Gastroenterology Practice Questions

Q: A 15-year-old boy presents with abdominal cramps and diarrhea for 8 weeks along with delayed puberty. Perianal examination reveals the following. What is the diagnosis? (NEET Pattern 2018)

Crohn's disease. ***Crohn's disease*** - The combination of **chronic abdominal cramps and diarrhea**, **delayed puberty**, and the presence of **perianal lesions** (like skin tags, fissures, or abscesses, as depicted) is highly indicative of Crohn's disease. - Delayed puberty suggests **malabsorption** and chronic inflammation, which are characteristic systemic effects of Crohn's disease, particularly when it affects the small bowel. *Celiac disease* - While celiac disease can cause **abdominal cramps**, **diarrhea**, and **growth delays** (potentially leading to delayed puberty due to malabsorption), it typically does **not present with perianal lesions**. - It is an **autoimmune response to gluten**, not an inflammatory bowel disease presenting with perianal manifestations. *Ulcerative colitis* - This condition is characterized by **colonic inflammation**, causing symptoms like **bloody diarrhea** and abdominal pain. - While it can manifest with some **extraintestinal symptoms**, **perianal disease** is rare and less severe compared to Crohn's disease, and delayed puberty is less commonly associated. *Irritable bowel syndrome* - IBS is a **functional gastrointestinal disorder** without underlying structural or biochemical abnormalities, presenting with abdominal pain and altered bowel habits. - It does **not cause perianal lesions**, malabsorption, or systemic complications like delayed puberty.

Q: The following appearance of esophagus is seen in:

Eosinophilic esophagitis. ***Eosinophilic esophagitis*** - The image clearly shows **trachealization** of the esophagus, characterized by **concentric rings** and **linear furrows**, which are hallmark endoscopic findings of eosinophilic esophagitis. - This condition is an **allergic inflammatory disorder** involving the esophagus, often leading to dysphagia and food impaction. *GERD* - While GERD can cause inflammation (esophagitis), it typically presents with **erosions**, **strictures**, or **Barrett's esophagus**, but not the characteristic ringed appearance seen here. - The presence of **longitudinal furrows** and a pale, corrugated appearance rather than the distinct circular rings would be less typical for classic GERD. *Stricture* - A stricture would appear as a **localized narrowing** of the esophageal lumen, which is not the predominant feature in this image. - While strictures can occur in chronic eosinophilic esophagitis, the primary morphological feature visualized is the **ringed esophagus**. *Radiation esophagitis* - This condition results from **radiation exposure** to the chest and typically presents with **mucosal edema**, **erythema**, **ulcerations**, or **fibrosis** in acute and chronic phases, respectively. - It does not commonly cause the distinctive **trachealization** or ringed appearance seen in the image.

Q: A 20-year-old man with history of melena and abdominal pain has pigmentation of lips. Probable diagnosis is:

Peutz Jeghers syndrome. ***Peutz Jeghers syndrome*** - The combination of **mucocutaneous pigmentation** (especially on the lips and buccal mucosa, as seen in the image) with gastrointestinal symptoms like **melena** (due to bleeding from polyps) and abdominal pain is characteristic of Peutz-Jeghers syndrome. - This syndrome is also associated with an increased risk of various cancers, including gastrointestinal cancers. *Incontinentia pigmenti* - This is a rare **X-linked dominant genetic disorder** primarily affecting the skin, nervous system, eyes, and teeth. - It presents with **linear or whorled skin lesions**, typically developing in infancy, and does not cause gastrointestinal polyps or bleeding. *Cronkhite Canada Syndrome* - This syndrome is characterized by generalized gastrointestinal **hamartomatous polyposis** combined with ectodermal abnormalities including **alopecia**, onychodystrophy (nail changes), and cutaneous pigmentation. - While it involves gastrointestinal symptoms and pigmentation, the specific mucocutaneous pigmentation pattern seen in the image and absence of other ectodermal features make Peutz-Jeghers more likely. *Brooke Spiegler syndrome* - This is a rare autosomal dominant disorder characterized by the development of **multiple adnexal tumors**, such as cylindromas, trichoepitheliomas, and spiradenomas. - It primarily affects the skin, particularly on the head and neck, and does not typically involve gastrointestinal symptoms or mucocutaneous pigmentation as described.

Q: Which of the following is not a component of prognostic index of Nazer in the patient whose naked eye examination is shown below?

Urine copper. ***Urine copper*** - The image shows a **Kayser-Fleischer ring**, which is a hallmark of **Wilson's disease**, a disorder of copper metabolism. - While urinary copper excretion is a diagnostic test for Wilson's disease, it is **not** a component of the **Nazer prognostic index**, which is used to assess the severity of Wilson's disease-related acute liver failure. *Serum bilirubin* - **Serum bilirubin** is a crucial component of the **Nazer prognostic index**, reflecting the severity of **liver dysfunction**. - Elevated bilirubin levels indicate impaired bile excretion and significant liver damage. *Serum aspartate aminotransferase* - **Serum aspartate aminotransferase (AST)** is another essential component of the **Nazer prognostic index**. - Markedly elevated AST levels, particularly with a high AST/ALT ratio, are characteristic of acute liver failure in Wilson's disease. *Prothrombin time* - **Prothrombin time (PT)** is included in the **Nazer prognostic index** to assess the liver's synthetic function. - A prolonged PT indicates impaired production of clotting factors by the liver, signifying severe liver damage.

Q: Consider the following statements regarding Plummer-Vinson syndrome : I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia. II. It is a rare disease, mainly affecting middle-aged women. III. There is predisposition to postcricoid, cervical oesophageal cancer. IV. Treatment is usually surgical. Which of the statements given above are correct?

I, II and III. **I, II and III** - **Plummer-Vinson syndrome** is characterized by the triad of **dysphagia**, **iron deficiency anemia**, and an **esophageal web**, typically in the **cervical esophagus**. - It predominantly affects **middle-aged women** and is associated with an increased risk of **postcricoid esophageal cancer**. *I, II and IV* - While statements I and II are correct, statement IV is incorrect because the primary treatment for Plummer-Vinson syndrome is usually medical management of **iron deficiency** and endoscopic dilation of the web, not surgery. - Surgical intervention is generally reserved for complications or malignancy. *II, III and IV* - While statements II and III are correct, statement IV is incorrect as surgery is not the usual first-line treatment for Plummer-Vinson syndrome. - Statement I, which describes the characteristic findings of the syndrome, is also correct and is excluded from this option. *I, III and IV* - While statements I and III are correct, statement IV regarding surgical treatment is incorrect. - The syndrome is indeed rare and mainly affects middle-aged women, making statement II correct, which is excluded from this option.

Q: Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?

High resolution manometry. ***High resolution manometry*** - **High-resolution manometry (HRM)** is considered the **gold standard** for diagnosing oesophageal motility disorders because it provides detailed, real-time pressure topography of the entire oesophagus during swallowing [1]. - It allows for precise identification and classification of conditions such as **achalasia**, diffuse oesophageal spasm, and **scleroderma oesophagus** based on objective metrics [1]. *Upper GI endoscopy* - While essential for evaluating **mucosal abnormalities** and ruling out structural causes (e.g., tumours, strictures), it does not directly assess oesophageal motility [1]. - An **endoscopy** provides visual information but cannot quantify or characterize the contractile function of the oesophageal muscle [1]. *Contrast enhanced CT scan (CECT) oesophagus* - A **CECT scan** is primarily used for evaluating **extramural compression**, mediastinal involvement, or the presence of mass lesions, not for assessing the functional contractions of the oesophagus. - It provides anatomical information but offers very limited insight into the dynamic pressure changes associated with **oesophageal peristalsis**. *Barium swallow* - A **barium swallow** can suggest motility disorders by visualizing the passage of contrast and identifying abnormalities like **tertiary contractions** or delayed emptying, but it is less precise than manometry [1]. - It provides an anatomical overview and may show gross motility disturbances, but it lacks the quantitative and detailed pressure data that **HRM** offers for definitive diagnosis [1].

Q: A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Kayser-Fleisher rings in the cornea. Detailed clinical features point towards Wilson's disease. ***Kayser-Fleisher rings in the cornea*** - The history of **recurrent jaundice** and **facial grimacing** (likely dystonia/tremors) points towards a **neuropsychiatric disorder** with liver involvement, which is characteristic of **Wilson's disease** [1]. - **Kayser-Fleisher rings** are copper deposits in the Descemet's membrane of the cornea, a pathognomonic sign of Wilson's disease. *Adenoma sebaceum in the mid face* - **Adenoma sebaceum** (facial angiofibromas) is a characteristic skin lesion associated with **tuberous sclerosis complex**, which typically presents with seizures, intellectual disability, and characteristic skin lesions, not recurrent jaundice or facial grimacing indicative of movement disorders. - This condition does not primarily involve recurrent jaundice or movement disorders like facial grimacing. *Erythema nodosum on the skin* - **Erythema nodosum** is an inflammatory condition characterized by painful, red nodules, typically on the shins. - It is often associated with conditions like **sarcoidosis**, inflammatory bowel disease, infections, or drug reactions, and does not commonly present with recurrent jaundice and facial grimacing. *Osler's nodes at the finger tips* - **Osler's nodes** are painful, tender, red or purple lesions found on the fingertips and toes, indicative of **infective endocarditis**. - This symptom is related to immune complex deposition and systemic infection, rather than genetic disorders causing liver disease and neurological dysfunction.

Q: Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Sinusoidal - Veno-occlusive disease. ***Sinusoidal - Veno-occlusive disease*** - **Veno-occlusive disease** (also known as sinusoidal obstruction syndrome) specifically affects the blood flow within the **sinusoids** of the liver [1]. - This obstruction at the sinusoidal level directly leads to **sinusoidal portal hypertension** [1]. *Post-hepatic - Schistosomiasis post sinusoidal* - **Schistosomiasis** primarily causes **presinusoidal portal hypertension**, specifically due to periportal fibrosis in the liver. - **Post-hepatic portal hypertension** typically involves obstruction *after* the liver sinusoids, such as in **Budd-Chiari syndrome** or right heart failure [1]. *Pre-hepatic - Portal vein presinusoidal thrombosis* - **Portal vein thrombosis** occurring *before* the liver sinusoids would indeed be classified as **pre-hepatic portal hypertension** [2]. - However, the description **"presinusoidal thrombosis"** describes the *location* of the thrombosis but does not inherently define it as pre-hepatic versus intrahepatic. **Pre-hepatic** explicitly means before the liver substance. *Intrahepatic - Cirrhosis presinusoidal* - **Cirrhosis** is a classic cause of **intrahepatic portal hypertension**, but the obstruction in cirrhosis is predominantly **sinusoidal and post-sinusoidal**, due to fibrosis and regenerating nodules [2]. - While some early fibrotic changes may have presinusoidal components, the dominant site of obstruction in established cirrhosis is at the sinusoidal and perisinusoidal levels, not strictly presinusoidal.

Q: Which one of the following is a contraindication to wireless capsule endoscopy?

Small bowel stricture. ***Small bowel stricture*** - A **small bowel stricture** is a major contraindication for wireless capsule endoscopy due to the significant risk of the capsule becoming **retained** at the narrowed segment [1]. - Capsule retention can lead to **obstruction** requiring surgical intervention, thus posing a serious safety concern. *Small bowel Crohn's disease* - While Crohn's disease *can* cause strictures, the existence of Crohn's disease itself is not an absolute contraindication unless a **significant stricture** is already known or highly suspected [1]. - Capsule endoscopy is often used to *diagnose* and *monitor* small bowel Crohn's disease [1]. *Coeliac disease* - **Coeliac disease** is not a contraindication; in fact, capsule endoscopy can be a useful tool in evaluating the small bowel mucosa in refractory cases or for confirming diagnosis [1]. - There is no increased risk of capsule retention or other adverse events directly attributable to coeliac disease itself. *Obscure gastrointestinal bleeding* - **Obscure gastrointestinal bleeding** is considered a primary *indication* for wireless capsule endoscopy, rather than a contraindication [1]. - The capsule can visualize the entire small bowel, often identifying bleeding sources that are not accessible by conventional endoscopy [1].

Question 1

A 15-year-old boy presents with abdominal cramps and diarrhea for 8 weeks along with delayed puberty. Perianal examination reveals the following. What is the diagnosis? (NEET Pattern 2018)

Accepted Answer

Crohn's disease

Answer

Celiac disease

Answer

Ulcerative colitis

Answer

Irritable bowel syndrome

Question 2

The following appearance of esophagus is seen in:

Accepted Answer

Eosinophilic esophagitis

Answer

GERD

Answer

Stricture

Answer

Radiation esophagitis

Question 3

A 20-year-old man with history of melena and abdominal pain has pigmentation of lips. Probable diagnosis is:

Accepted Answer

Peutz Jeghers syndrome

Answer

Incontinentia pigmenti

Answer

Cronkhite Canada Syndrome

Answer

Brooke Spiegler syndrome

Question 4

Which of the following is not a component of prognostic index of Nazer in the patient whose naked eye examination is shown below?

Accepted Answer

Urine copper

Answer

Serum bilirubin

Answer

Serum aspartate aminotransferase

Answer

Prothrombin time

Question 5

Which one of following statements is correct regarding Budd-Chiari Syndrome (BCS)?

Accepted Answer

Abdominal discomfort and ascites are the main presenting features.

Answer

Venous drainage of the liver is occluded by IVC thrombus.

Answer

It principally affects young males.

Answer

Quadrate lobe (Segment 4) undergoes hypertrophy.

Question 6

Consider the following statements regarding Plummer-Vinson syndrome :
I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia.
II. It is a rare disease, mainly affecting middle-aged women.
III. There is predisposition to postcricoid, cervical oesophageal cancer.
IV. Treatment is usually surgical.

Which of the statements given above are correct?

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 7

Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?

Accepted Answer

High resolution manometry

Answer

Upper GI endoscopy

Answer

Contrast enhanced CT scan (CECT) oesophagus

Answer

Barium swallow

Question 8

A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Accepted Answer

Kayser-Fleisher rings in the cornea

Answer

Adenoma sebaceum in the mid face

Answer

Erythema nodosum on the skin

Answer

Osler's nodes at the finger tips

Question 9

Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Accepted Answer

Sinusoidal - Veno-occlusive disease

Answer

Post-hepatic - Schistosomiasis post sinusoidal

Answer

Pre-hepatic - Portal vein presinusoidal thrombosis

Answer

Intrahepatic - Cirrhosis presinusoidal

Question 10

Which one of the following is a contraindication to wireless capsule endoscopy?

Accepted Answer

Small bowel stricture

Answer

Small bowel Crohn's disease

Answer

Coeliac disease

Answer

Obscure gastrointestinal bleeding

Gastroenterology — MCQs

Gastroenterology — MCQs

On this page

Practice by Chapter

Want unlimited practice?