Gastroenterology Practice Questions

Q: What is the drug of choice for an acute exacerbation of ulcerative colitis?

Corticosteroids. **Explanation:** **Correct Answer: D. Corticosteroids** The primary goal in an **acute exacerbation** of Ulcerative Colitis (UC) is to induce rapid remission by suppressing intense systemic and local inflammation. **Corticosteroids** (e.g., oral Prednisolone or IV Hydrocortisone/Methylprednisolone) are the **drugs of choice for inducing remission** in moderate-to-severe acute flares due to their potent anti-inflammatory effects and rapid onset of action. However, they are never used for maintenance therapy due to significant long-term side effects. **Why other options are incorrect:** * **A. Sulfasalazine:** This is a 5-ASA (Aminosalicylate) derivative. While it is the drug of choice for **maintaining remission** and treating mild-to-moderate UC, it is not potent enough to manage an acute, severe exacerbation. * **B. Methotrexate:** This is an immunomodulator used primarily in Crohn’s disease. It has a slow onset of action (weeks to months) and is ineffective for the rapid control required during an acute flare. * **C. Infliximab:** This TNF-α inhibitor is used as "rescue therapy" in patients who are **refractory to corticosteroids**. While highly effective, it is generally considered a second-line option for acute flares after steroids have failed. **High-Yield Clinical Pearls for NEET-PG:** * **Induction of Remission:** Corticosteroids (Topical for proctitis, Oral/IV for systemic disease). * **Maintenance of Remission:** 5-ASA (Sulfasalazine/Mesalamine). * **Site of Action:** Sulfasalazine is cleaved by colonic bacteria into **Sulfapyridine** (causes side effects) and **5-ASA** (the active therapeutic moiety). * **Toxic Megacolon:** A dreaded complication of acute UC; managed with IV fluids, IV steroids, and bowel rest.

Q: The modified Mayo score is used in clinical trials to assess the severity of which condition?

Ulcerative colitis. The **Mayo Score** is the gold standard clinical scoring system used to evaluate the disease activity and severity of **Ulcerative Colitis (UC)** [1]. It is extensively used in clinical trials to assess treatment response and mucosal healing. **1. Why Ulcerative Colitis is correct:** The original Mayo score consists of four components: * **Stool frequency** (compared to normal) * **Rectal bleeding** * **Physician’s global assessment (PGA)** * **Endoscopic findings** (Sigmoidoscopy/Colonoscopy) [2] The **Modified Mayo Score** (often used in modern trials) excludes the "Physician’s Global Assessment" to make the score more objective, focusing primarily on patient-reported outcomes and endoscopic appearance. **2. Why other options are incorrect:** * **Crohn’s Disease:** The primary scoring system used is the **CDAI (Crohn’s Disease Activity Index)** or the **Harvey-Bradshaw Index (HBI)**. * **Diverticulosis:** Severity is typically graded using the **Hinchey Classification** (specifically for diverticulitis complications). * **Pancreatitis:** Severity is assessed using the **Ranson Criteria**, **APACHE II score**, or the **Modified Glasgow Score**. **High-Yield Clinical Pearls for NEET-PG:** * **Mucosal Healing:** In the Mayo score, an endoscopic sub-score of **0 or 1** is the definition of mucosal healing. * **Truelove and Witts Criteria:** Another high-yield classification for UC, used primarily to categorize "Acute Severe Colitis." * **Montreal Classification:** Used to define the anatomical extent of UC (E1: Proctitis, E2: Left-sided, E3: Extensive/Pancolitis).

Q: Which of the following is NOT associated with acute pancreatitis?

Steatorrhea. **Explanation:** **1. Why Steatorrhea is the Correct Answer:** Steatorrhea (fatty, foul-smelling stools) is a hallmark of **exocrine pancreatic insufficiency**. This occurs when more than 90% of the pancreatic parenchyma is destroyed or non-functional. It is a classic feature of **Chronic Pancreatitis**, where there is permanent structural damage [1]. In **Acute Pancreatitis**, the inflammation is sudden and usually reversible; the gland typically retains enough functional capacity to prevent malabsorption during the acute phase. **2. Analysis of Incorrect Options:** * **Upper Abdominal Pain:** This is the most common presenting symptom (95% of cases). It is typically steady, boring, and severe, located in the epigastrium or periumbilical region [1]. * **Epigastric Tenderness:** Physical examination usually reveals significant tenderness in the upper abdomen, often accompanied by guarding and distension [1]. * **Cullen’s Sign:** This refers to periumbilical ecchymosis (bluish discoloration) caused by the tracking of hemoperitoneum from the retroperitoneum. While rare, it is a specific sign of **severe necrotizing pancreatitis**. **3. Clinical Pearls for NEET-PG:** * **Grey Turner’s Sign:** Ecchymosis in the flanks (associated with severe/hemorrhagic pancreatitis). * **Fox’s Sign:** Ecchymosis over the inguinal ligament. * **Most Common Cause:** Gallstones (overall), followed by Alcohol. * **Diagnosis:** Requires 2 out of 3: (1) Typical abdominal pain, (2) Serum Amylase/Lipase >3x upper limit, (3) Characteristic findings on imaging (CECT is the gold standard) [1]. * **Lipase vs. Amylase:** Lipase is more specific and remains elevated longer than amylase.

Q: Which of the following is true regarding Gilbert syndrome?

Improves with phenobarbitone administration.. **Explanation:** Gilbert syndrome is a common, benign condition characterized by a reduction in the activity of the enzyme **UDP-glucuronosyltransferase (UGT1A1)** [1]. This enzyme is responsible for the conjugation of bilirubin in the liver [3]. **Why Option C is correct:** Phenobarbitone is a potent inducer of microsomal enzymes, including UGT1A1 [3]. Administration of phenobarbitone increases the expression of the enzyme, thereby enhancing bilirubin conjugation and effectively lowering serum bilirubin levels [2]. This is a classic pharmacological response used to differentiate Gilbert syndrome from more severe types of Crigler-Najjar syndrome [1]. **Analysis of Incorrect Options:** * **Option A:** Gilbert syndrome is characterized by **unconjugated (indirect) hyperbilirubinemia**, as the defect lies in the conjugation process [4]. * **Option B:** The condition actually **worsens with starvation**, fasting, dehydration, stress, or intercurrent illness. Caloric restriction leads to an increase in unconjugated bilirubin levels [4]. * **Option D:** It is a **benign, non-life-threatening** condition [1]. Most patients are asymptomatic, and the liver architecture and other liver function tests (ALT, AST, ALP) remain perfectly normal. **High-Yield Clinical Pearls for NEET-PG:** * **Genetic Defect:** Most commonly due to a TATAA box mutation in the *UGT1A1* gene [4]. * **Diagnosis:** Suggested by isolated unconjugated hyperbilirubinemia (<3 mg/dL) in the absence of hemolysis (normal reticulocyte count and hemoglobin) [4]. * **Rifampicin Test:** Administration of Rifampicin can provoke an increase in bilirubin in these patients, aiding diagnosis. * **Prognosis:** Excellent; no specific treatment is required other than reassurance.

Q: Primary sclerosing cholangitis is associated with which of the following conditions?

Ulcerative colitis. **Primary Sclerosing Cholangitis (PSC)** is a chronic cholestatic liver disease characterized by inflammation, fibrosis, and stricturing of the intrahepatic and extrahepatic bile ducts [1]. **Why Option A is correct:** There is a profound association between PSC and **Inflammatory Bowel Disease (IBD)**, specifically **Ulcerative Colitis (UC)** [1]. Approximately **70-80%** of patients with PSC have underlying UC [2]. Conversely, about 2-5% of UC patients develop PSC. Interestingly, PSC can be diagnosed before, during, or years after the onset of colitis, and even after a total proctocolectomy. **Why the other options are incorrect:** * **B. Celiac Sprue:** This is an autoimmune-mediated intolerance to gluten affecting the small intestine. While it is associated with other autoimmune conditions (like Type 1 Diabetes or Dermatitis Herpetiformis), it has no specific link to PSC. * **C. Wilson’s Disease:** This is a genetic disorder of copper metabolism. While it causes liver cirrhosis, the pathology involves copper deposition in hepatocytes, not the biliary tree. * **D. Whipple’s Disease:** Caused by *Tropheryma whipplei*, this is a systemic infectious disease primarily affecting the small bowel and joints, unrelated to the biliary destruction seen in PSC. **High-Yield Clinical Pearls for NEET-PG:** * **Imaging Gold Standard:** MRCP/ERCP shows a characteristic **"Beaded Appearance"** (multifocal strictures and dilations). * **Antibody Marker:** **p-ANCA** is positive in 60-80% of cases (though not specific) [1]. * **Biopsy:** May show pathognomonic **"Onion-skin fibrosis"** around bile ducts. * **Malignancy Risk:** PSC significantly increases the risk of **Cholangiocarcinoma** and Colorectal Cancer. * **Gender Predilection:** Unlike Primary Biliary Cholangitis (PBC), PSC is more common in **males** (M:F ratio 3:1) [1].

Q: Which of the following is a poor prognostic factor in a patient with acute pancreatitis?

Leukocytosis > 20000/µL. **Explanation:** The prognosis of acute pancreatitis is determined by the severity of the systemic inflammatory response and the extent of pancreatic necrosis [1]. To predict outcomes, clinicians use scoring systems like **Ranson’s Criteria**, APACHE II, and the BISAP score. **Why Option A is Correct:** According to **Ranson’s Criteria**, a White Blood Cell (WBC) count **> 16,000/µL** at the time of admission is a significant indicator of severity. A leukocytosis of **> 20,000/µL** (as given in the option) reflects a profound systemic inflammatory response syndrome (SIRS), which correlates with a higher risk of multi-organ failure and pancreatic necrosis, thus indicating a poor prognosis [1]. **Why the Other Options are Incorrect:** * **Options B & C (Decreased Amylase/Lipase):** The absolute levels of serum amylase and lipase are diagnostic but **not prognostic**. A very high level does not mean the disease is severe, and a decrease does not necessarily mean the patient is worsening (though it may occur in end-stage chronic pancreatitis or massive necrosis, it is not a standard prognostic marker). * **Option D (Diastolic BP > 90 mmHg):** Hypertension is not a poor prognostic sign. In fact, **hypotension** (Systolic BP 200 mg/dL, **A**ge >55 yrs, **L**DH >350 IU/L, **A**ST >250 IU/L, **W**BC >16,000/µL [1]. * **Most sensitive marker for prognosis:** C-Reactive Protein (CRP) > 150 mg/L at 48 hours. * **Single best predictor of mortality:** Rising Blood Urea Nitrogen (BUN) or persistent SIRS. * **Imaging:** Contrast-Enhanced CT (CECT) is the gold standard for assessing necrosis (best done after 72 hours) [1].

Question 1

What is the drug of choice for an acute exacerbation of ulcerative colitis?

Accepted Answer

Corticosteroids

Answer

Sulfasalazine

Answer

Methotrexate

Answer

Infliximab

Question 2

The modified Mayo score is used in clinical trials to assess the severity of which condition?

Accepted Answer

Ulcerative colitis

Answer

Crohn's disease

Answer

Diverticulosis

Answer

Pancreatitis

Question 3

What is true about hepatorenal syndrome?

Accepted Answer

It is due to intense hypoperfusion of the kidney.

Answer

It is seen in the advanced stage of cirrhosis.

Answer

Type II has a more serious prognosis than Type I.

Answer

Renal insult is the primary injury.

Question 4

What is the best test for determining the eradication of H. pylori infection?

Accepted Answer

Breath urea test

Answer

Urease test

Answer

Tissue biopsy

Answer

Serum ELISA

Question 5

Which of the following is NOT associated with acute pancreatitis?

Accepted Answer

Steatorrhea

Answer

Epigastric tenderness

Answer

Upper abdominal pain

Answer

Cullen's sign

Question 6

What is true about the early stages of GERD?

Accepted Answer

Increased number of transient lower esophageal sphincter relaxations (TLOSRs)

Answer

Increased lower esophageal sphincter (LOS) pressure

Answer

Shortening of the lower esophageal sphincter (LOS)

Answer

Loss of intra-abdominal esophagus

Question 7

Which of the following is true regarding Gilbert syndrome?

Accepted Answer

Improves with phenobarbitone administration.

Answer

Characterized by conjugated hyperbilirubinemia.

Answer

Worsens with starvation.

Answer

Is a life-threatening condition.

Question 8

Primary sclerosing cholangitis is associated with which of the following conditions?

Accepted Answer

Ulcerative colitis

Answer

Celiac sprue

Answer

Wilson's disease

Answer

Whipple's disease

Question 9

Which of the following statements about achalasia cardia are TRUE?

Accepted Answer

Statements 1, 2, and 4 are true; statements 3 and 5 are false.

Answer

Statements 1, 2, and 3 are true; statements 4 and 5 are false.

Answer

Statements 1, 2, 3, and 4 are true; statement 5 is false.

Answer

Statements 1, 2, 4, and 5 are true; statement 3 is false.

Question 10

Which of the following is a poor prognostic factor in a patient with acute pancreatitis?

Accepted Answer

Leukocytosis > 20000/µL

Answer

Decreased serum amylase

Answer

Decreased serum lipase

Answer

Diastolic BP > 90 mmHg

Gastroenterology — MCQs

Gastroenterology — MCQs

On this page

Practice by Chapter

Want unlimited practice?