Gastroenterology Practice Questions

Q: All are true regarding familial adenomatous polyposis except which of the following?

Autosomal recessive. ***Autosomal recessive*** - **Familial adenomatous polyposis (FAP)** is inherited in an **autosomal dominant** pattern, not autosomal recessive. - It is caused by a germline mutation in the **APC gene** on chromosome 5q21-q22. *Associated endocrine involvement can be present* - **Gardner syndrome**, a variant of FAP, is associated with **extracolonic manifestations**, including benign osteomas, desmoid tumors, and epidermal cysts, which can be linked to endocrine disturbances [1]. - Other manifestations can include **adrenal adenomas** and **thyroid cancer**, reflecting potential widespread systemic involvement. *Multiple duodenal polyps* - FAP is characterized by the development of numerous **adenomatous polyps** throughout the gastrointestinal tract, especially in the **colon and rectum**. - **Duodenal polyps**, particularly in the periampullary region, are common and can malignant change, requiring regular surveillance [1]. *More > 100 polyps in the colon* - The defining feature of FAP is the presence of **hundreds to thousands of colorectal adenomatous polyps**, often exceeding 100. - These polyps have a nearly **100% risk of malignant transformation** into colorectal cancer if left untreated.

Q: A 60-year-old male experienced a sudden fall in the toilet, with a blood pressure of 90/50 mm Hg and a pulse of 100 beats per minute. His relatives reported that his stool was black or dark in color. Further careful history revealed that he was a known case of hypertension and coronary artery disease, and was regularly taking aspirin, atenolol, and isosorbide dinitrate. What is the most likely diagnosis?

Gastric ulcer with hemorrhage. ### Gastric ulcer with hemorrhage - The patient's **hypotension** (90/50 mmHg), **tachycardia** (100 bpm), and a sudden fall are indicative of **hypovolemic shock**, most likely due to significant **blood loss** [1]. - **Black or dark stools (melena)** are a classic sign of **upper gastrointestinal bleeding**, commonly caused by a **gastric ulcer**, especially in a patient taking **aspirin**, which can cause gastrointestinal irritation and ulceration [1]. *Acute myocardial infarction* - While the patient has coronary artery disease, the primary symptoms presented (melena, signs of hypovolemia) are not typical of an **acute myocardial infarction**, which usually causes chest pain, dyspnea, and EKG changes. - Patients with MI can experience hypotension, but it's usually due to **cardiogenic shock**, and the GI bleed evidence points elsewhere. *Stroke* - A stroke typically presents with **focal neurological deficits** (e.g., weakness, speech difficulties), which are not described in this scenario. - While a fall can be a symptom of a stroke, the complete clinical picture including melena strongly points away from a primary neurological event. *Pulmonary embolism* - Pulmonary embolism typically presents with **acute dyspnea**, **chest pain**, and **tachycardia**, often without hypotension initially, or with right-sided heart strain. - The presence of melena and signs of hypovolemic shock are not consistent with a primary diagnosis of **pulmonary embolism**.

Q: Serum amylase is not raised in

Ruptured ovarian cyst. Ruptured ovarian cyst - A ruptured ovarian cyst involves the *gonads* and does not typically result in the release of **amylase** into the bloodstream. - While it can cause *acute abdominal pain*, it does not directly affect organs that produce significant amounts of amylase, such as the *pancreas* or *salivary glands*. Cholecystitis - **Cholecystitis** can cause *mild elevations* in serum amylase, particularly if there is associated *pancreatic inflammation* [1] or *gallstone pancreatitis* [2]. - Obstruction of the bile duct can lead to reflex pancreatic exocrine dysfunction and increased amylase. Peptic ulcer perforation - A **perforated peptic ulcer** can lead to the release of *gastric or duodenal contents* into the *peritoneal cavity*, causing **chemical peritonitis** [1]. - This irritation can sometimes trigger a *sympathetic response* leading to mild, transient increases in serum amylase or *pancreatic inflammation*. Intestinal ischemia - **Intestinal ischemia** can cause *cellular damage* and *inflammatory responses* within the bowel wall. - In severe cases, this can lead to the release of various enzymes, including *amylase*, from the damaged intestinal tissue or through a *secondary inflammatory effect* on the pancreas.

Q: Which of the following statements about Wilson's disease is true?

Low serum ceruloplasmin and high urinary copper. ***Low serum ceruloplasmin and high urinary copper*** - In **Wilson's disease**, there is a defect in **copper transport**, leading to impaired incorporation of copper into ceruloplasmin and reduced biliary excretion. - This results in **low serum ceruloplasmin** levels (since ceruloplasmin is the main copper-carrying protein in the blood) and **increased urinary copper excretion** as the body attempts to eliminate excess free copper. *Low serum ceruloplasmin and low urinary copper* - While **low serum ceruloplasmin** is characteristic, **low urinary copper** would indicate adequate copper elimination or a different condition, which is not the case for Wilson's disease. - Patients with Wilson's disease have **excess copper accumulation**, and increased urinary excretion is a compensatory mechanism [1]. *High serum ceruloplasmin and low urinary copper* - **High serum ceruloplasmin** is inconsistent with Wilson's disease, as ceruloplasmin levels are typically low due to the impaired copper binding. - **Low urinary copper** excretion would indicate normal or low total body copper, which contradicts the copper overload seen in Wilson's disease. *High serum ceruloplasmin and high urinary copper* - **High serum ceruloplasmin** would suggest normal or increased ceruloplasmin synthesis or release, which is contrary to the pathophysiology of Wilson's disease. - Although **high urinary copper** is a feature, it isn't accompanied by high ceruloplasmin in this condition, as ceruloplasmin is primarily involved in carrying copper in the blood rather than excreting excess copper [1].

Q: A 40-year-old patient presents with chronic abdominal pain and diarrhea, passing 22-25 stools per day, accompanied by weight loss. On examination, she has mild fever and right lower quadrant tenderness. A lower GI endoscopy reveals the following histopathological findings. An intern in the medicine ward generates a list of differential diagnoses for this patient. Which of the following options is most likely the diagnosis?

Crohn's disease. **Crohn's disease** - The image shows **non-caseating granulomas**, which are a characteristic histopathological finding in Crohn's disease, distinguishing it from other inflammatory bowel conditions. - The clinical presentation of chronic abdominal pain, diarrhea, weight loss, and **right lower quadrant tenderness** further supports Crohn's disease, as it commonly affects the ileum and colon in a "skip lesion" pattern. *Ulcerative colitis* - Ulcerative colitis affects only the **mucosa and submucosa** and **does not typically present with granulomas**. - While it causes chronic diarrhea and abdominal pain, it usually affects the **rectum and colon continuously**, and granulomas are absent. *Mesenteric ischemia* - Mesenteric ischemia is characterized by **ischemic necrosis** of the bowel wall due to reduced blood flow, not granulomatous inflammation. - While it can cause abdominal pain and diarrhea, the histopathology would show **infarction and inflammation secondary to ischemia**, not granulomas. *Infective enteritis* - Infective enteritis is typically an **acute condition** and while it can cause diarrhea and abdominal pain, it is not usually chronic and associated with granulomas unless it is a specific infection like tuberculosis. - The histopathological findings in most infective enteritis cases show **acute inflammation** and possibly mucosal damage, but not typically non-caseating granulomas.

Q: Toxic megacolon is most commonly associated with what?

Ulcerative colitis. ***Ulcerative colitis*** - Toxic megacolon is most commonly associated with **ulcerative colitis** [1], a condition causing severe colon inflammation and ulceration. - The risk of toxic megacolon increases with **colitis flares** and extends the colon's diameter significantly. *Reiter's disease* - Also known as **reactive arthritis**, it primarily affects the joints and has **no direct link** to toxic megacolon. - Symptoms include joint pain, urethritis, and conjunctivitis, unrelated to intestinal dilation. *Whipple's disease* - A rare bacterial infection affecting the gastrointestinal tract, but it does not commonly lead to **toxic megacolon**. - Primarily presents with **malabsorption**, weight loss, and other systemic symptoms rather than intestinal dilation. *Crohn's disease* - While it can lead to colon issues, toxic megacolon is **more characteristic of ulcerative colitis** rather than Crohn's. - Crohn's disease may cause **stenosis and fistulas**, not typically contributing to toxic megacolon [2].

Q: Multiple intrahepatic bile duct dilations with bile lakes and concurrent sepsis are suggestive of.

Caroli disease. ***Caroli disease*** - **Caroli disease** is characterized by **congenital dilation** of the large intrahepatic bile ducts, leading to bile stasis, stone formation, and recurrent bouts of cholangitis and sepsis [1]. - The presence of **multiple intrahepatic bile duct dilations** and **bile lakes** with concurrent **sepsis** is highly indicative of this condition [1]. *Watson-Algali syndrome* - This is an incorrect term; there is no recognized medical condition by this name associated with bile duct anomalies. - The symptoms described do not correspond to any known genetic or acquired liver disease under this designation. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** involves **fibrosing inflammation** of both intrahepatic and extrahepatic bile ducts, leading to strictures and dilations, but typically progresses to **cirrhosis** and does not primarily manifest with large "bile lakes" [1]. - While PSC can cause recurrent cholangitis and present with bile duct irregularities, the specific description of "bile lakes" and diffuse dilations better fits Caroli disease [1]. *Klatskin tumor* - A **Klatskin tumor** is a **cholangiocarcinoma** located at the bifurcation of the common hepatic duct, causing **proximal bile duct obstruction** and dilation. - While it can lead to cholangitis and sepsis due to obstruction, it is a localized neoplastic mass, not a congenital diffuse dilation with "bile lakes" throughout the intrahepatic system.

Q: Which of the following is a prognostic factor in acute liver failure?

Prothrombin time (PT). - **Prothrombin time (PT)** is a crucial prognostic factor in acute liver failure because the liver synthesizes **coagulation factors**, and severe liver dysfunction impairs this synthesis [1]. - A **prolonged PT** indicates reduced synthetic function of the liver, reflecting the severity of hepatic damage and poorer prognosis [1], [2]. *Alpha-fetoprotein (AFP)* - **Alpha-fetoprotein (AFP)** is primarily a tumor marker for **hepatocellular carcinoma** and germ cell tumors. - While it can be elevated in some liver diseases, it is not a direct or reliable prognostic marker for acute liver failure. *Serum albumin level* - **Serum albumin** is a measure of the liver's synthetic function, but its half-life is approximately **3 weeks**. - This makes it a better indicator of **chronic liver disease** rather than the rapid changes seen in acute liver failure. *Serum globulin level* - **Serum globulin levels** reflect a mixture of proteins, including immunoglobulins, and are not specific markers of acute liver failure severity. - Elevated globulins are often associated with **chronic inflammation** or certain autoimmune conditions.

Q: Dieulafoy's lesion is seen in what?

Stomach. ***Stomach*** - **Dieulafoy's lesion** is a rare cause of recurrent, massive gastrointestinal bleeding, most commonly found in the **stomach**, particularly along the lesser curvature within 6 cm of the gastroesophageal junction. - It is characterized by an abnormally large, tortuous arteriole that erodes through the mucosa, without an associated ulcer or aneurysm, leading to profuse arterial bleeding. *Jejunum* - While gastrointestinal bleeding can occur in the jejunum from various causes, **Dieulafoy's lesion** is exceedingly rare in the small bowel. - Causes of jejunal bleeding are more commonly related to disorders like **Meckel's diverticulum**, vascular malformations, or tumors. *Oesophagus* - The esophagus is a less common site for Dieulafoy's lesions, though rare cases have been reported. - **Esophageal bleeding** is more often associated with **esophageal varices** in patients with portal hypertension or **Mallory-Weiss tears**. *Anus* - Dieulafoy's lesion has been reported in the rectum and other parts of the colon, but it is extremely uncommon in the anus itself. - **Anal bleeding** is typically due to common conditions like **hemorrhoids**, **anal fissures**, or perianal abscesses.

Question 1

All are true regarding familial adenomatous polyposis except which of the following?

Accepted Answer

Autosomal recessive

Answer

Associated endocrine involvement can be present

Answer

Multiple duodenal polyps

Answer

More > 100 polyps in the colon

Question 2

Which of the following statements about Wilson's disease is false?

Accepted Answer

Urinary copper excretion < 100 micrograms/day

Answer

Autosomal recessive

Answer

Serum ceruloplasmin level < 20 mg/dl

Answer

Zinc acetate is used as maintenance therapy

Question 3

A 60-year-old male experienced a sudden fall in the toilet, with a blood pressure of 90/50 mm Hg and a pulse of 100 beats per minute. His relatives reported that his stool was black or dark in color. Further careful history revealed that he was a known case of hypertension and coronary artery disease, and was regularly taking aspirin, atenolol, and isosorbide dinitrate. What is the most likely diagnosis?

Accepted Answer

Gastric ulcer with hemorrhage

Answer

Acute myocardial infarction

Answer

Stroke

Answer

Pulmonary embolism

Question 4

Serum amylase is not raised in

Accepted Answer

Ruptured ovarian cyst

Answer

Peptic ulcer perforation

Answer

Intestinal ischemia

Answer

Cholecystitis

Question 5

Which of the following statements about Wilson's disease is true?

Accepted Answer

Low serum ceruloplasmin and high urinary copper

Answer

Low serum ceruloplasmin and low urinary copper

Answer

High serum ceruloplasmin and low urinary copper

Answer

High serum ceruloplasmin and high urinary copper

Question 6

A 40-year-old patient presents with chronic abdominal pain and diarrhea, passing 22-25 stools per day, accompanied by weight loss. On examination, she has mild fever and right lower quadrant tenderness. A lower GI endoscopy reveals the following histopathological findings. An intern in the medicine ward generates a list of differential diagnoses for this patient. Which of the following options is most likely the diagnosis?

Accepted Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Mesenteric ischemia

Answer

Infective enteritis

Question 7

Toxic megacolon is most commonly associated with what?

Accepted Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Whipple's disease

Answer

Reiter's disease

Question 8

Multiple intrahepatic bile duct dilations with bile lakes and concurrent sepsis are suggestive of.

Accepted Answer

Caroli disease

Answer

Watson-Algali syndrome

Answer

Primary sclerosing cholangitis

Answer

Klatskin tumor

Question 9

Which of the following is a prognostic factor in acute liver failure?

Accepted Answer

Prothrombin time (PT)

Answer

Alpha-fetoprotein (AFP)

Answer

Serum albumin level

Answer

Serum globulin level

Question 10

Dieulafoy's lesion is seen in what?

Accepted Answer

Stomach

Answer

Jejunum

Answer

Oesophagus

Answer

Anus

Gastroenterology — MCQs

Gastroenterology — MCQs

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