Which of the following statements regarding Ogilvie’s syndrome are correct?
1. It presents as acute large bowel mechanical obstruction
2. Marked caecal dilatation is a common feature on X-ray abdomen
3. Caecal perforation is a well recognized complication of this condition
4. Intravenous Neostigmine is used for the treatment of this condition
Q992
Match List-I with List-II and select the correct answer using the code given below the Lists:
Q993
The following conditions are associated with high incidence of pigment gallstones except:
Q994
A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:
Q995
A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:
Q996
A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:
Q997
Spontaneous bacterial peritonitis occurs due to:
Q998
Which of the following are correct regarding splenic artery aneurysm?
1. Main arterial trunk is the common site
2. Palpable thrill can be felt
3. It is symptomless unless it ruptures
Select the correct answer using the code given below:
Q999
The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:
Q1000
A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:
Gastroenterology Indian Medical PG Practice Questions and MCQs
Question 991: Which of the following statements regarding Ogilvie’s syndrome are correct?
1. It presents as acute large bowel mechanical obstruction
2. Marked caecal dilatation is a common feature on X-ray abdomen
3. Caecal perforation is a well recognized complication of this condition
4. Intravenous Neostigmine is used for the treatment of this condition
A. 1, 3 and 4
B. 1, 2 and 3
C. 1, 2 and 4
D. 2, 3 and 4 (Correct Answer)
Explanation: **2, 3 and 4**
- **Marked caecal dilatation** is a hallmark of Ogilvie's syndrome on X-ray, indicating the pseudo-obstruction.
- **Caecal perforation** is a serious and well-recognized complication, especially if the caecal diameter exceeds 12-14 cm.
- **Intravenous Neostigmine** is a parasympathomimetic drug used to stimulate colonic motility and is an effective treatment for Ogilvie's syndrome.
*1, 3 and 4*
- Ogilvie's syndrome is characterized by **acute large bowel pseudo-obstruction**, meaning it mimics a mechanical obstruction without an actual physical blockage.
- Therefore, statement 1, which claims it presents as acute large bowel *mechanical* obstruction, is incorrect.
*1, 2 and 3*
- As noted, Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical one, making statement 1 incorrect.
- The other statements regarding caecal dilatation and perforation are correct.
*1, 2 and 4*
- Again, the key differentiating factor is that Ogilvie's syndrome is a **pseudo-obstruction**, not a mechanical obstruction, rendering statement 1 inaccurate.
- Statements 2 and 4 are accurate descriptions of the condition and its treatment.
Question 992: Match List-I with List-II and select the correct answer using the code given below the Lists:
A. A→1 B→3 C→2 D→4 (Correct Answer)
B. A→1 B→2 C→3 D→4
C. A→3 B→2 C→4 D→1
D. A→4 B→3 C→2 D→1
Explanation: ***A→1 B→3 C→2 D→4***
- Caroli's disease is characterized by **dilatation of intrahepatic bile ducts**, predisposing to **bile stasis**, stone formation, and recurrent **biliary sepsis** with associated abdominal pain.
- Budd-Chiari Syndrome is defined by **hepatic venous outflow obstruction**, leading to symptoms like **ascites**, hepatomegaly, and abdominal pain.
- Polycystic Liver Disease involves the presence of **multiple cysts in the liver**, which can cause **hepatomegaly** and **pain** due to the size and mass effect of the cysts.
- Primary sclerosing cholangitis (PSC) is a **cholestatic liver disease** causing inflammation and fibrosis of the bile ducts, leading to **abnormal liver function tests** (elevated alkaline phosphatase and bilirubin) and often presenting with **jaundice**.
*A→1 B→2 C→3 D→4*
- This option incorrectly matches Budd-Chiari Syndrome with Hepatomegaly, Pain and Polycystic Liver Disease with Ascites.
- The hallmark of Budd-Chiari is venous outflow obstruction leading to **ascites**, while **hepatomegaly and pain** are more characteristic symptoms of Polycystic Liver Disease due to the expanding cysts.
*A→3 B→2 C→4 D→1*
- This option incorrectly associates Caroli's disease with ascites and Primary Sclerosing Cholangitis with Abdominal pain, Biliary sepsis.
- Caroli's disease is primarily characterized by **biliary complications** like cholangitis, not ascites, and ascites is a key feature of Budd-Chiari, not Polycystic Liver Disease.
*A→4 B→3 C→2 D→1*
- This option incorrectly links Caroli's disease with Abnormal LFT/jaundice generally and Primary Sclerosing Cholangitis with Abdominal pain, Biliary sepsis.
- While Caroli's can cause abnormal LFTs and jaundice secondarily to cholangitis, its primary specific presentation involves **recurrent infection (biliary sepsis)**. Primary Sclerosing Cholangitis directly causes **abnormal LFTs and jaundice** due to cholestasis, but it is not commonly associated with abdominal pain and biliary sepsis.
Question 993: The following conditions are associated with high incidence of pigment gallstones except:
A. Prosthetic heart valve (Correct Answer)
B. Cirrhosis
C. Thalassemia
D. Ileal disease
Explanation: The following conditions are associated with high incidence of pigment gallstones except:
***Prosthetic heart valve***
- A prosthetic heart valve is not directly associated with an increased incidence of **pigment gallstones**. Conditions leading to pigment gallstones typically involve **hemolysis** or biliary stasis/infection.
- While complications like endocarditis or hemolysis can occur with prosthetic valves, they are not a primary driver of pigment gallstone formation.
*Cirrhosis*
- **Cirrhosis** is associated with an increased risk of pigment gallstones due to altered bile composition and bile stasis.
- The impaired liver function in cirrhosis leads to increased **bilirubin excretion** and precipitation.
*Thalassemia*
- **Thalassemia** is a hematologic disorder characterized by **chronic hemolysis**, which leads to an overload of unconjugated bilirubin.
- This excess bilirubin is then excreted into the bile, increasing the risk of forming **pigment gallstones** [1].
*Ileal disease*
- **Ileal disease** (e.g., Crohn's disease affecting the ileum, ileal resection) is primarily associated with an increased risk of **cholesterol gallstones**, not pigment gallstones.
- Damage to the ileum impairs bile salt reabsorption, leading to a decreased bile salt pool and supersaturation of cholesterol in the bile.
Question 994: A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:
A. CTP–D
B. CTP–A
C. CTP–B (Correct Answer)
D. CTP–C
Explanation: CTP–B
- This patient scores 2 points for bilirubin (3.5-5 mg%), 1 point for albumin (>3.5 gm%), 2 points for INR (1.7-2.3), 1 point for no encephalopathy, and 1 point for no ascites. This sums to **7 points**, which falls into the **CTP Class B** range (7-9 points).
- The CTP classification is used to assess the prognosis of **chronic liver disease**, primarily **cirrhosis**, based on five clinical and laboratory criteria [1].
CTP–D
- The CTP classification only includes A, B, and C; there is no CTP–D class.
- This option is incorrect as it represents a classification that does not exist within the CTP scoring system.
CTP–A
- CTP Class A requires a total score of 5-6 points, indicating **mild liver dysfunction**.
- This patient's calculated score of 7 points places him beyond the Class A category.
CTP–C
- CTP Class C requires a total score of 10-15 points, indicating **severe liver dysfunction**.
- This patient's score of 7 points is considerably lower than the range for Class C.
Question 995: A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:
A. Ileocaecal Tuberculosis
B. Ulcerative colitis
C. Crohn disease (Correct Answer)
D. Amoebic colitis
Explanation: ### Crohn disease
- **Colicky abdominal pain**, **diarrhea**, **fever**, and **weight loss** are classic symptoms of Crohn disease, indicating chronic inflammation of the gastrointestinal tract [1].
- The presence of **discharging perineal sinuses** is highly characteristic of Crohn disease, as it commonly manifests with **perianal disease** including fistulas and abscesses [1].
### Ileocaecal Tuberculosis
- While ileocaecal tuberculosis can present with abdominal pain, diarrhea, fever, and weight loss, **perianal sinuses** are a less common feature compared to Crohn disease.
- Diagnosis typically requires **histopathological evidence** of granulomas with caseous necrosis and acid-fast bacilli, which is not suggested by the initial presentation.
### Ulcerative colitis
- **Ulcerative colitis** primarily affects the colon and rectum, leading to bloody diarrhea, abdominal pain, and tenesmus, but rarely causes **perianal fistulas** or sinuses [1].
- The disease typically presents with **continuous inflammation** extending proximally from the rectum, unlike the skip lesions seen in Crohn disease.
### Amoebic colitis
- **Amoebic colitis** is an infectious cause of diarrhea, often bloody, with abdominal pain, but typically presents with a more **acute course** and is less commonly associated with chronic weight loss or perianal disease.
- Diagnosis is confirmed by identifying **_Entamoeba histolytica_ trophozoites** or cysts in stool or tissue, and the presence of chronic discharging sinuses is not typical.
Question 996: A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:
A. Gastric outlet obstruction (Correct Answer)
B. Superior mesenteric artery syndrome
C. Carcinoma stomach
D. Gastro-oesophageal reflux with oesophagitis
Explanation: ***Gastric outlet obstruction***
- The combination of a long history of **periodic upper abdominal pain** followed by **projectile, non-bilious vomiting** containing undigested food is highly characteristic of gastric outlet obstruction. [1]
- **Weight loss** and **dehydration** are common due to inadequate nutrient absorption and persistent vomiting. [1]
*Superior mesenteric artery syndrome*
- This syndrome is characterized by compression of the **duodenum** between the superior mesenteric artery and the aorta.
- While it can cause vomiting and weight loss, the presenting symptoms are typically more acute or chronic pain related to postural changes, and not usually preceded by a long history of periodic upper abdominal pain suggesting prior peptic ulcer disease.
*Carcinoma stomach*
- While carcinoma of the stomach can cause weight loss and vomiting due to obstruction, the long history of **relieving periodic pain** prior to the onset of projectile vomiting is less typical.
- Vomiting in carcinoma stomach might be bilious if the tumor is distal to the ampulla of Vater.
*Gastro-oesophageal reflux with oesophagitis*
- This condition primarily causes **heartburn**, regurgitation, and sometimes difficulty swallowing or chest pain.
- It does not typically lead to repeated **projectile vomiting** of undigested food or significant weight loss in the absence of severe complications like stricture formation, which would present differently.
Question 997: Spontaneous bacterial peritonitis occurs due to:
A. duodenal stump blowout
B. infection via fallopian tubes
C. acute bacterial infection of ascites (Correct Answer)
D. peptic ulcer perforation
Explanation: ***acute bacterial infection of ascites***
- **Spontaneous bacterial peritonitis (SBP)** is a common and serious complication in patients with **cirrhosis and ascites**, characterized by an infection of the **ascitic fluid** without an obvious source within the abdominal cavity.
- The infection typically arises from the **translocation of bacteria** from the gut lumen into the mesenteric lymph nodes and then into the ascitic fluid.
*duodenal stump blowout*
- A **duodenal stump blowout** is a rare but severe complication following gastric surgery (e.g., gastrectomy with Billroth II reconstruction) where the closed end of the duodenum ruptures.
- This complication leads to **peritonitis**, but it is a **secondary bacterial peritonitis** due to leakage of GI contents, not spontaneous.
*infection via fallopian tubes*
- While bacteria can access the peritoneal cavity via the fallopian tubes, leading to **pelvic inflammatory disease (PID)** or **peritonitis**, this mechanism is specific to females and typically involves sexually transmitted infections ascending from the lower genital tract.
- This pathway does not describe the typical pathogenesis of SBP, which is primarily associated with **ascites** in cirrhotic patients and gut bacterial translocation.
*peptic ulcer perforation*
- A **perforated peptic ulcer** involves a breach in the wall of the stomach or duodenum, leading to the leakage of gastric or duodenal contents into the peritoneal cavity.
- This causes an acute abdomen and **secondary bacterial peritonitis**, which is distinguishable from SBP as it has an identifiable intrabdominal source of infection.
Question 998: Which of the following are correct regarding splenic artery aneurysm?
1. Main arterial trunk is the common site
2. Palpable thrill can be felt
3. It is symptomless unless it ruptures
Select the correct answer using the code given below:
A. 2 and 3 only
B. 1 and 2 only
C. 1, 2 and 3
D. 1 and 3 only (Correct Answer)
Explanation: ***1 and 3 only***
- The **main arterial trunk** is indeed the most common site for splenic artery aneurysms, accounting for approximately 60% of cases.
- Splenic artery aneurysms are typically **asymptomatic** until rupture, which can be a life-threatening event.
*1, 2 and 3*
- While the main arterial trunk is a common site and these aneurysms are often symptomless until rupture, a **palpable thrill** is generally not a feature of splenic artery aneurysms.
- Thrills are usually associated with **arteriovenous fistulas** or very large, superficial aneurysms with turbulent flow, which is less common for the splenic artery.
*2 and 3 only*
- A **palpable thrill** is not a typical finding for splenic artery aneurysms.
- While they are often symptomless until rupture, the statement that the **main arterial trunk is a common site** is also correct and should be included.
*1 and 2 only*
- Although the main arterial trunk is a common site, a **palpable thrill** is not a characteristic sign of splenic artery aneurysms.
- The crucial point that they are **symptomless unless they rupture** is omitted from this option.
Question 999: The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:
A. INR (International Normalised Ratio)
B. Serum creatinine (Correct Answer)
C. Serum bilirubin
D. Serum albumin
Explanation: ***Body Mass Index (BMI)***
- The Child-Turcotte-Pugh (CTP) score is an established clinical tool for assessing prognosis in **chronic liver disease**, and it does not include **Body Mass Index (BMI)** as one of its parameters.
- The CTP score focuses on liver function and complications of portal hypertension, which are reflected by specific laboratory values and clinical signs, not nutritional status as measured by BMI [1].
*International Normalized Ratio (INR)*
- **INR** is a crucial component of the Child-Turcotte-Pugh (CTP) score, as it reflects the liver's synthetic function, specifically its ability to produce clotting factors [1].
- An elevated INR indicates **impaired liver synthetic function** and contributes to a higher CTP score, signifying more severe liver disease.
*Serum bilirubin*
- **Serum bilirubin** is a key laboratory parameter included in the Child-Turcotte-Pugh (CTP) score [1].
- Elevated bilirubin levels indicate **impaired liver excretory function** and hepatocellular damage, directly correlating with the severity of liver disease.
*Serum albumin*
- **Serum albumin** is a vital component of the Child-Turcotte-Pugh (CTP) score, reflecting the liver's synthetic capacity [1].
- Low serum albumin levels indicate **reduced liver synthesis**, often seen in advanced liver disease, and contribute to a higher CTP score [1].
Question 1000: A 22-year female has presented with a history of malaise, cough, alternating constipation and diarrhoea with intermittent abdominal pain for last 6 months. She also complains of abdominal distension for last 2 days. On examination her abdomen has a doughy feel along with an ill defined mass over the right lower quadrant. She is most likely suffering from:
A. Ileocaecal tuberculosis (Correct Answer)
B. Ovarian mass
C. Appendicular lump
D. Carcinoma caecum
Explanation: ***Ileocaecal tuberculosis***
- The combination of **constitutional symptoms** (malaise, cough), chronic gastrointestinal complaints (alternating constipation/diarrhea, abdominal pain), a **doughy abdomen**, and an **ill-defined right lower quadrant mass** is highly characteristic of ileocecal tuberculosis.
- This presentation suggests chronic inflammation and potential **mass formation** in the ileocecal region, which is the most common site for intestinal tuberculosis.
*Ovarian mass*
- While an ovarian mass can cause abdominal distension and pain, it typically does not present with a **doughy feel** or the specific long-standing cough and alternating bowel habits described.
- A definitive ovarian mass would usually be palpable as a more distinct, often mobile, pelvic mass rather than an ill-defined right lower quadrant mass that is sometimes seen with ileocecal tuberculosis.
*Appendicular lump*
- An appendicular lump is usually associated with **acute appendicitis** that has localized, leading to a firm, tender mass.
- The patient's chronic symptoms over 6 months, fluctuating bowel habits, and doughy feel are not typical for an appendicular lump which is generally an acute or subacute process.
*Carcinoma caecum*
- Carcinoma of the caecum can present with an abdominal mass, changes in bowel habits, and abdominal pain.
- However, the **doughy feel** and the presence of significant constitutional symptoms like persistent cough are less typical for early-stage caecal carcinoma and point more towards a chronic inflammatory or infectious process like tuberculosis.
