Gastroenterology Practice Questions

Q: Which of the following is false regarding malignancy in ulcerative colitis?

Has a poorer prognosis compared to sporadic cancers. In Ulcerative Colitis (UC), the risk of Colorectal Cancer (CRC) is significantly higher than in the general population. However, the statement that it has a **poorer prognosis** compared to sporadic cancers is **false**, making it the correct answer. ### **Explanation of Options** * **Option C (Correct Answer):** Studies indicate that when matched for stage at diagnosis, the **prognosis of UC-associated CRC is similar** to that of sporadic colorectal cancer. The survival rates are comparable, although UC-associated cancers are often detected at a later stage if surveillance is inadequate. * **Option A:** UC-associated malignancy occurs at a much younger age than sporadic CRC. The mean age of onset is approximately **30–50 years**, whereas sporadic CRC typically occurs in the 6th or 7th decade. * **Option B:** Unlike sporadic cancers which are usually well-differentiated adenocarcinomas, UC-associated malignancies are more likely to be **anaplastic, signet-ring cell, or mucinous carcinomas**, making them more aggressive histologically. * **Option D:** In sporadic cases, cancers are often localized to the rectum or sigmoid [1]. In UC, the malignancy is **evenly distributed throughout the colon** (proximal and distal) and is frequently **multifocal**. ### **High-Yield Clinical Pearls for NEET-PG** * **Risk Factors:** Duration of disease (>8–10 years), extent of involvement (Pancolitis > Left-sided), and co-existence of **Primary Sclerosing Cholangitis (PSC)** [3]. * **Surveillance:** Screening colonoscopy is recommended **8 years** after the onset of symptoms for pancolitis. * **Precursor Lesion:** Unlike the polyp-to-cancer sequence in sporadic cases [1], UC follows a **Dysplasia-Associated Lesion or Mass (DALM)** sequence [2]. * **Chemoprevention:** Long-term use of **5-ASA (Mesalamine)** and Folic acid is thought to reduce the risk of malignancy in UC patients [3].

Q: A 50-year-old male presented with chronic breathlessness and intermittent jaundice. He denies smoking and alcohol abuse. Lung biopsy revealed panacinar emphysema with lower lobe predominance, and liver biopsy showed PAS-positive, diastase-resistant intracytoplasmic globules in hepatocytes. What is the most probable diagnosis?

Alpha 1 antitrypsin deficiency. ***Alpha 1 antitrypsin deficiency*** - Causes **panacinar emphysema** with **lower lobe predominance** in non-smokers, leading to chronic breathlessness, and **hepatocyte globules** (PAS-positive, diastase-resistant) causing liver dysfunction and jaundice. - This condition uniquely affects both **lungs and liver** simultaneously, fitting the clinical presentation of respiratory symptoms with intermittent jaundice in a non-smoker/non-drinker. *Hemochromatosis* - Primarily causes **hepatic iron overload** leading to liver dysfunction, but respiratory symptoms are not a typical feature. - Associated with **diabetes mellitus**, **cardiomyopathy**, and **bronze skin pigmentation**, not primarily respiratory disease. *Cystic fibrosis* - Typically presents in **childhood** with **recurrent pulmonary infections**, **pancreatic insufficiency**, and **failure to thrive**. - Adult presentation is rare and usually involves a history of chronic infections and **bronchiectasis**, not isolated breathlessness with jaundice. *Wilson's disease* - Primarily affects the **liver** and **brain** with **copper accumulation**, causing neuropsychiatric symptoms and **Kayser-Fleischer rings**. - Respiratory involvement is **not characteristic**, and the disease typically presents with hepatic or neurological manifestations without lung disease.

Q: Which of the following statements is NOT true regarding Wilson's disease?

Kayser-Fleischer rings are present in up to 30% of cases.. Wilson’s disease (Hepatolenticular degeneration) is an autosomal recessive disorder of copper metabolism. **1. Why Option D is the correct answer (The False Statement):** Kayser-Fleischer (KF) rings, caused by copper deposition in the Descemet’s membrane of the cornea, are much more common than 30%. They are present in **95–100% of patients with neurological manifestations** and approximately **50–60% of patients with isolated hepatic involvement**. Therefore, stating they occur in only 30% of cases is clinically inaccurate. **2. Analysis of Incorrect Options (True Statements):** * **Option A:** The disease is caused by mutations in the **ATP7B gene** on chromosome 13. This defect impairs biliary copper excretion and the incorporation of copper into ceruloplasmin. * **Option B:** While serum ceruloplasmin is the initial screening test, **24-hour urinary copper excretion (>100 μg/day)** is considered the most reliable and specific screening tool for symptomatic patients. * **Option C:** **Liver biopsy** with quantitative copper assay (>250 μg/g dry weight) remains the **gold standard** for diagnosis, especially when biochemical tests are inconclusive. **Clinical Pearls for NEET-PG:** * **Diagnosis:** Low serum ceruloplasmin (<20 mg/dL) + KF rings (on slit-lamp exam) + high urinary copper. * **Hematology:** Look for **Coombs-negative hemolytic anemia** (due to sudden release of copper into the blood) [1]. * **Neurology:** "Giant Panda Sign" on MRI brain (midbrain involvement) [1]. * **Treatment:** **D-Penicillamine** (chelator) is the drug of choice; Zinc is used for maintenance or asymptomatic patients (prevents absorption).

Q: The BISAP score is used to assess the severity of which of the following conditions?

Pancreatitis. The **BISAP score** (Bedside Index for Severity in Acute Pancreatitis) is a validated clinical scoring system used to predict the severity and in-hospital mortality of **Acute Pancreatitis** [1]. It is preferred in clinical practice because it is simple, requires only data available within the first 24 hours of admission, and does not require complex calculations like the Ranson criteria. ### **Breakdown of the BISAP Score (Mnemonic: BISAP)** A score of **≥3** indicates a high risk of severe pancreatitis and increased mortality. * **B: BUN** > 25 mg/dL * **I: Impaired Mental Status** (Glasgow Coma Scale 60 years * **P: Pleural Effusion** (detected on imaging) ### **Why the other options are incorrect:** * **Pancreatic Abscess & Pseudocyst (Options B, C, D):** While these are complications of acute pancreatitis, the BISAP score is specifically designed to assess the **initial systemic severity** and mortality risk of the inflammatory process itself, rather than diagnosing or grading localized anatomical complications [1]. Local complications are better assessed using the **Balthazar Score** (CT Severity Index). ### **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for Diagnosis:** Lipase (more specific than Amylase). * **Most Common Cause:** Gallstones (followed by Alcohol) [1]. * **Prognostic Scoring Systems:** Other scores for Acute Pancreatitis include **Ranson’s Criteria**, **APACHE II** (most accurate but complex), and the **Modified Glasgow Score** [1]. * **Timing:** BISAP is calculated within the first 24 hours; Ranson’s requires 48 hours for a complete assessment.

Question 1

Which of the following is false regarding malignancy in ulcerative colitis?

Accepted Answer

Has a poorer prognosis compared to sporadic cancers

Answer

Mean age of onset is 30 years

Answer

Anaplastic cancers are common

Answer

Malignancy is evenly distributed throughout the colon

Question 2

A 30-year-old male presents with chronic diarrhea, anemia, and raised liver enzymes. Which of the following is most likely associated?

Accepted Answer

Anti-endomysial antibody

Answer

Antimitochondrial antibody

Answer

Anti-smooth muscle antibody

Answer

Antinuclear antibody

Question 3

A 50-year-old male presented with chronic breathlessness and intermittent jaundice. He denies smoking and alcohol abuse. Lung biopsy revealed panacinar emphysema with lower lobe predominance, and liver biopsy showed PAS-positive, diastase-resistant intracytoplasmic globules in hepatocytes. What is the most probable diagnosis?

Accepted Answer

Alpha 1 antitrypsin deficiency

Answer

Hemochromatosis

Answer

Cystic fibrosis

Answer

Wilson's disease

Question 4

Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension?

Accepted Answer

Upper gastrointestinal bleeding

Answer

Chronic liver failure

Answer

Ascites

Answer

Encephalopathy

Question 5

A 45-year-old cirrhotic patient presented with severe haematemesis. What is the management of choice?

Accepted Answer

Whole blood transfusion is the best initial management.

Answer

Colloids are preferred over crystalloids for initial fluid resuscitation.

Answer

Normal saline infusion is the primary fluid therapy.

Answer

IV fluid administration with diuretics should be initiated.

Question 6

Which of the following is NOT true regarding GERD?

Accepted Answer

Lower esophageal sphincter length and pressure are important.

Answer

Avoidance of coffee and tea is recommended.

Answer

Transient lower esophageal relaxation is a contributing factor.

Answer

Proton pump inhibitors are the treatment of choice.

Question 7

A 30-year-old male presents with chronic diarrhea, anemia, and elevated liver enzymes. What is the most likely associated condition?

Accepted Answer

Anti-endomysial antibody

Answer

Antimitochondrial antibody

Answer

Anti-smooth muscle antibody

Answer

Antinuclear antibody

Question 8

Which of the following statements is NOT true regarding Wilson's disease?

Accepted Answer

Kayser-Fleischer rings are present in up to 30% of cases.

Answer

It is caused by ATP7B mutation leading to impairment in copper metabolism.

Answer

The most specific screening test is urinary excretion of copper.

Answer

The gold standard diagnostic test is liver biopsy.

Question 9

Which of the following is NOT true about persistent caliber arteries?

Accepted Answer

Deep enteroscopy

Answer

Thermal coagulation

Answer

Angiographic embolization

Answer

Bleeding pinpoint mucosal erosion

Question 10

The BISAP score is used to assess the severity of which of the following conditions?

Accepted Answer

Pancreatitis

Answer

Pancreatic abscess

Answer

Pseudocyst of the pancreas

Answer

Pseudocyst of the pancreas

Gastroenterology — MCQs

Gastroenterology — MCQs

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