Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1251: Which of the following is not included in the Child-Turcotte-Pugh scoring system?

A. Encephalopathy
B. ALT (Correct Answer)
C. Albumin
D. Ascites

Explanation: ***ALT*** - The **Child-Turcotte-Pugh (CTP) score** assesses the severity of **liver cirrhosis** and its prognosis, using parameters like bilirubin, albumin, INR, ascites, and encephalopathy. [1] - **Alanine aminotransferase (ALT)** levels are indicators of hepatocellular injury or inflammation but are not used in the CTP scoring system for chronic liver disease severity. [1] *Encephalopathy* - **Hepatic encephalopathy** is a crucial component of the CTP score, reflecting the liver's inability to detoxify harmful substances. [1] - Its presence and severity (graded 1-4) strongly correlate with a worse prognosis in **cirrhotic patients**. *Albumin* - **Albumin** levels are inversely correlated with the severity of liver dysfunction, as synthetic function of the liver declines. [1] - Low albumin (hypoalbuminemia) indicates poor **synthetic capacity** of the liver and is a prognostic marker in the CTP score. [1] *Ascites* - **Ascites**, the accumulation of fluid in the abdominal cavity, is a common complication of **portal hypertension** in advanced liver disease. [1] - Its presence and refractoriness are critical components of the CTP score, indicating significant fluid imbalance and circulatory dysfunction. [1]

Question 1252: Monu, a 30-year-old male with a history of chronic alcoholism, presents with sudden onset of epigastric pain that radiates to the back. All are seen except:

A. Hypocalcaemia
B. Increased serum amylase
C. Low serum lipase (Correct Answer)
D. Increased LDH

Explanation: ***Low serum lipase*** - In **acute pancreatitis**, serum lipase levels are typically **elevated**, not low, due to the inflammation and damage to pancreatic acinar cells. - A low serum lipase level would indicate a lack of pancreatic enzyme release, which contradicts the classic presentation of acute pancreatitis. *Increased LDH* - **Lactate dehydrogenase (LDH)** can be elevated in **severe acute pancreatitis**, indicating **tissue necrosis** and cell damage. - Elevated LDH is a marker of organ damage and can be used as an indicator of prognosis in acute pancreatitis, particularly in established scoring systems like Ranson's criteria. *Hypocalcaemia* - **Hypocalcaemia** can occur in acute pancreatitis due to the **saponification of peripancreatic fat** by free fatty acids, which binds calcium. - This is a serious complication, and severe hypocalcemia can lead to adverse outcomes like tetany and cardiac arrhythmias. *Increased serum amylase* - **Elevated serum amylase** is a hallmark finding in **acute pancreatitis**, typically rising within hours of onset. - Amylase levels are generally at least **three times the upper limit of normal** to be diagnostic of acute pancreatitis.

Question 1253: What does the MELD diagnostic score predict in patients awaiting liver transplantation?

A. Higher score - less mortality risk
B. Predicts mortality risk for a 60 day period
C. It is a 4 to 60 scale
D. Predicts mortality in patients waiting for liver transplant (Correct Answer)

Explanation: ***Predicts mortality in patients waiting for liver transplant*** - The **Model for End-Stage Liver Disease (MELD)** score was developed to predict **mortality risk** in patients with severe liver disease [1]. - It is crucial for **prioritizing patients** on the liver transplant waiting list, ensuring those with the greatest immediate need receive organs first. *Higher score - less mortality risk* - A **higher MELD score** indicates **more severe liver disease** and a **higher risk of mortality**, not less [1]. - The scoring system is designed to identify patients who are most critically ill and therefore have a greater need for transplantation [1]. *Predicts mortality risk for a 60 day period* - The MELD score was originally developed to predict **3-month (90-day) mortality** in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) procedures. - While it's used for short-term prediction, 60 days is not the standard predictive period. *It is a 4 to 60 scale* - The MELD score typically ranges from **6 to 40**, although extreme clinical conditions can lead to scores outside this range in rare cases. - A score of 4 would be unusually low and not reflective of the calculated range based on its components.

Question 1254: H. pylori infection is associated with an increased risk of

A. Proximal gastric cancer
B. Carcinoma of body and pylorus of stomach (Correct Answer)
C. Carcinoma of duodenum first part
D. Carcinoma involving gastroesophageal junction

Explanation: ***Carcinoma of body and pylorus of stomach*** - *H. pylori* infection is a well-established risk factor for **gastric adenocarcinoma**, most commonly affecting the **distal stomach (body and pylorus)** [1]. - Chronic inflammation induced by *H. pylori* leads to atrophy, intestinal metaplasia, dysplasia, and ultimately, carcinoma in these regions [1]. *Proximal gastric cancer* - **Proximal gastric cancers**, particularly those involving the **cardia**, are less strongly associated with *H. pylori* infection. - The prevalence of *H. pylori* in cardia gastric cancer is lower compared to distal gastric cancer. *Carcinoma of duodenum first part* - **Duodenal carcinoma** is a rare malignancy, and its association with *H. pylori* is not significant [2]. - While *H. pylori* can cause duodenal ulcers, it does not typically lead to cancer in the duodenum [2]. *Carcinoma involving gastroesophageal junction* - **Gastroesophageal junction (GEJ) adenocarcinoma** has been *inversely* associated with *H. pylori* infection in some studies. - The development of GEJ cancer is more strongly linked to **gastroesophageal reflux disease (GERD)** and **Barrett's esophagus** [3].

Question 1255: A 25-year-old woman presents with bloody diarrhea and is diagnosed with ulcerative colitis. Which of the following conditions is least likely to be associated with it?

A. Iritis
B. Ankylosing spondylitis
C. Pancreatitis (Correct Answer)
D. Sclerosing cholangitis

Explanation: ***Pancreatitis*** - While **pancreatitis** can occur with inflammatory bowel disease, it is generally considered a less common extraintestinal manifestation of **ulcerative colitis**. [1] - Other conditions like primary sclerosing cholangitis and ocular/arthritic manifestations have a stronger and more frequent association. [2] *Sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is strongly associated with ulcerative colitis, affecting a significant portion of patients. [3] - It involves progressive inflammation and fibrosis of the **bile ducts**, leading to cholestasis and liver damage. [3] *Iritis* - **Iritis** (anterior uveitis) is a known extraintestinal manifestation of inflammatory bowel disease, including ulcerative colitis. [2] - It presents with **eye pain, redness, and photophobia**, and requires prompt ophthalmologic evaluation. [2] *Ankylosing spondylitis* - **Ankylosing spondylitis** is a seronegative spondyloarthropathy that has a strong association with ulcerative colitis. [4] - It causes **chronic inflammatory back pain** and stiffness, predominantly affecting the spine and sacroiliac joints. [4]

Question 1256: A child presents with massive hematemesis and systemic hypotension, with no fever or other significant history. Examination reveals massive splenomegaly but no hepatomegaly. What is the likely diagnosis?

A. Hepatocellular carcinoma
B. Bleeding duodenal ulcer
C. Oesophageal varices
D. Non-cirrhotic portal fibrosis (Correct Answer)

Explanation: ***Non-cirrhotic portal fibrosis*** - This condition is characterized by **portal hypertension** [1] without cirrhosis, often leading to **splenomegaly** and **esophageal varices** due to increased portal vein pressure. - The massive hematemesis and hypotension, coupled with massive splenomegaly and normal liver size, are highly suggestive of **variceal bleeding** secondary to portal hypertension from non-cirrhotic portal fibrosis [1]. *Hepatocellular carcinoma* - While it can cause gastrointestinal bleeding and systemic symptoms, it typically presents with **hepatomegaly** and signs of liver dysfunction, which are absent here. - **Splenomegaly without hepatomegaly** would be unusual for primary hepatocellular carcinoma unless advanced portal vein thrombosis is also present. *Bleeding duodenal ulcer* - A bleeding duodenal ulcer would cause **hematemesis** and **hypotension** [2], but it does not typically cause **massive splenomegaly**. - Its presentation is usually associated with epigastric pain or dyspepsia, which is not mentioned. *Oesophageal varices* - While esophageal varices are the **direct cause of the hematemesis**, they are a **manifestation** of an underlying condition like non-cirrhotic portal fibrosis, not the primary diagnosis. - The question asks for the "likely diagnosis," implying the root cause of the varices and splenomegaly, not just the bleeding source.

Question 1257: A 43-year-old patient presents to the emergency department with chest pain, has a history of chronic alcoholism, and had an episode of vomiting with bright red blood. Endoscopy reveals a partial-thickness tear in the distal oesophagus. What is the diagnosis?

A. None of the options
B. Boerhaave syndrome
C. Alcoholic liver disease
D. Mallory-Weiss tears (Correct Answer)

Explanation: ***Mallory-Weiss tears*** - This condition involves a **partial-thickness tear** in the **distal oesophagus** due to forceful vomiting, often seen in association with **chronic alcoholism**. [1] - The presence of **bright red blood** in the vomitus after an episode of vomiting strongly suggests a Mallory-Weiss tear. [1] *Boerhaave syndrome* - This diagnosis typically presents with a **full-thickness oesophageal rupture**, leading to mediastinitis and sepsis, which is a more severe condition than a partial tear. - While also associated with forceful vomiting, the endoscopic finding of a **partial tear** rules out Boerhaave syndrome. *Alcoholic liver disease* - While the patient has a history of **chronic alcoholism**, liver disease itself does not directly cause an oesophageal tear or bleeding from vomiting. - Alcoholic liver disease can lead to **oesophageal varices**, but the endoscopy specifically found a tear, not variceal bleeding. *None of the options* - **Mallory-Weiss tears** perfectly match the clinical presentation of chronic alcoholism, forceful vomiting, bright red blood, and the endoscopic finding of a partial-thickness tear in the distal oesophagus.

Question 1258: Linitis plastica is a feature of which of the following conditions?

A. Hiatus hernia
B. Chronic gastric ulcer
C. Lymphoma of the stomach
D. Diffuse carcinoma of the stomach (Correct Answer)

Explanation: ***Diffuse carcinoma of the stomach*** - **Linitis plastica** is characterized by **thickening of the gastric wall**, commonly seen in diffuse gastric carcinoma. - This type of cancer leads to a **rigid and infiltrative appearance** of the stomach upon imaging or endoscopy. *Hiatus hernia* - Primarily involves **herniation of abdominal organs** through the diaphragm, not affecting the gastric wall thickness. - Symptoms include **reflux** and **esophageal discomfort**, which are distinct from linitis plastica. *Chronic gastric ulcer* - Associated with localized **ulceration**, causing tissue destruction but not the **widespread wall thickening** seen in linitis plastica. - The typical presentation is with **epigastric pain** and **bleeding**, rather than a rigid stomach wall. *Lymphoma of the stomach* - While gastric lymphoma can cause **thickening**, it typically presents differently, often with **mass lesions** rather than diffuse wall changes [1]. - Symptoms include **abdominal pain** and **weight loss**, but do not match the characteristic linitis plastica findings.

Question 1259: The commonest cause of significant lower gastrointestinal bleeding in a middle-aged person with an unknown reason is?

A. Angiodysplasia
B. Ischemic colitis
C. Ulcerative colitis
D. Sigmoid diverticula (Correct Answer)

Explanation: ### Sigmoid diverticula - **Diverticulosis** is highly prevalent in middle-aged and older adults, and **diverticular bleeding** is the most common cause of significant lower GI bleeding in this demographic [1]. - Bleeding typically results from rupture of the **vasa recta** overlying a diverticulum and is often **painless** and profuse [1]. ### Angiodysplasia - While it is a common cause of lower GI bleeding, particularly in older individuals with **aortic stenosis** or **renal failure**, it is generally less common than diverticular bleeding as the overall *commonest* cause in a middle-aged person [1]. - Bleeding from angiodysplasia is often **slow and chronic**, leading to iron deficiency anemia, though it can present as acute bleeding [1]. ### Ischemic colitis - Occurs due to temporary reduction in blood flow to a segment of the colon, commonly presenting with **abdominal pain**, **tenderness**, and **bloody diarrhea** [2]. - While it causes bleeding, it is typically accompanied by significant pain and is not usually the *commonest* cause of acute, significant, and otherwise unexplained lower GI bleeding [2]. ### Ulcerative colitis - A form of **inflammatory bowel disease** characterized by diffuse inflammation and ulceration of the colonic mucosa, typically presenting with **bloody diarrhea**, **abdominal cramps**, and **tenesmus**. - While it causes significant lower GI bleeding, it usually has other prominent symptoms and is less common than diverticular disease in the general middle-aged population presenting with unexplained bleeding.

Question 1260: Which of the following is a feature of ulcerative colitis?

A. Spiking fever
B. Proctitis (Correct Answer)
C. Fistula formation
D. Cobble stone mucosa

Explanation: ***Proctitis*** - **Proctitis**, or inflammation of the rectum, is a hallmark feature of ulcerative colitis as the disease always begins in the rectum and can extend proximally [1]. - Patients typically experience **tenesmus**, urgency, and bloody diarrhea due to rectal involvement. *Spiking fever* - While patients with severe ulcerative colitis can experience fever, a **spiking fever** is less common than in other inflammatory conditions or infections. - Fever is a more common and prominent symptom in **Crohn's disease**, particularly with perianal complications or abscesses. *Fistula formation* - **Fistulas** (abnormal connections between organs or to the skin) are a characteristic complication of **Crohn's disease**, not ulcerative colitis. - Ulcerative colitis affects only the **mucosa** and submucosa, making transmural inflammation and fistula formation rare [1]. *Cobble stone mucosa* - **Cobblestone mucosa**, characterized by linear ulcers interspersed with edematous, normal-appearing mucosa, is a classic endoscopic finding in **Crohn's disease**. - In contrast, ulcerative colitis presents with **diffuse, continuous inflammation** and ulceration without skip lesions or cobblestoning [1].

Practice by Chapter

Esophageal Disorders

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Peptic Ulcer Disease

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Inflammatory Bowel Disease

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Irritable Bowel Syndrome

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Malabsorption Syndromes

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Pancreatitis (Acute and Chronic)

Practice Questions

Gastrointestinal Bleeding

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Liver Diseases and Cirrhosis

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Viral Hepatitis

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Biliary Tract Disorders

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Gastrointestinal Motility Disorders

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Gastrointestinal Malignancies

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