Gastroenterology Practice Questions

Q: Before starting Infliximab in a 65-year-old gentleman for Inflammatory bowel disease, which of the following tests is mandatory?

Mantoux test. **Explanation:** **1. Why Mantoux Test is Correct:** Infliximab is a potent **TNF-alpha (Tumor Necrosis Factor) inhibitor**. TNF-alpha plays a crucial role in the formation and maintenance of **granulomas**, which are the body’s primary mechanism for sequestering *Mycobacterium tuberculosis*. By inhibiting TNF-alpha, Infliximab can lead to the breakdown of these granulomas, causing the **reactivation of Latent Tuberculosis Infection (LTBI)** into active, often disseminated, disease. Therefore, screening for TB using a **Mantoux test (TST)** or an Interferon-Gamma Release Assay (IGRA), along with a Chest X-ray, is mandatory before initiating any anti-TNF therapy, especially in TB-endemic regions like India [1]. **2. Why Other Options are Incorrect:** * **Colonoscopy (A):** While essential for the initial diagnosis and monitoring of IBD, it is not a specific safety requirement "mandatory" immediately before starting a biologic agent. * **ERCP (C):** This is an invasive procedure used for biliary or pancreatic duct pathologies (e.g., Primary Sclerosing Cholangitis associated with UC) and has no role in the pre-biologic screening protocol. * **Liver Biopsy (D):** This is not required. While baseline Liver Function Tests (LFTs) are checked, a biopsy is an invasive procedure reserved for specific diagnostic dilemmas, not routine screening. **Clinical Pearls for NEET-PG:** * **Pre-Infliximab Screening Checklist:** TB screening (Mantoux/IGRA + CXR), Hepatitis B Surface Antigen (HBsAg), and Hepatitis C serology [1]. * **Vaccination:** Patients should receive inactivated vaccines (e.g., Flu, Pneumococcal) before starting; **Live vaccines** (e.g., BCG, Yellow Fever) are **contraindicated** once therapy begins. * **Side Effects:** Infliximab increases the risk of serious infections, reactivation of Hepatitis B, and potentially worsens Heart Failure (NYHA Class III/IV).

Q: Wilson's disease is characterized by all of the following except?

The defective gene is ATP7A. **Explanation:** Wilson’s Disease (Hepatolenticular Degeneration) is an autosomal recessive disorder of copper metabolism. **1. Why Option A is the Correct Answer (The Exception):** The defective gene in Wilson’s disease is **ATP7B**, located on **Chromosome 13**. This gene encodes a copper-transporting P-type ATPase responsible for transporting copper into the bile and incorporating it into ceruloplasmin. * **ATP7A** is the defective gene in **Menkes Disease** ("Kinky Hair Syndrome"), which leads to systemic copper deficiency rather than overload. **2. Analysis of Other Options:** * **Option B:** Copper deposition in the basal ganglia (especially the putamen) leads to extrapyramidal symptoms [1]. Common features include **Parkinsonian signs** (tremors, rigidity), dystonia, ataxia, and a characteristic "wing-beating" tremor [1]. * **Option C:** **Kayser-Fleischer (KF) rings** (copper deposition in the Descemet’s membrane of the cornea) are present in 95% of neurological cases. **Sunflower cataracts** (copper in the lens) are also classic, though less common. * **Option D:** While initial screening involves serum ceruloplasmin and 24-hour urinary copper, a **liver biopsy** showing a copper content **>250 µg/g dry weight** remains the gold standard and confirmatory test for diagnosis. **Clinical Pearls for NEET-PG:** * **Screening Test:** Serum Ceruloplasmin (usually 100 µg/day). * **MRI Brain Finding:** "Face of the Giant Panda" sign in the midbrain. * **Treatment:** Chelators like **D-Penicillamine** (first-line) or Trientine [1]; Zinc is used for maintenance as it inhibits intestinal copper absorption.

Q: A 20-year-old woman presents with a 2-year history of difficulty swallowing and increasing fatigue. A CBC shows iron-deficiency anemia. Upper endoscopy reveals an annular narrowing in the upper third of the esophagus. A mucosal biopsy shows no evidence of inflammation or neoplasia. Which of the following is the most likely diagnosis?

Esophageal web. ### Explanation **Correct Answer: D. Esophageal Web** **1. Why it is correct:** The clinical presentation describes the classic triad of **Plummer-Vinson Syndrome** (also known as Paterson-Brown-Kelly Syndrome), which consists of: * **Iron-deficiency anemia** (fatigue, low hemoglobin). * **Dysphagia** (difficulty swallowing). * **Esophageal webs** (annular narrowing in the upper esophagus). Esophageal webs are thin, eccentric, mucosal protrusions most commonly found in the **upper third** of the esophagus. Histologically, they consist of squamous epithelium and vascularized connective tissue without inflammation or malignancy, matching the biopsy findings. **2. Why other options are incorrect:** * **A. Achalasia:** Characterized by failure of the Lower Esophageal Sphincter (LES) to relax and aperistalsis [2]. It typically presents with dysphagia to both solids and liquids and involves the **distal** esophagus, not the upper third. * **B. Barrett Esophagus:** This is intestinal metaplasia of the **distal** esophagus due to chronic GERD. It does not typically cause upper esophageal narrowing or iron-deficiency anemia unless a significant ulcer or malignancy develops. * **C. Diverticulum:** While a Zenker’s diverticulum occurs in the upper esophagus, it is an outpouching (not an annular narrowing) and usually presents with halitosis and regurgitation of undigested food [2]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Plummer-Vinson Syndrome (PVS):** Most common in middle-aged women. * **Risk of Malignancy:** PVS is a premalignant condition; it increases the risk of **Squamous Cell Carcinoma** of the esophagus and pharynx. * **Diagnosis:** Barium swallow is often more sensitive than endoscopy for detecting thin webs [3]. * **Treatment:** Iron supplementation often improves the dysphagia; severe cases require endoscopic dilation [1].

Q: Which of the following is not a feature of non-cirrhotic portal hypertension?

Ascites. **Explanation:** Non-cirrhotic portal hypertension (NCPH) refers to a group of disorders characterized by increased portal pressure in the absence of cirrhosis. The hallmark of NCPH is **preserved liver synthetic function** and a normal hepatic venous pressure gradient (HVPG). **1. Why Ascites is the correct answer:** In NCPH, the site of resistance to portal flow is usually **pre-sinusoidal** (e.g., Non-cirrhotic portal fibrosis or Extrahepatic portal vein obstruction). Because the resistance occurs before the sinusoids, the sinusoidal pressure remains relatively normal. Ascites typically requires high sinusoidal pressure and hypoalbuminemia (due to liver failure) to develop. Therefore, **ascites is conspicuously absent** [1] or only transiently seen after a major variceal bleed. **2. Analysis of Incorrect Options:** * **B. Hematemesis:** This is a common presentation of NCPH. Increased portal pressure leads to the development of gastroesophageal varices. Since liver function is preserved, these patients tolerate bleeds better than cirrhotic patients but often present with massive hematemesis. * **C. Splenomegaly:** This is a cardinal feature of NCPH. Congestive splenomegaly is often massive and is frequently the first clinical sign, often accompanied by hypersplenism (thrombocytopenia/leukopenia). **Clinical Pearls for NEET-PG:** * **Key Examples of NCPH:** Non-cirrhotic portal fibrosis (NCPF), Extrahepatic portal vein obstruction (EHPVO), and Schistosomiasis. * **Differentiating Feature:** In NCPH, Liver Function Tests (LFTs) and liver biopsy (architecture) are typically **normal**. * **HVPG:** In pre-sinusoidal NCPH, the HVPG (Hepatic Venous Pressure Gradient) is usually normal [2] or low, despite the presence of clinical portal hypertension.

Q: Steakhouse syndrome or intermittent food impaction is due to which of the following anomalies?

Schatzki ring. ### **Explanation** **Schatzki Ring (Correct Answer):** Steakhouse syndrome refers to acute esophageal food impaction, typically caused by a large, poorly chewed piece of meat. The most common underlying structural cause is a **Schatzki ring**. This is a smooth, benign, circumferential mucosal thinning located at the squamocolumnar junction (lower esophagus). It characteristically presents with **intermittent episodic dysphagia** to solids only. When the luminal diameter is <13 mm, food impaction is highly likely. **Analysis of Incorrect Options:** * **Feline Esophagus:** This is a transient endoscopic finding of multiple horizontal mucosal folds (resembling a cat's esophagus), usually associated with Gastroesophageal Reflux Disease (GERD) or Eosinophilic Esophagitis. It does not typically cause acute food impaction. * **Achalasia Cardia:** This is a motility disorder characterized by failure of the Lower Esophageal Sphincter (LES) to relax [1]. It presents with **progressive dysphagia** to both solids and liquids, rather than the sudden, intermittent impaction seen in Steakhouse syndrome [1]. * **Esophageal Carcinoma:** This presents with **progressive, persistent dysphagia** (solids followed by liquids) accompanied by significant weight loss and constitutional symptoms, unlike the episodic nature of Schatzki rings. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Schatzki rings are always found at the **B-line** (squamocolumnar junction). * **Association:** Frequently associated with **Hiatal Hernia**. * **Diagnosis:** Barium swallow is often more sensitive than endoscopy for detection. * **Management:** Reassurance, chewing food thoroughly, and endoscopic dilation if symptoms persist.

Question 1

A 30-year-old chronic alcoholic presents with sudden onset of epigastric pain radiating to the back. Which of the following findings is NOT typically seen in this patient's presentation?

Accepted Answer

Low serum lipase

Answer

Increased LDL

Answer

Hypocalcemia

Answer

Increased serum amylase

Question 2

Which of the following is NOT true regarding Gilbert's syndrome?

Accepted Answer

Conjugated hyperbilirubinemia

Answer

Fasting hypoglycemia

Answer

Normal liver histology

Answer

Normal liver enzymes

Question 3

Which of the following anemias is caused by H. pylori infection?

Accepted Answer

Iron deficiency anemia

Answer

Sideroblastic anemia

Answer

Hemolytic anemia

Answer

Aplastic anemia

Question 4

Before starting Infliximab in a 65-year-old gentleman for Inflammatory bowel disease, which of the following tests is mandatory?

Accepted Answer

Mantoux test

Answer

Colonoscopy

Answer

ERCP

Answer

Liver biopsy

Question 5

A young female with a known myeloproliferative disorder presents with a 3-day history of progressive abdominal discomfort and ascites. What is the most likely diagnosis?

Accepted Answer

Budd-Chiari syndrome

Answer

Hepatitis A

Answer

Perforation peritonitis

Answer

Acute pancreatitis

Question 6

Wilson's disease is characterized by all of the following except?

Accepted Answer

The defective gene is ATP7A

Answer

Neurological features include Parkinsonian features and ataxia

Answer

Kayser-Fleischer rings and sunflower cataracts are typical eye findings

Answer

Liver biopsy is confirmatory for the diagnosis

Question 7

A patient presents with lower gastrointestinal bleed. Sigmoidoscopy shows ulcers in the sigmoid colon. Biopsy from this area shows flask-shaped ulcers. Which of the following is the most appropriate treatment?

Accepted Answer

Intravenous metronidazole

Answer

Intravenous ceftriaxone

Answer

Intravenous steroids and sulphasalazine

Answer

Hydrocortisone enemas

Question 8

A 20-year-old woman presents with a 2-year history of difficulty swallowing and increasing fatigue. A CBC shows iron-deficiency anemia. Upper endoscopy reveals an annular narrowing in the upper third of the esophagus. A mucosal biopsy shows no evidence of inflammation or neoplasia. Which of the following is the most likely diagnosis?

Accepted Answer

Esophageal web

Answer

Achalasia

Answer

Barrett esophagus

Answer

Diverticulum

Question 9

Which of the following is not a feature of non-cirrhotic portal hypertension?

Accepted Answer

Ascites

Answer

Hematemesis

Answer

Splenomegaly

Answer

All are seen

Question 10

Steakhouse syndrome or intermittent food impaction is due to which of the following anomalies?

Accepted Answer

Schatzki ring

Answer

Feline esophagus

Answer

Achalasia cardia

Answer

Esophageal carcinoma

Gastroenterology — MCQs

Gastroenterology — MCQs

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