Gastroenterology Practice Questions

Q: The single most important treatment and prognostic factor in alcohol-related liver disease is

Cessation of alcohol consumption. ***Cessation of alcohol consumption*** - **Abstinence from alcohol** is the fundamental and most effective intervention for halting the progression of **alcohol-related liver disease (ARLD)** and significantly improving patient prognosis [1]. - Continued alcohol intake directly fuels liver damage, whereas stopping consumption allows the **liver to regenerate** and reduces inflammation, often leading to clinical improvement [1]. *N-acetyl cysteine* - While **N-acetyl cysteine (NAC)** is used in some liver conditions, particularly paracetamol overdose, its routine use for chronic ARLD is not supported by strong evidence as a primary treatment [3]. - It functions as an antioxidant and glutathione precursor, but **does not address the root cause** of alcohol-induced liver injury. *High dose vitamin E* - **High-dose vitamin E** is an antioxidant that has been investigated for various liver diseases, particularly non-alcoholic fatty liver disease (NAFLD) [2]. - However, there is **insufficient evidence** to support its widespread use as a primary or prognostic treatment in **alcohol-related liver disease** [2]. *Liver transplantation* - While **liver transplantation** can be a definitive treatment for end-stage ARLD, it is a **major surgical procedure** with strict criteria and is only considered after prolonged alcohol abstinence (typically 6 months) [1]. - It is a **salvage therapy** for irreversible damage, not the "single most important treatment and prognostic factor" in managing the disease from its earlier stages [1].

Q: Consider the following with regard to Gilbert Syndrome : I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme II. Elevation of unconjugated bilirubin III. No stigmata of chronic liver disease other than jaundice IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome Which of the above are correct?

II and III only. ***II and III only*** - **Gilbert Syndrome** is characterized by an **elevation of unconjugated bilirubin** [1] due to reduced activity of the UGT1A1 enzyme [2]. - Patients typically present with **no stigmata of chronic liver disease** other than mild, fluctuating jaundice, often triggered by stress or fasting [2]. *I and II only* - While it involves **elevation of unconjugated bilirubin (II)** [1], Gilbert syndrome is an **autosomal recessive** condition due to a **polymorphism** in the promoter region of the **UGT1A1 gene**, leading to reduced enzyme activity [2], not a mutation that completely abolishes it. - The reduced enzyme activity is typically mild, resulting in only intermittent, mild hyperbilirubinemia. *III and IV* - **No stigmata of chronic liver disease other than jaundice (III)** is correct [2]. However, **early liver biopsy (IV)** is **not recommended** in patients with suspected Gilbert Syndrome. - Gilbert syndrome is a benign condition [1], and a liver biopsy is generally unnecessary and invasive for diagnosis in the absence of other liver disease signs. *I, II and III* - Although it features **elevation of unconjugated bilirubin (II)** and **no stigmata of chronic liver disease (III)**, the description of **I** is partially incorrect. - Gilbert syndrome is due to a **polymorphism** in the UGT1A1 gene promoter resulting in reduced enzyme activity [1], and it follows an **autosomal recessive inheritance pattern**, but the core issue is the **polymorphism**, not a standard mutation that significantly impairs the enzyme.

Q: Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Transabdominal ultrasound. ***Transabdominal ultrasound*** - It is an **accurate, non-invasive, and cost-effective** imaging modality for detecting gallstones [1]. - Ultrasound can visualize the stones, their size, number, and any associated complications like **gallbladder wall thickening** or **pericholecystic fluid**. *Capsule endoscopy* - This procedure is primarily used to visualize the **small intestine** and is not suitable for evaluating the gallbladder. - It works by capturing images as it passes through the digestive tract, an area where the gallbladder is not directly accessible. *Computed Tomography* - While CT can sometimes detect gallstones, especially those that are calcified, it is **less sensitive than ultrasound** for non-calcified stones [1]. - CT also exposes the patient to **ionizing radiation**, making it less favorable as a primary diagnostic tool for gallstones compared to ultrasound. *Erect X ray of abdomen* - An erect X-ray of the abdomen is **poor at detecting gallstones** as only about 10-20% of gallstones are radiopaque (calcified) and visible on X-ray. - This imaging technique is more useful for detecting conditions like **bowel obstruction** or **perforations**, rather than gallbladder pathology.

Q: A 42-year old man with history of alcohol dependency presents with progressive abdominal distension. Abdominal examination reveals a shifting dullness. Which one of the following is the most appropriate drug to relieve this abdominal distension?

Spironolactone. **Spironolactone** - **Spironolactone** is an **aldosterone antagonist**, which is the **first-line diuretic** used in the management of **ascites** due to **cirrhosis**, often developing secondary to alcohol dependency. - It works by blocking aldosterone receptors in the **renal collecting duct**, leading to increased sodium and water excretion while conserving potassium, effectively reducing fluid accumulation. *Lactulose* - **Lactulose** is a non-absorbable disaccharide primarily used to treat and prevent **hepatic encephalopathy** by reducing ammonia levels. - It does not directly relieve abdominal distension caused by ascites, and its use is unrelated to fluid overload. *Propranolol* - **Propranolol** is a **non-selective beta-blocker** used to reduce **portal pressure** and prevent **variceal bleeding** in patients with cirrhosis. - While it addresses a complication of chronic liver disease, it does not directly manage or relieve ascites. *Octreotide* - **Octreotide** is a **somatostatin analog** used to treat complications like **acute variceal bleeding** or **hepatic encephalopathy** by reducing splanchnic blood inflow. - It is not indicated for the management of ascites or relief of abdominal distension caused by fluid accumulation.

Q: Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Perianal disease is common in Crohn's disease.. ***Perianal disease is common in Crohn's disease.*** [1] - **Crohn's disease** is characterized by **transmural inflammation** that involves all layers of the bowel wall, leading to complications like **fistulas, strictures, and perianal disease** [2]. - **Perianal disease** manifestations include **fissures, fistulas, abscesses**, and skin tags, and it is a defining characteristic of Crohn's [2]. *Stricture formation is common in Ulcerative Colitis.* - **Stricture formation** is generally **uncommon in uncomplicated ulcerative colitis** but can occur in severe, long-standing disease. - **Strictures** are more characteristic of **Crohn's disease** due to its transmural inflammation and fibrotic changes [3]. *Fistula formation is common in Ulcerative Colitis.* - **Fistula formation** is a hallmark of **Crohn's disease**, resulting from the deep, transmural inflammation that penetrates the bowel wall [2]. - **Ulcerative colitis** inflammation is typically **mucosal and superficial**, making fistula formation rare in this condition [1]. *Rectum is always involved in Crohn's disease.* - While **Crohn's disease** can affect any part of the gastrointestinal tract from mouth to anus, skip lesions are common, and the **rectum is often spared** [1]. - In contrast, **ulcerative colitis always involves the rectum**, extending proximally in a continuous fashion [1].

Q: Zollinger Ellison syndrome is characterized by which of the following ?

Non-beta islet cell tumour of pancreas. ***Non-beta islet cell tumour of pancreas*** - **Zollinger-Ellison syndrome (ZES)** is caused by a **gastrin-secreting tumor** (gastrinoma), which is a type of **non-beta islet cell tumor** of the pancreas or duodenum. - This gastrinoma leads to excessive gastric acid secretion [1]. *Recurrent ulceration despite treatment* - While **recurrent ulceration** is a prominent symptom of ZES due to hypersecretion of gastric acid, it is a *consequence* of the underlying disease rather than its defining characteristic or cause. - The persistence of ulcers despite standard anti-secretory therapy is a strong clinical indicator that points towards ZES [1]. *Recurrent episodes of dysentery* - **Dysentery** is characterized by bloody diarrhea, often caused by bacterial infections, and is not a typical or primary feature of Zollinger-Ellison syndrome. - While severe diarrhea can occur in ZES due to inactivation of pancreatic enzymes and damage to intestinal mucosa from excessive acid, it is not described as dysentery. *Fulminating gastric ulcers* - Gastric ulcers in ZES can be severe and numerous, but the term "fulminating" typically implies a rapid onset, severe, and aggressive course, often seen in conditions like *H. pylori*-associated ulcers with complications. - While ulcers in ZES are often refractory and severe, the defining characteristic of the syndrome is the gastrinoma itself, not merely the severity of ulcers.

Q: Which of the following are correct regarding Trichobezoar ? 1. It is a hair ball in the stomach. 2. It is common in psychiatric patients. 3. Common complications are bleeding, perforation or obstruction. 4. Treated with long course of proton pump inhibitors. Select the correct answer using the code given below :

1, 2 and 3. ***1, 2 and 3*** - A **trichobezoar** is indeed a mass of undigested hair found in the gastrointestinal tract, most commonly in the **stomach**. [1] - It is frequently associated with **psychiatric conditions** such as trichotillomania (compulsive hair pulling) and trichophagia (compulsive hair eating), leading to its occurrence predominantly in psychiatric patients. Common complications include **gastrointestinal bleeding**, **perforation**, and **obstruction** due to the size and abrasive nature of the hairball. [1] *2, 3 and 4* - While trichobezoars are common in psychiatric patients and can lead to bleeding, perforation, or obstruction, the treatment is typically **surgical removal** or **endoscopic fragmentation**, not long-term proton pump inhibitors (PPIs). - PPIs are used to reduce gastric acid, which is not the primary treatment for a physical obstruction like a trichobezoar. *1, 3 and 4* - Although a trichobezoar is a hairball in the stomach and can cause bleeding, perforation, or obstruction, the statement about treatment with a long course of **proton pump inhibitors (PPIs)** is incorrect. - PPIs would not resolve a physical mass like a trichobezoar, which usually requires removal. *1, 2 and 4* - While trichobezoars are stomach hairballs and are more prevalent in psychiatric patients, and long-term **proton pump inhibitors (PPIs)** are not a primary treatment for trichobezoars. - The correct management involves physical removal rather than acid suppression.

Q: Which of the following statements are correct regarding Barrett's oesophagus? 1. It is a metaplastic change. 2. It is a risk factor for development of adenocarcinoma. 3. Ingestion of NSAIDs is the aetiological factor for its development. 4. Endoscopic mucosal resection is an effective treatment. Select the answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** - **Barrett's esophagus** is characterized by the replacement of the normal **stratified squamous epithelium** of the distal esophagus with **specialized intestinal columnar epithelium**, which is a classic example of **metaplasia**. [1] - This metaplastic change is a significant **risk factor** for developing **esophageal adenocarcinoma**, making regular surveillance and treatment crucial. [1] **Endoscopic mucosal resection (EMR)** is an effective treatment option for early-stage adenocarcinoma or high-grade dysplasia in Barrett's esophagus, capable of removing superficial neoplastic tissue. *2, 3 and 4* - This option incorrectly includes ingestion of NSAIDs as an etiological factor for Barrett's esophagus. **NSAIDs** are not directly associated with the development of Barrett's esophagus. - While statements 2 and 4 are correct, the inclusion of statement 3 makes this option incorrect. *1, 3 and 4* - This option wrongly implicates **NSAIDs** in the etiology of Barrett's esophagus. The primary cause is **chronic gastroesophageal reflux disease (GERD)**, not NSAID use. [1] - Statement 2, which identifies Barrett's as a risk factor for adenocarcinoma, is critically important but is omitted here. *1, 2 and 3* - This option incorrectly states that NSAID ingestion is an etiological factor for Barrett's esophagus. The main cause is **chronic acid reflux**. [1] - While statements 1 and 2 are correct, statement 3 is incorrect, rendering this entire option invalid.

Q: Which of the following statements are correct with regard to Budd-Chiari syndrome? 1. Venous drainage of liver is occluded by hepatic vein thrombosis. 2. It most commonly affects the young males. 3. It is associated with protein C, protein S and antithrombin III deficiency. 4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.

1, 3 and 4. ***1, 3 and 4*** - **Budd-Chiari syndrome** is characterized by the **occlusion of hepatic venous outflow**, typically due to **thrombosis** in the hepatic veins or inferior vena cava [1]. - It is frequently associated with **hypercoagulable states**, including deficiencies of **protein C, protein S, and antithrombin III**, and commonly presents acutely with **abdominal discomfort, ascites**, and hepatomegaly due to acute thrombosis [1], [2]. *1, 2 and 3* - This option is incorrect because Budd-Chiari syndrome does not most commonly affect young males; it has a variable incidence and can affect both sexes, often in their early adulthood or middle age. - While venous drainage occlusion and association with hypercoagulable states are correct, the demographic statement renders this option partially incorrect. *1, 2 and 4* - This option is incorrect because the statement that Budd-Chiari syndrome most commonly affects young males is not accurate; it has a broader demographic distribution. - The other points regarding venous occlusion and clinical features are correct, but the demographic inaccuracy makes this option incorrect. *2, 3 and 4* - This option is incorrect because statement 2, claiming that Budd-Chiari syndrome most commonly affects young males, is not consistently true. - While deficiencies like protein C, protein S, and antithrombin III, as well as symptoms like abdominal discomfort and ascites, are indeed associated, the demographic claim invalidates this choice.

Q: Which of the following statements regarding peptic ulcers are correct? 1. Duodenal ulcers are more common as compared to gastric ulcers. 2. Helicobacter pylori and NSAIDs are most common causative agents. 3. Bleeding is the most common complication associated with posterior duodenal ulcer.

1 and 2 only. ***1 and 2 only*** - **Duodenal ulcers** are significantly more common than gastric ulcers, with a ratio of about 4:1 [1]. - The two primary causes of peptic ulcers are infection with **_Helicobacter pylori_** and the use of **non-steroidal anti-inflammatory drugs (NSAIDs)** [1]. *2 and 3 only* - While _**H. pylori**_ and **NSAIDs** are indeed the most common causes, the statement incorrectly assumes that bleeding is the most common complication associated with **posterior duodenal ulcers**, when the most common complication of all peptic ulcers is **hemorrhage** but it is more specifically associated with posterior duodenal ulcers due to proximity to the **gastroduodenal artery**. - Hence, the second and third statements are individually correct, but the first statement which says duodenal ulcers are more common then gastric ulcers is also correct. *1, 2 and 3* - While statements 1 and 2 are correct individually, statement 3, which attributes bleeding as the most common complication specifically to posterior duodenal ulcers, is correct because posterior duodenal ulcers are particularly prone to bleeding due to the proximity of the **gastroduodenal artery** [1]. - Thus, all three statements are individually correct, but the combination chosen is redundant. *1 and 3 only* - This option is flawed because it omits statement 2, which correctly identifies **_H. pylori_** and **NSAIDs** as the primary causes of peptic ulcers [1]. - Although posterior duodenal ulcers are associated with bleeding, statement 3 is not complete enough without the inclusion of statement 2.

Question 1

The single most important treatment and prognostic factor in alcohol-related liver disease is

Accepted Answer

Cessation of alcohol consumption

Answer

N -acetyl cysteine

Answer

High dose vitamin E

Answer

Liver transplantation

Question 2

Consider the following with regard to Gilbert Syndrome :
I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme
II. Elevation of unconjugated bilirubin
III. No stigmata of chronic liver disease other than jaundice
IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome

Which of the above are correct?

Accepted Answer

II and III only

Answer

I and II only

Answer

III and IV

Answer

I, II and III

Question 3

Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Accepted Answer

Transabdominal ultrasound

Answer

Capsule endoscopy

Answer

Computed Tomography

Answer

Erect X ray of abdomen

Question 4

A 42-year old man with history of alcohol dependency presents with progressive abdominal distension. Abdominal examination reveals a shifting dullness. Which one of the following is the most appropriate drug to relieve this abdominal distension?

Accepted Answer

Spironolactone

Answer

Lactulose

Answer

Propranolol

Answer

Octreotide

Question 5

Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

Accepted Answer

Perianal disease is common in Crohn's disease.

Answer

Stricture formation is common in Ulcerative Colitis.

Answer

Fistula formation is common in Ulcerative Colitis.

Answer

Rectum is always involved in Crohn's disease.

Question 6

Zollinger Ellison syndrome is characterized by which of the following ?

Accepted Answer

Non-beta islet cell tumour of pancreas

Answer

Recurrent ulceration despite treatment

Answer

Recurrent episodes of dysentery

Answer

Fulminating gastric ulcers

Question 7

Which of the following are correct regarding Trichobezoar ?

1. It is a hair ball in the stomach.

2. It is common in psychiatric patients.

3. Common complications are bleeding, perforation or obstruction.

4. Treated with long course of proton pump inhibitors.

Select the correct answer using the code given below :

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 8

Which of the following statements are correct regarding Barrett's oesophagus?

1. It is a metaplastic change.
2. It is a risk factor for development of adenocarcinoma.
3. Ingestion of NSAIDs is the aetiological factor for its development.
4. Endoscopic mucosal resection is an effective treatment. Select the answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Question 9

Which of the following statements are correct with regard to Budd-Chiari syndrome?

1. Venous drainage of liver is occluded by hepatic vein thrombosis.
2. It most commonly affects the young males.
3. It is associated with protein C, protein S and antithrombin III deficiency.
4. Abdominal discomfort and ascites are the most common features associated with acute thrombosis.

Accepted Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Answer

2, 3 and 4

Question 10

Which of the following statements regarding peptic ulcers are correct?

1. Duodenal ulcers are more common as compared to gastric ulcers.
2. Helicobacter pylori and NSAIDs are most common causative agents.
3. Bleeding is the most common complication associated with posterior duodenal ulcer.

Accepted Answer

1 and 2 only

Answer

2 and 3 only

Answer

1, 2 and 3

Answer

1 and 3 only

Gastroenterology — MCQs

Gastroenterology — MCQs

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