Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1291: Achalasia cardia presents with all of the following except:

A. Increased lower esophagus sphincter tone
B. Normal peristalsis (Correct Answer)
C. Absence of peristalsis
D. Dysphagia

Explanation: ***Normal peristalsis*** - Achalasia is characterized by the **absence of esophageal peristalsis**, specifically in the distal two-thirds of the esophagus [1]. - The presence of normal peristalsis would argue against a diagnosis of achalasia, as it is a core defining feature of the condition. *Increased lower esophagus sphincter tone* - Achalasia is defined by **incomplete relaxation of the lower esophageal sphincter (LES)** and often an **elevated resting LES pressure** [1]. - This increased tone contributes significantly to the difficulty in swallowing experienced by patients. *Absence of peristalsis* - A definitive diagnostic feature of achalasia is the **loss of primary and secondary peristalsis** in the esophageal body [1]. - This motor dysfunction prevents effective propulsion of food into the stomach. *Dysphagia* - **Dysphagia for both solids and liquids** is the most common presenting symptom of achalasia, progressing over months to years [1]. - It results from the impaired esophageal motility and the incomplete relaxation of the LES [1].

Question 1292: Which of the following statements about celiac disease is false?

A. Diagnosis requires duodenal biopsy showing villous atrophy
B. Diarrhea, Malabsorption, iron deficiency anaemia
C. Celiac disease is caused by a viral infection. (Correct Answer)
D. Patients express HLA DQ2 or DQ8 haplotypes

Explanation: ### Celiac disease is caused by a viral infection - Celiac disease is an **autoimmune disorder**, not a viral infection, triggered by the ingestion of **gluten** in genetically predisposed individuals [1]. - The immune response causes inflammation and damage to the **small intestinal lining**. ### Diarrhea, Malabsorption, iron deficiency anaemia - These are **classic symptoms** and common complications of celiac disease due to the damage to the small intestinal villi, impairing nutrient absorption [1]. - **Malabsorption** leads to various deficiencies, including iron deficiency anemia [2]. ### Diagnosis requires duodenal biopsy showing villous atrophy - A definitive diagnosis typically involves an **endoscopic biopsy** of the small intestine, which reveals characteristic findings like **villous atrophy**, crypt hyperplasia, and increased intraepithelial lymphocytes [1]. - This **histological evidence** is crucial for confirming the diagnosis. ### Patients express HLA DQ2 or DQ8 haplotypes - The presence of **HLA-DQ2 or HLA-DQ8 Class II major histocompatibility complex (MHC) allelic variants** is a strong genetic predisposition for celiac disease [1]. - While necessary, these **haplotypes** are not sufficient for diagnosis, as many individuals with these genes never develop the condition.

Question 1293: Which of the following statements is true regarding ulcerative colitis?

A. String sign of kantor positive
B. Skip lesions are seen
C. Rectum is always involved (Correct Answer)
D. Fistulas are common

Explanation: ***Rectum is always involved*** - In **ulcerative colitis (UC)**, inflammation invariably begins in the **rectum** and extends proximally in a continuous fashion [1]. - This **proctitis** is a hallmark feature, making rectal involvement a near-universal finding in UC [1]. *String sign of kantor positive* - The **string sign of Kantor** is typically associated with **Crohn's disease**, particularly in the terminal ileum [2]. - It refers to the severe narrowing of a bowel segment due to inflammation, which is not characteristic of UC [2]. *Skip lesions are seen* - **Skip lesions**, which are areas of normal mucosa interspersed with inflamed areas, are a classic finding in **Crohn's disease**. - Ulcerative colitis, in contrast, presents with **continuous inflammation** extending proximally from the rectum without skip lesions [1]. *Fistulas are common* - While possible, **fistulas** (abnormal connections between organs or to the skin) are much more common in **Crohn's disease** than in ulcerative colitis [3]. - UC primarily causes superficial mucosal inflammation, which rarely leads to transmural involvement and subsequent fistula formation [3].

Question 1294: Which of the following statements is true regarding small bowel diverticula?

A. Most commonly located in the jejunum and ileum.
B. Contains all layers of the bowel wall (Correct Answer)
C. Surgical treatment is required only in cases of complications.
D. Can be visualized using imaging modalities such as CT or barium studies.

Explanation: ***Contains all layers of the bowel wall*** - **True diverticula** involve all three layers of the bowel wall: **mucosa**, **submucosa**, and **muscularis propria**. - This differentiates them from **pseudodiverticula**, which are herniations of only the mucosa and submucosa through the muscularis. *Most commonly located in the jejunum and ileum.* - While small bowel diverticula can occur in the jejunum and ileum, the **duodenum** is the **most common site** for small bowel diverticula. - Diverticula in the jejunum and ileum are less common but can be more prone to complications. *Surgical treatment is required only in cases of complications.* - This statement is generally true; **asymptomatic small bowel diverticula** usually do not require surgical intervention. - **Surgical treatment** is typically reserved for complications such as **bleeding**, **perforation**, **obstruction**, or **diverticulitis**. *Can be visualized using imaging modalities such as CT or barium studies.* - This is true; **CT scans** and **barium studies** (like small bowel series) are common imaging modalities used to diagnose diverticula. - Other methods include **endoscopy** or **capsule endoscopy**, depending on the location and presentation.

Question 1295: Capsule endoscopy is used for:

A. GERD
B. Motility disorder
C. Bleeding (Correct Answer)
D. Peritoneal metastasis

Explanation: ***Bleeding*** - Capsule endoscopy is primarily used to investigate **obscure gastrointestinal bleeding** when upper endoscopy and colonoscopy are negative, allowing for visualization of the **small bowel** [3]. - It helps identify sources of bleeding such as **angiodysplasias**, small bowel tumors, or ulcers that are inaccessible by conventional scopes [3]. *GERD* - **Gastroesophageal reflux disease (GERD)** is typically diagnosed clinically based on symptoms and can be confirmed with **upper endoscopy** [1] or **pH monitoring**, not capsule endoscopy. - Capsule endoscopy offers no functional assessment of the lower esophageal sphincter or pH within the esophagus. *Motility disorder* - **Motility disorders** are diagnosed through specialized tests like **esophageal manometry** or **gastric emptying studies**, which assess the muscular function of the GI tract. - Capsule endoscopy provides static images and cannot evaluate the propulsive movements of the gut. *Peritoneal metastasis* - **Peritoneal metastasis** involves cancer spread to the lining of the abdomen and is often diagnosed via **cross-sectional imaging** (CT, MRI) [2] or **laparoscopy with biopsy**. - Capsule endoscopy visualizes the lumen of the bowel and cannot detect lesions outside the bowel wall, such as peritoneal implants.

Question 1296: A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhoea, and severe abdominal pain. Which of the following diagnostic tests would help confirm that the patient has bleeding from the gastrointestinal tract?

A. Observation of melena (black, tarry stools)
B. Guaiac test for occult blood. (Correct Answer)
C. Presence of hematemesis (vomiting blood)
D. Hematochezia (bright red blood in stool)

Explanation: ***Guaiac test for occult blood*** - The **Guaiac test** detects invisible amounts of blood in the stool, which is characteristic of **occult gastrointestinal bleeding** [2]. - This test is crucial when overt signs like **hematemesis** or **melena** are not yet present, but GI bleeding is suspected based on other symptoms like abdominal pain, nausea, and vomiting [3]. *Presence of hematemesis (vomiting blood)* - While **hematemesis** is a clear sign of upper GI bleeding, it is a clinical observation, not a diagnostic test [1]. - Its presence directly confirms macroscopic bleeding, but the question asks for a **diagnostic test** to confirm bleeding, particularly when it might be occult. *Observation of melena (black, tarry stools)* - **Melena** indicates black, tarry stools resulting from digested blood, strongly suggesting upper GI bleeding [2]. This is a clinical symptom, not a diagnostic test - While informative, like hematemesis, it is an overt symptom and not a diagnostic test performed in a lab or clinical setting to confirm the presence of blood. *Hematochezia (bright red blood in stool)* - **Hematochezia** signifies the passage of bright red blood from the rectum, typically indicating lower GI bleeding. This is a clinical symptom and not a diagnostic test - As with hematemesis and melena, hematochezia is a clinical manifestation of bleeding rather than a diagnostic test.

Question 1297: Which of the following conditions is NOT typically associated with H. pylori infection?

A. Gastric ulcer
B. Duodenal ulcer
C. Fundal atrophic gastritis (Correct Answer)
D. Gastric lymphoma

Explanation: ***Fundal atrophic gastritis*** - While *H. pylori* can cause multifocal atrophic gastritis impacting the antrum and body, **fundal atrophic gastritis** typically refers to **autoimmune atrophic gastritis** which spares the antrum [2] and is not directly caused by *H. pylori*. - Autoimmune atrophic gastritis is characterized by antibodies to **parietal cells** and **intrinsic factor**, leading to vitamin B12 deficiency [2]. *Gastric ulcer* - *H. pylori* infection is a leading cause of **gastric ulcers**, often by inducing chronic inflammation that compromises the mucosal protective barrier [4]. - The bacteria colonize the gastric antrum, contributing to local inflammation and increased acid production, leading to ulcer formation [1]. *Duodenal ulcer* - The vast majority of **duodenal ulcers** are associated with *H. pylori* infection, which is a major factor in their pathogenesis [1]. - *H. pylori* colonization of the gastric antrum can lead to increased gastrin release, elevated acid secretion, and resultant duodenal mucosal injury [1]. *Gastric lymphoma* - Specifically, **Mucosa-Associated Lymphoid Tissue (MALT) lymphoma** of the stomach is strongly linked to chronic *H. pylori* infection [3]. - Eradication of *H. pylori* can lead to regression of low-grade gastric MALT lymphoma in a significant number of cases [3].

Question 1298: All are true about pseudopancreatic cyst of pancreas except:

A. Common after acute pancreatitis
B. Serum amylase is increased
C. Most common site is in head of pancreas (Correct Answer)
D. Presents as an abdominal mass

Explanation: ***Most common site is in head of pancreas*** - The **body and tail of the pancreas** are the most common sites for pseudocysts due to the typical location of pancreatic inflammation and fluid accumulation. - While pseudocysts can theoretically occur anywhere, the head is less frequently affected as the primary site. *Common after acute pancreatitis* - **Pancreatic pseudocysts** are a frequent complication, occurring in about 10-20% of patients following an episode of **acute pancreatitis** [1]. - They form when pancreatic fluid, rich in enzymes, leaks and becomes walled off by granulation tissue. *Presents as an abdominal mass* - Depending on its size and location, a **pseudocyst** can present as a palpable and sometimes painful **abdominal mass**. - Larger pseudocysts can cause symptoms by compressing adjacent organs [1]. *Serum amylase is increased* - Although the acute phase of pancreatitis has resolved, some **leakage of pancreatic enzymes** into the peritoneum or bloodstream can persist, leading to elevated **serum amylase** levels. - This elevation reflects the ongoing enzymatic activity within the pseudocyst.

Question 1299: A middle-aged woman presents to her physician with fatigue, pruritus, and steatorrhea. Further studies demonstrate primary biliary cholangitis and the presence of antimitochondrial antibodies. If left untreated, this patient is also at increased risk of developing which of the following?

A. Increased serum cholesterol levels due to cholestasis (Correct Answer)
B. Severe respiratory failure
C. Decreased serum uric acid levels
D. Increased serum pyruvic acid levels

Explanation: ***Markedly increased serum cholesterol*** - Patients with **primary biliary cholangitis** (PBC) often have **cholestasis** leading to elevated cholesterol levels due to impaired bile salt excretion. - Untreated PBC can progress, increasing the risk of **hyperlipidemia**, including markedly elevated serum cholesterol levels, evidenced by xanthomatous deposits [1]. *Markedly increased serum pyruvic acid* - Increased serum pyruvic acid typically indicates issues with **glycolysis** or **liver metabolism**, which are not primary complications of PBC. - This condition is more associated with **lactic acidosis** or certain genetic disorders, not directly related to the severe cholestatic picture seen in this patient. *Markedly decreased PaO2* - Markedly decreased **PaO2** suggests respiratory failure or severe lung disease, not a complication of cholestatic liver disease. - This does not typically correlate with PBC, where the main concerns are liver function and metabolism, not oxygenation. *Markedly decreased serum uric acid* - Decreased serum uric acid is typically seen in conditions like **chronic liver disease**, but it is not a hallmark of PBC or its complications. - PBC is more associated with **autoimmune disorders** [1] rather than metabolic alterations affecting uric acid levels in this context.

Question 1300: In which condition are Anti-Gliadin antibodies typically detectable?

A. Tropical sprue (malabsorption syndrome)
B. Celiac disease (gluten sensitivity) (Correct Answer)
C. Intestinal lymphoma (malignancy)
D. Whipple's disease (systemic infection)

Explanation: ***Celiac disease*** - The presence of **Anti-Gliadin antibodies** is a hallmark of celiac disease, which is an autoimmune disorder triggered by gluten ingestion [1]. - These antibodies indicate an inappropriate immune response to gluten, leading to **intestinal damage** and malabsorption [1][2]. *Whipple's disease* - Characterized by **trophic intestinal lesions**, but not associated with **Anti-Gliadin antibodies**; instead, it involves a different pathogenesis linked to the bacterium *Tropheryma whipplei*. - Symptoms include **malabsorption**, **weight loss**, and systemic issues like arthritis and CNS symptoms, unrelated to gluten. *Tropical sprue* - This condition is caused by **nutritional deficiencies**, particularly due to malabsorption in tropical regions, without a specific autoimmune response to gluten seen in celiac disease. - Typically presents with **diarrhea** and **weight loss**, but **Anti-Gliadin antibodies** are not typically detectable. *Intestinal lymphoma* - While intestinal lymphoma may occur in patients with celiac disease as a complication, it does not produce **Anti-Gliadin antibodies** as part of its pathophysiology. - The presence of these antibodies does not indicate lymphoma; the condition usually involves a more complex array of symptoms and does not directly relate to gluten sensitivity.

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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