Gastroenterology Practice Questions

Q: Which drug is used in the treatment of steroid-resistant ulcerative colitis?

Cyclosporine. **Explanation:** The management of Ulcerative Colitis (UC) follows a step-ladder approach. When a patient presents with **acute severe ulcerative colitis** that fails to respond to intravenous corticosteroids (typically after 3–5 days), the condition is termed **steroid-resistant UC**. 1. **Why Cyclosporine is correct:** Cyclosporine is a calcineurin inhibitor that acts rapidly to induce remission in severe, steroid-refractory cases. It serves as a "rescue therapy" to avoid emergency colectomy. In modern practice, **Infliximab** (a TNF-α inhibitor) is the other primary alternative for this indication. 2. **Why other options are incorrect:** * **Azathioprine (Option A):** While used in UC, it has a slow onset of action (3–6 months). It is used for **maintaining remission** or as a steroid-sparing agent, but it is ineffective for the acute management of steroid-resistant flares. * **5-ASA (Option C):** These (e.g., Sulfasalazine, Mesalamine) are first-line agents for **mild-to-moderate** UC [1]. They are insufficient for severe or steroid-resistant disease [1]. * **Racecadotril (Option D):** This is an enkephalinase inhibitor used as an anti-secretory drug for acute infectious diarrhea; it has no role in the inflammatory process of UC. **High-Yield Clinical Pearls for NEET-PG:** * **Truelove and Witts Criteria:** Used to define "Acute Severe UC" (≥6 bloody stools/day + systemic toxicity). * **Drug of Choice for Maintenance:** Azathioprine (if 5-ASA fails). * **Surgery:** Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA) is the definitive curative treatment for UC. * **Monitoring:** When using Cyclosporine, monitor renal function and serum drug levels to prevent nephrotoxicity and neurotoxicity.

Q: Which of the following conditions is characterized by hypoxemia?

Hepatopulmonary syndrome. **Hepatopulmonary Syndrome (HPS)** is the correct answer because it is defined by a specific clinical triad: **Advanced liver disease** (usually cirrhosis), **intrapulmonary vascular dilatations (IPVDs)**, and **arterial hypoxemia** (increased alveolar-arterial oxygen gradient) [1]. The underlying pathophysiology involves the failure of the diseased liver to clear circulating vasodilators (like Nitric Oxide). This leads to precapillary and capillary dilatations in the lungs [1]. These dilated vessels cause a **ventilation-perfusion (V/Q) mismatch** and a functional "shunt" [2] because oxygen cannot effectively diffuse to the center of the abnormally widened capillaries, resulting in significant hypoxemia [1]. **Analysis of Incorrect Options:** * **A. Hepatorenal Syndrome:** Characterized by functional renal failure in patients with advanced liver disease due to intense renal vasoconstriction [3]. It presents with oliguria and rising creatinine, not primary hypoxemia. * **C. Hepatic Encephalopathy:** A neuropsychiatric syndrome caused by the accumulation of neurotoxins (like ammonia). While it affects consciousness, it does not inherently cause hypoxemia unless complicated by aspiration or hypoventilation. * **D. Hepatic Failure:** Refers to the global loss of liver function. While it can lead to HPS, "hepatic failure" itself describes the organ status rather than the specific physiological state of hypoxemia. **NEET-PG High-Yield Pearls:** * **Platypnea:** Shortness of breath that worsens when sitting upright. * **Orthodeoxia:** A decrease in arterial oxygen saturation when moving from a supine to a standing position (highly suggestive of HPS) [1]. * **Gold Standard Diagnosis:** Contrast-enhanced echocardiography (Bubble study) showing microbubbles appearing in the left atrium after 3–6 cardiac cycles. * **Definitive Treatment:** Liver Transplantation [1].

Q: Anti-T.T.G. antibodies are seen in which condition?

Gluten enteropathy. **Gluten enteropathy** (Celiac Disease) is an autoimmune-mediated enteropathy triggered by the ingestion of gluten in genetically predisposed individuals (HLA-DQ2/DQ8) [1]. The enzyme **Tissue Transglutaminase (tTG)** plays a central role in the pathogenesis by deamidating gliadin peptides, making them more immunogenic [1]. This leads to the production of **IgA anti-tTG antibodies**, which are the most sensitive and specific serological markers for diagnosis and monitoring treatment adherence. **Analysis of Incorrect Options:** * **A. Giardia malabsorption:** While *Giardia lamblia* causes malabsorption and can mimic the histological features of Celiac disease (villous atrophy), it is an infectious parasitic condition and does not involve autoantibodies. * **C. Lactose deficiency:** This is a biochemical deficiency of the enzyme lactase at the brush border [2]. It leads to osmotic diarrhea but does not involve an immune response or antibody production [2]. * **D. Bile acid malabsorption:** This occurs due to ileal resection or disease (e.g., Crohn’s), leading to secretory diarrhea. It is a physiological failure of the enterohepatic circulation, not an autoimmune process. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** D2 (distal duodenal) biopsy showing villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes (Marsh Criteria) [1]. * **Best Screening Test:** IgA anti-tTG antibody. * **Important Caveat:** Always check **Total Serum IgA levels**; if the patient is IgA deficient (common in Celiac), IgA-based tests will be false negatives, and **IgG-deamidated gliadin peptide (DGP)** should be tested instead. * **Dermatological Association:** Dermatitis herpetiformis (intense pruritic vesicles on extensors).

Q: A patient after heavy drinking of alcohol presents with excessive vomiting and haematemesis. What is the most likely diagnosis?

Mallory Weiss syndrome. The clinical presentation of **hematemesis following a bout of heavy alcohol consumption and forceful vomiting** is a classic description of **Mallory-Weiss Syndrome (MWS)**. **1. Why Mallory-Weiss Syndrome is correct:** MWS involves a **longitudinal mucosal laceration** at the gastroesophageal junction or distal esophagus. The underlying mechanism is a sudden increase in intra-abdominal pressure (due to retching or vomiting), which causes the gastric contents to rush against the GE junction, leading to a tear [1]. Alcohol is a common precipitant as it induces both gastritis and vomiting. The bleeding is usually arterial but self-limiting in 80-90% of cases. **2. Why the other options are incorrect:** * **Boerhaave Syndrome:** This involves a **transmural (full-thickness) perforation** of the esophagus, not just a mucosal tear. It presents with the "Mackler triad" (vomiting, chest pain, and subcutaneous emphysema) and is a surgical emergency, unlike the typically self-limiting MWS. * **Oesophageal Carcinoma:** While it can cause bleeding, it usually presents with progressive dysphagia (solids then liquids) and significant weight loss in an older age group, rather than acute hematemesis after vomiting. * **Achalasia Cardia:** This is a motility disorder characterized by failure of the LES to relax [2]. Symptoms include dysphagia and regurgitation of undigested food, but not typically acute hematemesis [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Most tears occur just below the GE junction on the **gastric side** (lesser curvature). * **Diagnosis:** **Upper GI Endoscopy** is the gold standard. * **Management:** Most cases are managed conservatively with IVF and PPIs; endoscopic therapy (clips/epinephrine) is reserved for active bleeding. * **Distinction:** Remember: **Mallory-Weiss = Mucosal tear** (Bleeding); **Boerhaave = Transmural rupture** (Sepsis/Air in mediastinum).

Q: What is the best method to diagnose GERD?

Esophageal pH determination. **Explanation:** **1. Why Esophageal pH Determination is Correct:** Ambulatory 24-hour esophageal pH monitoring is considered the **gold standard** and the most objective test for diagnosing GERD. It measures the frequency and duration of acid reflux episodes (pH < 4) and, more importantly, allows for **symptom-reflux correlation**. This is essential for confirming the diagnosis in patients with persistent symptoms despite therapy or those with atypical (extra-esophageal) presentations. **2. Why the Other Options are Incorrect:** * **Endoscopy (EGD):** While often the first-line investigation to rule out complications (like Barrett’s esophagus or malignancy), it has low sensitivity for diagnosing GERD itself. Approximately 50-70% of patients with symptomatic GERD have **NERD (Non-Erosive Reflux Disease)**, where the endoscopic findings are completely normal [1]. * **Barium Swallow:** This is useful for identifying structural abnormalities like hiatal hernias, strictures, or rings. However, it cannot reliably detect physiological acid reflux and is neither sensitive nor specific for a GERD diagnosis. * **Laparoscopy:** This is a surgical approach (e.g., Nissen Fundoplication) used for treatment, not a diagnostic modality for GERD. **Clinical Pearls for NEET-PG:** * **Initial Management:** In typical cases (heartburn/regurgitation), the first step is a **PPI trial** for 8 weeks. * **Indications for Endoscopy:** "Alarm symptoms" (dysphagia, weight loss, anemia, or age >50) [1]. * **DeMeester Score:** A composite score used during pH monitoring to quantify the severity of reflux. * **Manometry:** Not used to diagnose GERD, but mandatory **before surgery** to rule out motility disorders like Achalasia.

Question 1

A 30-year-old female patient presents with non-progressive dysphagia for both solids and liquids. What characteristic finding on barium swallow will confirm the probable diagnosis?

Accepted Answer

Multiple sacculations and pseudodiverticula (corkscrew esophagus)

Answer

Dilated esophagus with a narrow lower end (rat tail esophagus)

Answer

Narrow and irregular esophageal lumen

Answer

Stricture ulcer in the esophagus

Question 2

Which drug is used in the treatment of steroid-resistant ulcerative colitis?

Accepted Answer

Cyclosporine

Answer

Azathioprine

Answer

5-aminosalicylic acid (5ASA)

Answer

Racecadotril

Question 3

Which of the following conditions is characterized by hypoxemia?

Accepted Answer

Hepatopulmonary syndrome

Answer

Hepatorenal syndrome

Answer

Hepatic encephalopathy

Answer

Hepatic failure

Question 4

Anti-T.T.G. antibodies are seen in which condition?

Accepted Answer

Gluten enteropathy

Answer

Giardia malabsorption

Answer

Lactose deficiency

Answer

Bile acid malabsorption

Question 5

A patient after heavy drinking of alcohol presents with excessive vomiting and haematemesis. What is the most likely diagnosis?

Accepted Answer

Mallory Weiss syndrome

Answer

Oesophageal carcinoma

Answer

Achalasia cardia

Answer

Boerhaave syndrome

Question 6

Which of the following factors predispose to hepatic encephalopathy?

Accepted Answer

Gastrointestinal bleeding and Spontaneous bacterial peritonitis

Answer

Increased potassium

Answer

Dehydration

Answer

Constipation

Question 7

A 40-year-old woman presents with severe abdominal pain localized to the right upper quadrant. A urine sample is taken for rapid dipstick reagent strip analysis. A positive result for which of the following substances would most strongly suggest gallstone disease as a possible cause of her abdominal pain?

Accepted Answer

Bilirubin

Answer

Glucose

Answer

Nitrite

Answer

Protein

Question 8

Which grain can be used safely in Celiac sprue?

Accepted Answer

Barley

Answer

Corn

Answer

Rye

Answer

Rice

Question 9

A 50-year-old diabetic patient has laboratory and clinical findings indicating liver cirrhosis, along with hyperpigmentation of the skin. Which of the following is the probable diagnosis?

Accepted Answer

Hemochromatosis

Answer

Wilson's disease

Answer

Primary biliary cholangitis (PBC)

Answer

Primary sclerosing cholangitis (PSC)

Question 10

What is the best method to diagnose GERD?

Accepted Answer

Esophageal pH determination

Answer

Endoscopy

Answer

Barium swallow

Answer

Laparoscopy

Gastroenterology — MCQs

Gastroenterology — MCQs

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