Gastroenterology Practice Questions

Q: A patient with a known history of ulcerative colitis presents to the emergency department with abdominal distension and tenderness. An abdominal X-ray was performed. Which of the following is true regarding the patient's condition?

Toxic megacolon. ***Toxic megacolon*** - **Abdominal distension** and **tenderness** in a UC patient with **dilated transverse colon >6cm** and **loss of haustra** on X-ray are classic findings of **toxic megacolon**. - This is a **life-threatening complication** of ulcerative colitis requiring immediate medical intervention and possible surgical management. *Toxic megacolon is rarely seen in ulcerative colitis* - This statement is incorrect as **toxic megacolon** is a **well-recognized serious complication** of ulcerative colitis, occurring in 1-9% of patients. - It represents **acute colonic dilatation** with **systemic toxicity** and is considered a **medical emergency** in UC patients. *Sigmoid volvulus* - **Sigmoid volvulus** presents with a characteristic **coffee bean sign** on X-ray, showing twisted sigmoid colon with two air-fluid levels. - The clinical presentation typically involves **sudden onset crampy pain** and **obstipation**, different from the systemic toxicity seen in this UC patient. *Adhesions* - **Intestinal adhesions** cause **mechanical bowel obstruction** with **dilated small bowel loops** and **air-fluid levels** on X-ray. - The history lacks **previous abdominal surgery** or trauma, and adhesions don't typically cause **colonic dilatation** with **loss of haustra** as seen here.

Q: A 50-year-old lady presented with a history of pain in the upper abdomen, nausea, and decreased appetite for 5 days. She had undergone cholecystectomy 2 years back. Her bilirubin was 10 mg/dl, SGOT 900 IU/L, SGPT 700 IU/L, and serum alkaline phosphatase was 280 IU/L. What is the most likely diagnosis?

Acute viral hepatitis. **Explanation:** The diagnosis of **Acute Viral Hepatitis** is primarily based on the biochemical profile of the liver function tests (LFTs). In this patient, the hallmark is the **massive elevation of transaminases (SGOT 900 IU/L, SGPT 700 IU/L)**. In viral hepatitis, aminotransferases typically exceed 500–1000 IU/L, reflecting acute hepatocellular injury. While the bilirubin is elevated (10 mg/dl), the Serum Alkaline Phosphatase (ALP) is only mildly elevated (280 IU/L), which is characteristic of a hepatocellular pattern rather than an obstructive one. **Why other options are incorrect:** * **Acute Cholangitis:** This typically presents with Charcot’s Triad (fever, jaundice, RUQ pain). While jaundice is present here, the ALP would be significantly higher (usually >3 times the upper limit of normal), and transaminase levels rarely reach such high peaks unless there is secondary hepatic ischemia. * **Acute Pancreatitis:** While it causes upper abdominal pain and nausea, it does not typically cause such profound elevations in bilirubin or transaminases unless there is a concomitant common bile duct stone (Gallstone Pancreatitis). Furthermore, the patient is post-cholecystectomy. * **Posterior Penetration of Peptic Ulcer:** This presents with referred back pain and signs of peritonitis or localized ileus, but it does not cause significant jaundice or a 10-20 fold increase in transaminases. **Clinical Pearls for NEET-PG:** * **De Ritis Ratio:** In most viral hepatitis, SGPT (ALT) > SGOT (AST). An exception is Alcoholic Hepatitis, where AST:ALT > 2:1. * **Obstructive vs. Hepatocellular:** High ALP + High Bilirubin = Obstructive (Surgical) Jaundice. High Transaminases + High Bilirubin = Hepatocellular (Medical) Jaundice. * **Post-cholecystectomy pain:** Always consider Post-cholecystectomy Syndrome (PCS), but biochemical markers must guide the specific etiology.

Q: Feline esophagus is most commonly associated with which of the following conditions?

Gastroesophageal reflux disease (GERD). **Explanation:** The term **"Feline Esophagus"** (also known as esophageal shingling or transient esophageal rings) refers to the endoscopic appearance of multiple, fine, concentric mucosal rings that resemble the normal anatomy of a cat's esophagus. **1. Why GERD is the correct answer:** While historically debated, current medical literature and standard textbooks (including Harrison’s) associate the classic "feline esophagus" primarily with **Gastroesophageal Reflux Disease (GERD)**. These rings are transient and occur due to the contraction of the *muscularis mucosae* in response to acid irritation [1]. They typically disappear upon esophageal insufflation during endoscopy. **2. Analysis of Incorrect Options:** * **Option A: Eosinophilic Esophagitis (EoE):** This is the most common distractor. EoE is characterized by **fixed** concentric rings (often called "trachealization" of the esophagus). Unlike the transient feline esophagus of GERD, these rings are permanent and do not disappear with air insufflation. * **Option C & D: Radiation Esophagitis and Carcinoma:** These conditions typically present with strictures, ulcerations, or irregular masses rather than the rhythmic, concentric, transient rings seen in feline esophagus. **3. Clinical Pearls for NEET-PG:** * **Feline Esophagus:** Transient rings, associated with **GERD** [1]. * **Trachealization/Ringed Esophagus:** Fixed rings, associated with **Eosinophilic Esophagitis**. * **Endoscopic Triad of EoE:** Fixed rings, linear furrows, and white exudates (microabscesses). * **Key Distinction:** If the question mentions rings that **disappear with insufflation**, think GERD. If they are **fixed/permanent**, think EoE.

Q: What is the best treatment for a refractory peri-anal fistula in Crohn's disease?

Infliximab. **Explanation:** The management of perianal Crohn’s disease (PCD) is complex and requires a multidisciplinary approach. For **refractory perianal fistulas**, medical therapy with biological agents is the gold standard. **1. Why Infliximab is correct:** Infliximab (a chimeric monoclonal antibody against TNF-α) is the first-line medical treatment for complex or refractory fistulizing Crohn’s disease. It is the only agent proven in randomized controlled trials (ACCENT II study) to be effective in inducing and maintaining the closure of enterocutaneous and perianal fistulas. It works by reducing transmural inflammation, allowing the fistula tract to heal. **2. Why the other options are incorrect:** * **Fistulectomy (A):** In Crohn’s disease, aggressive surgeries like fistulectomy are generally **contraindicated** because the underlying tissue has poor healing capacity. It carries a high risk of non-healing wounds, fecal incontinence, and may eventually necessitate a proctectomy. Surgery in PCD is usually limited to "conservative" measures like seton placement to prevent abscess formation. * **Olasalizine (C) & Mesalamine (D):** These are 5-ASA derivatives. While they are used for maintaining remission in mild-to-moderate luminal ulcerative colitis or Crohn’s, they have **no proven efficacy** in treating fistulizing disease or perianal complications. **NEET-PG High-Yield Pearls:** * **First-line for simple fistula:** Metronidazole or Ciprofloxacin (Antibiotics). * **Best imaging modality:** MRI Pelvis (Gold standard for mapping the fistula tract). * **Surgical goal:** "Drainage, not cure." Use non-cutting setons to maintain patency and prevent recurrent abscesses. * **Combination Therapy:** Combining Infliximab with surgical seton drainage yields better results than either alone.

Question 1

A 30-year-old male patient with cholelithiasis is found to have serum bilirubin 2.5 mg/dL, Hb 6 g/dL, and urine test positive for urobilinogen. What is the most likely diagnosis?

Accepted Answer

Hemolytic jaundice

Answer

Obstructive jaundice

Answer

Hepatocellular jaundice

Answer

Erythropoietic Protoporphyria

Question 2

A patient with a known history of ulcerative colitis presents to the emergency department with abdominal distension and tenderness. An abdominal X-ray was performed. Which of the following is true regarding the patient's condition?

Accepted Answer

Toxic megacolon

Answer

Toxic megacolon is rarely seen in ulcerative colitis

Answer

Sigmoid volvulus

Answer

Adhesions

Question 3

A patient presents with upper abdominal pain and vomiting. His pulse is 110/min and BP is 70/40 mm Hg. A diagnosis of pancreatitis is made. What is the next appropriate management?

Accepted Answer

Immediate IV fluids

Answer

Removal of necrosed pancreatic tissues

Answer

Start enteral nutrition first

Answer

IV antibiotics

Question 4

A 50-year-old lady presented with a history of pain in the upper abdomen, nausea, and decreased appetite for 5 days. She had undergone cholecystectomy 2 years back. Her bilirubin was 10 mg/dl, SGOT 900 IU/L, SGPT 700 IU/L, and serum alkaline phosphatase was 280 IU/L. What is the most likely diagnosis?

Accepted Answer

Acute viral hepatitis

Answer

Acute pancreatitis

Answer

Acute cholangitis

Answer

Posterior penetration of peptic ulcer

Question 5

Feline esophagus is most commonly associated with which of the following conditions?

Accepted Answer

Gastroesophageal reflux disease (GERD)

Answer

Eosinophilic esophagitis

Answer

Radiation esophagitis

Answer

Carcinoma of the esophagus

Question 6

Which of the following statements regarding Crohn's disease is correct?

Accepted Answer

Medical management includes antibiotics, immunosuppressive agents, and biologic agents.

Answer

Crohn's disease has no increased risk for colonic cancer.

Answer

Crohn's disease has no effect on fertility.

Answer

An associated enteroenteric fistula is an indication for urgent surgery.

Question 7

A 25-year-old woman develops nausea, vomiting, and abdominal pain. On examination, she has tender hepatomegaly and ascites. She was recently started on oral contraceptives. What is the most likely clinical diagnosis?

Accepted Answer

Budd-Chiari syndrome

Answer

Acute viral hepatitis

Answer

Portal hypertension

Answer

Acute cholecystitis

Question 8

Which one of the following treatments is effective in primary biliary cirrhosis?

Accepted Answer

Ursodeoxycholic acid

Answer

Prednisolone

Answer

Interferon a-2B

Answer

D-Penicillamine

Question 9

What is the best treatment for a refractory peri-anal fistula in Crohn's disease?

Accepted Answer

Infliximab

Answer

Fistulectomy

Answer

Olasalizine

Answer

Mesalamine

Question 10

Hyper-pigmented skin with xanthelasma and xanthomas suggests the possibility of which diagnosis?

Accepted Answer

Primary biliary cirrhosis

Answer

Primary sclerosing cholangitis

Answer

Amyloidosis

Answer

Tuberculosis

Gastroenterology — MCQs

Gastroenterology — MCQs

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