Gastroenterology Practice Questions

Q: Which of the following findings is more characteristic of ulcerative colitis when compared to Crohn's disease?

Rectal bleeding. **Explanation:** The correct answer is **Rectal bleeding**. This is a hallmark clinical feature of **Ulcerative Colitis (UC)** because the disease process involves continuous, superficial inflammation of the colonic mucosa, almost always starting in the rectum and extending proximally [1]. Because the rectal mucosa is consistently inflamed and friable, hematochezia (bloody stools) is present in over 90% of UC patients. In contrast, **Crohn’s Disease (CD)** often spares the rectum and involves transmural inflammation; while bleeding can occur, it is significantly less common than in UC [3]. **Analysis of Incorrect Options:** * **A. Segmental involvement:** This is characteristic of **Crohn’s Disease**, where "skip lesions" (areas of disease separated by normal mucosa) occur [2]. UC is characterized by continuous, symmetrical involvement [1]. * **B. Granulomas:** Non-caseating granulomas are a pathognomonic histological finding in **Crohn’s Disease** (seen in ~30% of cases). They are absent in UC. * **C. Lymph node involvement:** While both can have lymphadenopathy, prominent mesenteric lymph node involvement and "creeping fat" are classic surgical/pathological findings associated with the transmural nature of **Crohn’s Disease**. **High-Yield NEET-PG Pearls:** * **Smoking Paradox:** Smoking is a risk factor for Crohn’s Disease but appears to be **protective** against Ulcerative Colitis. * **Depth of Inflammation:** UC is limited to the **mucosa and submucosa** [1], whereas CD is **transmural** (leading to fistulas and strictures) [4]. * **Lead Pipe Sign:** Seen on barium enema in chronic UC due to loss of haustrations. * **ASCA vs. p-ANCA:** CD is associated with **ASCA** (+), while UC is associated with **p-ANCA** (+).

Q: Enteric fever on the fourth day is best diagnosed by?

Blood culture. The diagnosis of Enteric Fever (Typhoid) follows a specific chronological pattern based on the pathogenesis of *Salmonella typhi*. After ingestion, the bacteria multiply in the Peyer's patches and enter the bloodstream, causing a **primary bacteremia** during the first week of illness. **1. Why Blood Culture is correct:** During the **first week** (Days 1–7) of fever, blood culture is the gold standard and the most sensitive diagnostic method (positive in 70–90% of cases). Since the question specifies the **fourth day**, the bacteria are actively circulating in the blood, making blood culture the definitive investigation. **2. Why other options are incorrect:** * **Widal Test:** This serological test detects antibodies (Anti-O and Anti-H). These antibodies only reach significant titers by the **end of the second week** or the beginning of the third week. Testing on the fourth day would likely yield a false negative. * **Stool Test:** While *S. typhi* is shed in feces, cultures are most likely to be positive during the **second and third weeks** as the bacteria are released from the gallbladder and inflamed Peyer's patches into the intestinal lumen [1]. * **Urine Test:** This is the least sensitive method and typically becomes positive only in the **third week** of the illness. **Clinical Pearls for NEET-PG:** * **Mnemonic "BASU":** To remember the sequence of positivity—**B**lood (1st week), **A**gglutination/Widal (2nd week), **S**tool (3rd week), **U**rine (4th week). * **Bone Marrow Culture:** This is the **most sensitive** overall (up to 95%), even if the patient has already started antibiotics. * **Rose Spots:** These faint salmon-colored rashes typically appear on the trunk during the second week. * **Drug of Choice:** Ceftriaxone is currently the preferred empirical treatment due to widespread multi-drug resistance (MDR) and fluoroquinolone resistance.

Q: Which of the following is not a component of the Child-Pugh score?

Bleeding time. The **Child-Pugh Score** (also known as the Child-Turcotte-Pugh score) is a clinical tool used to assess the prognosis and severity of chronic liver disease, particularly cirrhosis [1]. ### **Why "Bleeding Time" is the Correct Answer** Bleeding time is a measure of platelet function and vascular integrity, which is not used in the Child-Pugh classification. Instead, the score utilizes **Prothrombin Time (PT)** or the **International Normalized Ratio (INR)** to assess the liver's synthetic function regarding coagulation factors [1]. ### **Explanation of Incorrect Options** The Child-Pugh score consists of five parameters (mnemonic: **ABCDE**): * **A - Albumin (Option A):** A marker of the liver's long-term synthetic function [1]. * **B - Bilirubin (Option D):** An indicator of the liver's excretory capacity [1]. * **C - Clinical Ascites (Option C):** Assessed as absent, slight, or moderate/severe [1]. * **D - Degree of Encephalopathy:** Assessed based on the West Haven criteria [1]. * **E - PT/INR:** Measures the synthesis of vitamin K-dependent clotting factors [1]. ### **NEET-PG High-Yield Pearls** * **Scoring:** Each parameter is scored 1–3. Total scores range from 5 to 15. * **Class A (5–6):** Least severe, 100% 1-year survival. * **Class B (7–9):** Moderate severity. * **Class C (10–15):** Most severe, ~45% 1-year survival. * **MELD Score:** Unlike Child-Pugh, the MELD score (Model for End-Stage Liver Disease) uses **Creatinine, Bilirubin, and INR** [1]. It is more objective as it excludes subjective clinical assessments like ascites and encephalopathy. * **Clinical Note:** Child-Pugh Class C is often a contraindication for major non-transplant surgeries.

Q: Which of the following is not a feature of autoimmune hepatitis?

Anti-Sm antigen antibodies. The correct answer is **D. Anti-Sm (Smith) antigen antibodies**. **Why Anti-Sm is the correct choice:** Anti-Sm antibodies are highly specific for **Systemic Lupus Erythematosus (SLE)**, not autoimmune hepatitis (AIH) [1]. While AIH is an autoimmune condition, its diagnosis relies on specific liver-related autoantibodies. Anti-Sm is part of the ENA (Extractable Nuclear Antigen) panel used to confirm a diagnosis of SLE [1]. **Analysis of incorrect options:** * **A. Anti-SMA (Smooth Muscle Antibodies):** These are the hallmark of **Type 1 AIH** (the most common form). They are often found alongside positive ANA (Anti-Nuclear Antibodies) [1]. * **B. Anti-LKM1 (Liver Kidney Microsome type 1):** These antibodies are the serological marker for **Type 2 AIH**, which typically affects children and adolescents and follows a more aggressive course. * **C. Anti-mitochondrial antibodies (AMA):** While AMA is the classic marker for Primary Biliary Cholangitis (PBC), it can be present in **"Overlap Syndrome,"** where a patient exhibits features of both AIH and PBC. Therefore, it is considered a recognized feature in the spectrum of autoimmune liver diseases. **NEET-PG High-Yield Pearls:** * **AIH Type 1:** ANA (+), Anti-SMA (+), associated with HLA-DR3/DR4 [1]. * **AIH Type 2:** Anti-LKM1 (+), Anti-LC1 (Liver Cytosol type 1) (+). * **Histology:** Look for **"Interface Hepatitis"** (piecemeal necrosis) and a dense infiltrate of **plasma cells**. * **Treatment:** Prednisolone (Corticosteroids) and Azathioprine are the mainstays of therapy.

Q: Petterson-Kelly syndrome is characterized by all of the following EXCEPT:

Vitamin B12 deficiency anemia. **Explanation:** **Petterson-Kelly Syndrome** (also known as **Plummer-Vinson Syndrome**) is a classic clinical triad characterized by **Iron Deficiency Anemia (IDA)**, **Esophageal webs**, and **Dysphagia**. It is most commonly seen in middle-aged women and carries an increased risk of squamous cell carcinoma of the esophagus and pharynx. **Why Option D is the Correct Answer:** Petterson-Kelly syndrome is fundamentally linked to chronic, severe **iron deficiency** [1], not Vitamin B12 deficiency. While both can cause glossitis, the pathophysiological hallmark of this syndrome is the formation of post-cricoid esophageal webs resulting from iron-depleted mucosal atrophy. Vitamin B12 deficiency leads to megaloblastic (macrocytic) anemia [2], which is not a feature of this syndrome. **Analysis of Incorrect Options:** * **Option A (Koilonychia):** This refers to spoon-shaped nails, a classic physical sign of chronic, severe iron deficiency. * **Option B & C (Microcytic hypochromic anemia / Iron deficiency anemia):** These are essentially describing the same hematological state. Iron deficiency results in a microcytic (low MCV) and hypochromic (low MCHC) blood picture [1]. These are the defining laboratory features of Petterson-Kelly syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Triad:** Dysphagia + Iron Deficiency Anemia + Esophageal Webs. * **Pre-malignant condition:** It is associated with an increased risk of **Squamous Cell Carcinoma** of the esophagus. * **Treatment:** Iron supplementation often resolves the dysphagia and mucosal changes; mechanical dilation is used for persistent webs. * **Other associated signs:** Glossitis (smooth red tongue), Cheilosis/Angular stomatitis.

Q: A 40-year-old woman complains of severe back pain for about 3 months and recurrent fever. Her past medical history is significant for ulcerative colitis. On physical examination, the patient is thin and jaundiced. The liver edge descends 1 cm below the right costal margin and is nontender. Laboratory studies show normal serum levels of AST and ALT but elevated serum levels of alkaline phosphatase (420 U/L). Endoscopic retrograde cholangiopancreatography demonstrates a beaded appearance of the extrahepatic biliary tree. Which of the following diseases is a late complication of this patient's condition?

Cholangiocarcinoma. The clinical presentation points toward **Primary Sclerosing Cholangitis (PSC)**. The key diagnostic features in this case are the patient’s history of **Ulcerative Colitis (UC)**, elevated alkaline phosphatase (suggesting cholestasis), and the classic **"beaded appearance"** (multifocal strictures and dilations) of the biliary tree on ERCP [1]. **1. Why Cholangiocarcinoma is correct:** PSC is a chronic, progressive inflammatory disorder of the bile ducts. It is the most significant risk factor for **Cholangiocarcinoma**, which develops in approximately 10–15% of patients with PSC [2]. The chronic inflammation and cellular dysplasia within the biliary epithelium predispose patients to this malignancy, often occurring years after the initial diagnosis. **2. Why the other options are incorrect:** * **A. Adenocarcinoma of the gallbladder:** While PSC increases the risk of gallbladder polyps and stones, the association with cholangiocarcinoma is much stronger and more characteristic for NEET-PG scenarios [2]. * **C. Hepatic adenoma:** This is primarily associated with oral contraceptive use or anabolic steroids, not chronic biliary inflammation. * **D. Hepatic angiosarcoma:** This rare tumor is linked to environmental toxins like vinyl chloride, arsenic, or Thorotrast, rather than autoimmune or inflammatory bowel conditions. **Clinical Pearls for NEET-PG:** * **The "Rule of 70% ":** Approximately 70-80% of patients with PSC have underlying Ulcerative Colitis (though only 4-5% of UC patients develop PSC) [1]. * **Antibody Marker:** **p-ANCA** is positive in about 60-80% of PSC cases [1]. * **Imaging Gold Standard:** MRCP is now the initial diagnostic test of choice, showing the "beaded" pattern [1]. * **Management:** PSC does not improve with a colectomy (unlike other extraintestinal manifestations of UC). Liver transplantation is the only definitive treatment for end-stage disease.

Q: Which of the following is NOT a common cause of oesophagitis in an immunocompromised person?

Human Immunodeficiency Virus (HIV). In immunocompromised patients (such as those with AIDS, organ transplants, or malignancy), infectious oesophagitis is a frequent complication. The correct answer is **HIV (Option B)** because, while HIV is the underlying cause of the immunosuppression that predisposes a patient to infections, the virus itself is **not a common direct cause** of oesophagitis. While "HIV-associated idiopathic esophageal ulcers" can occur during seroconversion, they are significantly less common than opportunistic infections. **Analysis of Options:** * **HSV (Option A):** A very common cause. It typically presents with small, punched-out "volcano-like" ulcers. Histology shows Cowdry Type A inclusion bodies and multinucleated giant cells. * **CMV (Option D):** Another frequent cause in severely immunocompromised patients (CD4 <50). It typically presents with large, linear, shallow ulcers. Histology reveals characteristic "owl’s eye" intranuclear inclusions. * **VZV (Option C):** Though less common than HSV or CMV, VZV is a recognized cause of viral oesophagitis in the immunocompromised, often occurring in association with disseminated zoster or chickenpox. **NEET-PG High-Yield Pearls:** 1. **Most Common Cause:** *Candida albicans* is the #1 overall cause of infectious oesophagitis (presents with white plaques) [1]. 2. **Endoscopic Differentiation:** * **HSV:** Multiple, small, deep ulcers (Volcano ulcers). * **CMV:** Large, solitary, shallow/linear ulcers. 3. **Drug of Choice:** Fluconazole for *Candida*, Acyclovir for HSV, and Ganciclovir for CMV. 4. **Odynophagia:** Severe pain on swallowing is the hallmark symptom of viral oesophagitis, often more prominent than dysphagia.

Question 1

Which of the following findings is more characteristic of ulcerative colitis when compared to Crohn's disease?

Accepted Answer

Rectal bleeding

Answer

Segmental involvement

Answer

Granulomas

Answer

Lymph node involvement

Question 2

Enteric fever on the fourth day is best diagnosed by?

Accepted Answer

Blood culture

Answer

Stool test

Answer

Widal test

Answer

Urine test

Question 3

Which of the following is not a component of the Child-Pugh score?

Accepted Answer

Bleeding time

Answer

Albumin levels

Answer

Ascites

Answer

Bilirubin

Question 4

A 29-year-old man with acquired immune deficiency syndrome (AIDS) presents with progressively increasing abdominal discomfort and voluntary guarding in the upper abdomen. His biochemistry is normal except for an elevated amylase at 370 U/L (25-125 U/L). Which of the following infections can trigger this disorder in AIDS patients?

Accepted Answer

Mycobacterium avium complex

Answer

Toxoplasmosis

Answer

Mycobacterium tuberculosis

Answer

Pneumocystis jirovecii pneumonia

Question 5

Which of the following is not a feature of autoimmune hepatitis?

Accepted Answer

Anti-Sm antigen antibodies

Answer

Anti-SMA antibodies

Answer

Anti-LKM1 antibodies

Answer

Anti-mitochondrial antibodies

Question 6

Petterson-Kelly syndrome is characterized by all of the following EXCEPT:

Accepted Answer

Vitamin B12 deficiency anemia

Answer

Koilonychia

Answer

Microcytic hypochromic anemia

Answer

Iron deficiency anemia

Question 7

In celiac sprue, which vitamin deficiency is least likely?

Accepted Answer

Vitamin B12

Answer

Vitamin A

Answer

Folic acid

Answer

Iron

Question 8

A 40-year-old woman complains of severe back pain for about 3 months and recurrent fever. Her past medical history is significant for ulcerative colitis. On physical examination, the patient is thin and jaundiced. The liver edge descends 1 cm below the right costal margin and is nontender. Laboratory studies show normal serum levels of AST and ALT but elevated serum levels of alkaline phosphatase (420 U/L). Endoscopic retrograde cholangiopancreatography demonstrates a beaded appearance of the extrahepatic biliary tree. Which of the following diseases is a late complication of this patient's condition?

Accepted Answer

Cholangiocarcinoma

Answer

Adenocarcinoma of the gallbladder

Answer

Hepatic adenoma

Answer

Hepatic angiosarcoma

Question 9

Which of the following is NOT a common cause of oesophagitis in an immunocompromised person?

Accepted Answer

Human Immunodeficiency Virus (HIV)

Answer

Herpes Simplex Virus (HSV)

Answer

Varicella-Zoster Virus (VZV)

Answer

Cytomegalovirus (CMV)

Question 10

King's College criteria for orthotopic liver transplantation in acute liver failure (paracetamol induced) include all of the following except?

Accepted Answer

pH < 7.30

Answer

PT > 100s

Answer

Grade III encephalopathy

Answer

Serum bilirubin > 300 micromol/L

Gastroenterology — MCQs

Gastroenterology — MCQs

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