AIM • KMU Exam Practice

Question:

A 58-year-old man undergoes upper gastrointestinal endoscopy for dyspepsia. A 1.5 cm gastric polyp is removed. Histology shows elongated, tortuous foveolar epithelium with inflamed and edematous stroma without dysplasia. Which type of gastric polyp is most likely?

Options:

Correct Answer: Hyperplastic polyp

Explanation: Hyperplastic polyps characteristically show elongated, tortuous foveolar glands in an inflamed edematous stroma and are commonly associated with chronic gastritis.

Question:

A 67-year-old woman has a solitary polypoid lesion in the gastric antrum. Biopsy shows dysplastic columnar epithelium forming crowded glands. Which lesion best matches these findings?

Options:

Correct Answer: Gastric adenoma

Explanation: Gastric adenomas are true dysplastic epithelial neoplasms and are important because dysplasia increases their association with gastric adenocarcinoma.

Question:

A 62-year-old man has progressive weight loss, early satiety and epigastric discomfort. Endoscopy reveals an irregular ulcerated mass in the distal stomach. Which investigation is most appropriate to establish the definitive diagnosis?

Options:

Correct Answer: Endoscopic biopsy of the lesion

Explanation: Histopathological examination of endoscopic biopsy tissue confirms gastric malignancy and defines the tumor type.

Question:

A 64-year-old man with long-standing chronic gastritis develops gastric adenocarcinoma. Previous gastric biopsies showed intestinal metaplasia and dysplasia. Which carcinogenic sequence best explains this progression?

Options:

Correct Answer: Chronic gastritis → atrophy → intestinal metaplasia → dysplasia

Explanation: Intestinal-type gastric carcinoma may arise through a chronic inflammation–atrophy–metaplasia–dysplasia sequence, particularly in longstanding gastritis.

Question:

A 55-year-old patient with gastric cancer has biopsy showing individual malignant cells containing abundant intracellular mucin that displaces the nucleus to one side. Which tumor pattern is most consistent with this finding?

Options:

Correct Answer: Diffuse signet-ring cell carcinoma

Explanation: Signet-ring cells contain abundant mucin that pushes the nucleus peripherally and are characteristic of diffuse-type gastric adenocarcinoma.

Question:

A 60-year-old man is diagnosed with distal gastric adenocarcinoma. He has a long history of Helicobacter-associated chronic gastritis. Which change most directly increases the risk of intestinal-type gastric carcinoma in this setting?

Options:

Correct Answer: Intestinal metaplasia with dysplasia

Explanation: Persistent gastritis may progress to atrophy, intestinal metaplasia and dysplasia, creating a premalignant field for intestinal-type adenocarcinoma.

Question:

A 68-year-old man with gastric carcinoma develops a hard left supraclavicular lymph node. Which mechanism best explains this finding?

Options:

Correct Answer: Lymphatic spread through the thoracic duct

Explanation: Gastric carcinoma may spread via abdominal lymphatics to the thoracic duct and produce metastatic enlargement of the left supraclavicular node.

Question:

A 63-year-old woman with gastric adenocarcinoma is found to have bilateral ovarian masses during staging. Which interpretation is most appropriate?

Options:

Correct Answer: Metastatic spread from the gastric primary

Explanation: Bilateral ovarian metastases from gastric carcinoma are classically recognized as Krukenberg tumors and indicate metastatic disease.

Question:

A 59-year-old man has progressive weight loss and epigastric discomfort. Endoscopy shows diffuse thickening and rigidity of the stomach rather than a discrete exophytic mass. Which pathological process best explains this gross appearance?

Options:

Correct Answer: Diffuse infiltrative carcinoma with desmoplasia

Explanation: Diffuse infiltration with stromal fibrosis produces a thick, rigid “leather-bottle” stomach rather than a localized mass.

Question:

A 61-year-old man with resectable distal gastric cancer has no distant metastases. Which management principle provides the best chance of cure?

Options:

Correct Answer: Oncological gastric resection with appropriate lymphadenectomy

Explanation: In localized resectable gastric carcinoma, curative treatment centers on complete oncological resection with regional lymph-node management.

Question:

A 70-year-old man with known gastric carcinoma develops progressive non-bilious vomiting of food eaten several hours earlier, early satiety and visible upper abdominal peristalsis. Which complication is most likely?

Options:

Correct Answer: Gastric outlet obstruction

Explanation: Retained food vomiting, early satiety and visible gastric peristalsis are classic consequences of mechanical obstruction at the pylorus or distal stomach.

Question:

A 45-year-old man with a long history of peptic ulcer disease develops recurrent large-volume vomiting and dehydration. Examination reveals a succussion splash several hours after his last meal. What is the most appropriate initial management principle?

Options:

Correct Answer: Nasogastric decompression with fluid and electrolyte correction

Explanation: Initial management of gastric outlet obstruction includes gastric decompression and correction of dehydration and electrolyte disturbance before definitive treatment.

Question:

A patient with prolonged gastric outlet obstruction has persistent vomiting and volume depletion. Which acid-base disturbance is most likely to develop?

Options:

Correct Answer: Hypochloremic metabolic alkalosis

Explanation: Repeated loss of hydrochloric acid in gastric contents causes hydrogen and chloride depletion, producing hypochloremic metabolic alkalosis.

Question:

A 66-year-old man presents with progressive vomiting, weight loss and a palpable epigastric mass. Gastric outlet obstruction caused by malignancy is suspected. Which investigation most directly allows visualization of the obstructing lesion and tissue diagnosis?

Options:

Correct Answer: Upper gastrointestinal endoscopy with biopsy

Explanation: Endoscopy identifies the level and nature of the obstruction and permits biopsy when gastric malignancy is suspected.

Question:

A 57-year-old man with gastric adenocarcinoma undergoes evaluation for operability. Imaging demonstrates multiple liver lesions consistent with metastases. Which route of spread most directly explains this pattern?

Options:

Correct Answer: Hematogenous spread through portal circulation

Explanation: Venous drainage from the stomach enters the portal system, making the liver a common site of hematogenous metastasis.

Question:

A gastric biopsy from a 60-year-old woman shows malignant cells infiltrating individually through the gastric wall with minimal gland formation. Which biological behavior is most consistent with this pattern?

Options:

Correct Answer: Diffuse infiltration producing gastric-wall rigidity

Explanation: Poorly cohesive malignant cells can infiltrate widely through the stomach wall, leading to diffuse thickening and loss of distensibility.

Question:

A 48-year-old man has benign pyloric stenosis following chronic peptic ulcer disease. Despite adequate resuscitation and gastric decompression, the obstruction remains fixed. Which management principle is most appropriate?

Options:

Correct Answer: Definitive relief of the mechanical obstruction

Explanation: Persistent fixed obstruction requires definitive intervention after correction of fluid, electrolyte and nutritional abnormalities.

Question:

A 72-year-old man presents with progressive weight loss, early satiety and iron-deficiency anemia. Endoscopy reveals a suspicious gastric lesion. Which feature most strongly favors malignancy over a simple benign gastric polyp?

Options:

Correct Answer: Invasion of malignant cells beyond the mucosa

Explanation: Stromal invasion by malignant epithelial cells is a defining feature of invasive carcinoma and separates it from non-invasive benign or dysplastic polyps.

Question:

A patient with advanced distal gastric carcinoma presents with persistent vomiting and marked dehydration. Before any definitive palliative or surgical procedure, which problem should be corrected first?

Options:

Correct Answer: Fluid and electrolyte depletion

Explanation: Repeated vomiting causes major volume and electrolyte losses; stabilization is required before definitive management of the obstruction.

Question:

A 65-year-old man with gastric carcinoma has malignant ascites and multiple peritoneal nodules discovered during evaluation. Which mode of tumor spread best accounts for these findings?

Options:

Correct Answer: Transcoelomic dissemination

Explanation: Gastric carcinoma can seed the peritoneal cavity, producing peritoneal deposits and malignant ascites through transcoelomic spread.