Gastroenterology Practice Questions

Q: Intermittent dysphagia is caused by which of the following conditions?

Achalasia cardia and Diffuse esophageal spasm. ### Explanation The key to answering dysphagia questions lies in distinguishing between **mechanical obstruction** and **motility disorders**. **1. Why Option C is Correct:** Both **Achalasia cardia** and **Diffuse Esophageal Spasm (DES)** are primary esophageal motility disorders. [3] * **Achalasia cardia:** Characterized by the failure of the Lower Esophageal Sphincter (LES) to relax and aperistalsis. [1] While it often presents with progressive dysphagia, the symptoms can be **intermittent** in the early stages and characteristically involve both **solids and liquids** from the onset. [4] * **Diffuse Esophageal Spasm (DES):** Presents with classic **intermittent** dysphagia and non-cardiac chest pain. [2] The symptoms are episodic because the uncoordinated "corkscrew" contractions occur sporadically. **2. Why Other Options are Incorrect:** * **Strictures and Reflux Esophagitis (Options A & B):** These are mechanical/structural issues. Dysphagia due to a peptic stricture is typically **progressive** (starting with solids and later involving liquids) rather than intermittent. [3] * **Pharyngeal (Zenker’s) Diverticulum (Options B & D):** This is a structural outpouching. While it can cause gurgling and regurgitation [1], the dysphagia is usually constant or progressive as the sac enlarges and compresses the esophagus. **3. NEET-PG High-Yield Pearls:** * **Solids only dysphagia:** Suggests mechanical obstruction (e.g., Schatzi ring, Carcinoma, Stricture). [3] * **Solids + Liquids dysphagia (from start):** Suggests a motility disorder (Achalasia, DES, Scleroderma). * **Intermittent + Solids only:** Classic for **Schatzki Ring**. * **Intermittent + Solids/Liquids + Chest pain:** Classic for **Diffuse Esophageal Spasm**. [2] * **Progressive + Weight loss + Elderly:** Highly suspicious of **Esophageal Carcinoma**.

Q: Entero-enteric fistula is seen in:

Crohn's disease. **Explanation:** The hallmark of **Crohn’s disease** is **transmural inflammation**, meaning the inflammatory process involves all layers of the bowel wall (from mucosa to serosa). This deep, penetrating inflammation leads to the formation of deep ulcers and fissures. When these fissures extend through the serosa and penetrate an adjacent loop of bowel, an **entero-enteric fistula** is formed [1]. Fistulae are a common complication of Crohn’s disease, occurring in approximately 30-50% of patients, and can also involve the bladder (enterovesical), skin (enterocutaneous), or vagina (enterovaginal) [1]. **Why other options are incorrect:** * **Ulcerative Colitis (UC):** Unlike Crohn’s, UC is characterized by **superficial inflammation** limited to the mucosa and submucosa [2]. Because the inflammation does not typically penetrate the muscularis propria or serosa, the formation of fistulae or strictures is extremely rare. UC primarily presents with continuous colonic involvement and bloody diarrhea rather than penetrating complications [2]. **High-Yield Clinical Pearls for NEET-PG:** * **Pathology:** Crohn’s disease features **"Skip lesions"** and non-caseating granulomas; UC features continuous involvement and **Crypt abscesses** [2]. * **Radiology:** Crohn’s shows the **"String sign of Kantor"** (due to strictures) and a **"Cobblestone appearance."** [1] UC shows a **"Lead pipe appearance"** (loss of haustrations). * **Surgery:** Surgery is curative in Ulcerative Colitis (Total Proctocoloctomy) but only palliative/reserved for complications in Crohn’s disease due to its high recurrence rate. * **Smoking:** Smoking is a risk factor for Crohn’s disease but is protective against Ulcerative Colitis.

Q: A one-year-old child presents with a palpable fullness in the right upper quadrant of the abdomen. Her medical history is significant for type 2 diabetes mellitus.

Non-alcoholic steatohepatitis. **Explanation:** The correct answer is **Non-alcoholic steatohepatitis (NASH)**. **Concept:** NASH is the progressive form of Non-alcoholic Fatty Liver Disease (NAFLD), characterized by hepatic steatosis, inflammation, and hepatocyte injury [1]. It is strongly associated with **Metabolic Syndrome**, which includes obesity, insulin resistance, and **Type 2 Diabetes Mellitus (T2DM)** [2]. In a child with T2DM and a palpable fullness in the RUQ (suggestive of hepatomegaly), NASH is the most likely diagnosis due to the metabolic link between insulin resistance and fat accumulation in the liver. **Analysis of Incorrect Options:** * **Peliosis hepatis:** Characterized by blood-filled lacunar spaces in the liver. It is typically associated with anabolic steroid use, oral contraceptives, or chronic infections like HIV/Bartonella, rather than metabolic disorders. * **Autoimmune hepatitis:** An inflammatory liver disease involving autoantibodies (ANA, ASMA). While it causes hepatomegaly, it is not specifically linked to T2DM or metabolic syndrome [2]. * **Primary biliary cirrhosis (PBC):** Now called Primary Biliary Cholangitis, this is a chronic cholestatic disease seen almost exclusively in middle-aged women. It is extremely rare in children and presents with pruritus and elevated alkaline phosphatase. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Liver biopsy (shows macrovesicular steatosis, Mallory-Denk bodies, and "chicken-wire" fibrosis). * **First-line Investigation:** Ultrasonography (shows "bright" echogenic liver). * **Key Association:** NAFLD is considered the hepatic manifestation of metabolic syndrome [2]. * **Management:** Weight loss and exercise are the mainstays; Vitamin E or Pioglitazone may be used in biopsy-proven NASH.

Q: Which of the following is NOT true about Crohn disease?

Loss of haustration. **Explanation:** The correct answer is **A. Loss of haustration**. **Why it is correct:** Loss of haustration (the "Lead Pipe" appearance on imaging) is a classic radiological feature of **Ulcerative Colitis (UC)**, not Crohn disease. In UC, chronic inflammation leads to the shortening of the colon and the loss of normal mucosal folds (haustra) [1]. In contrast, Crohn disease is characterized by transmural inflammation and skip lesions, which often results in luminal narrowing (String sign of Kantor) rather than a smooth, featureless "lead pipe" colon. **Why the other options are incorrect:** * **B. Growth failure:** This is a common extra-intestinal manifestation in pediatric Crohn disease, often occurring due to chronic inflammation, malabsorption, and corticosteroid use [1]. It may precede gastrointestinal symptoms. * **C. Cobblestone colon:** This is a hallmark endoscopic finding of Crohn disease. it is caused by deep, longitudinal, and transverse aphthous ulcers separated by areas of normal, edematous mucosa. * **D. Perianal fistula formation:** Crohn disease is known for its **transmural** nature (involving all layers of the bowel wall). This leads to complications like fistulae (perianal, enteroenteric, or enterocutaneous), abscesses, and strictures [1]. Perianal involvement is rare in Ulcerative Colitis [1]. **NEET-PG High-Yield Pearls:** * **Crohn Disease:** Skip lesions, transmural inflammation, non-caseating granulomas (pathognomonic), and "Creeping fat." * **Ulcerative Colitis:** Continuous involvement (starts at rectum) [1], mucosal/submucosal inflammation [1], Crypt abscesses, and Pseudopolyps. * **Smoking:** Increases the risk of Crohn disease but is protective in Ulcerative Colitis. * **ASCA** is positive in Crohn; **p-ANCA** is more common in UC.

Question 1

In 24-hour ambulatory pH testing for the diagnosis of GERD, what percentage of the day should the pH be less than 4?

Accepted Answer

> 5%

Answer

> 20%

Answer

> 1%

Answer

> 1%

Question 2

Intermittent dysphagia is caused by which of the following conditions?

Accepted Answer

Achalasia cardia and Diffuse esophageal spasm

Answer

Stricture, Reflux esophagitis, and Achalasia cardia

Answer

Reflux esophagitis, Achalasia cardia, and Pharyngeal diverticulum

Answer

Pharyngeal diverticulum and Diffuse esophageal spasm

Question 3

Which of the following is FALSE about Mallory-Weiss syndrome?

Accepted Answer

Massive hemorrhage is the most common manifestation.

Answer

Alcohol is an associated etiology.

Answer

Conservative treatment is effective in most cases.

Answer

Anti-reflux procedures do not have an added advantage.

Question 4

Which of the following statements about achalasia cardiae is true?

Accepted Answer

There is a loss of ganglion cells within the esophageal myenteric plexus.

Answer

Achalasia is a common disorder.

Answer

Excess lower esophageal sphincter relaxation is the major pathology.

Answer

Latent infection with rubella virus is responsible for achalasia cardiae.

Question 5

Entero-enteric fistula is seen in:

Accepted Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Both of the above

Answer

None of the above

Question 6

A one-year-old child presents with a palpable fullness in the right upper quadrant of the abdomen. Her medical history is significant for type 2 diabetes mellitus.

Accepted Answer

Non-alcoholic steatohepatitis

Answer

Peliosis hepatis

Answer

Autoimmune hepatitis

Answer

Primary biliary cirrhosis

Question 7

According to Child-Pugh criteria, a patient with partial encephalopathy and a bilirubin level of 2.5 mg/dL, albumin level of 3 gm/dL, and controlled ascites is classified as:

Accepted Answer

Grade B

Answer

Grade A

Answer

Grade C

Answer

More information needed

Question 8

Which of the following is NOT true about Crohn disease?

Accepted Answer

Loss of haustration

Answer

Growth failure

Answer

Cobblestone colon

Answer

Perianal fistula formation

Question 9

Syndromes associated with jaundice include all EXCEPT?

Accepted Answer

Gardner's syndrome

Answer

Gilbert's syndrome

Answer

Dubin-Johnson syndrome

Answer

Rotor's syndrome

Question 10

A 40-year-old man presents with severe, constant abdominal pain radiating to the back, accompanied by nausea and vomiting for one day. His past medical history is unremarkable, but he consumes one to two 6-packs of beer each weekend. He denies diarrhea or fever. Laboratory findings show markedly elevated serum amylase and lipase levels. What is the anatomical location of the structure primarily involved in this condition?

Accepted Answer

Retroperitoneal

Answer

Completely Intraperitoneal

Answer

Partially intraperitoneal

Answer

Subperitoneal

Gastroenterology — MCQs

Gastroenterology — MCQs

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