Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1171: What is the most accurate method for diagnosing Gastroesophageal Reflux Disease (GERD)?

A. Histological study
B. Manometry
C. 24-hour pH recording and electrical impedance measurement (Correct Answer)
D. Barium swallow studies and Upper GI endoscopy

Explanation: ***24-hour pH recording and electrical impedance measurement*** - This method directly measures the **frequency and duration of acid reflux** into the esophagus, correlating symptoms with reflux episodes. - **Electrical impedance** also detects non-acidic reflux, making it the most comprehensive and accurate diagnostic tool for GERD. *Histological study* - While histology can show **esophageal inflammation** (esophagitis), this finding is not specific to GERD and can be caused by other conditions. - It does not directly assess the **frequency or severity of reflux episodes**. *Manometry* - Esophageal manometry measures the pressure and coordination of muscle contractions, primarily used to diagnose **motility disorders** such as achalasia. [1] - It assesses the integrity of the **lower esophageal sphincter (LES)** but does not quantify reflux events. [1] *Barium swallow studies and Upper GI endoscopy* - **Barium swallow** can identify anatomical abnormalities like hiatal hernias or severe reflux, but it has low sensitivity for diagnosing GERD itself. [1] - **Upper GI endoscopy** can visualize mucosal damage (esophagitis) consistent with GERD but does not confirm reflux is the cause of symptoms if the mucosa appears normal (non-erosive reflux disease). [1]

Question 1172: Which enzyme is most specific for pancreatic pathology in the evaluation of chronic pancreatitis?

A. Amylase
B. Lipase (Correct Answer)
C. Elastase
D. Trypsin

Explanation: Lipase - **Lipase** is highly specific to the pancreas and is useful for diagnosing chronic pancreatitis, especially when evaluating for **pancreatic insufficiency**. - Its levels can remain elevated longer than amylase in acute pancreatitis, and it is less prone to elevation from non-pancreatic sources. *Amylase* - While elevated in pancreatic pathology, **amylase** can also be increased due to non-pancreatic conditions such as salivary gland issues, kidney failure, or certain cancers. - Its specificity for the pancreas is lower compared to lipase, and it may not be persistently elevated in chronic pancreatitis due to widespread destruction of acinar cells. *Elastase* - **Fecal elastase-1** is a sensitive and specific test for **exocrine pancreatic insufficiency**, a common feature of chronic pancreatitis [1]. - However, it measures pancreatic function by assessing the enzyme's presence in stool rather than being a direct marker of acute pancreatic injury in serum. *Trypsin* - **Trypsin** and **immunoreactive trypsinogen** are markers of pancreatic function, and elevated levels can suggest pancreatic damage. - However, like amylase, serum trypsin levels can also be affected by renal impairment and are not as widely used as lipase for routine diagnosis of chronic pancreatitis.

Question 1173: In men, what quantity of ethyl alcohol consumed daily for more than 10 years increases the relative risk of developing alcoholic liver disease?

A. 20g/d
B. 60g/d
C. 80g/d
D. 40g/d (Correct Answer)

Explanation: 40g/d - Chronic consumption of 40g/d or more of ethanol in men, and 20g/d or more in women, significantly increases the risk of developing alcoholic liver disease over 10 years [1]. - This threshold represents a level of regular alcohol intake that causes cumulative hepatic damage over time [1]. 20g/d - While 20g/d in women significantly increases the risk, in men, this amount is generally considered the threshold for low-risk drinking in the absence of other risk factors. - Consistent consumption at this level in men for more than 10 years would be very unlikely to raise the relative risk of developing alcoholic liver disease above that of the general population. 60g/d - This amount certainly carries a high risk of alcoholic liver disease, but it is above the minimum threshold required to significantly increase the relative risk. - The risk of cirrhosis and other severe liver damage escalates with intake greater than 40g/d [1]. 80g/d - Consumption at 80g/d represents a very high level of alcohol intake and is associated with a substantially elevated risk of severe alcoholic liver disease. - However, the question asks for the quantity that increases the relative risk, meaning the lowest dose above which the risk is significantly higher than baseline.

Question 1174: In which of the following conditions is non-surgical medical treatment for gallstones indicated?

A. Prophylaxis in patients at high risk for gallstone formation
B. Dissolution therapy candidates with radiolucent stones <15mm
C. Small cholesterol stones in patients unfit for surgery
D. Patient refusal of surgical intervention with cholesterol stones (Correct Answer)

Explanation: **Patient refusal of surgical intervention with cholesterol stones** - When a patient with **symptomatic gallstones** (even cholesterol stones) refuses surgery, medical dissolution therapy may be considered as an alternative, despite its limitations and lower efficacy compared to cholecystectomy. - This option prioritizes **patient autonomy** when surgical intervention is the standard but declined. *Small cholesterol stones in patients unfit for surgery* - While medical dissolution therapy can be considered for **small cholesterol stones**, being "unfit for surgery" in itself doesn't automatically mean medical treatment is indicated without symptoms. - Asymptomatic stones generally do not require treatment, regardless of surgical fitness; treatment is usually reserved for symptomatic cases or specific high-risk scenarios. *Dissolution therapy candidates with radiolucent stones <15mm* - This describes ideal candidates for dissolution therapy using oral bile acids (e.g., **ursodeoxycholic acid**). - The size and radiolucency (indicating cholesterol stones) are important criteria, but this option isn't the *most likely* sole indication for non-surgical treatment when compared to a patient who actively refuses surgery, which forces consideration of alternatives even if less effective. *Prophylaxis in patients at high risk for gallstone formation* - Prophylactic treatment for gallstones is generally **not indicated** even in high-risk patients (e.g., rapid weight loss, bariatric surgery) unless they become symptomatic [1]. - The focus is usually on watchful waiting or, in very high-risk scenarios (e.g., post-bariatric surgery), ursodeoxycholic acid might be used to prevent stone formation, but this is a specific prophylactic use, not a direct treatment for existing stones.

Question 1175: Which of the following is the most common screening test for acute pancreatitis?

A. Serum lipase (Correct Answer)
B. Urine trypsinogen
C. Insulin
D. Serum amylase

Explanation: ***Serum lipase*** - **Serum lipase** is considered the most specific and sensitive enzyme for diagnosing acute pancreatitis. [1] - Its levels typically rise within 4-8 hours of acute pancreatitis onset and can remain elevated for 8-14 days. [1] *Serum amylase* - While **serum amylase** is also elevated in acute pancreatitis, it is less specific than lipase as it can be elevated in other conditions (e.g., salivary gland disease, bowel ischemia). [1] - Its levels usually normalize more quickly than lipase, making it less useful for diagnosing pancreatitis with delayed presentation. [1] *Urine trypsinogen* - **Urine trypsinogen** can be elevated in pancreatitis, but it is not a routinely used or widely available screening test. [1] - Its diagnostic accuracy and clinical utility are not as well-established or practical as serum lipase or amylase. [1] *Insulin* - **Insulin** is a hormone produced by the pancreas involved in glucose regulation and is not a marker for pancreatic inflammation or injury in acute pancreatitis. - Its levels would not be used to diagnose acute pancreatitis.

Question 1176: Portal hypertension is said to be present if portal venous pressure is more than:

A. 10 mm Hg (Correct Answer)
B. 3-5 mm Hg
C. 5-10 mm Hg
D. 12-15 mm Hg

Explanation: ***10 mm Hg*** - Portal hypertension is defined by a **hepatic venous pressure gradient (HVPG)** greater than 5 mmHg, but significant clinical consequences usually arise when the **portal venous pressure** exceeds **10 mmHg** [1]. - A persistent elevation above this threshold leads to the development of complications such as **ascites**, **varices**, and **splenomegaly** [1]. *3-5 mm Hg* - A portosystemic gradient of 3-5 mmHg is considered **normal portal pressure**, indicating no significant obstruction or resistance to portal flow [1]. - Pressures within this range do not cause the clinical manifestations associated with portal hypertension. *5-10 mm Hg* - While a **hepatic venous pressure gradient (HVPG)** greater than 5 mmHg technically defines portal hypertension, clinical symptoms typically do not appear until the pressure exceeds 10 mmHg [1]. - This range represents **mild portal hypertension** which may not be clinically significant. *12-15 mm Hg* - Pressures in the range of 12-15 mmHg indicate **severe portal hypertension**, which is often associated with a high risk of complications such as **esophageal variceal bleeding**. - This is a critical threshold for developing serious clinical sequelae, not the lower limit for defining portal hypertension.

Question 1177: All of the following drugs may be used in the treatment of ulcerative colitis except:

A. Corticosteroids
B. Sulfasalazine
C. Methotrexate (Correct Answer)
D. Azathioprine

Explanation: ***Methotrexate*** - While methotrexate is an immunosuppressant used in some autoimmune conditions, it is **not a first-line or commonly used drug for ulcerative colitis**. [2] - Its role in inflammatory bowel disease is primarily established for **Crohn's disease**, not ulcerative colitis. *Corticosteroids* - **Corticosteroids** are commonly used for inducing remission in **moderate to severe ulcerative colitis** due to their potent anti-inflammatory effects. [1] - They are effective for short-term management of flares but are not suitable for long-term maintenance therapy due to significant side effects. *Sulfasalazine* - **Sulfasalazine** is an aminosalicylate (5-ASA) drug, frequently used for the **induction and maintenance of remission in mild to moderate ulcerative colitis**. [1] - It works by reducing inflammation in the colon. *Azathioprine* - **Azathioprine** is an immunosuppressant often used for **maintaining remission in moderate to severe ulcerative colitis** when corticosteroids cannot be tapered or are ineffective. - It helps reduce the need for long-term corticosteroid use and can prevent disease flares.

Question 1178: What disease is associated with ascitic fluid SAAG < 1.1?

A. Peritoneal carcinomatosis (Correct Answer)
B. Liver failure
C. Portal vein thrombosis
D. Tuberculosis peritonitis

Explanation: Peritoneal carcinomatosis - A serum-ascites albumin gradient (SAAG) less than 1.1 g/dL indicates that the ascites is not due to portal hypertension [1]. - In peritoneal carcinomatosis, the malignant cells in the peritoneum disrupt the normal fluid exchange, leading to fluid accumulation that is low in albumin relative to serum [1]. Liver failure - Liver failure, especially when leading to cirrhosis, is typically associated with portal hypertension and a SAAG ≥ 1.1 g/dL [1]. - The high SAAG reflects the increased hydrostatic pressure in the hepatic sinusoids, forcing fluid low in protein into the peritoneal cavity [1]. Portal vein thrombosis - Portal vein thrombosis causes portal hypertension and would therefore be associated with a high SAAG (≥ 1.1 g/dL) [1]. - The obstruction of the portal vein leads to increased sinusoidal hydrostatic pressure, similar to other causes of portal hypertension [1]. Tuberculosis peritonitis - Tuberculosis peritonitis is an inflammatory condition that can cause ascites, but it is typically associated with a SAAG < 1.1 g/dL [1]. - This is because the inflammatory process in the peritoneum allows for the leakage of albumin into the ascitic fluid, diminishing the gradient [1].

Question 1179: Phlegmonous gastritis occurs due to?

A. H. pylori
B. Staphylococcus aureus
C. Streptococcus species (Correct Answer)
D. Clostridium perfringens

Explanation: **Streptococcus species** - **Phlegmonous gastritis** is a **rare, severe bacterial infection** of the stomach wall often caused by **Streptococcus species**. - These bacteria invade the gastric submucosa, leading to **purulent inflammation** and potential perforation. *H. pylori* - **H. pylori** is a common cause of **chronic gastritis**, peptic ulcers, and is associated with gastric cancer and MALT lymphoma [1]. - It typically causes **superficial inflammation** rather than invasive, purulent infection of the stomach wall [1]. *Staphylococcus aureus* - **Staphylococcus aureus** is a common cause of **food poisoning** due to its secreted toxins, which cause rapid onset of nausea, vomiting, and diarrhea [3]. - While it can cause other severe infections, it is **not a primary pathogen** for phlegmonous gastritis. *Clostridium perfringens* - **Clostridium perfringens** is known for causing **gas gangrene** and certain types of **food poisoning** (especially anaerobic cellulitis and myonecrosis) [2]. - It is **not typically implicated** in the severe, purulent inflammation of phlegmonous gastritis.

Question 1180: Blood group most commonly associated with gastric carcinoma is

A. Blood Group 0
B. Blood group A (Correct Answer)
C. Blood group AB
D. Blood group B

Explanation: ***Blood group A*** - Individuals with **blood group A** have been statistically shown to have a higher risk of developing **gastric carcinoma**. - This association is thought to be related to the presence of **A antigens**, which may influence cell adhesion and immune response in the gastric mucosa. *Blood Group O* - Blood group O is more commonly associated with an increased risk of **peptic ulcer disease**, particularly **duodenal ulcers**. - It does not show a strong positive correlation with the development of gastric carcinoma. *Blood group AB* - Blood group AB is the rarest blood type and the association with gastric carcinoma risk is not as significant or well-established compared to blood group A. - While showing some increased risk, it is less pronounced than for blood group A. *Blood group B* - Individuals with blood group B do not show a significant or commonly acknowledged increased risk for gastric carcinoma. - Research has not identified a strong correlation between blood group B and the development of this type of cancer.

Practice by Chapter

Esophageal Disorders

Practice Questions

Peptic Ulcer Disease

Practice Questions

Inflammatory Bowel Disease

Practice Questions

Irritable Bowel Syndrome

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Malabsorption Syndromes

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Pancreatitis (Acute and Chronic)

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Gastrointestinal Bleeding

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Liver Diseases and Cirrhosis

Practice Questions

Viral Hepatitis

Practice Questions

Biliary Tract Disorders

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Gastrointestinal Motility Disorders

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Gastrointestinal Malignancies

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