute cholangitic abscess:

a) Caused by mixed flora
b) Grossly, appeal' as single yellow small abscess
c) Located mostly in the portal tract areas around the bile ducts
d) The bile ducts show all features of acute suppurative inflammation

12. Write the scientific term:

a) Accumulation of bile in the liver cells & bile canaliculi
b) Symptomatic liver disease with biochemical or serological evidence of liver
damage for more than 6 months
c) A type of hepatitis that is associated with severe liver necrosis, may be
massive or submassive
d) Liver inflammation with destruction of liver cells at the limiting plates of
liver lobules
e) Chronic diffuse irreversible liver disease characterized by progressive liver
damage, repair by regeneration and fibrosis & deterioration of liver function
f) An inherited liver disease characterized by failure of the liver to excrete
copper in bile, and copper accumulation in the liver & brain

Solving is the solve 2

Liver MCQs Pathology DR ELNEMR

13. Mechanism of steatosis induced alcoholism include all of the following

except:
a) Increased fatty acid oxidation
b) Increased synthesis of triglycerides
c) Impaired secretion of lipoproteins
d) Increased fat mobilization from stores

14. Enumerate the three forms of alcoholic related liver disease.

15. A type of cirrhosis caused by hemochromatosis is:

a) Pigmented cirrhosis
b) Post-necrotic cirrhosis
c) Nutritional cirrhosis
d) alcoholic cirrhosis

16. Budd-Chiari syndrome is characterized by:

a) Prolonged obstruction of extrahepatic bile ducts
b) Chronic venous congestion of the liver
c) Thrombosis of hepatic veins followed by fibrosis & cirrhosis
d) Toxic alkaloids in some plants producing fibrosis of hepatic veins followed by
cirrhosis

17. Gall stones may be complicated by:

a) Cardiac cirrhosis
b) Secondary biliary cirrhosis
c) Post-necrotic cirrhosis
d) Nutritional cirrhosis

18. One of the following features concerning regeneration nodules of liver

cirrhosis is not true:
a) Liver cells proliferate as one cell thick, regularly radiating from the central vein
b) The sinusoids are irregular and the central vein may be absent or eccentric
c) Liver cells may be binucleated & may undergo dysplastic changes
d) Other changes as necrotic foci, fatty change or hydropic change may be observed

19. Pathological gross features of alcoholic cirrhosis include:

a) The liver is dark brown in color
b) The liver is softer in consistency
c) The edges are rounded
d) It could be micronodular, macronodular or mixed

Solving is the solve 3

Liver MCQs Pathology DR ELNEMR

20. One of the following is incorrect about primary biliary cirrhosis:

a) It is an autoimmune disease
b) In most cases, serum antimitochondrial antibodies are detected
c) Mostly affects middle aged males
d) The liver is enlarged, green with micronodular cut section

21. Causes of pre-sinusoidal portal hypertension include:

a) Portal tract fibrosis by schistosomiais
b) Liver cirrhosis
c) Veno-occlusive disease
d) Budd-Chiari syndrome

22. One of the features of liver cell adenoma is:

a) It is a benign bile duct neoplasm
b) Commonly occur in young males
c) Commonly harbors hepatocellular carcinoma
d) There is an association with oral contraceptive use

23. A 45-year-old woman was admitted for delirium, confusion, jaundice,

fatigue and pruritus. Her previous medical history was unremarkable.
There was no history of alcohol, drug abuse, or family history of liver
disease. Physical examination revealed hepatomegaly and splenomegaly.
Her skin and sclera were icteric. Also, there were ascites, skin bruising and
spider nevi. Viral serologic tests of hepatitis B and C were both negative.
Whereas anti mitochondrial antibody was positive.
a) What is your diagnosis?
b) What is your differential diagnosis?
c) What are the other possible complications in this patient?

24. The serum of patients with hepatocellular carcinoma is characterized by

elevation of:
a) CEA
b) PSA
c) aFP
d) CA19-9

25. Causes of chronic liver failure include all of the following except:
a) Chronic biliary obstruction
b) Primary & metastatic liver tumors
c) Liver granulomas
d) Reye s syndrome

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Liver MCQs Pathology DR ELNEMR

26. Which of the following is not true about hepatoblastoma?

a) It is an embryonic tumor composed of immature hepatocytes
b) Tumor stroma may contain fibrous tissue, cartilage or bone
c) It has a historical associations with vinyl chloride or arsenic
d) The serum alpha fetoprotein level may be high in such cases

27. Which of the following is incorrect about cholangiocarcinoma?

a) Arises from elements of the intra & extrahepatic biliary tree
b) Females are more common than males
c) Associated with increase in alpha feto protein
d) Can be associated with primary sclerosing cholangitis, HCV infection &
thorotrast administration

28. All of the following could be a cause of cholesterol stones in the gall
bladder except:
a) Diabetes
b) Pregnancy
c) Obesity
d) Hemolytic anemia

29. Pure pigment stones of the gall bladder commonly caused by:
a) Diabetes
b) Hemolytic anemia
c) Obesity
d) Infection

30. The most common cause of chronic pancreatitis is:

a) Alcohol intake
b) Pancreatic tumors
c) Pancreatic calculi
d) Recurrent acute pancreatitis

31. Which of the following is not true about pathogenesis of chronic

pancreatitis?
a) Alcohol decreases the protein content of pancreatic secretions
b) Plug is formed which become calcified
c) Alcohol can be directly injurious to acinar cells
d) It ends in irreversible parenchymal destruction & fibrosis

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Liver MCQs Pathology DR ELNEMR

32. Possible complications of chronic pancreatitis include all of the following

except:
a) Malabsorption
b) Diabetes mellitus
c) Pseudocyst formation
d) Tumor transformation

33. Pancreatic carcinoma could be clinically presented by all of the following

except:
a) Jaundice
b) Diabetes
c) Weight loss
d) Back pain

34. Majority of pancreatic carcinomas arise in:

a) Head of the gland
b) Body of the gland
c) Tail of the gland
d) Body & tail of the gland

35. One of the following is not a feature of pancreatic pseudocyst:

a) Accounts for most of pancreatic cysts
b) Lined by simple squamous epithelium
c) Encircled by fibrosed granulation tissue
d) Occur after bouts of acute pancreatitis or following trauma

36. Secondary peritoneal deposits are commonly derived from:

a) Hepatocellular carcinoma
b) Gastric carcinoma
c) Colorectal carcinoma
d) Ovarian & pancreatic adenocarcinoma

37. 32 years old alcoholic male came to emergency department complaining

of sudden severe upper abdominal pain radiating to the back, nausea &
vomiting. On examination, the upper abdomen is tender. Laboratory
findings include leukocytosis, elevation of serum amylase & hypocalcemia.
a) What is your diagnosis?
b) Explain his laboratory findings
c) Enumerate 3 possible causes
d) Mention 2 possible complications

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Liver MCQs Pathology DR ELNEMR

38. 65-year-old man was referred to the outpatient hepatology clinic with a
new diagnosis of a positive hepatitis C antibody. The patient reported
nonspecific right upper quadrant abdominal pain. At that time, a computed
tomographic (CT) scan of the abdomen was performed, which noted two
hepatic focal lesions. His labs revealed elevated alpha fetoprotein.
a) What is the most probable diagnosis?
b) Describe the most likely microscopic features of this lesion
c) Mention the other microscopic types of this lesion
d) Enumerate 3 possible risk factors

39. Define:
a) Gall stone ileus
b) Mucocele of gall bladder
c) Rokitansky-Aschoff sinuses
40. Enumerate 3 possible complications of acute cholecystitis.

41. What are causes of solitary & multiple liver abscesses?

42. Define cirrhosis & mention four types.

43. What are regeneration nodules?

44. List three types of malignant liver tumors.

45. What are possible complications of gall bladder stones?

46. The following images are different types of gall bladder stones.
a) Describe each image
b) Mention the type of each one
c) Mention one possible cause of each condition
d) Enumerate 3 possible complications of this disease

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Liver MCQs Pathology DR ELNEMR

47- The following image is of amoebic liver abscess, answer the following
questions.
a) What is the etiology of this condition
b) Describe this image

48- The following microscopic image of acute viral hepatitis. Identify the labelled arrows
a) The short arrow refers to...
b) The long arrow refers to…

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Liver MCQs Pathology DR ELNEMR

ASWERS

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Liver MCQs Pathology DR ELNEMR
6)

HAV HBV HCV

RNA DNA RNA
Fecal-oral *Blood, blood components Similar to HBV
*Sexual
*transplacental
Commonly acute self- Can cause acute, Similar to HBV but
chronic, fulminant progression to chronic
limited hepatitis
hepatitis or carrier state disease is more common

12) A- cholestasis. B- chronic hepatitis.

C- fulminant viral hepatitis. D- interface hepatitis (piecemeal necrosis).

E- liver cirrhosis. F- Wilson disease.

23) A- Primary biliary cirrhosis complicated by liver cell failure.

B- Other causes of cirrhosis.

C- Portal hypertension & Hepatocellular carcinoma.

37) A-acute hemorrhagic pancreatitis.

B- leukocytosis due to inflammation, amylase is a diagnostic marker, hypocalcemia from

precipitation of calcium soaps in fat necrosis.

C- excess alcohol, obstruction of ampulla of vater by gall stones.

D- shock, acute renal failure, pancreatic pseudocysts.

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Liver MCQs Pathology DR ELNEMR

38) A-multifocal hepatocellular carcinoma (HCC).

B- classic HCC formed of trabeculae & acini of large polyhydral malignant hepatocytes
having eosinophilic large nucleolus.
C- anaplastic & fibrolamellar.
D- direct, lymphatic & blood spread.

39) A-passage of gall stone to the intestine through a fistulous tract between gall bladder &
duodenum, large stone can lodge in the ileo-cecal valve causing ileus.

B- distended gall bladder due to obstruction of cystic duct by stone.

C- the wall of gall bladder shows mucosal diverticulae due to cholecystitis that weaken the wall.

40) Chronicity, gangrene, perforation.

41) Solitary: liver abscesses are ameobic, infected hytadid cyst, traumatic
Multiple: amoebic, abscesses of ascending cholangitis, actinomyocosis and pyemic
abscesses.

42) Chronic diffuse irreversible liver disease characterized by progressive necrosis of

liver cells with formation of regeneration nodules and surrounding fibrosis with
deterioration of liver functions.
Types: posthepatititic, nutritional, alcoholic, postnecrotic, primary biliary cirrhosis
secondary biliary cirrhosis.

43) Regenerating hepatocytes arranged in collections but the sinusoids are irregular in
the central vein and may be absent or eccentric or maybe more than one central
vein in the nodule. Theses masses are surrounded by fibrous bands.

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Liver MCQs Pathology DR ELNEMR

44) Hepatocellular carcinoma, cholangiocarcinoma, hepatoblastoma, angiosarcoma.

45) Cholecystitis, colics and jaundice, gall stone ileus, mucocele, acute pancreatitis.

46) A-multiple small dark stones with smooth surface, multiple yellowish white large stones
with mamillated surface, multiple soft stones with faceted surface and laminated cross section.

B- pigment, cholesterol, mixed stones.

C- hemolytic anemia, hypercholesterolemia, infection.

D- Cholecystitis, acute pancreatitis, mucocele.

47) A- Amoeba trophozites enter the portal venous radicals in colonic submucosa to reach

the liver.

B- Single, may be large cavity in the right lobe. The wall is necrotic, the lining is

shreddy & its content is brown liquid material.

48) A- hepatocyte.

B- councilman bodies

Solving is the solve 12