Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1221: Genitourinary complication of ulcerative colitis

A. Urinary calculi (Correct Answer)
B. Pyelonephritis
C. Urethritis
D. Cystitis

Explanation: ***Urinary calculi*** - Patients with ulcerative colitis are at an increased risk of developing **urinary calculi** due to several factors, including chronic dehydration, malabsorption of fats leading to increased oxalate absorption (enteric hyperoxaluria), and altered urine composition. - The inflammatory process and potential for surgical interventions (e.g., colectomy with ileostomy) can further predispose individuals to kidney stone formation. *Cystitis* - While cystitis (bladder inflammation) can occur in the general population, it is not considered a specific or significantly elevated genitourinary complication directly linked to the pathogenesis of ulcerative colitis itself. - It results primarily from bacterial infection, and there is no direct evidence suggesting UC patients have a higher intrinsic risk compared to the general population. *Pyelonephritis* - Pyelonephritis (kidney infection) is not a direct or common complication of ulcerative colitis. - It is typically caused by bacterial ascent from the lower urinary tract and is not specifically promoted by the inflammatory processes or metabolic changes associated with UC. *Urethritis* - Urethritis (inflammation of the urethra) is primarily associated with sexually transmitted infections or irritation and is not a recognized genitourinary complication directly caused by ulcerative colitis. - There is no increased incidence of urethritis in UC patients compared to the general population.

Question 1222: Extraintestinal manifestations of Inflammatory bowel disease include all of the following, Except:

A. Sclerosing cholangitis
B. Skin nodules
C. Osteoarthritis (Correct Answer)
D. Uveitis

Explanation: ***Osteoarthritis*** - **Osteoarthritis** is a **degenerative joint disease** caused by wear and tear on cartilage, and it is **not** an extraintestinal manifestation of IBD [3]. - While patients with IBD can develop osteoarthritis, it does not share the same **pathophysiological link** to the inflammatory process of IBD as other extraintestinal manifestations. *Uveitis* - **Uveitis** is an inflammation of the **uvea** (middle layer of the eye) and is a well-recognized ocular extraintestinal manifestation of IBD [2]. - It can cause eye pain, redness, and blurred vision, and its severity may correlate with IBD disease activity. *Sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the **bile ducts**, and it is strongly associated with **ulcerative colitis** [1]. - It often progresses to **cirrhosis** and liver failure and is a significant extraintestinal manifestation. *Skin nodules* - **Erythema nodosum** and **pyoderma gangrenosum** are common cutaneous extraintestinal manifestations of IBD, often presenting as **painful red nodules** or ulcers on the skin [2]. - These skin conditions are thought to be immune-mediated and often parallel the activity of the underlying inflammatory bowel disease.

Question 1223: Which of the following is NOT an indication for a liver biopsy?

A. Amoebic hepatitis (Correct Answer)
B. Chronic hepatitis B and C
C. Autoimmune hepatitis
D. Wilson's disease

Explanation: ***Amoebic hepatitis*** - Liver biopsy is **not routinely indicated** for amoebic hepatitis as diagnosis is typically made through clinical history and serological tests. - The condition is usually managed with **medications** rather than requiring invasive procedures like a biopsy. *Wilson's disease* - Liver biopsy is important for assessing **copper accumulation** in Wilson's disease, establishing a diagnosis. - It may also provide information regarding the extent of **hepatocellular damage**. *Chronic hepatitis B and C* - In chronic hepatitis B and C, liver biopsy is crucial to evaluate the **degree of fibrosis** and hepatic inflammation. - It assists in determining the need for **antiviral therapy** and prognostication. *Autoimmune hepatitis* - Liver biopsy helps confirm the diagnosis of autoimmune hepatitis and assess the **severity of liver damage**. [1] - It also aids in monitoring the response to **immunosuppressive therapy**. [1] **Note on technique:** Percutaneous liver biopsy requires specific conditions for safety, such as cooperative patients and adequate coagulation profiles. [2]

Question 1224: Which of the following is not a recognized complication of chronic pancreatitis?

A. Renal artery thrombosis (Correct Answer)
B. Pancreatic pseudocyst
C. Splenic vein thrombosis
D. Pancreatic fistula

Explanation: ***Renal artery thrombosis*** - **Renal artery thrombosis** is generally associated with conditions like **atherosclerosis**, atrial fibrillation, or vasculitis, not directly with chronic pancreatitis. - While chronic pancreatitis can lead to systemic complications, direct renal arterial clotting is an atypical and **uncommon sequela**. *Pancreatic pseudocyst* - **Pancreatic pseudocysts** are common complications of chronic pancreatitis, occurring when fluid collections around the pancreas become walled off by fibrous tissue [1]. - They can cause pain, obstruction, and even rupture if left untreated [2]. *Splenic vein thrombosis* - **Splenic vein thrombosis** can result from inflammation and compression of the splenic vein by the diseased pancreatic tissue in chronic pancreatitis [1]. - This can lead to **splenomegaly** and **gastric varices** due to increased pressure in the portal system. *Pancreatic fistula* - A **pancreatic fistula** occurs when pancreatic fluid leaks from the gland, often forming a connection to another organ or the skin [2]. - This is a well-recognized complication of both acute and chronic pancreatitis, usually due to ductal disruption.

Question 1225: In the context of hemorrhagic pancreatitis, which sign is indicated by bluish discoloration of the flank?

A. Grey Turner's sign (Correct Answer)
B. Cullen's sign
C. Trousseau's sign
D. None of the options

Explanation: ***Grey Turner's sign*** - This sign refers to **bluish discoloration of the flank** due to **hemorrhage** into the retroperitoneal space, commonly seen in severe hemorrhagic pancreatitis. [1] - The discoloration is caused by **peripancreatic inflammation** and fat necrosis, leading to localized bleeding. *Cullen's sign* - Cullen's sign is characterized by **bluish discoloration around the umbilicus**. - It is also indicative of **retroperitoneal hemorrhage**, but specifically in the periumbilical region. *Trousseau's sign* - This sign refers to **carpal spasm** induced by inflating a blood pressure cuff above systolic pressure for several minutes. - It is indicative of **hypocalcemia**, not hemorrhage, and is seen in conditions like pancreatitis that cause low calcium levels. *None of the options* - This option is incorrect because **Grey Turner's sign** specifically describes the bluish discoloration of the flank associated with hemorrhagic pancreatitis.

Question 1226: All of the following are causes of hemobilia, EXCEPT:

A. Trauma to Abdomen
B. Hepatitis (Correct Answer)
C. Rupture of hepatic artery aneurysm
D. Malignancy

Explanation: ***Hepatitis*** - **Hepatitis** is an inflammation of the liver, typically caused by viral infections, alcohol, or autoimmune processes. While it can lead to liver damage and dysfunction, it does not typically cause **hemobilia**. - **Hemobilia** involves bleeding into the biliary tree, which is usually a result of vascular-biliary fistula formation; hepatitis primarily affects liver parenchymal cells and does not directly result in this type of bleeding. *Trauma to Abdomen* - **Abdominal trauma**, especially liver injuries, can lead to **vascular-biliary fistulae** or direct bleeding into the bile ducts, causing **hemobilia**. - Blunt or penetrating trauma can damage the liver parenchyma and blood vessels, allowing blood to enter the biliary system. *Malignancy* - **Malignant tumors** of the liver or biliary tract (e.g., **cholangiocarcinoma**, **hepatocellular carcinoma**) can erode into blood vessels and bile ducts, leading to **hemobilia**. - The growth of these tumors can rupture fragile vessels within the tumor or adjacent to it, causing blood to leak into the biliary tree. *Rupture of hepatic artery aneurysm* - A ruptured **hepatic artery aneurysm** is a significant and direct cause of **hemobilia**. - The forceful bleeding from the artery can breach the wall of an adjacent bile duct, creating a **fistula** and allowing arterial blood to enter the biliary system.

Question 1227: All of the following are features of Obstructive jaundice except:

A. Clay colour stools
B. Pruritis
C. Normal alkaline phosphatase (Correct Answer)
D. Elevated serum aminotransferases level

Explanation: ***Normal alkaline phosphatase*** - In obstructive jaundice, alkaline phosphatase is typically **elevated** due to bile duct obstruction [2]. - A **normal level** suggests that the jaundice may not be of obstructive origin. *Pruritis* - Often seen in obstructive jaundice due to **bile salts** accumulating in the bloodstream, leading to itching. - It is a common symptom associated with **cholestasis**. *Mildly elevated serum aminotransferases level* - In obstructive jaundice, serum aminotransferases are usually elevated, though may be mildly in early cases [1]. - This reflects liver involvement, which is consistent with biliary obstruction [2]. *Clay colour stools* - Clay-colored stools arise from the absence of **bile** in the intestines, indicative of obstruction [3]. - This is a direct result of blockage in the bile duct system affecting stool pigmentation [3].

Question 1228: What is the drug of choice for bleeding oesophageal varices?

A. Ethanolamine oleate
B. Octreotide (Correct Answer)
C. Propanolol
D. Phytonadione

Explanation: ***Octreotide*** - **Octreotide** is an analogue of **somatostatin** that reduces splanchnic blood flow and portal pressure, thereby decreasing bleeding from esophageal varices. - It is often used in the acute management of **bleeding esophageal varices** due to its rapid onset of action and favorable safety profile. *Ethanolamine oleate* - **Ethanolamine oleate** is a **sclerosing agent** used for endoscopic sclerotherapy of esophageal varices, not typically as the initial drug of choice for acute bleeding [1]. - It acts by causing inflammation and fibrosis of the varices, which can be effective but carries risks such as **esophageal ulceration** or perforation. *Propranolol* - **Propranolol** is a **non-selective beta-blocker** used for the prophylactic prevention of variceal bleeding, not for acute management of active bleeding. - It works by reducing portal venous pressure by decreasing cardiac output and splanchnic vasoconstriction. *Phytonadione* - **Phytonadione** (vitamin K1) is used to reverse **coumarin anticoagulant effects** or to treat **vitamin K deficiency**, which can contribute to bleeding but is not a direct treatment for variceal bleeding itself. - It helps in the synthesis of **coagulation factors II, VII, IX, and X**, thereby improving clotting.

Question 1229: What is the most common location of gastrinoma?

A. Pancreas
B. Duodenum (Correct Answer)
C. Jejunum
D. Gall bladder

Explanation: ***Duodenum*** - The **duodenum** is the most common site for gastrinomas, accounting for over **half of all cases**, particularly in sporadic gastrinoma and Zollinger-Ellison syndrome. - These tumors are often **small** and **multiple** in the duodenum, making them challenging to locate. *Pancreas* - Pancreatic gastrinomas are also common, representing approximately **25-40% of cases**, but are less frequent than duodenal gastrinomas. - Pancreatic gastrinomas tend to be **larger** and more amenable to surgical resection when compared to duodenal gastrinomas. *Jejunum* - Gastrinomas found in the jejunum are **rare**, accounting for only a small percentage of cases. - The small intestine distal to the duodenum is an **uncommon site** for primary gastrinoma formation. *Gall bladder* - The **gallbladder** is not a typical location for gastrinoma development. - Gastrinomas are neuroendocrine tumors that arise from **gastrin-producing cells**, which are not found in the gallbladder.

Question 1230: Which of the following statements about Gilbert syndrome is false?

A. Normal liver histology
B. Autosomal dominant
C. Elevated bilirubin levels are present
D. Causes cirrhosis (Correct Answer)

Explanation: ***Causes cirrhosis*** - **Gilbert syndrome** is a benign condition characterized by intermittent unconjugated hyperbilirubinemia and does **not lead to cirrhosis** [1]. - Cirrhosis is a severe form of **liver scarring** resulting from chronic damage, which is not a feature of Gilbert syndrome. *Normal liver histology* - The liver structure and function in individuals with Gilbert syndrome are typically **normal**, distinguishing it from other liver disorders [2]. - Histological examination of liver biopsies usually reveals no abnormalities, reflecting the **benign nature** of the condition. *Autosomal dominant* - Gilbert syndrome is inherited in an **autosomal recessive** pattern, not autosomal dominant [2]. - It results from a reduction in the activity of the **UGT1A1 enzyme**, which is responsible for bilirubin conjugation [1], [2]. *Elevated bilirubin levels are present* - Individuals with Gilbert syndrome experience **intermittent unconjugated hyperbilirubinemia**, meaning their indirect bilirubin levels are elevated [3]. - This elevation is usually mild and can be exacerbated by stress, fasting, or illness, but it is typically **harmless** [1], [2].

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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