Gastroenterology — MCQs

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?

Q965

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

Q966

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

Q967

Zollinger Ellison syndrome is characterized by which of the following ?

Q968

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 :

Q969

Which of the following are local complications of acute pancreatitis? 1. Pseudocyst 2. Pleural effusion 3. Ileus 4. Acute fluid collection Select the correct answer using the code given below.

Q970

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.

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 961: Which of the following are correct regarding late dumping? I. It usually occurs during the second hour after meal. II. It lasts for 30-40 minutes. III. Major symptoms are tremor, faintness, prostration IV. It is relieved by lying down. Select the answer using the code given below :

A. I, III and IV
B. II, III and IV
C. I, II and III (Correct Answer)
D. I, II and IV

Explanation: ***I, II and III*** - Late dumping syndrome typically manifests **1 to 3 hours after a meal** (usually around the second hour), triggered by rapid carbohydrate absorption leading to hyperinsulinemia and subsequent hypoglycemia. - The symptoms, which include **tremor, faintness, prostration, sweating, and confusion**, are due to hypoglycemia and usually last for **30-60 minutes**. *I, III and IV* - This option is incorrect because lying down generally **does not relieve symptoms** of late dumping syndrome; instead, consuming a small amount of sugar or glucose is recommended to raise blood glucose levels. - While I and III are correct, the inclusion of IV makes this option incorrect. *II, III and IV* - This option is incorrect because statement IV, suggesting relief by lying down, is **false** for late dumping syndrome. - Additionally, statement I "It usually occurs during the second hour after meal" is an accurate description of late dumping, which this option omits. *I, II and IV* - This option is incorrect because statement IV, which claims symptoms are relieved by lying down, is **inaccurate** for late dumping syndrome. - While I and II are correct, the inclusion of IV makes this option incorrect regarding the characteristic management or relief of late dumping.

Question 962: Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

A. Sinusoidal - Veno-occlusive disease (Correct Answer)
B. Post-hepatic - Schistosomiasis post sinusoidal
C. Pre-hepatic - Portal vein presinusoidal thrombosis
D. Intrahepatic - Cirrhosis presinusoidal

Explanation: ***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.

Question 963: Which one of the following is a contraindication to wireless capsule endoscopy?

A. Small bowel stricture (Correct Answer)
B. Small bowel Crohn's disease
C. Coeliac disease
D. Obscure gastrointestinal bleeding

Explanation: ***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 964: 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?

A. I and II only
B. III and IV
C. I, II and III
D. II and III only (Correct Answer)

Explanation: ***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.

Question 965: Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

A. Capsule endoscopy
B. Computed Tomography
C. Erect X ray of abdomen
D. Transabdominal ultrasound (Correct Answer)

Explanation: ***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.

Question 966: Which one of the following statements regarding Inflammatory Bowel Disease is correct ?

A. Stricture formation is common in Ulcerative Colitis.
B. Fistula formation is common in Ulcerative Colitis.
C. Rectum is always involved in Crohn's disease.
D. Perianal disease is common in Crohn's disease. (Correct Answer)

Explanation: ***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].

Question 967: Zollinger Ellison syndrome is characterized by which of the following ?

A. Recurrent ulceration despite treatment
B. Non-beta islet cell tumour of pancreas (Correct Answer)
C. Recurrent episodes of dysentery
D. Fulminating gastric ulcers

Explanation: ***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.

Question 968: 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 :

A. 2, 3 and 4
B. 1, 2 and 3 (Correct Answer)
C. 1, 3 and 4
D. 1, 2 and 4

Explanation: ***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.

Question 969: Which of the following are local complications of acute pancreatitis? 1. Pseudocyst 2. Pleural effusion 3. Ileus 4. Acute fluid collection Select the correct answer using the code given below.

A. 2, 3 and 4
B. 1, 3 and 4
C. 1, 2 and 4 (Correct Answer)
D. 1, 2 and 3

Explanation: ***1, 2 and 4*** - **Pseudocyst**, **acute fluid collections**, and **pleural effusions** are all recognized **local complications** of acute pancreatitis due to their direct anatomical proximity or fluid spread from the pancreas [1]. - **Ileus** is a common **systemic complication** rather than a local one, and it arises from inflammation and irritation of the bowel. *2, 3 and 4* - This option correctly identifies **pleural effusion** and **acute fluid collection** as local complications, but **ileus** is typically classified as a **systemic complication** of acute pancreatitis. - While it includes two correct local complications, the inclusion of ileus makes it incorrect as a complete list of local complications. *1, 3 and 4* - This option correctly identifies **pseudocyst** and **acute fluid collection** as local complications, but incorrectly lists **ileus** as a local complication when it is a **systemic complication** [1]. - It also fails to include **pleural effusion**, which is a significant local complication. *1, 2 and 3* - This option correctly identifies **pseudocyst** and **pleural effusion** as local complications but incorrectly includes **ileus**, which is a **systemic complication**. - It also omits **acute fluid collection**, an important local complication of acute pancreatitis.

Question 970: 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.

A. 2, 3 and 4
B. 1, 3 and 4
C. 1, 2 and 3
D. 1, 2 and 4 (Correct Answer)

Explanation: ***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.

Practice by Chapter

Esophageal Disorders

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Peptic Ulcer Disease

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Inflammatory Bowel Disease

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Irritable Bowel Syndrome

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Malabsorption Syndromes

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Pancreatitis (Acute and Chronic)

Practice Questions

Gastrointestinal Bleeding

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Liver Diseases and Cirrhosis

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Viral Hepatitis

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Biliary Tract Disorders

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Gastrointestinal Motility Disorders

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Gastrointestinal Malignancies

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