Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1111: A 48-year-old male with a history of cirrhosis presents with confusion and lethargy. Examination reveals asterixis, jaundice, and ascites. Laboratory results show elevated ammonia levels. What is the most likely diagnosis and appropriate treatment?

A. Hepatic encephalopathy; lactulose (Correct Answer)
B. Acute liver failure; liver transplant evaluation
C. Wernicke's encephalopathy; IV thiamine
D. Sepsis; broad-spectrum antibiotics

Explanation: ### Hepatic encephalopathy; lactulose - The patient's history of **cirrhosis**, coupled with **confusion, lethargy, asterixis, and elevated ammonia levels**, strongly indicates hepatic encephalopathy [1]. - **Lactulose** is the cornerstone of treatment, as it reduces ammonia absorption by acidifying the gut and promoting its excretion. ### Acute liver failure; liver transplant evaluation - While the patient has liver disease, the presentation is more chronic (cirrhosis) than acute [2]; **acute liver failure** typically presents with rapid onset of severe liver dysfunction in previously healthy individuals [3]. - This patient's long-standing cirrhosis suggests a chronic rather than acute process [2], and immediate **liver transplant evaluation** is not the primary intervention for this specific presentation. ### Wernicke's encephalopathy; IV thiamine - **Wernicke's encephalopathy** is primarily caused by **thiamine deficiency** and presents with a triad of **ophthalmoplegia, ataxia, and confusion**. - While confusion is present, the other classic signs and the elevated ammonia level are not typical for Wernicke's; the liver dysfunction is the central issue here [4]. ### Sepsis; broad-spectrum antibiotics - Although patients with cirrhosis are prone to infections, the primary symptoms (confusion, asterixis, elevated ammonia) point directly to impaired liver function rather than a systemic infection [4]. - While infection can **precipitate hepatic encephalopathy**, the immediate diagnosis and treatment should target the encephalopathy first, and there are no specific signs of infection (e.g., fever, leukocytosis) mentioned.

Question 1112: In a patient with acute pancreatitis showing elevated serum amylase, which enzyme elevation would be most specific to pancreatic damage?

A. Elevated Lipase levels (Correct Answer)
B. Elevated Alanine transaminase (ALT) levels
C. Elevated Alkaline phosphatase levels
D. Elevated Aspartate transaminase (AST) levels

Explanation: ***Elevated Lipase levels*** - **Lipase** is significantly more **specific to the pancreas** than amylase, making its elevation a more reliable indicator of pancreatic damage. - While amylase can be elevated due to various conditions (e.g., salivary gland issues), lipase elevation primarily points to **pancreatitis** [1]. *Elevated Alanine transaminase (ALT) levels* - **ALT** is primarily an indicator of **hepatocellular damage**, not pancreatic damage. - While gallstone pancreatitis might cause transient ALT elevation, it's not a direct marker of pancreatic injury. *Elevated Alkaline phosphatase levels* - **Alkaline phosphatase (ALP)** is typically associated with **biliary obstruction** or bone disease. - Although it can be elevated in pancreatitis with biliary involvement, it is not a specific marker for pancreatic damage itself. *Elevated Aspartate transaminase (AST) levels* - **AST** is found in many tissues, including the liver, heart, and skeletal muscle. - Elevated AST levels predominantly suggest **liver damage** or other tissue injury, not specifically pancreatic damage.

Question 1113: A 65-year-old male presents with a long history of gastroesophageal reflux and recent difficulty swallowing. What is the most likely diagnosis?

A. Esophageal cancer (Correct Answer)
B. Peptic stricture
C. Achalasia
D. Esophagitis

Explanation: ***Esophageal cancer*** - A long history of **gastroesophageal reflux disease (GERD)** is a significant risk factor for developing **Barrett's esophagus**, which can progress to **adenocarcinoma of the esophagus** [1]. - **Progressive dysphagia** (difficulty swallowing) in an older patient with a strong GERD history raises high suspicion for esophageal cancer [1]. *Peptic stricture* - While chronic GERD can lead to **peptic strictures**, which cause dysphagia, the advanced age and the term "recent" difficulty swallowing make cancer a more concerning diagnosis given the risk factors [2]. - Peptic strictures typically cause **gradual, slow-onset dysphagia**, and while they are a common complication of GERD, they are less likely to be the "most likely" cause of new, troublesome dysphagia in this context compared to cancer [1]. *Achalasia* - **Achalasia** is a motility disorder characterized by incomplete relaxation of the lower esophageal sphincter and loss of peristalsis, leading to dysphagia for both solids and liquids [3]. - It is not directly linked to a long history of GERD and typically presents with symptoms like regurgitation of undigested food, chest pain, and weight loss, without the direct precursor of chronic reflux damage to the esophageal lining [3]. *Esophagitis* - **Chronic esophagitis** from GERD is common, but it usually presents with heartburn and odynophagia (painful swallowing), not typically with significant dysphagia as the primary new symptom, unless it's severe and causing narrowing or ulceration [2]. - While esophagitis is a precursor to more severe complications, the onset of "difficulty swallowing" suggests a more advanced structural or neoplastic change rather than just inflammation.

Question 1114: A 50-year-old female presents with abdominal pain and jaundice. An MRI reveals multiple liver lesions with a 'target' appearance. What is the most likely diagnosis?

A. Hepatic cysts
B. Liver metastases (Correct Answer)
C. Hepatocellular carcinoma
D. Focal nodular hyperplasia

Explanation: ***Liver metastases*** - The "target" or "bull's eye" appearance on MRI is a **classic radiological sign** for **liver metastases**, particularly from colon, lung, or breast cancers [1]. - **Abdominal pain** and **jaundice** in a 50-year-old female are significant symptoms that raise concern for advanced disease, potentially obstructive due to metastatic involvement of the biliary tree [1], [2]. *Hepatic cysts* - Hepatic cysts typically appear as well-defined, **anechoic (fluid-filled)** lesions on ultrasound or T2-hyperintense with thin walls on MRI, without a "target" appearance. - They are usually **asymptomatic** unless very large, or causing obstruction, and do not typically present with jaundice unless compressing the bile ducts directly. *Hepatocellular carcinoma* - HCC often presents as a **solitary mass** or multifocal lesions, typically showing characteristic **arterial enhancement** and **venous washout** on dynamic imaging, not usually a "target" appearance. - While HCC can cause abdominal pain and jaundice, the "target" sign is far more suggestive of metastatic disease [1]. *Focal nodular hyperplasia* - FNH is a **benign liver lesion** characterized by a **central stellate scar** and typically shows homogeneous enhancement on arterial phase with iso- or hyperintensity on portal venous phase, distinct from a "target" appearance. - It is usually **asymptomatic** and discovered incidentally; therefore, it is less likely to cause abdominal pain and jaundice.

Question 1115: A 45-year-old woman presents with chronic diarrhea and weight loss. She has a history of scleroderma. What is the most likely cause of her symptoms?

A. Small intestinal bacterial overgrowth (Correct Answer)
B. Celiac disease
C. Irritable bowel syndrome
D. Crohn's disease

Explanation: ***Small intestinal bacterial overgrowth*** - **Scleroderma** can lead to gut dysmotility due to fibrosis of the smooth muscle, which predisposes to **small intestinal bacterial overgrowth (SIBO)** [1]. - SIBO causes **chronic diarrhea** and **malabsorption**, leading to **weight loss**, and should be considered in patients with scleroderma and gastrointestinal symptoms [1], [2]. *Celiac disease* - **Celiac disease** is an autoimmune disorder triggered by gluten, causing villous atrophy and malabsorption, leading to diarrhea and weight loss [3]. - While it presents with similar symptoms, it is not directly linked to scleroderma and would require specific serological testing and biopsy for diagnosis [3]. *Irritable bowel syndrome* - **Irritable bowel syndrome (IBS)** is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and altered bowel habits. - While it can cause chronic diarrhea, it typically does not cause significant **weight loss** and is not directly explained by the systemic effects of scleroderma. *Crohn's disease* - **Crohn's disease** is a type of inflammatory bowel disease characterized by transmural inflammation that can affect any part of the GI tract. - While it can cause chronic diarrhea and weight loss, there is no direct association between Crohn's disease and scleroderma, and the symptoms are not typically explained by the underlying pathophysiology of scleroderma.

Question 1116: A 50-year-old woman with cirrhosis presents with ascites and lower extremity edema. Which management approach would best reduce her complications?

A. Paracentesis followed by albumin infusion
B. High-protein diet and exercise
C. Diuretic therapy with sodium restriction (Correct Answer)
D. Transjugular intrahepatic portosystemic shunt

Explanation: Diuretic therapy with sodium restriction [1] - Diuretic therapy, especially with spironolactone and a loop diuretic (e.g., furosemide), is the cornerstone of managing ascites and edema in cirrhosis by promoting fluid excretion [1]. - Sodium restriction is crucial as sodium retention is a primary driver of fluid overload and ascites formation in cirrhosis [1]. Paracentesis followed by albumin infusion - Paracentesis is indicated for large-volume ascites causing discomfort or respiratory compromise, but it's not the primary long-term management strategy for routine ascites unless diuretics fail. - Albumin infusion is typically given with large-volume paracentesis (>5 liters) to prevent post-paracentesis circulatory dysfunction, rather than as a standalone fluid management approach. High-protein diet and exercise - A high-protein diet can worsen hepatic encephalopathy in patients with severe cirrhosis and may not be beneficial for fluid overload. - Exercise is generally beneficial but does not directly address the pathophysiology of ascites and edema in cirrhosis. Transjugular intrahepatic portosystemic shunt - A TIPS procedure is reserved for refractory ascites that does not respond to maximal diuretic therapy or for complications like recurrent variceal bleeding. - It carries significant risks, including an increased risk of hepatic encephalopathy and is not a first-line therapy for uncomplicated ascites and edema.

Question 1117: A 75-year-old male presents with chronic constipation and abdominal distension. A barium enema reveals a narrowing in the sigmoid colon. What is the most likely diagnosis?

A. Colon cancer (Correct Answer)
B. Diverticulosis
C. Ulcerative colitis
D. Irritable bowel syndrome

Explanation: ***Colon cancer*** - The patient's age (75 years), chronic constipation, abdominal distension, and the finding of a **narrowing (apple-core lesion)** in the sigmoid colon on barium enema are highly suggestive of **colorectal carcinoma**. [1] - **Sigmoid colon** is a common site for colorectal cancer, and a barium enema can effectively visualize obstructive lesions. [1] *Diverticulosis* - While diverticulosis is common in older adults and can cause constipation, it typically presents with **outpouchings** (diverticula) on barium enema, not a distinct narrowing indicative of an obstructive mass. [2] - Complications like **diverticulitis** can cause inflammatory strictures, but the primary finding is still diverticula. [2] *Ulcerative colitis* - Ulcerative colitis causes diffuse inflammation of the colon, typically starting in the rectum and extending proximally, resulting in findings like **mucosal ulcerations**, loss of haustra, and a **"lead pipe" appearance** on barium enema, not usually a focal narrowing. - It often presents with **bloody diarrhea**, which is not mentioned in this case. *Irritable bowel syndrome* - IBS is a **functional bowel disorder** characterized by abdominal pain and altered bowel habits (constipation, diarrhea, or both) without structural abnormalities. [3] - A barium enema would typically be normal in IBS, as it does not cause **anatomical narrowing** or strictures. [3]

Question 1118: A 45-year-old male with a history of chronic hepatitis C presents with abdominal distension, jaundice, and lower extremity edema. Laboratory tests reveal low serum albumin and prolonged prothrombin time. Which of the following is the most likely diagnosis?

A. Cirrhosis (Correct Answer)
B. Acute viral hepatitis
C. Hepatocellular carcinoma
D. Primary biliary cholangitis

Explanation: Cirrhosis - The constellation of **abdominal distension** (ascites), **jaundice**, and **lower extremity edema** in a patient with chronic hepatitis C strongly suggests **decompensated cirrhosis** [1]. - **Low serum albumin** indicates impaired synthetic function of the liver, and **prolonged prothrombin time** reflects reduced production of clotting factors, both characteristic features of cirrhosis [1]. *Acute viral hepatitis* - While acute viral hepatitis can cause jaundice and liver inflammation, it typically does not lead to **ascites** or **edema** in its acute phase, nor does it commonly result in significant **synthetic dysfunction** as indicated by low albumin and prolonged PT. - The history of **chronic hepatitis C** points towards a long-standing liver disease process rather than an acute infection [1]. *Hepatocellular carcinoma* - Although **hepatocellular carcinoma (HCC)** can develop as a complication of chronic hepatitis C and cirrhosis, the primary presentation here with signs of liver synthetic dysfunction like **low albumin** and **prolonged PT** is more indicative of **underlying cirrhosis** itself causing these features. - HCC symptoms often involve worsening pain, weight loss, or a new mass, which are not explicitly mentioned as primary complaints. *Primary biliary cholangitis* - **Primary biliary cholangitis (PBC)** is an autoimmune liver disease that primarily affects the small bile ducts, leading to cholestasis and eventually cirrhosis [1]. - While it can manifest with jaundice and lead to cirrhosis, it is usually associated with specific serological markers like **anti-mitochondrial antibodies (AMA)** and is less directly linked to **chronic hepatitis C** as the primary underlying cause for the presented symptoms.

Question 1119: A 48-year-old male presents with abdominal pain, bloating, and diarrhea, with symptoms worsening after the consumption of wheat-containing foods. What is the most likely diagnosis?

A. Irritable bowel syndrome
B. Celiac disease (Correct Answer)
C. Crohn's disease
D. Ulcerative colitis

Explanation: ***Celiac disease*** - **Celiac disease** is characterized by an immune reaction to **gluten** (a protein found in wheat, barley, and rye), leading to damage in the small intestine [1]. This perfectly aligns with symptoms worsening after consuming wheat. - Common symptoms include **abdominal pain, bloating, and diarrhea**, which can vary in severity [1]. Diagnosis is often confirmed by specific antibody tests and small bowel biopsy. *Irritable bowel syndrome (IBS)* - While IBS can present with **abdominal pain, bloating, and altered bowel habits** [2], it does not typically involve a direct worsening of symptoms specifically tied to **wheat consumption** due to an immune reaction to gluten. - IBS is a **functional gastrointestinal disorder** without structural damage to the bowel, unlike celiac disease [2]. *Crohn's disease* - **Crohn's disease** is an **inflammatory bowel disease (IBD)** that can affect any part of the gastrointestinal tract, causing inflammation and damage. - While symptoms like abdominal pain and diarrhea are common, they are generally not specifically triggered or exacerbated by **wheat consumption** in the same way as celiac disease. *Ulcerative colitis* - **Ulcerative colitis** is another type of **inflammatory bowel disease (IBD)** that primarily affects the **colon and rectum**, causing inflammation and ulceration. - Symptoms usually include bloody diarrhea, tenesmus, and abdominal pain but are not typically linked to a specific trigger like **wheat** in the way experienced by individuals with celiac disease.

Question 1120: A 60-year-old male presents with chronic constipation and abdominal distension. A barium enema shows a 'coffee bean sign.' What is the most likely diagnosis?

A. Intussusception
B. Sigmoid volvulus (Correct Answer)
C. Colon cancer
D. Crohn's disease

Explanation: ***Sigmoid volvulus*** - The "coffee bean sign" on a plain abdominal film or barium enema is a **classic radiographic finding** for **sigmoid volvulus**, representing the dilated, redundant sigmoid colon. - **Chronic constipation** and **abdominal distension** in an older male are common presenting symptoms due to the twisting of the sigmoid colon on its mesentery. *Intussusception* - Intussusception typically presents with **acute, intermittent abdominal pain** and **currant jelly stools**, most commonly in pediatric populations. - The classic radiographic sign for intussusception is a **target sign** on ultrasound, not the "coffee bean sign." *Colon cancer* - Colon cancer can cause **chronic constipation** and **abdominal distension** due to obstruction, but it does not typically produce a "coffee bean sign." - Radiographic findings often include an **"apple core" lesion** on barium enema, indicating circumferential narrowing. *Crohn's disease* - Crohn's disease is an **inflammatory bowel disease** characterized by **transmural inflammation** that can affect any part of the gastrointestinal tract. - While it can cause chronic constipation and abdominal distension, it would not typically manifest with a "coffee bean sign" and often presents with **diarrhea, abdominal pain, and weight loss**.

Practice by Chapter

Esophageal Disorders

Practice Questions

Peptic Ulcer Disease

Practice Questions

Inflammatory Bowel Disease

Practice Questions

Irritable Bowel Syndrome

Practice Questions

Malabsorption Syndromes

Practice Questions

Pancreatitis (Acute and Chronic)

Practice Questions

Gastrointestinal Bleeding

Practice Questions

Liver Diseases and Cirrhosis

Practice Questions

Viral Hepatitis

Practice Questions

Biliary Tract Disorders

Practice Questions

Gastrointestinal Motility Disorders

Practice Questions

Gastrointestinal Malignancies

Practice Questions

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