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Gastrointestinal Pathology — Step 1 practice questions
52 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Pathology questions in this section combine two things the exam tests separately elsewhere. Pathology is the largest discipline on Step 1. GI is a pathology-heavy section.
Sample questions
Sample question 1
A patient with longstanding poorly-controlled celiac disease develops worsening symptoms despite strict gluten avoidance, along with weight loss and lymphadenopathy. Which of the following complications should be considered?
Explanations
A. Irritable bowel syndrome as the only consideration
IBS is a diagnosis of exclusion and does not explain this pattern with lymphadenopathy and refractory symptoms in the context of known celiac disease.
B. Simple gluten cross-contamination as the only consideration
While cross-contamination should always be considered/ruled out first, the combination of additional concerning features (lymphadenopathy, significant weight loss) should also prompt evaluation for this more serious complication.
C. Normal, expected celiac disease course requiring no further evaluation
This presentation (worsening despite strict avoidance, plus additional concerning features) is not simply an expected normal course and warrants further evaluation.
D. Iron deficiency anemia as the sole possible explanation
While iron deficiency can occur in celiac disease, the additional concerning features described (lymphadenopathy, refractory course) should prompt broader evaluation beyond just anemia.
E. Enteropathy-associated T-cell lymphoma · correct
Longstanding, poorly-controlled celiac disease carries an increased risk of enteropathy-associated T-cell lymphoma, an uncommon but serious complication that should be considered when symptoms worsen despite dietary adherence, particularly with additional concerning features like significant weight loss and lymphadenopathy.
Sample question 2
A 24-year-old man has chronic abdominal pain, non-bloody diarrhea, and weight loss. Colonoscopy shows patchy areas of ulceration with intervening normal mucosa and a cobblestone appearance in the terminal ileum; biopsy shows transmural inflammation with noncaseating granulomas. Which of the following complications is most characteristic of this disease?
Explanations
A. Enterovesical fistula formation and calcium oxalate kidney stones · correct
Crohn disease causes TRANSMURAL inflammation anywhere from mouth to anus with skip lesions and noncaseating granulomas — hence penetrating complications: fistulas (enterovesical, enterocutaneous, perianal), abscesses, and strictures with obstruction. Terminal ileal disease impairs bile acid reabsorption, so unabsorbed fat binds calcium and free oxalate is absorbed, producing calcium oxalate stones; B12 deficiency and gallstones also result.
B. Toxic megacolon as the predominant complication
Toxic megacolon is more characteristic of ulcerative colitis (though it can occur in Crohn colitis).
C. Lead-pipe colon on barium enema
Lead-pipe colon from haustral loss is an ulcerative colitis finding.
D. Continuous rectal involvement with pseudopolyps
Continuous rectal involvement with pseudopolyps describes ulcerative colitis.
E. Primary sclerosing cholangitis in most patients
PSC is strongly associated with ULCERATIVE COLITIS.
Sample question 3
A patient with a history of prior abdominal surgery develops crampy abdominal pain, distension, and vomiting, with high-pitched bowel sounds on exam. Imaging shows dilated bowel loops with air-fluid levels. Which of the following is the most likely cause?
Explanations
A. Peptic ulcer disease without obstruction
Uncomplicated peptic ulcer disease does not typically cause this small bowel obstruction picture (though a complication like gastric outlet obstruction from scarring is a separate possible entity, distinct from this small bowel adhesion-related presentation).
B. Irritable bowel syndrome
IBS is a chronic functional disorder without this acute obstructive imaging pattern.
C. Adhesions causing small bowel obstruction · correct
Adhesions from prior abdominal surgery are the most common cause of small bowel obstruction, presenting with crampy pain, distension, vomiting, high-pitched ("tinkling") bowel sounds, and dilated bowel loops with air-fluid levels on imaging.
D. Simple constipation
Simple constipation would not typically cause this acute obstructive picture with high-pitched bowel sounds and air-fluid levels.
E. Gastroesophageal reflux disease
GERD causes reflux symptoms, not this small bowel obstruction pattern.
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