Gastroenterology Practice Questions

Q: Which of the following endoscopic findings is suggestive of Crohn's disease in a patient with chronic diarrhea?

Anorectal lesions. **Explanation:** Crohn’s disease (CD) is a chronic inflammatory bowel disease characterized by transmural inflammation that can affect any part of the gastrointestinal tract from the mouth to the anus. **Why Anorectal Lesions are correct:** Anorectal involvement is a hallmark feature of Crohn’s disease and is rarely seen in Ulcerative Colitis (UC). These lesions include **perianal fistulae, fissures, skin tags, and anorectal abscesses**. They occur due to the transmural nature of the inflammation, which leads to the formation of sinus tracts. Finding perianal disease in a patient with chronic diarrhea strongly points toward CD over UC [1]. **Analysis of Incorrect Options:** * **A. Transverse ulcers:** In Crohn’s disease, ulcers are typically **longitudinal (serpentine)** or aphthous [1]. When longitudinal ulcers intersect with edematous mucosa, it creates the classic "cobblestone appearance." Transverse ulcers are more characteristic of Intestinal Tuberculosis. * **B. Nodularity:** While the mucosa may appear irregular, "nodularity" is a non-specific finding. In the context of IBD, "pseudopolyps" are more common, particularly in UC during the healing phase [1]. * **C. Hypertrophic lesions:** These are not a classic endoscopic description for CD. CD is characterized by strictures (due to fibrosis) and "skip lesions" (areas of normal mucosa between inflamed segments) [1]. **NEET-PG High-Yield Pearls:** * **Distribution:** CD is "mouth to anus" with **rectal sparing**; UC involves the rectum and moves proximally (continuous) [1]. * **Microscopy:** **Non-caseating granulomas** are pathognomonic for CD (seen in 30% of cases). * **Radiology:** Look for the **"String sign of Kantor"** (terminal ileum narrowing) and "Proud flesh" sign [1]. * **Serology:** CD is associated with **ASCA** (Anti-Saccharomyces cerevisiae antibodies), while UC is associated with **p-ANCA**.

Q: What is the commonest cause of acute pancreatitis?

Biliary calculi. Explanation: Acute pancreatitis is an inflammatory condition of the pancreas characterized by the premature activation of digestive enzymes [1]. Globally and in India, **Biliary calculi (Gallstones)** are the most common cause, accounting for approximately 40–70% of cases [1]. The mechanism involves the passage of a gallstone into the common bile duct, causing transient or persistent obstruction of the ampulla of Vater. This leads to increased pancreatic ductal pressure and bile reflux, triggering intra-acinar activation of trypsinogen to trypsin, resulting in autodigestion of the gland. **Analysis of Options:** * **Alcohol abuse:** This is the **second most common cause** overall and the most common cause of *chronic* pancreatitis [1]. It typically requires years of heavy intake. * **Infective causes:** Viral infections (e.g., Mumps, Coxsackievirus, HIV) are recognized but rare causes compared to metabolic or mechanical factors [1]. * **Idiopathic causes:** About 10–20% of cases remain idiopathic after initial workup, though many are later attributed to biliary sludge or microlithiasis. **High-Yield Pearls for NEET-PG:** * **Most common cause (Overall):** Gallstones [1]. * **Most common cause (Chronic Pancreatitis):** Alcohol [1]. * **Most common metabolic cause:** Hypertriglyceridemia (typically when levels >1000 mg/dL). * **Drug-induced:** Azathioprine, Sulfonamides, Valproate, and Estrogens are frequently cited. * **Post-ERCP:** Pancreatitis is the most common complication of ERCP (approx. 5% of cases). * **Scoring:** Ranson’s criteria and APACHE II are used to predict severity; however, **C-Reactive Protein (CRP)** is a useful delayed marker of necrosis [1].

Q: All of the following are true for patients with ulcerative colitis associated with primary sclerosing cholangitis (PSC), EXCEPT?

PSC resolves after a total colectomy.. ### Explanation **1. Why Option D is the Correct Answer (The Exception):** Primary Sclerosing Cholangitis (PSC) is an **extra-intestinal manifestation** of Inflammatory Bowel Disease (IBD), most commonly Ulcerative Colitis (UC). Unlike some other manifestations (like episcleritis or erythema nodosum) that parallel the activity of the bowel disease, **PSC follows an independent clinical course.** Performing a total colectomy—even if it "cures" the colonic disease [2]—has no impact on the progression of PSC. The biliary destruction continues, often necessitating a liver transplant regardless of the status of the colon. **2. Analysis of Incorrect Options:** * **Option A (Biliary Cirrhosis):** PSC is a chronic cholestatic disease characterized by "onion-skin" fibrosis of the bile ducts. This leads to progressive biliary obstruction, eventually resulting in secondary biliary cirrhosis and portal hypertension. * **Option B (Raised Alkaline Phosphatase):** An elevated serum Alkaline Phosphatase (ALP) is the most common biochemical abnormality in PSC, reflecting the cholestatic nature of the disease [1]. * **Option C (Hilar Cholangiocarcinoma):** Patients with PSC have a significantly increased lifetime risk (up to 10–15%) of developing cholangiocarcinoma, most commonly at the ductal confluence (hilar region). **3. NEET-PG High-Yield Pearls:** * **The "70/70" Rule:** Approximately 70% of patients with PSC have UC, and 70% of PSC patients are male [3]. * **Imaging Gold Standard:** MRCP is the initial diagnostic test of choice, showing the classic **"beaded appearance"** (multifocal strictures and dilations). * **Cancer Risk:** UC patients with PSC have a higher risk of **colorectal cancer** compared to those with UC alone; they require annual screening colonoscopies from the time of PSC diagnosis. * **Antibody:** **p-ANCA** is positive in about 60-80% of PSC cases but is not specific [1].

Q: What is the most likely diagnosis for a finding detected during esophageal endoscopy?

Adenocarcinoma. ***Adenocarcinoma*** - Presents as an **irregular ulcerated mass** in the distal esophagus, often arising from **Barrett's esophagus** with intestinal metaplasia. - Endoscopic features include **raised irregular borders**, **friable tissue**, and **luminal narrowing** with potential obstruction. *Candidiasis* - Characterized by **white plaques** or pseudomembranes that can be easily brushed off during endoscopy. - Typically occurs in **immunocompromised patients** and presents with **odynophagia** rather than mass lesions. *Dieulafoy's lesion* - Appears as a **single bleeding point** from a **submucosal arterial vessel** without surrounding mucosal abnormality. - Primarily causes **acute upper GI bleeding** rather than forming visible masses or ulcerative lesions. *Schatzki ring* - Shows a **smooth, thin mucosal ring** at the **gastroesophageal junction** causing intermittent dysphagia. - Appears as a **benign stricture** without irregular borders, ulceration, or mass-like characteristics.

Q: Coomb's positive hemolytic anemia is seen in all of the following conditions except:

Alcoholic cirrhosis. The core concept tested here is the association between **Autoimmune Liver Diseases** and **Autoimmune Hemolytic Anemia (AIHA)**. [1] **1. Why Alcoholic Cirrhosis is the correct answer:** Hemolytic anemia in alcoholic cirrhosis is typically **Coombs-negative**. It is usually caused by **Zieve’s Syndrome** (triad of hemolytic anemia, hyperlipidemia, and jaundice) or **Spur Cell Anemia** (acanthocytosis due to abnormal cholesterol loading of the RBC membrane). These are metabolic and mechanical processes, not immune-mediated; hence, the Direct Antiglobulin Test (Coombs) is negative. **2. Why the other options are incorrect:** * **Chronic Active Hepatitis (Autoimmune Hepatitis):** AIH is frequently associated with other autoimmune phenomena. Coombs-positive AIHA is a well-documented extrahepatic manifestation of this condition. [1] * **Primary Biliary Cholangitis (PBC) & Primary Sclerosing Cholangitis (PSC):** Both are immune-mediated cholestatic liver diseases. [1] They are part of the "overlap syndromes" and are associated with various autoimmune markers and conditions, including warm-antibody AIHA (Coombs-positive). [2] **NEET-PG High-Yield Pearls:** * **Zieve’s Syndrome:** Look for a history of heavy alcohol binge, sudden jaundice, and hemolytic anemia with a negative Coombs test. * **Spur Cell Anemia:** Indicates advanced alcoholic liver disease and carries a very poor prognosis. * **Coombs-Positive AIHA** is also associated with SLE, CLL, and drugs like Methyldopa or Penicillin. * **Wilson’s Disease:** A crucial differential for liver failure with hemolytic anemia; however, the hemolysis in Wilson’s is typically Coombs-negative (due to direct toxic effects of copper on RBCs).

Q: Which of the following is NOT a metabolic complication of cirrhosis?

Hypoammonemia. Explanation: In cirrhosis, the liver's metabolic and synthetic functions are severely compromised. The correct answer is **Hypoammonemia** because cirrhosis characteristically leads to **Hyperammonemia**, not low levels. [1] 1. **Why Hypoammonemia is the Correct Answer:** The liver is the primary site for the **Urea Cycle**, which converts toxic ammonia (produced by gut bacteria and protein metabolism) into water-soluble urea for excretion. In cirrhosis, hepatocellular dysfunction and portosystemic shunting prevent this conversion. [1] This results in elevated serum ammonia levels (**Hyperammonemia**), which cross the blood-brain barrier and play a central role in the pathogenesis of **Hepatic Encephalopathy**. [1] 2. **Analysis of Incorrect Options:** * **Hyponatremia:** This is a hallmark of advanced cirrhosis. It is typically **dilutional (hypervolemic) hyponatremia** caused by the non-osmotic release of ADH (Vasopressin) due to splanchnic vasodilation and decreased effective arterial blood volume. * **Hypokalemia:** Frequently seen due to secondary hyperaldosteronism (the liver cannot degrade aldosterone) and the use of loop diuretics (e.g., Furosemide) to manage ascites. [2] * **Hypoglycemia:** The liver is responsible for glycogen storage and gluconeogenesis. In end-stage cirrhosis, the loss of functional hepatocytes leads to a failure in maintaining blood glucose levels during fasting. [3] **High-Yield NEET-PG Pearls:** * **Most common electrolyte abnormality in cirrhosis:** Hyponatremia. * **Precipitant of Hepatic Encephalopathy:** Hypokalemia (it increases renal ammonia production). * **Management of Hyperammonemia:** Lactulose (converts $NH_3$ to non-absorbable $NH_4^+$) and Rifaximin (reduces ammonia-producing gut flora).

Question 1

Which of the following endoscopic findings is suggestive of Crohn's disease in a patient with chronic diarrhea?

Accepted Answer

Anorectal lesions

Answer

Transverse ulcer

Answer

Nodularity

Answer

Hypertrophic lesions

Question 2

What is the commonest cause of acute pancreatitis?

Accepted Answer

Biliary calculi

Answer

Alcohol abuse

Answer

Infective causes

Answer

Idiopathic causes

Question 3

A 34-year-old female with a history of oral contraceptive pill (OCP) usage presented to the ER with hematemesis, severe acute RUQ abdominal pain, and a history of DVT. Physical evaluation revealed ascites and tender hepatomegaly. What is the most likely cause for these symptoms?

Accepted Answer

Thrombosis of the hepatic veins

Answer

Obstruction of the common bile duct

Answer

Obstruction of the intrahepatic sinusoids

Answer

Thrombosis of the hepatic artery

Question 4

A 69-year-old man presents with new symptoms of confusion and sleep disturbance. His partner reports a history of cirrhosis due to chronic alcoholism, with abstinence from alcohol for the past 3 months. His medications include nadolol, furosemide, spironolactone, and lactulose. On examination, he is jaundiced. Supine blood pressure is 102/78 mm Hg, and standing blood pressure is 86/64 mm Hg with a heart rate increase from 72 to 100 beats/min. He is afebrile and has an oxygen saturation of 98% on room air. The abdomen is soft with a palpable spleen tip and no ascites. He is disoriented to place and time but moves all four limbs on command. A digital rectal examination reveals dark black stool. Which of the following is the most likely cause?

Accepted Answer

Gastrointestinal bleeding

Answer

Spontaneous bacterial peritonitis

Answer

Spironolactone

Answer

Nadolol

Question 5

All of the following are true for patients with ulcerative colitis associated with primary sclerosing cholangitis (PSC), EXCEPT?

Accepted Answer

PSC resolves after a total colectomy.

Answer

They may develop biliary cirrhosis.

Answer

May have a raised alkaline phosphatase.

Answer

Increased risk of hilar cholangiocarcinoma.

Question 6

What is the most likely diagnosis for a finding detected during esophageal endoscopy?

Accepted Answer

Adenocarcinoma

Answer

Candidiasis

Answer

Dieulafoy's lesion

Answer

Schatzki ring

Question 7

Which of the following conditions does NOT cause a false positive D-xylose test?

Accepted Answer

Celiac sprue

Answer

Bacterial overgrowth

Answer

Renal failure

Answer

Ascites

Question 8

The characteristic esophageal manometry finding in achalasia cardia is:

Accepted Answer

Impaired lower esophageal sphincter relaxation and absent peristalsis

Answer

Impaired lower esophageal sphincter relaxation and increased peristalsis

Answer

Decreased lower esophageal sphincter pressure and absent peristalsis

Answer

Decreased lower esophageal sphincter pressure and increased peristalsis

Question 9

Coomb's positive hemolytic anemia is seen in all of the following conditions except:

Accepted Answer

Alcoholic cirrhosis

Answer

Chronic active hepatitis

Answer

Primary biliary cirrhosis

Answer

Primary sclerosing cholangitis

Question 10

Which of the following is NOT a metabolic complication of cirrhosis?

Accepted Answer

Hypoammonemia

Answer

Hypokalemia

Answer

Hyponatremia

Answer

Hypoglycemia

Gastroenterology — MCQs

Gastroenterology — MCQs

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