Gastroenterology Practice Questions

Q: Which of the following is NOT a feature of Celiac disease?

Biopsy findings are pathognomonic for the disease.. **Explanation:** The correct answer is **D**. While small bowel biopsy is a cornerstone of diagnosis, the findings (villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes) are **not pathognomonic** [1]. These histological features can also be seen in Tropical Sprue, Giardiasis, Common Variable Immunodeficiency (CVID), and Autoimmune Enteropathy. Diagnosis requires a combination of clinical features, positive serology (anti-tTG IgA), and biopsy findings that improve on a gluten-free diet [1]. **Analysis of Incorrect Options:** * **Option A:** Celiac disease typically presents with malabsorptive symptoms [1]. Iron deficiency anemia (refractory to oral iron) is a classic "silent" presentation due to primary involvement of the duodenum, where iron is absorbed [1]. * **Option B:** It is an immune-mediated enteropathy triggered by the ingestion of **gluten** (specifically the gliadin fraction) found in wheat, barley, and rye [1]. * **Option C:** Over 95% of patients express **HLA-DQ2** (most common) or **HLA-DQ8** [1]. The absence of these alleles has a high negative predictive value, effectively ruling out the disease. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Small bowel biopsy (D2 part of the duodenum). * **Best Initial Screening Test:** IgA Anti-tissue Transglutaminase (anti-tTG) antibody. * **Dermatological Association:** **Dermatitis Herpetiformis** (itchy, vesicular rash on extensors; biopsy shows IgA deposits at dermal papillae). * **Associated Malignancy:** Increased risk of **Enteropathy-associated T-cell lymphoma (EATL)**. * **Marsh Classification:** Used to grade the severity of histological changes on biopsy.

Q: A 50-year-old male presented with a history of hematemesis of 500ml of blood. On examination, his BP was 90/60 mmHg, PR was 110 bpm, and he had splenomegaly 5 cm below the lower costal margin. What is the most probable diagnosis?

Portal hypertension. ### Explanation The correct diagnosis is **Portal Hypertension**, likely leading to esophageal variceal bleeding [1]. **1. Why Portal Hypertension is correct:** The clinical presentation features a classic triad: **Massive Hematemesis** (500ml), **Hemodynamic Instability** (Hypotension 90/60 mmHg and Tachycardia 110 bpm), and **Splenomegaly** [2]. In the context of upper GI bleeding, the presence of splenomegaly is a hallmark sign of portal hypertension (congestive splenomegaly) [3]. This suggests that the bleeding source is most likely esophageal or gastric varices resulting from underlying cirrhosis or non-cirrhotic portal fibrosis [1]. **2. Why other options are incorrect:** * **Mallory-Weiss tear:** This involves a mucosal tear at the gastroesophageal junction, typically following forceful vomiting or retching. While it causes hematemesis, it is **not associated with splenomegaly**. * **Duodenal Ulcer:** This is a common cause of upper GI bleed (peptic ulcer disease). However, it does not cause splenomegaly unless there is a co-existing liver disease. * **Gastritis:** Erosive gastritis can cause hematemesis, but the bleeding is usually less massive, and like the other incorrect options, it **does not explain the presence of an enlarged spleen**. **Clinical Pearls for NEET-PG:** * **Splenomegaly + Hematemesis = Portal Hypertension** until proven otherwise [2]. * **Initial Management:** The first step in any massive hematemesis is hemodynamic stabilization (IV fluids/resuscitation), followed by an urgent Upper GI Endoscopy [2]. * **Drug of Choice:** Octreotide or Terlipressin is used to reduce portal pressure in suspected variceal bleeds. * **Prophylaxis:** Propranolol (non-selective beta-blocker) is used for primary prophylaxis of variceal bleeding.

Q: Which of the following cereals can be safely consumed by patients with Celiac disease?

Maize. Explanation: Celiac disease is an immune-mediated enteropathy triggered by the ingestion of **gluten** in genetically susceptible individuals (carrying HLA-DQ2 or HLA-DQ8). [1] Gluten is a complex of proteins found in specific grains that triggers an inflammatory response, leading to villous atrophy and malabsorption. [1] **Why Maize is Correct:** Maize (corn) and rice are safe for patients with Celiac disease because they do not contain the specific toxic prolamins that trigger the autoimmune response. Patients are advised to follow a strict lifelong **Gluten-Free Diet (GFD)**, which includes maize, rice, millet, sorghum, buckwheat, and quinoa. [1] **Why the Other Options are Incorrect:** The "toxic" grains in Celiac disease contain specific prolamins that are rich in proline and glutamine, which are resistant to enzymatic digestion: * **Wheat:** Contains **Gliadin** (the most potent trigger). [1] * **Barley:** Contains **Hordein**. [1] * **Rye:** Contains **Secalin**. [1] * *(Note: Oats contain **Avenin**, which is generally tolerated by most, but often cross-contaminated during processing).* [1] **NEET-PG High-Yield Pearls:** * **Mnemonic for Toxic Grains:** **BROW** (Barley, Rye, Oats*, Wheat). * **Gold Standard Diagnosis:** Endoscopic small bowel biopsy showing **Villous atrophy**, Crypt hyperplasia, and increased Intraepithelial lymphocytes (Marsh Classification). [1] * **Best Screening Test:** IgA anti-tissue Transglutaminase (**anti-tTG**) antibody. [1] * **Associated Conditions:** Dermatitis herpetiformis (pathognomonic skin manifestation), Type 1 Diabetes, and IgA deficiency. * **Long-term Complication:** Increased risk of **Enteropathy-associated T-cell lymphoma (EATL)** if the diet is not strictly followed.

Q: Which of the following conditions is NOT associated with Primary Sclerosing Cholangitis (PSC)?

Idiopathic thrombocytopenic purpura. **Explanation:** Primary Sclerosing Cholangitis (PSC) is a chronic cholestatic liver disease characterized by inflammation and "onion-skin" fibrosis [1] of the intrahepatic and extrahepatic bile ducts. It is strongly associated with various autoimmune and fibroinflammatory conditions. **Why Option B is Correct:** **Idiopathic Thrombocytopenic Purpura (ITP)** is an isolated hematological autoimmune disorder characterized by low platelet counts. While PSC is associated with several autoimmune conditions, there is no established clinical or pathophysiological link between PSC and ITP. **Why the other options are Incorrect:** * **Ulcerative Colitis (UC):** This is the most common association. Approximately 70-80% of patients with PSC have coexisting Inflammatory Bowel Disease (IBD), most commonly UC [1]. * **Sarcoidosis:** PSC is known to coexist with other granulomatous and systemic inflammatory diseases, including sarcoidosis. * **Retroperitoneal Fibrosis:** PSC is part of the spectrum of **IgG4-related systemic diseases**. It is frequently associated with other fibrotic conditions such as retroperitoneal fibrosis (Ormond’s disease), Riedel’s thyroiditis, and mediastinal fibrosis. **NEET-PG High-Yield Pearls:** 1. **Gold Standard Investigation:** Magnetic Resonance Cholangiopancreatography (MRCP) showing a characteristic **"beaded appearance"** (multifocal strictures and dilations). 2. **Antibody Marker:** **p-ANCA** is positive in about 60-80% of cases (though not specific) [1], [2]. 3. **Malignancy Risk:** PSC significantly increases the risk of **Cholangiocarcinoma** (10-15% lifetime risk) and Colorectal Cancer (due to associated UC). 4. **Liver Biopsy:** Classically shows **"onion-skin fibrosis"** (periductal concentric fibrosis). 5. **Treatment:** Liver transplantation is the only definitive treatment for end-stage PSC.

Q: Which oral lesion is associated with ulcerative colitis?

Pyostomatitis vegetans. **Explanation:** **Pyostomatitis vegetans (PV)** is a rare, highly specific oral manifestation of Inflammatory Bowel Disease (IBD), most commonly associated with **Ulcerative Colitis (UC)** (and occasionally Crohn’s disease). It is considered the oral counterpart of *Pyoderma gangrenosum*. * **Mechanism:** It is characterized by multiple "snail-track" ulcers (friable, yellowish-white pustules) on an erythematous base in the oral mucosa. These lesions often mirror the activity of the intestinal disease; they flare when the colitis is active and typically resolve once the underlying UC is treated or a colectomy is performed. **Analysis of Incorrect Options:** * **Pemphigus:** This is an autoimmune blistering disorder (Type II hypersensitivity) involving antibodies against desmogleins. While it causes oral ulcers, it has no specific association with UC. * **Scleroderma:** Characterized by microvascular damage and fibrosis. Oral findings include a widened periodontal ligament space and microstomia (limited mouth opening), not vegetative pustules. * **Sarcoidosis:** A multisystem granulomatous disease. Oral involvement is rare but usually presents as asymptomatic nodules or salivary gland enlargement (Heerfordt syndrome), not pustular lesions. **NEET-PG High-Yield Pearls:** * **Most common oral lesion in IBD:** Aphthous ulcers (seen in both UC and Crohn’s). * **Most specific oral lesion for UC:** Pyostomatitis vegetans. * **Skin counterpart:** Pyoderma gangrenosum (associated with UC) and Erythema nodosum (more common in Crohn’s). * **Histology of PV:** Intraepithelial abscesses filled with **eosinophils** and neutrophils.

Question 1

A 47-year-old man presents to the emergency room with sudden onset of severe upper abdominal pain with vomiting. The pain is focused in the epigastrium with radiation to the back. Serum amylase levels are 2000 U/L. Which of the following are the most commonly encountered predisposing factors for this condition?

Accepted Answer

Alcohol use and gallstones

Answer

Helicobacter pylori infection and excess gastric acid secretion

Answer

Hepatitis B infection and iron overload

Answer

Obesity and high serum cholesterol

Question 2

What is Dieulafoy's lesion?

Accepted Answer

An aberrant vessel in the submucosa that bleeds from a mucosal defect

Answer

Prolapse gastropathy

Answer

Gastric antral vascular ectasia

Answer

Gastric hemorrhagic telangiectasias

Question 3

Which of the following is NOT a feature of Celiac disease?

Accepted Answer

Biopsy findings are pathognomonic for the disease.

Answer

Diarrhea, malabsorption, and iron deficiency anemia are common symptoms.

Answer

It is a condition characterized by sensitivity to gluten.

Answer

Individuals with Celiac disease often express HLA DQ2 or DQ8.

Question 4

A 50-year-old male presented with a history of hematemesis of 500ml of blood. On examination, his BP was 90/60 mmHg, PR was 110 bpm, and he had splenomegaly 5 cm below the lower costal margin. What is the most probable diagnosis?

Accepted Answer

Portal hypertension

Answer

Mallory-Weiss tear

Answer

Duodenal ulcer

Answer

Gastritis

Question 5

Which of the following cereals can be safely consumed by patients with Celiac disease?

Accepted Answer

Maize

Answer

Wheat

Answer

Barley

Answer

Rye

Question 6

Which of the following conditions is NOT associated with Primary Sclerosing Cholangitis (PSC)?

Accepted Answer

Idiopathic thrombocytopenic purpura

Answer

Ulcerative colitis

Answer

Sarcoidosis

Answer

Retroperitoneal fibrosis

Question 7

Thickened gastric folds are not seen in which of the following conditions?

Accepted Answer

Peptic ulcer disease

Answer

Carcinoma stomach

Answer

Menetrier disease

Answer

Eosinophilic gastritis

Question 8

Which oral lesion is associated with ulcerative colitis?

Accepted Answer

Pyostomatitis vegetans

Answer

Pemphigus

Answer

Scleroderma

Answer

Sarcoidosis

Question 9

Regarding hepatic encephalopathy, which of the following statements is TRUE or FALSE?

Accepted Answer

Statement 1 is True and Statement 5 is True, while Statement 2 is False, Statement 3 is False, and Statement 4 is False.

Answer

Statement 1 is True, Statement 2 is True, Statement 3 is True, and Statement 5 is True, while Statement 4 is False.

Answer

Statement 1 is True, Statement 2 is True, and Statement 5 is True, while Statement 3 is False and Statement 4 is False.

Answer

Statement 1 is True, Statement 2 is True, and Statement 5 is True, while Statement 3 is False and Statement 4 is False.

Question 10

Which of the following conditions does not cause secretory diarrhea?

Accepted Answer

Somatostatinoma

Answer

Medullary carcinoma of the thyroid

Answer

Carcinoid syndrome

Answer

Zollinger-Ellison syndrome

Gastroenterology — MCQs

Gastroenterology — MCQs

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