Gastroenterology Practice Questions

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: A 48-year-old male presents with a 6-month history of constant abdominal pain, particularly after meals, located in the upper mid-abdomen superior to the umbilicus. He also reports some heartburn that occurred during the previous year. Under significant stress, he has been self-medicating with over-the-counter antacids, with some relief. He notes that his stools have changed in colour over the previous 2 months and are now intermittently dark and tarry in consistency. Following stool testing, which organ is most likely to be affected?

Stomach. ***Stomach*** - The patient's symptoms, including **constant epigastric pain after meals**, heartburn, and **dark, tarry stools (melena)**, are highly suggestive of an **upper gastrointestinal bleed**, most commonly due to a **peptic ulcer** in the stomach or duodenum [1]. - While antacids provide some relief for heartburn, they do not address the underlying cause of a bleeding ulcer, and **melena** indicates significant blood loss from the upper GI tract [1]. *Liver* - Liver conditions, such as **cirrhosis or hepatitis**, might cause abdominal pain or dark stools if there's significant bleeding from **esophageal varices**, but the primary location of pain (upper mid-abdomen superior to the umbilicus) and **heartburn** point away from the liver as the primary affected organ. - Liver disease would typically present with other symptoms like **jaundice, ascites**, or abnormal liver function tests, which are not mentioned. *Pancreas* - Pancreatic conditions, such as **pancreatitis or pancreatic cancer**, typically cause **severe epigastric pain** that often radiates to the back and is not usually relieved by antacids. - While pancreatic issues can lead to complications affecting digestion, they don't typically manifest with **dark, tarry stools** as a primary symptom unless there's an unusual complication like a fistula causing GI bleeding. *None of the options* - Given the classic presentation of **epigastric pain, heartburn**, and **melena**, one of the provided organs (stomach) is very likely to be affected by the patient's condition [1]. - The symptom cluster strongly points to an issue within the upper gastrointestinal tract, specifically involving acid-related damage and bleeding.

Q: D-xylose absorption test is used to assess which of the following conditions?

Celiac disease. Celiac disease - The **D-xylose absorption test** assesses the functional integrity of the **small intestinal mucosa**, which is damaged in celiac disease. [1] - In celiac disease, the damaged villi impair the absorption of D-xylose, leading to **low urinary excretion** of the sugar. *Colon cancer* - Colon cancer primarily affects the **large intestine** and does not typically interfere with small intestinal D-xylose absorption. [2] - Diagnosis commonly involves **colonoscopy** and biopsy, not absorption tests. *PUD* - **Peptic ulcer disease (PUD)** affects the stomach or duodenum and does not impair the absorptive function of the small intestine. [3] - The primary diagnostic tool for PUD is **endoscopy** with biopsy for H. pylori. *Ulcerative colitis* - **Ulcerative colitis** is an inflammatory condition predominantly affecting the **large intestine** and rectum. [2] - It does not cause malabsorption in the small intestine, and therefore, D-xylose absorption would typically be normal.

Q: A 45-year-old man presents with an upper gastrointestinal bleed. An upper endoscopy reveals multiple duodenal ulcers and an enlarged stomach.

Zollinger-Ellison syndrome (ZES). ***Zollinger-Ellison syndrome (ZES)*** - **ZES** is characterized by excessive **gastrin** secretion, leading to multiple, refractory peptic ulcers, especially in the **duodenum**, and often an **enlarged stomach** due to gastric hyperplasia [1]. - The combination of **multiple duodenal ulcers** and an **upper gastrointestinal bleed** strongly suggests this diagnosis [1]. *Glucagonoma* - Characterized by a **necrolytic migratory erythema** rash, stomatitis, and diabetes, which are not present here. - Does not typically cause **multiple duodenal ulcers** or an **enlarged stomach**. *Insulinoma* - Presents with symptoms of **hypoglycemia** such as sweating, tremors, and confusion, which are absent in this case. - Does not cause **gastric hyperplasia** or **recurrent peptic ulcers**. *Watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome* - Primarily presents with **severe watery diarrhea**, **hypokalemia**, and **achlorhydria** due to VIPoma (vasoactive intestinal peptide-secreting tumor). - This syndrome does not typically cause **gastrointestinal bleeding** or **duodenal ulcers**.

Q: Crohn's disease can be seen in which of the following locations?

Mouth to anus. ***Mouth to anus*** - Crohn's disease is a **transmural inflammatory condition** that can affect any part of the gastrointestinal tract, from the mouth to the anus [1]. - This pan-GI involvement is a key characteristic, distinguishing it from other inflammatory bowel diseases [1]. *Jejunum only* - While Crohn's can affect the **jejunum**, it is rarely confined to this segment alone [1]. - Such limited involvement is atypical for the widespread nature of Crohn's disease [1]. *Colon only* - If inflammation were restricted to the **colon only**, it would be more suggestive of **ulcerative colitis**, not Crohn's disease [1]. - Crohn's disease often presents with "skip lesions," meaning affected areas are interspersed with healthy tissue, which is uncommon in diffuse colonic involvement [1]. *Terminal ileum and right side* - Involvement of the **terminal ileum and right colon** is the most common presentation of Crohn's disease [1]. - However, it is not the *only* location, nor does it encompass the full potential extent of the disease throughout the GI tract [1].

Q: Erosive gastritis commonly affects which part of the stomach?

Stomach antrum. ***Stomach antrum*** - The **antrum** is the most common site for erosive gastritis due to its role in regulating gastric emptying and exposure to gastric acid and pepsin [1]. - While gastritis can affect any part of the stomach, inflammation and erosion are often pronounced in the antrum due to its location relative to the pylorus and continuous exposure to luminal contents [1]. *Stomach fundus* - The **fundus** is the upper part of the stomach and is less commonly affected by erosive gastritis compared to the antrum and body. - It plays a significant role in accumulating gas during digestion. Its location and functions make it less susceptible to the type of chronic inflammation that leads to erosions [2]. *Stomach body* - The **stomach body (corpus)** is responsible for producing acid and pepsin and can be affected by gastritis, but it is less frequently the primary site of erosions than the antrum [1]. - Inflammatory changes in the body are often associated with other forms of gastritis, such as autoimmune gastritis, which typically does not manifest with widespread erosions [1]. *Pylorus* - The **pylorus** is the muscular valve connecting the stomach to the duodenum; while it is adjacent to the antrum, erosions are typically described as occurring in the antrum itself rather than within the pyloric channel. - Inflammation affecting the pylorus directly might lead to issues with gastric emptying but is usually secondary to disease in the antrum or duodenum.

Q: Which of the following can cause toxic megacolon in a 36-year-old lady?

Ulcerative colitis. ***Ulcerative colitis*** - **Ulcerative colitis** is a well-known cause of **toxic megacolon**, a severe complication characterized by acute colonic distension and systemic toxicity [1]. - The inflammatory process in ulcerative colitis can lead to deep ulcerations and transmural inflammation, compromising the enteric nervous system and causing acute colonic dysfunction. *Amoebic dysentery* - While **amoebic dysentery** can cause severe colonic inflammation and necrosis, it is **less commonly associated with toxic megacolon** compared to inflammatory bowel diseases. - The primary concern with amoebic dysentery is often **amoebic liver abscess** or colonic perforation rather than toxic megacolon. *Irritable bowel syndrome (IBS)* - **IBS** is a **functional gastrointestinal disorder** and does **not cause structural changes or significant inflammation** in the colon. - It is characterized by symptoms like abdominal pain, bloating, and altered bowel habits, but it is **not associated with toxic megacolon**. *Viral diarrhea* - **Viral diarrhea** typically causes **acute, self-limiting gastroenteritis** and does **not involve the severe, transmural inflammation** required to induce toxic megacolon. - The primary concern with viral diarrhea is **dehydration**, especially in vulnerable populations.

Q: In modified Pugh's classification score of 8, what is the line of management?

Conservative management. Conservative management - A modified Child-Pugh score of 8 falls into Child-Pugh class B, indicating **moderate liver dysfunction**. - At this stage, **medical management** aimed at addressing complications and improving liver function is the primary line of treatment. *Orthotopic liver transplant* - Liver transplantation is generally considered for patients with **Child-Pugh class C** (scores 10-15) or those with class B who are unresponsive to medical therapy and have a high risk of mortality [1]. - While a score of 8 indicates significant disease, it's not immediately indicative of the need for transplant without failure of conservative measures or other specific indications [1]. *Sclerotherapy* - **Sclerotherapy** is a procedure primarily used to treat **esophageal varices** to prevent or treat bleeding [2]. - It is a targeted intervention for a specific complication of portal hypertension, not a general management strategy for a Child-Pugh score of 8. *Shunt surgery* - **Shunt surgery**, such as a Transjugular Intrahepatic Portosystemic Shunt (TIPS), is used to decompress the **portal venous system** in cases of severe portal hypertension [3]. - It's typically reserved for patients with recurrent variceal bleeding or refractory ascites, and not a primary management for a Child-Pugh score of 8 as a whole [3].

Q: Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?

Arthritis. ***Arthritis*** - **Peripheral arthritis** associated with inflammatory bowel disease (IBD) often **worsens with intestinal disease exacerbations** and improves with resolution of flares [1]. - This type of arthritis typically affects larger joints and is **non-deforming and asymmetric**. *Erythema nodosum* - **Erythema nodosum**, a skin manifestation, is generally **correlated with IBD activity** and usually improves as the bowel disease is treated [1]. - It presents as **tender, red nodules** on the shins and is not consistently one of the symptoms that *worsens* with exacerbation, but rather is *present* during active disease. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic liver condition that is **associated with IBD**, particularly ulcerative colitis. - However, the progression of PSC is largely **independent of the intestinal disease activity** and does not necessarily worsen during IBD exacerbations. *Uveitis* - **Uveitis**, an inflammation of the eye's middle layer, is an extra-intestinal manifestation of IBD that can occur **independently of intestinal disease activity**. - It does not consistently worsen during IBD exacerbations and may require separate focused treatment.

Q: A 67-year-old woman complains of paresthesias in the limbs. Examination shows loss of vibratory sense, positional sense, and sense of light touch in the lower limbs. She is found to have pernicious anemia. Endoscopy reveals an ulcer in the body of the stomach. What vitamin deficiency does she most likely have?

Cancer of the stomach. **Cancer of the stomach** - The presence of **pernicious anemia** with an **ulcer in the body of the stomach** in an elderly patient suggests an increased risk of **gastric adenocarcinoma** [2]. - **Atrophic gastritis** associated with pernicious anemia is a **precursor lesion** for gastric cancer, and a stomach ulcer in this context warrants suspicion for malignancy [2]. *Chronic atrophic gastritis* - While **chronic atrophic gastritis** is the underlying cause of pernicious anemia, the question specifies an **ulcer in the body of the stomach** [3]. - An ulcer in the setting of atrophic gastritis should raise concern for **malignancy**, especially in an older patient, rather than just chronic inflammation [2]. *Gastric sarcoma* - **Gastric sarcomas** are mesenchymal tumors of the stomach, which are **rare** compared to gastric adenocarcinomas. - While they can present as ulcers, the strong association with **pernicious anemia** points more directly towards adenocarcinoma. *Deficiency of vitamin B12* - The patient clearly has **vitamin B12 deficiency** due to pernicious anemia, which explains the neurological symptoms like **paresthesias** and loss of vibratory/positional sense [1]. - However, the question asks what new pathology is suggested by the **ulcer in the stomach body** given the underlying pernicious anemia, rather than about the deficiency itself.

Question 1

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 2

A 48-year-old male presents with a 6-month history of constant abdominal pain, particularly after meals, located in the upper mid-abdomen superior to the umbilicus. He also reports some heartburn that occurred during the previous year. Under significant stress, he has been self-medicating with over-the-counter antacids, with some relief. He notes that his stools have changed in colour over the previous 2 months and are now intermittently dark and tarry in consistency. Following stool testing, which organ is most likely to be affected?

Accepted Answer

Stomach

Answer

Liver

Answer

Pancreas

Answer

None of the options

Question 3

D-xylose absorption test is used to assess which of the following conditions?

Accepted Answer

Celiac disease

Answer

Colon cancer

Answer

PUD

Answer

Ulcerative colitis

Question 4

A 45-year-old man presents with an upper gastrointestinal bleed. An upper endoscopy reveals multiple duodenal ulcers and an enlarged stomach.

Accepted Answer

Zollinger-Ellison syndrome (ZES)

Answer

Insulinoma

Answer

Glucagonoma

Answer

Watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome

Question 5

Crohn's disease can be seen in which of the following locations?

Accepted Answer

Mouth to anus

Answer

Jejunum only

Answer

Colon only

Answer

Terminal ileum and right side

Question 6

Erosive gastritis commonly affects which part of the stomach?

Accepted Answer

Stomach antrum

Answer

Stomach fundus

Answer

Stomach body

Answer

Pylorus

Question 7

Which of the following can cause toxic megacolon in a 36-year-old lady?

Accepted Answer

Ulcerative colitis

Answer

Viral diarrhea

Answer

Amoebic dysentery

Answer

Irritable bowel syndrome (IBS)

Question 8

In modified Pugh's classification score of 8, what is the line of management?

Accepted Answer

Conservative management

Answer

Sclerotherapy

Answer

Shunt surgery

Answer

Orthotopic liver transplant

Question 9

Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?

Accepted Answer

Arthritis

Answer

Primary sclerosing cholangitis

Answer

Uveitis

Answer

Erythema nodosum

Question 10

A 67-year-old woman complains of paresthesias in the limbs. Examination shows loss of vibratory sense, positional sense, and sense of light touch in the lower limbs. She is found to have pernicious anemia. Endoscopy reveals an ulcer in the body of the stomach. What vitamin deficiency does she most likely have?

Accepted Answer

Cancer of the stomach

Answer

Gastric sarcoma

Answer

Chronic atrophic gastritis

Answer

Deficiency of vitamin B12

Gastroenterology — MCQs

Gastroenterology — MCQs

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