Gastroenterology Practice Questions

Q: Erosive gastritis commonly affects which part of the stomach?

Stomach antrum. ***Stomach antrum*** - The **antrum** is the most common site for erosive gastritis due to its role in regulating gastric emptying and exposure to gastric acid and pepsin [1]. - While gastritis can affect any part of the stomach, inflammation and erosion are often pronounced in the antrum due to its location relative to the pylorus and continuous exposure to luminal contents [1]. *Stomach fundus* - The **fundus** is the upper part of the stomach and is less commonly affected by erosive gastritis compared to the antrum and body. - It plays a significant role in accumulating gas during digestion. Its location and functions make it less susceptible to the type of chronic inflammation that leads to erosions [2]. *Stomach body* - The **stomach body (corpus)** is responsible for producing acid and pepsin and can be affected by gastritis, but it is less frequently the primary site of erosions than the antrum [1]. - Inflammatory changes in the body are often associated with other forms of gastritis, such as autoimmune gastritis, which typically does not manifest with widespread erosions [1]. *Pylorus* - The **pylorus** is the muscular valve connecting the stomach to the duodenum; while it is adjacent to the antrum, erosions are typically described as occurring in the antrum itself rather than within the pyloric channel. - Inflammation affecting the pylorus directly might lead to issues with gastric emptying but is usually secondary to disease in the antrum or duodenum.

Q: Which of the following can cause toxic megacolon in a 36-year-old lady?

Ulcerative colitis. ***Ulcerative colitis*** - **Ulcerative colitis** is a well-known cause of **toxic megacolon**, a severe complication characterized by acute colonic distension and systemic toxicity [1]. - The inflammatory process in ulcerative colitis can lead to deep ulcerations and transmural inflammation, compromising the enteric nervous system and causing acute colonic dysfunction. *Amoebic dysentery* - While **amoebic dysentery** can cause severe colonic inflammation and necrosis, it is **less commonly associated with toxic megacolon** compared to inflammatory bowel diseases. - The primary concern with amoebic dysentery is often **amoebic liver abscess** or colonic perforation rather than toxic megacolon. *Irritable bowel syndrome (IBS)* - **IBS** is a **functional gastrointestinal disorder** and does **not cause structural changes or significant inflammation** in the colon. - It is characterized by symptoms like abdominal pain, bloating, and altered bowel habits, but it is **not associated with toxic megacolon**. *Viral diarrhea* - **Viral diarrhea** typically causes **acute, self-limiting gastroenteritis** and does **not involve the severe, transmural inflammation** required to induce toxic megacolon. - The primary concern with viral diarrhea is **dehydration**, especially in vulnerable populations.

Q: In modified Pugh's classification score of 8, what is the line of management?

Conservative management. Conservative management - A modified Child-Pugh score of 8 falls into Child-Pugh class B, indicating **moderate liver dysfunction**. - At this stage, **medical management** aimed at addressing complications and improving liver function is the primary line of treatment. *Orthotopic liver transplant* - Liver transplantation is generally considered for patients with **Child-Pugh class C** (scores 10-15) or those with class B who are unresponsive to medical therapy and have a high risk of mortality [1]. - While a score of 8 indicates significant disease, it's not immediately indicative of the need for transplant without failure of conservative measures or other specific indications [1]. *Sclerotherapy* - **Sclerotherapy** is a procedure primarily used to treat **esophageal varices** to prevent or treat bleeding [2]. - It is a targeted intervention for a specific complication of portal hypertension, not a general management strategy for a Child-Pugh score of 8. *Shunt surgery* - **Shunt surgery**, such as a Transjugular Intrahepatic Portosystemic Shunt (TIPS), is used to decompress the **portal venous system** in cases of severe portal hypertension [3]. - It's typically reserved for patients with recurrent variceal bleeding or refractory ascites, and not a primary management for a Child-Pugh score of 8 as a whole [3].

Q: Which of the following statements is true regarding gallbladder carcinoma?

90% associated with gallstones. 90% associated with gallstones - The vast majority of gallbladder carcinomas are linked to **gallstone disease**, which is considered a major risk factor due to chronic inflammation [2]. - This strong association highlights the role of prolonged irritation in the development of malignancy in the gallbladder. *Most commonly presents with abdominal pain and weight loss* - While **abdominal pain** and **weight loss** can be symptoms, they are non-specific and often present at advanced stages [1]. - Earlier symptoms might include **jaundice** or **right upper quadrant discomfort**, but these are also often vague [1]. *5-year survival is approximately 25%* - The overall 5-year survival rate for gallbladder carcinoma is significantly lower, typically ranging from **5-10%**, making it one of the more lethal cancers. - The poor prognosis is often due to late diagnosis, as symptoms usually appear when the disease is already advanced and has metastasized; death typically occurs within 1 year in symptomatic patients [1]. *30% are squamous cell carcinoma* - The vast majority of gallbladder carcinomas (approximately **90%**) are **adenocarcinomas**. - Squamous cell carcinoma and other rare types represent only a small minority of cases.

Q: Which of the following is least likely to be a cause of cholecystitis?

Estrogen. ### Estrogen - While **estrogen** can contribute to the formation of gallstones (cholelithiasis) by increasing cholesterol secretion into bile, it is **least directly implicated** as a primary cause of cholecystitis itself [1]. - Cholecystitis is primarily caused by **gallstone obstruction** of the cystic duct or, less commonly, by acalculous inflammation [1]. ### OCP - **Oral contraceptive pills (OCPs)** contain estrogen, which is a known risk factor for the formation of **gallstones**, leading to cholelithiasis [1]. - Gallstones are the most common cause of **acute cholecystitis** due to obstruction of the cystic duct [1]. ### Diabetes mellitus - **Diabetes mellitus** increases the risk of gallstone formation due to **impaired gallbladder motility** and changes in bile composition. - Diabetic patients are also at higher risk for severe cholecystitis and complications, including **gangrenous cholecystitis** or emphysematous cholecystitis [1]. ### Obesity - **Obesity** is a significant risk factor for the development of **cholesterol gallstones** due to increased cholesterol synthesis and secretion into bile [1]. - The presence of gallstones, or cholelithiasis, is the primary predisposing factor for **acute cholecystitis** [1].

Q: Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?

Arthritis. ***Arthritis*** - **Peripheral arthritis** associated with inflammatory bowel disease (IBD) often **worsens with intestinal disease exacerbations** and improves with resolution of flares [1]. - This type of arthritis typically affects larger joints and is **non-deforming and asymmetric**. *Erythema nodosum* - **Erythema nodosum**, a skin manifestation, is generally **correlated with IBD activity** and usually improves as the bowel disease is treated [1]. - It presents as **tender, red nodules** on the shins and is not consistently one of the symptoms that *worsens* with exacerbation, but rather is *present* during active disease. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic liver condition that is **associated with IBD**, particularly ulcerative colitis. - However, the progression of PSC is largely **independent of the intestinal disease activity** and does not necessarily worsen during IBD exacerbations. *Uveitis* - **Uveitis**, an inflammation of the eye's middle layer, is an extra-intestinal manifestation of IBD that can occur **independently of intestinal disease activity**. - It does not consistently worsen during IBD exacerbations and may require separate focused treatment.

Q: All of the following may be features of a silent carcinoma of the body of the stomach except which of the following?

Dysphagia. ***Dysphagia*** - **Dysphagia** (difficulty swallowing) is a prominent symptom typically associated with carcinomas of the **cardia** or **fundus** of the stomach, where the tumor directly impedes food passage [1]. - A silent carcinoma of the **body of the stomach** is less likely to cause dysphagia until it has grown extensively or metastasized, making this the exception among the listed options [1]. *Obstructive jaundice* - A silent carcinoma of the stomach body can metastasize to the **liver** or the **porta hepatis** lymph nodes, leading to compression of the bile ducts [1]. - This compression can cause **obstructive jaundice**, characterized by yellow skin and eyes due to bile flow obstruction [1]. *Ascites* - **Ascites**, the accumulation of fluid in the abdominal cavity, can occur with advanced gastric cancer due to **peritoneal carcinomatosis** (spread of cancer cells to the peritoneum) [1]. - This is a common finding in widespread metastatic disease, even from a initially "silent" primary tumor. *Krukenberg's tumours* - These are **metastatic ovarian tumors** originating from a primary gastrointestinal cancer, most commonly the stomach [1]. - A silent gastric carcinoma can present with these secondary tumors as the first noticeable symptom, especially due to **lymphatic spread** to the ovaries [1].

Q: A 60-year-old male presents with hypotension (90/50 mm Hg), tachycardia (100 beats per minute), and a history of hypertension and coronary artery disease. He has been passing black, tarry stools while on aspirin, atenolol, and sorbitrate. What is the most likely diagnosis?

Gastric ulcer with bleeding. ***Gastric ulcer with bleeding*** - The patient's presentation with **hypotension** and **tachycardia** indicates **hypovolemia**, which is consistent with significant blood loss [1]. - **Black, tarry stools (melena)** are a classic sign of **upper gastrointestinal bleeding**, often originating from a gastric ulcer, especially given the patient's use of **aspirin**, a known risk factor [1]. *Acute MI with cardiogenic shock* - While the patient has a history of coronary artery disease, **cardiogenic shock** would typically present with signs of **poor tissue perfusion** secondary to pump failure, not primarily with melena [2]. - Melena is not a typical symptom of myocardial infarction itself, though GI bleeding can exacerbate cardiac ischemia [1]. *Acute CVA* - An **acute cerebrovascular accident (CVA)** would present with focal neurological deficits, such as hemiparesis, aphasia, or vision changes. - The patient's symptoms of melena, hypotension, and tachycardia are not characteristic of a CVA [1]. *Pulmonary embolism* - A **pulmonary embolism (PE)** typically presents with acute onset of **dyspnea, pleuritic chest pain**, and sometimes hemoptysis. - While it can cause hypotension and tachycardia, **melena is not a symptom** of pulmonary embolism.

Q: In a patient with liver disease, which maneuvers may lead to the development of hyperammonemia?

The use of loop diuretics.. ***The use of loop diuretics.*** - Loop diuretics can lead to **hypokalemia** and **metabolic alkalosis**, which promotes the conversion of NH4+ to NH3, the un-ionized form that can cross the blood-brain barrier. [2] - They also can induce **prerenal azotemia** due to volume depletion, increasing protein catabolism and ammonia production. *Protein restriction may help in managing hyperammonemia.* - **Protein restriction** is a strategy to *reduce* ammonia production in the gut, especially in patients with hepatic encephalopathy. [1] - This statement describes a management strategy, not a maneuver that *leads* to hyperammonemia. *A branched-chain amino acid-enriched protein mixture can help lower ammonia levels.* - **Branched-chain amino acids (BCAAs)** are often used as nutritional support in liver disease to *improve* nitrogen balance and reduce ammonia levels. - They compete with aromatic amino acids for transport into the brain, which can help in *reducing* ammonia's neurotoxic effects. *The use of neomycin can help reduce ammonia levels.* - **Neomycin** is an antibiotic that *reduces* ammonia production by killing ammonia-producing bacteria in the gut. - Therefore, using neomycin would *decrease* ammonia levels, not cause hyperammonemia.

Q: A 67-year-old woman complains of paresthesias in the limbs. Examination shows loss of vibratory sense, positional sense, and sense of light touch in the lower limbs. She is found to have pernicious anemia. Endoscopy reveals an ulcer in the body of the stomach. What vitamin deficiency does she most likely have?

Cancer of the stomach. **Cancer of the stomach** - The presence of **pernicious anemia** with an **ulcer in the body of the stomach** in an elderly patient suggests an increased risk of **gastric adenocarcinoma** [2]. - **Atrophic gastritis** associated with pernicious anemia is a **precursor lesion** for gastric cancer, and a stomach ulcer in this context warrants suspicion for malignancy [2]. *Chronic atrophic gastritis* - While **chronic atrophic gastritis** is the underlying cause of pernicious anemia, the question specifies an **ulcer in the body of the stomach** [3]. - An ulcer in the setting of atrophic gastritis should raise concern for **malignancy**, especially in an older patient, rather than just chronic inflammation [2]. *Gastric sarcoma* - **Gastric sarcomas** are mesenchymal tumors of the stomach, which are **rare** compared to gastric adenocarcinomas. - While they can present as ulcers, the strong association with **pernicious anemia** points more directly towards adenocarcinoma. *Deficiency of vitamin B12* - The patient clearly has **vitamin B12 deficiency** due to pernicious anemia, which explains the neurological symptoms like **paresthesias** and loss of vibratory/positional sense [1]. - However, the question asks what new pathology is suggested by the **ulcer in the stomach body** given the underlying pernicious anemia, rather than about the deficiency itself.

Question 1

Erosive gastritis commonly affects which part of the stomach?

Accepted Answer

Stomach antrum

Answer

Stomach fundus

Answer

Stomach body

Answer

Pylorus

Question 2

Which of the following can cause toxic megacolon in a 36-year-old lady?

Accepted Answer

Ulcerative colitis

Answer

Viral diarrhea

Answer

Amoebic dysentery

Answer

Irritable bowel syndrome (IBS)

Question 3

In modified Pugh's classification score of 8, what is the line of management?

Accepted Answer

Conservative management

Answer

Sclerotherapy

Answer

Shunt surgery

Answer

Orthotopic liver transplant

Question 4

Which of the following statements is true regarding gallbladder carcinoma?

Accepted Answer

90% associated with gallstones

Answer

30% are squamous cell carcinoma

Answer

5-year survival is approximately 25%

Answer

Most commonly presents with abdominal pain and weight loss

Question 5

Which of the following is least likely to be a cause of cholecystitis?

Accepted Answer

Estrogen

Answer

OCP

Answer

Diabetes mellitus

Answer

Obesity

Question 6

Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?

Accepted Answer

Arthritis

Answer

Primary sclerosing cholangitis

Answer

Uveitis

Answer

Erythema nodosum

Question 7

All of the following may be features of a silent carcinoma of the body of the stomach except which of the following?

Accepted Answer

Dysphagia

Answer

Obstructive jaundice

Answer

Krukenberg's tumours

Answer

Ascites

Question 8

A 60-year-old male presents with hypotension (90/50 mm Hg), tachycardia (100 beats per minute), and a history of hypertension and coronary artery disease. He has been passing black, tarry stools while on aspirin, atenolol, and sorbitrate. What is the most likely diagnosis?

Accepted Answer

Gastric ulcer with bleeding

Answer

Acute MI with cardiogenic shock

Answer

Acute CVA

Answer

Pulmonary embolism

Question 9

In a patient with liver disease, which maneuvers may lead to the development of hyperammonemia?

Accepted Answer

The use of loop diuretics.

Answer

Protein restriction may help in managing hyperammonemia.

Answer

A branched-chain amino acid-enriched protein mixture can help lower ammonia levels.

Answer

The use of neomycin can help reduce ammonia levels.

Question 10

A 67-year-old woman complains of paresthesias in the limbs. Examination shows loss of vibratory sense, positional sense, and sense of light touch in the lower limbs. She is found to have pernicious anemia. Endoscopy reveals an ulcer in the body of the stomach. What vitamin deficiency does she most likely have?

Accepted Answer

Cancer of the stomach

Answer

Gastric sarcoma

Answer

Chronic atrophic gastritis

Answer

Deficiency of vitamin B12

Gastroenterology — MCQs

Gastroenterology — MCQs

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