Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1201: Which of the following statements is incorrect regarding King's Criteria for acute fulminant liver failure?

A. Age <10 years or >40 years
B. Jaundice <7 days (Correct Answer)
C. INR >3.5
D. Serum bilirubin >17.5 mg/dl

Explanation: Jaundice <7 days - This statement is **incorrect** because King's College Criteria for non-acetaminophen-induced acute liver failure uses **jaundice duration of >7 days** as a poor prognostic factor. - A short duration of jaundice (<7 days) before the onset of encephalopathy is generally associated with a **better prognosis**. *Age <10 years or >40 years* - This is a **correct** statement of King's Criteria, as **age less than 10 or greater than 40 years** are considered poor prognostic indicators. - These age groups are associated with a higher risk of adverse outcomes in acute liver failure. *INR >3.5* - This is a **correct** component of King's Criteria, indicating **severe coagulopathy** and poor liver synthetic function. - An **INR greater than 3.5** is a key predictor of non-survival without transplantation in non-acetaminophen-induced acute liver failure. *Serum bilirubin >17.5 mg/dl* - This is a **correct** criterion, as a **serum bilirubin level exceeding 17.5 mg/dl** is a significant marker for poor prognosis. - High bilirubin levels reflect severe hepatocellular dysfunction and impaired metabolic capacity of the liver.

Question 1202: A young man met with a motorbike accident and had injuries to ileum and jejunum. Therefore the entire ileum and partial jejunum were resected. Which of the following would the patient suffer from

A. Vitamin B12 malabsorption due to ileal resection (Correct Answer)
B. Atrophic gastritis unrelated to resection
C. Constipation due to dietary changes
D. No significant symptoms

Explanation: **Vitamin B12 malabsorption due to ileal resection** - The **terminal ileum** is the primary site for the absorption of **vitamin B12** (cobalamin) complexed with intrinsic factor [3]. - Its resection would directly lead to the inability to absorb this vitamin, resulting in **B12 deficiency** and associated symptoms like macrocytic anemia [3]. *Atrophic gastritis unrelated to resection* - **Atrophic gastritis** is a chronic inflammatory condition of the stomach lining leading to loss of glandular tissue and often impaired production of **intrinsic factor**. - While it can cause B12 malabsorption, it is an independent condition and not a direct consequence of ileum and jejunum resection. *Constipation due to dietary changes* - Resection of the ileum and jejunum primarily impacts **nutrient absorption** and can lead to diarrhea due or **short bowel syndrome** [1], rather than constipation. - While diet changes can affect bowel habits, prolonged **severe gastrointestinal resection** is more likely to cause malabsorption-related diarrhea [1], [2]. *No significant symptoms* - The **ileum** and **jejunum** are crucial for the absorption of most nutrients, including vitamins, minerals, fats, and carbohydrates [4]. - Resection of these segments, especially a significant portion, would lead to **malabsorption syndromes** with various severe symptoms, potentially including weight loss, diarrhea, and nutritional deficiencies [1], [4].

Question 1203: Which statement is true regarding Crohn's disease?

A. Rectum is not involved
B. Crohn's disease typically presents with skip lesions. (Correct Answer)
C. Cobblestone appearance is a classic endoscopic finding.
D. Caseating granulomas are a characteristic histological feature.

Explanation: ***Continuous lesion visualized in endoscopy*** - Crohn's disease typically presents with **discontinuous lesions**, also known as **skip lesions**, which are not found in continuous patterns [1]. - This statement fails to align with the characteristic **cobblestone mucosa** appearance of the disease seen during endoscopy. *Rectum is not involved* - While Crohn's disease primarily affects the **ileum** and **colon**, it can indeed involve the **rectum**, although it is more common in ulcerative colitis [1]. - Hence, rectal involvement is possible in Crohn's, opposing this statement. *Non caseating granulomas* - Crohn's disease is known for the presence of **non-caseating granulomas**, which are a pathological hallmark of the condition. - This statement incorrectly describes a feature that is, in fact, true for Crohn's. *Cobblestone appearance* - The characteristic **cobblestone appearance** is typical in Crohn's disease due to the patchy involvement of the intestinal mucosa. - This statement is also true, as it accurately describes a prominent finding in Crohn's disease.

Question 1204: Common cause of chronic pancreatitis

A. Chronic alcohol (Correct Answer)
B. Chronic pancreatic calculi
C. pancreas divisum
D. Gall bladder stones

Explanation: ***Chronic alcohol*** - **Chronic alcohol consumption** is the most common and well-established cause of chronic pancreatitis, accounting for a significant majority of cases [1]. - Alcohol induces premature activation of pancreatic enzymes within the acinar cells, leading to recurrent inflammation, fibrosis, and eventual pancreatic destruction [1]. *Chronic pancreatic calculi* - While **pancreatic calcifications** (calculi) are a common finding in chronic pancreatitis, they are typically a *consequence* of the disease process rather than its primary cause [1]. - These calculi often develop due to protein plug formation and subsequent calcification in the ducts, exacerbated by recurrent inflammation [1]. *pancreas divisum* - **Pancreas divisum** is a congenital anomaly where the dorsal and ventral pancreatic ducts fail to fuse, leading to the majority of pancreatic secretions draining through a smaller accessory papilla. - While it can be a rare cause of recurrent acute pancreatitis or, less commonly, chronic pancreatitis, it is far less frequent than chronic alcohol abuse. *Gall bladder stones* - **Gallbladder stones (cholelithiasis)** are a common cause of *acute pancreatitis* when they obstruct the common bile duct or pancreatic duct. - They are generally not a direct cause of *chronic* pancreatitis unless recurrent acute episodes lead to irreversible pancreatic damage, making alcohol the leading primary cause [1].

Question 1205: Which of the following is true about menetrier's disease

A. Atrophied mucosal folds are seen
B. It is premalignant condition
C. There is decreased gastric acid secretion (Correct Answer)
D. It causes increased gastric acid secretion

Explanation: ***It is a premalignant condition*** - Menetrier's disease is characterized by **hyperplastic gastric mucosa** and is considered a **premalignant condition** due to its association with gastric cancers. - Regular surveillance and monitoring are recommended because of this increased risk for malignancy. *Affects the stomach and small intestines* - Menetrier's disease primarily **affects the stomach**, specifically leading to excessive growth of the gastric mucosa. - It does not typically involve the **small intestines**, which differentiates it from other gastrointestinal diseases. *There is increased gastric acid secretion* - In Menetrier's disease, there is actually a **decreased gastric acid secretion** due to the alteration of gastric mucosal structure. - This condition leads to **hypochlorhydria**, contrasting with conditions that increase acid secretion like Zollinger-Ellison syndrome. *Atrophied mucosal folds are seen* - Menetrier's disease is marked by **hypertrophy of the gastric folds**, not atrophy, resulting in **enlarged rugae** within the stomach. - Atrophied mucosal folds are more associated with conditions like chronic atrophic gastritis.

Question 1206: All of the following statements about Gastrointestinal carcinoid tumors are true, Except:

A. Small intestine and appendix account for almost 60% of all gastrointestinal carcinoid
B. Rectum is spared (Correct Answer)
C. Appendicial carcinoids are more common in females than males
D. 5 year survival for carcinoid tumors is >60%

Explanation: ***Rectum is spared*** - This statement is **incorrect**; carcinoid tumors can occur in the rectum, which is often **affected** by such tumors. - It is more accurate to say that carcinoid tumors arise in various gastrointestinal locations, including the **rectum** itself. *Small intestine and appendix account for almost 60% of all gastrointestinal carcinoid* - This statement is **true**; small intestine and appendix are indeed significant sites for carcinoid tumors, together accounting for nearly **60% of cases**. - These locations are particularly prominent due to the number of neuroendocrine cells found in these areas of the **gastrointestinal tract** [1][2]. *5 year survival for carcinoid tumors is >60%* - This statement is **true**, as many patients with localized carcinoid tumors exhibit a **5-year survival rate** greater than 60%. - Survival rates vary depending on the tumor's stage and location, but overall, they tend to have a favorable prognosis when diagnosed early. *Appendicial carcinoids are more common in females than males* - This statement is **true**; studies indicate that appendiceal carcinoids are indeed more frequently diagnosed in **females** compared to males [2]. - This differentiation is one of the notable epidemiological trends observed with carcinoid tumors.

Question 1207: If 90% of the jejunum and ileum is removed, which of the following features will NOT be seen?

A. Steatorrhoea
B. Diarrhoea
C. Weight gain (Correct Answer)
D. Megaloblastic anemia

Explanation: ***Weight gain*** - Extensive **resection of the jejunum and ileum** (90% removal) significantly reduces the absorptive surface area of the small intestine [3]. - This severe malabsorption of nutrients, including fats and carbohydrates, would lead to **weight loss** due to calorie deficit, not weight gain [2]. *Steatorrhoea* - The ileum is crucial for the absorption of **bile acids**; its extensive removal leads to bile acid malabsorption [1]. - Reduced bile acid reabsorption impairs **fat emulsification and absorption**, resulting in increased fat in the stool and causing steatorrhoea [1]. *Diarrhoea* - Loss of significant length of the ileum and jejunum reduces the ability to absorb water and electrolytes, leading to increased luminal fluid [3]. - The unabsorbed bile acids reaching the colon also act as **secretagogues**, further contributing to osmotic and secretory diarrhea. *Megaloblastic anemia* - The terminal ileum is the primary site for the absorption of **vitamin B12** (cobalamin), which binds to intrinsic factor produced by the stomach. - Extensive ileal resection would severely impair vitamin B12 absorption, leading to a deficiency that manifests as **macrocytic, megaloblastic anemia** [2].

Question 1208: Which of the following is used to decrease the duration and severity of acute diarrhea?

A. Zn (Correct Answer)
B. Mg
C. Fe
D. Ca

Explanation: ***Zn*** - **Zinc supplementation** has been shown to reduce the **duration** and **severity** of acute diarrhea, particularly in children in developing countries [1]. - It plays a crucial role in **immune function** and **intestinal integrity**, which helps in recovery from diarrheal episodes [1]. *Mg* - **Magnesium** is an essential mineral, but it is not directly used to decrease the duration or severity of acute diarrhea. - In fact, high doses of magnesium can act as a **laxative** and may worsen diarrhea. *Fe* - **Iron** is vital for red blood cell formation and oxygen transport, but it does not directly impact the duration or severity of acute diarrhea. - Iron supplementation is primarily used to treat **anemia**. *Ca* - **Calcium** is important for bone health and various metabolic processes, but it is not a primary intervention for reducing the duration or severity of acute diarrhea. - While sometimes used for mild digestive issues, it does not have the same evidence base as zinc for acute diarrhea.

Question 1209: All of the following are features of Zollinger Ellison syndrome except:

A. Severe diarrhoea
B. Beta cell tumours of the pancreas (Correct Answer)
C. Very high acid output
D. Intractable peptic ulcers

Explanation: ***Beta cell tumours of the pancreas*** - Zollinger-Ellison syndrome (ZES) is caused by **gastrinomas**, which are **neuroendocrine tumors** that typically arise from the **gastrin-producing G cells**, not the insulin-producing beta cells, of the pancreas or duodenum. - While pancreatic tumors are common in ZES, they are specifically **gastrinomas**, leading to excessive gastrin secretion. *Severe diarrhoea* - This is a common feature of ZES resulting from the **high acid output** reaching the small intestine. - The excessive acid inactivates pancreatic lipase, leading to **maldigestion** and stimulates fluid and electrolyte secretion, causing secretory diarrhea. *Very high acid output* - ZES is characterized by the **overproduction of gastrin**, which stimulates the parietal cells of the stomach to secrete large amounts of **hydrochloric acid**. - This leads to a significantly **increased basal and maximal acid output** in the stomach. *Intractable peptic ulcers* - The extremely high gastric acid secretion in ZES causes **multiple, recurrent, and often refractory peptic ulcers**, which can be located in atypical sites such as the jejunum. - These ulcers are typically difficult to treat with standard anti-ulcer medications due to the persistent gastric hypersecretion.

Question 1210: A 45 year old lawyer presents with pain in the abdomen more so in the epigastric region that worsens with eating spicy food and is relieved by bending forward. Complications of the above mentioned condition could be all except:

A. Splenic Vein Thrombosis (Correct Answer)
B. Bleeding
C. Gastric Outlet Obstruction
D. Perforation

Explanation: ***Splenic Vein Thrombosis*** - The patient's symptoms (epigastric pain worsening with spicy food, relieved by bending forward) are highly suggestive of **pancreatitis**, not peptic ulcer disease [1]. **Splenic vein thrombosis** is a known complication of chronic pancreatitis due to inflammation and compression of the splenic vein [2]. - While pancreatitis can cause significant morbidity, **splenic vein thrombosis** is a specific vascular complication associated with prolonged inflammation of the pancreas, leading to localized portal hypertension and potentially isolated gastric varices. *Perforation* - **Perforation** (specifically of a peptic ulcer or potentially surrounding bowel in severe pancreatitis) is a severe complication that can occur in conditions causing abdominal pain, but it is not the *exception* among the given options for the likely underlying condition indicated by the patient's symptoms (pancreatitis) [3]. - This complication typically leads to **peritonitis**, a medical emergency requiring immediate surgical intervention [3]. *Bleeding* - **Bleeding** (e.g., from a pancreatic pseudocyst rupturing into the gastrointestinal tract or from localized varices secondary to portal hypertension in pancreatitis) is a recognized complication of the patient's likely underlying condition [1]. - Gastrointestinal bleeding can also result from **gastric erosions** or ulcers exacerbated by ongoing inflammation. *Gastric Outlet Obstruction* - **Gastric outlet obstruction** can occur as a complication of severe or chronic pancreatitis, often due to **inflammation**, **fibrosis**, or **pseudocyst formation** compressing the duodenum [1]. - This typically presents with **postprandial vomiting** and early satiety, which can arise in the context of chronic pancreatic inflammation.

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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