Gastroenterology — MCQs

A 48-year-old female patient presented to the outpatient department with complaints of intermittent dysphagia limited to solids, accompanied by weakness, fatigue, and dyspnea, for 2 months. On examination, she exhibited angular cheilitis, glossitis, koilonychia, and pallor. Laboratory findings revealed iron deficiency anemia. A barium swallow was performed, followed by upper GI endoscopy. Which of the following is the most likely diagnosis?

Q1247

A patient with biliary atresia is more prone to the deficiency of:

Q1248

The most common cause of death in peptic ulcer patients is:

Q1249

What is the primary vascular abnormality associated with intestinal angiodysplasia?

Q1250

A 60-year-old male presents with progressive difficulty in swallowing, vomiting, and occasional regurgitation for the past three months. Barium studies show marked dilatation of the upper esophagus with narrowing of the lower segment. Manometry shows absent esophageal peristalsis. Which of the following conditions is he most likely at risk of developing?

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1241: What is the most common site of gastrointestinal stromal tumors (GISTs)?

A. Ileum
B. Esophagus
C. Colon
D. Stomach (Correct Answer)

Explanation: Stomach - The stomach is the most common site for gastrointestinal stromal tumors (GISTs), accounting for approximately 60-70% of cases. - GISTs in the stomach often present with symptoms like abdominal pain or bleeding and are associated with mutations in the KIT gene. Ileum - Although GISTs can occur in the ileum, they are far less common than those found in the stomach, representing about 10-15% of cases [1]. - GISTs in the ileum tend to present differently, often with intestinal obstruction or pain [1]. Esophagus - Esophageal GISTs are rare and account for only about 5% of GIST cases, making them an uncommon location. - Symptoms are usually related to dysphagia or chest pain, not typical for GISTs arising from more common sites. Colon - Although GISTs can occur in the colon, their frequency is much lower compared to the stomach and represents a small percentage of cases. - Clinical features in colonic GISTs can mimic other colorectal tumors, often causing obstruction or bleeding rather than classic GIST symptoms.

Question 1242: Anti-transglutaminase antibody is seen in?

A. Celiac disease (Correct Answer)
B. Systemic lupus erythematosus (SLE)
C. Collagenous colitis (CC)
D. Tropical sprue (TS)

Explanation: ***Celiac disease*** - Anti-transglutaminase antibodies are **highly specific and sensitive** for celiac disease, indicating an autoimmune response to gluten [1]. - This antibody is associated with **intestinal damage** and the clinical features of malabsorption in affected individuals. *Collagenous colitis* - This condition typically involves **chronic diarrhea** without the elevation of anti-transglutaminase antibodies. - The main feature is a **thickened collagen layer** in the intestinal wall, not directly related to gluten intolerance. *SLE* - Systemic lupus erythematosus (SLE) is associated with multiple autoantibodies, but **not specifically** anti-transglutaminase antibodies [1]. - Key features include **butterfly rash** and **renal involvement**, which are not relevant to gluten sensitivity. *Tropical sprue* - Characterized by **malabsorption**, often in travelers to tropical areas, but does not involve the presence of anti-transglutaminase antibodies [1]. - It is linked to deficiencies in **vitamin B12** and **folate**, rather than gluten-related disorders.

Question 1243: What is the most common cause of chronic liver disease?

A. Hepatitis B
B. Hepatitis A
C. Hepatitis C (Correct Answer)
D. Hepatitis E

Explanation: ***Hepatitis C*** - **Hepatitis C virus** (HCV) infection is a major cause of **chronic liver disease**, leading to **cirrhosis**, liver cancer, and the need for liver transplantation. [1] - Its high propensity for developing into a **chronic infection** (in 75-85% of cases) makes it a predominant cause of long-term liver damage. [1] *Hepatitis B* - While **Hepatitis B virus** (HBV) can cause chronic liver disease, a large proportion of acute infections in adults resolve spontaneously. - The chronicity rate for HBV is significantly lower in adults compared to HCV, although it is a high concern in perinatal transmission. *Hepatitis A* - **Hepatitis A virus** (HAV) typically causes an **acute, self-limiting infection** and does not lead to chronic liver disease. - Recovery is complete, and individuals develop lifelong immunity. *Hepatitis E* - **Hepatitis E virus** (HEV) infection is usually **acute and self-limiting**, similar to Hepatitis A. - Chronic HEV infection can occur in **immunocompromised individuals**, but it is relatively uncommon in the general population and not considered the most common cause of chronic liver disease overall.

Question 1244: Obstruction of the hepatic vein by thrombosis or a membranous web is known as

A. Plummer Vinson Syndrome
B. Budd-Chiari syndrome (Correct Answer)
C. Caroli's disease
D. Schatzki's ring (esophageal narrowing)

Explanation: ***Budd-Chiari syndrome*** - **Budd-Chiari syndrome** is specifically defined as the obstruction of outflow from the liver due to occlusion of the **hepatic veins** or the suprahepatic inferior vena cava [1]. - This obstruction can be caused by **thrombosis** or a **membranous web**, leading to hepatomegaly, ascites, and abdominal pain [1]. *Schatzki's ring (esophageal narrowing)* - A **Schatzki's ring** is a benign circumferential stenosis of the distal esophagus, typically at the **squamocolumnar junction**. - It primarily causes **dysphagia** (difficulty swallowing) for solids and has no relation to hepatic vein obstruction. *Plummer Vinson Syndrome* - **Plummer-Vinson syndrome** is a rare condition characterized by the triad of **iron deficiency anemia**, **dysphagia** (due to esophageal webs), and **glossitis**. - It involves the **upper gastrointestinal tract** and is unrelated to liver or hepatic venous outflow obstruction. *Caroli's disease* - **Caroli's disease** is a rare congenital disorder characterized by multifocal, segmental dilatation of the **intrahepatic bile ducts**. - It is associated with recurrent **cholangitis** and an increased risk of cholangiocarcinoma, but does not involve hepatic vein obstruction.

Question 1245: Referred pain to the inferior angle of the right scapula in acute cholecystitis is known as

A. Boa's sign (Correct Answer)
B. Murphy's sign
C. Naunyn's sign
D. Cullen's sign

Explanation: ***Boa's sign*** - This sign is characterized by **referred pain** to the **inferior angle of the right scapula** due to irritation of the **phrenic nerve** (C3-C5 dermatomes) by an inflamed gallbladder [1]. - The pain is typically felt unilaterally on the right side and is a classic presentation in **acute cholecystitis** [1]. *Murphy's sign* - This is a test for acute cholecystitis, characterized by **inspiratory arrest** upon deep palpation of the right upper quadrant under the costal margin [1]. - It indicates **visceral tenderness** of the gallbladder itself, rather than referred pain to the scapula. *Naunyn's sign* - This sign is not a recognized clinical sign associated with acute cholecystitis or referred pain patterns in common medical practice. - There might be confusion with other eponymous signs that are not directly related to gallbladder pathology and referred scapular pain. *Cullen's sign* - This sign refers to **periumbilical ecchymosis** (bruising around the umbilicus). - It is indicative of **retroperitoneal hemorrhage**, such as in acute pancreatitis [2] or ruptured ectopic pregnancy, not acute cholecystitis.

Question 1246: A 48-year-old female patient presented to the outpatient department with complaints of intermittent dysphagia limited to solids, accompanied by weakness, fatigue, and dyspnea, for 2 months. On examination, she exhibited angular cheilitis, glossitis, koilonychia, and pallor. Laboratory findings revealed iron deficiency anemia. A barium swallow was performed, followed by upper GI endoscopy. Which of the following is the most likely diagnosis?

A. Plummer-Vinson syndrome (Correct Answer)
B. Pill-induced esophageal stricture due to medication use
C. Heterotopic gastric mucosa causing esophageal narrowing
D. Achalasia cardia with progressive dysphagia for solids and liquids

Explanation: ***Plummer-Vinson syndrome*** - This syndrome is characterized by the triad of **iron deficiency anemia**, **dysphagia** (due to esophageal webs), and **esophageal webs**. - The patient's symptoms of intermittent dysphagia for solids, angular cheilitis, glossitis, koilonychia, and pallor are all consistent with chronic **iron deficiency**. *Pill-induced esophageal stricture due to medication use* - This usually presents with a history of taking certain medications (e.g., NSAIDs, bisphosphonates, antibiotics) causing esophageal irritation and inflammation. - While it can cause dysphagia, it typically doesn't present with the systemic signs of iron deficiency such as angular cheilitis or koilonychia. *Heterotopic gastric mucosa causing esophageal narrowing* - This congenital condition ("inlet patch") is usually asymptomatic but can cause symptoms like dysphagia or heartburn if it becomes inflamed or causes stricture. - It does not explain the associated **iron deficiency anemia** and its systemic manifestations. *Achalasia cardia with progressive dysphagia for solids and liquids* - **Achalasia** features dysphagia for both solids and liquids due to impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax [1]. - While it causes dysphagia, it is not directly linked to **iron deficiency anemia** or its mucocutaneous manifestations like glossitis and koilonychia [2].

Question 1247: A patient with biliary atresia is more prone to the deficiency of:

A. Vitamin K (Correct Answer)
B. Vitamin B12
C. Vitamin C
D. Niacin

Explanation: ***Vitamin K*** - Biliary atresia causes **impaired bile flow**, which is essential for the **absorption of fat-soluble vitamins** (A, D, E, K) from the small intestine [1], [2]. - **Vitamin K deficiency** leads to impaired synthesis of **prothrombin** and other clotting factors, increasing the risk of **bleeding diathesis** [1], [2]. *Vitamin B12* - **Vitamin B12 (cobalamin)** is a **water-soluble vitamin** whose absorption is not directly dependent on bile acids [4]. - Its absorption requires **intrinsic factor** secreted by gastric parietal cells, and is mainly affected in conditions like **pernicious anemia** or **Crohn's disease**. *Vitamin C* - **Vitamin C (ascorbic acid)** is a **water-soluble vitamin** and its absorption is not dependent on bile [3]. - Deficiency typically occurs due to **inadequate dietary intake** and leads to **scurvy** [3]. *Niacin* - **Niacin (Vitamin B3)** is a **water-soluble vitamin** and its absorption is not affected by biliary obstruction. - Deficiency mainly causes **pellagra**, characterized by the "3 Ds": **dermatitis**, **diarrhea**, and **dementia**.

Question 1248: The most common cause of death in peptic ulcer patients is:

A. Pyloric stenosis
B. Perforation
C. Hemorrhage (Correct Answer)
D. Malignancy

Explanation: ***Hemorrhage*** - **Gastrointestinal bleeding** is the most frequent and life-threatening complication of peptic ulcers, leading to significant morbidity and mortality [1]. - Bleeding can range from occult blood loss to **massive hematemesis** or **melena**, which can quickly cause **hypovolemic shock** and death if not promptly managed [1]. *Perforation* - While a serious complication, leading to **peritonitis**, perforation is less common as a cause of death compared to hemorrhage [2]. - Perforation typically causes acute, severe abdominal pain and requires urgent surgical intervention [2]. *Pyloric stenosis* - This complication involves narrowing of the pyloric outlet due to **scarring from chronic ulceration**, causing **gastric outlet obstruction**. - Pyloric stenosis is more associated with chronic symptoms like **vomiting** and **weight loss**, and while debilitating, it is rarely a direct cause of immediate death. *Malignancy* - The risk of **malignant transformation** is primarily associated with **gastric ulcers**, particularly those due to *H. pylori* infection, but it is not a direct, immediate cause of death in the acute setting of peptic ulcer disease [2]. - **Duodenal ulcers** are almost never malignant.

Question 1249: What is the primary vascular abnormality associated with intestinal angiodysplasia?

A. Arteriovenous malformation (Correct Answer)
B. Capillary hemangioma (usually superficial)
C. Malignant tumor
D. Cavernous hemangioma

Explanation: ***AV malformation*** - **Intestinal angiodysplasia** is characterized by abnormal **arteriovenous (AV) connections**, leading to vascular lesions in the gut [1]. - These malformations can cause **chronic gastrointestinal bleeding** due to fragility of the blood vessels [1]. *Capillary hemangioma* - This is a **benign vascular tumor** often found in the skin or subcutaneous tissue, not specifically associated with intestinal vascular changes. - **Capillary hemangiomas** typically do not cause significant gastrointestinal bleeding as seen in angiodysplasia. *Malignant tumor* - Intestinal angiodysplasia is a **benign condition** and not a malignant tumor, therefore it does not fit the characteristics of malignancy. - **Malignant tumors** usually present with different symptoms and underlying pathophysiology than angiodysplasia. *Cavernous hemangioma* - This type of hemangioma involves larger vascular channels and is typically more associated with the liver than the intestines. - **Cavernous hemangiomas** do not relate to the intestinal bleeding patterns seen in angiodysplasia.

Question 1250: A 60-year-old male presents with progressive difficulty in swallowing, vomiting, and occasional regurgitation for the past three months. Barium studies show marked dilatation of the upper esophagus with narrowing of the lower segment. Manometry shows absent esophageal peristalsis. Which of the following conditions is he most likely at risk of developing?

A. Mallory-Weiss syndrome
B. Peptic ulcer disease
C. Squamous cell carcinoma of the esophagus (Correct Answer)
D. Rupture of esophageal varices

Explanation: ***Squamous cell carcinoma of the esophagus*** - The patient's symptoms (dysphagia, regurgitation, esophageal dilation) and manometry findings (absent peristalsis) are characteristic of **achalasia** [1]. - Long-standing achalasia is a significant risk factor for developing **squamous cell carcinoma of the esophagus** due to chronic inflammation and irritation of the esophageal lining. *Mallory-Weiss syndrome* - This condition involves **longitudinal tears** in the esophageal mucosa, typically near the gastroesophageal junction, due to forceful vomiting or retching. - While the patient experiences vomiting, the underlying pathology of achalasia does not directly predispose to esophageal tears more than other conditions causing vomiting. *Peptic ulcer disease* - Peptic ulcers are typically caused by **Helicobacter pylori infection** or **NSAID use**, affecting the stomach or duodenum. - Achalasia is a primary motility disorder of the esophagus and does not directly increase the risk of developing peptic ulcers. *Rupture of esophageal varices* - Esophageal varices are **dilated submucosal veins** in the lower esophagus, almost always a result of **portal hypertension**, commonly due to liver cirrhosis. - Achalasia does not cause portal hypertension or directly lead to the formation of esophageal varices.

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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