Gastroenterology — MCQs

A 35 year old woman presented with a lump in her upper abdomen for two months which was slightly increasing. She also complained of early satiety. She gave a history of acute severe pain in upper abdomen for which she was admitted in hospital for 10 days, about three months ago. On examination, the mass was firm, smooth surfaced and not moving with respiration. She was most likely suffering from:

Q985

In endoscopic retrograde cholangiopancreatography endoscope used is:

Q986

In Crohn’s disease all are true except:

Q987

A 55 year old gentleman presented with history of right upper quadrant discomfort, jaundice, pruritis, fever, fatigue and weight loss. His serum bilirubin and alkaline phosphatase levels are raised and he also gives history of treatment for inflammatory bowel disease. He is most likely to be suffering from:

Q988

Which one of the following regarding Pancreatic effusion is correct?

Q989

The Model for End Stage Liver Disease (MELD) score includes which of the following variables? 1. Serum bilirubin 2. Serum albumin 3. Serum creatinine 4. International Normalised Ratio (INR)

Q990

Among the extra intestinal manifestations of Crohn’s disease which one of the following is related to the disease activity ?

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 981: Factors important in the formation of gall stones include all of the following except :

A. Obesity
B. The size of micelles
C. Cholesterol saturation in bile
D. Gall bladder motility (Correct Answer)

Explanation: ***Gall bladder motility*** - While factors like gallbladder **stasis** or **hypomotility** can *contribute* to gallstone formation by allowing bile to concentrate, normal gallbladder motility itself does not directly form stones. - Efficient gallbladder emptying helps prevent the supersaturation and precipitation of cholesterol and bilirubin that lead to stone formation [2]. *Obesity* - Obesity increases the **hepatic secretion of cholesterol**, leading to more cholesterol in the bile [1]. - This increased cholesterol can lead to **supersaturation** of bile, making it prone to forming cholesterol gallstones. *Cholesterol saturation in bile* - When bile contains more cholesterol than can be kept in solution by bile salts and phospholipids, it becomes **supersaturated** [3]. - This supersaturation is a primary driver for the **precipitation of cholesterol crystals**, which aggregate to form gallstones [1]. *The size of micelles* - Micelles are small aggregates of bile salts and phospholipids that solubilize cholesterol in bile [3]. - If the **micelle size is insufficient** or their number is reduced, they cannot adequately solubilize the cholesterol, leading to its precipitation and stone formation [3].

Question 982: The Ranson prognostic criteria used at the time of admission in acute pancreatitis include all of the following except

A. Blood glucose more than 200 mg/100 mL
B. WBC count more than 16,000/mm3
C. Serum calcium < 2.0 mmol/L (Correct Answer)
D. Age more than 55 years

Explanation: ***Serum calcium < 2.0 mmol/L*** - This option refers to a low serum calcium level, which is part of the **Ranson criteria measured 48 hours after admission**, not at admission. - The initial Ranson criteria (on admission) focus on demographic and immediate lab results. *Blood glucose more than 200 mg/100 mL* - An elevated **blood glucose > 200 mg/100 mL** is one of the five Ranson criteria assessed at the time of admission. - High glucose indicates significant physiological stress and typically a more severe illness. *WBC count more than 16,000/mm3* - An elevated **white blood cell count > 16,000/mm3** is one of the Ranson criteria assessed at admission. - This indicates a significant inflammatory response, suggesting severe pancreatitis. *Age more than 55 years* - **Age > 55 years** is one of the Ranson criteria assessed at the time of admission [1]. - Older age is a recognized risk factor for more severe outcomes in acute pancreatitis [1].

Question 983: The prognostic indicators in a case of portal hypertension include: 1. Serum globulin 2. Serum albumin 3. Serum bilirubin 4. Ascites Select the correct answer using the code given below :

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

Explanation: ***2, 3 and 4*** - **Serum albumin**, **serum bilirubin**, and the presence of **ascites** are all key components of scoring systems like the **Child-Pugh score**, which is widely used to assess the severity and prognosis of **liver disease** and **portal hypertension** [1]. - **Low albumin** reflects impaired synthetic function, **high bilirubin** indicates impaired excretory function, and **ascites** points to decompensation, all contributing to a worse prognosis [2]. *3 and 4 only* - This option is incomplete as it correctly identifies **serum bilirubin** and **ascites**, but omits **serum albumin**, which is a crucial prognostic indicator reflecting the liver's synthetic capacity. - While bilirubin and ascites are important, excluding albumin underestimates the complexity of prognostic assessment in **portal hypertension**. *1, 2 and 3* - This option incorrectly includes **serum globulin** as a direct prognostic indicator in the context of standard scoring systems like Child-Pugh which focus on liver function and clinical complications. - While **globulins** can be elevated in chronic liver disease due to inflammation, they are not part of the primary prognostic criteria for **portal hypertension**. *1 and 4 only* - This option incorrectly includes **serum globulin** and excludes **serum albumin** and **serum bilirubin**, two critical markers of liver function. - Relying solely on globulin and ascites would provide an incomplete and inaccurate assessment of prognosis in a patient with **portal hypertension**.

Question 984: A 35 year old woman presented with a lump in her upper abdomen for two months which was slightly increasing. She also complained of early satiety. She gave a history of acute severe pain in upper abdomen for which she was admitted in hospital for 10 days, about three months ago. On examination, the mass was firm, smooth surfaced and not moving with respiration. She was most likely suffering from:

A. Pseudocyst pancreas (Correct Answer)
B. Cancer colon
C. Splenic cyst
D. Cancer stomach

Explanation: Pseudocyst pancreas - The history of **acute severe upper abdominal pain** followed by a progressively enlarging, firm, smooth-surfaced upper abdominal mass points strongly towards a pancreatic pseudocyst, a common complication of **pancreatitis** [1]. - **Early satiety** can occur due to the mass effect of the pseudocyst compressing the stomach [1]. *Cancer colon* - A rapidly growing upper abdominal mass is **not a typical presentation** of colon cancer, which usually presents with changes in bowel habits, rectal bleeding, or weight loss. - Colon cancer does not typically cause a history of **acute, severe generalized abdominal pain** preceding mass formation in this manner. *Splenic cyst* - While a splenic cyst could present as an abdominal mass, it is **less likely to follow a history of acute severe abdominal pain** (unless trauma-related). - A history of acute pancreatitis is a strong indicator away from a splenic cyst as the primary diagnosis [1]. *Cancer stomach* - Gastric cancer can present with early satiety and an upper abdominal mass, but the specific history of **acute severe pain followed by a mass** is less characteristic of gastric cancer's typical insidious onset. - The "firm, smooth surfaced, not moving with respiration" description, especially in the context of prior pancreatitis, is more aligned with a **pancreatic pseudocyst** [1].

Question 985: In endoscopic retrograde cholangiopancreatography endoscope used is:

A. Side viewing (Correct Answer)
B. End viewing
C. Front viewing
D. Rigid

Explanation: ***Side viewing*** - **Side-viewing endoscopes** are specifically designed for ERCP, allowing the endoscopist to visualize the **ampulla of Vater** en face for precise cannulation [1]. - The side-viewing optic facilitates the passage of accessories like **catheters, guidewires**, and **sphincterotomes** into the bile and pancreatic ducts [1]. *End viewing* - **End-viewing endoscopes** (like standard gastroscopes or colonoscopes) have the camera directly at the tip, providing a straight-ahead view. - This design makes cannulation of the **ampulla of Vater** challenging, as it would be viewed tangentially, not directly. *Front viewing* - This term is synonymous with **end-viewing** and describes the typical orientation of standard gastrointestinal endoscopes. - While suitable for examining the lumen of organs, it lacks the specialized optics needed for the complex angulation and cannulation required in **ERCP**. *Rigid* - **Rigid endoscopes** are generally used for procedures where flexibility is not required, such as laparoscopy or cystoscopy [2]. - They are unsuitable for **ERCP**, which requires a highly flexible instrument to navigate the esophagus, stomach, duodenum, and access the **ampulla of Vater**.

Question 986: In Crohn’s disease all are true except:

A. Crypt abscess are common (Correct Answer)
B. Full thickness bowel involvement
C. Can occur anywhere in GIT
D. Fistula formation is common

Explanation: Crypt abscess are common - **Crypt abscesses** are a characteristic histological feature of **ulcerative colitis**, not Crohn's disease [1]. - In Crohn's disease, the inflammation is typically **transmural** and characterized by **non-caseating granulomas**, not crypt abscesses [1]. Full thickness bowel involvement - Crohn's disease is characterized by **transmural inflammation**, meaning it affects all layers of the intestinal wall, from the mucosa to the serosa. - This **full-thickness involvement** leads to complications such as strictures, fistulas, and abscesses [1]. Can occur anywhere in GIT - Crohn's disease can affect **any part of the gastrointestinal tract**, from the mouth to the anus, often with skip lesions [2]. - This widespread potential involvement contrasts with ulcerative colitis, which is typically confined to the colon and rectum [2]. Fistula formation is common - Due to the **transmural inflammation** in Crohn's disease, the inflamed bowel wall can penetrate into adjacent organs or tissues, leading to the formation of **fistulas**. - These can be entero-enteric, entero-cutaneous, perianal, or even enterovesical [2].

Question 987: A 55 year old gentleman presented with history of right upper quadrant discomfort, jaundice, pruritis, fever, fatigue and weight loss. His serum bilirubin and alkaline phosphatase levels are raised and he also gives history of treatment for inflammatory bowel disease. He is most likely to be suffering from:

A. Primary sclerosing cholangitis (Correct Answer)
B. Benign bile duct stricture with cholangitis
C. Biliary worms
D. Bile duct malignancy

Explanation: Primary sclerosing cholangitis - The presentation of jaundice, pruritus, RUQ discomfort, elevated bilirubin, and alkaline phosphatase in a patient with a history of inflammatory bowel disease (IBD) is highly suggestive of primary sclerosing cholangitis (PSC) [1], [2]. - PSC is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the intrahepatic and/or extrahepatic bile ducts, often leading to strictures and ultimately cirrhosis and liver failure [2]. Benign bile duct stricture with cholangitis - While a benign stricture could cause some of these symptoms, the strong association with inflammatory bowel disease makes PSC a more probable diagnosis [2]. - Cholangitis alone does not fully explain the progressive nature and chronic cholestatic picture often seen with PSC. Biliary worms - Biliary parasites (e.g., Clonorchis sinensis, Ascaris lumbricoides) can cause cholangitis and obstruct bile ducts, leading to jaundice and elevated LFTs. - However, they are typically found in endemic areas and are not directly associated with inflammatory bowel disease. Bile duct malignancy - Cholangiocarcinoma (bile duct cancer) can present with similar symptoms like jaundice, weight loss, and RUQ discomfort. - Although IBD, particularly ulcerative colitis, is a risk factor for cholangiocarcinoma, PSC itself is a major risk factor for cholangiocarcinoma and fits the overall clinical picture better as the primary diagnosis given the long-standing symptoms and the strong association with IBD [2].

Question 988: Which one of the following regarding Pancreatic effusion is correct?

A. Pancreatic stenting is to be done
B. Free fluid collection in Pleural cavity
C. Percutaneous drainage under image guidance is indicated for symptomatic effusions (Correct Answer)
D. Never associated with abdominal collection

Explanation: ***Percutaneous drainage under image guidance is indicated for symptomatic effusions*** - For **symptomatic pancreatic effusions**, particularly those causing pain, infection, or organ compression, percutaneous drainage offers an effective and less invasive management option. - This procedure is typically performed under **ultrasound or CT guidance** to ensure accurate placement of the drainage catheter, minimizing complications. *Pancreatic stenting is to be done* - **Pancreatic stenting** is primarily indicated for managing pancreatic duct strictures or leaks, often in the context of chronic pancreatitis or postsurgical complications. - It is not a direct treatment for a pancreatic effusion itself, which is a collection of fluid outside the ductal system. *Free fluid collection in Pleural cavity* - Pancreatic effusion refers to the **leakage of pancreatic fluid** into the abdominal cavity, typically surrounding the pancreas or in the peritoneum. - While pancreatic diseases can sometimes lead to **pleural effusions** (fluid in the chest cavity) due to translocation of fluid through the diaphragm, a pancreatic effusion itself is defined as an abdominal collection. *Never associated with abdominal collection* - This statement is incorrect as a **pancreatic effusion is by definition an abdominal collection** of fluid originating from the pancreas. - These collections can arise from disruptions in the pancreatic duct or parenchyma, leading to the accumulation of pancreatic enzymes, fluid, and debris in the peripancreatic region or elsewhere within the abdomen.

Question 989: The Model for End Stage Liver Disease (MELD) score includes which of the following variables? 1. Serum bilirubin 2. Serum albumin 3. Serum creatinine 4. International Normalised Ratio (INR)

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

Explanation: ***1, 3 and 4*** - The **MELD score** calculates a patient's risk of death due to **end-stage liver disease** using **serum bilirubin**, **serum creatinine**, and **INR** [1]. - These variables reflect important aspects of **liver function** (bilirubin and INR) and **renal function** (creatinine), which is often compromised in advanced liver disease [1]. *1, 2 and 4* - This option correctly includes **serum bilirubin** and **INR** but incorrectly includes **serum albumin** as a component of the MELD score. - While **albumin** is a measure of **liver synthetic function** and is used in the **Child-Pugh score**, it is not part of the MELD calculation [1]. *2, 3 and 4* - This option incorrectly includes **serum albumin** and omits **serum bilirubin**, which are critical components of the MELD score. - **Serum bilirubin** is a direct indicator of the liver's ability to process and excrete bile. *1, 2 and 3* - This option includes **serum albumin** while omitting **INR**, a crucial indicator of the liver's **synthetic function** and its ability to produce clotting factors. - The **INR** directly reflects the liver's capacity to synthesize **coagulation proteins**.

Question 990: Among the extra intestinal manifestations of Crohn’s disease which one of the following is related to the disease activity ?

A. Eye complications (Iritis/Uveitis) (Correct Answer)
B. Primary sclerosing cholangitis
C. Renal calculi
D. Chronic active hepatitis

Explanation: ***Eye complications (Iritis/Uveitis)*** - **Uveitis and iritis** in Crohn's disease often correlate with disease activity, meaning flares in the bowel disease can trigger or worsen these ocular manifestations [1]. - Successful treatment of the underlying intestinal inflammation frequently leads to improvement or resolution of these **eye complications** [1]. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic liver disease associated with inflammatory bowel disease, particularly ulcerative colitis, but its course is largely **independent of IBD activity**. - It progresses irrespective of intestinal disease flares and often requires its **own specific management**. *Renal calculi* - **Renal calculi (kidney stones)** can be a complication of Crohn's disease, linked to fluid loss and changes in oxalate absorption, but their occurrence is generally **not directly correlated with the inflammatory activity** of the bowel disease. - Instead, factors like **dehydration** and calcium/oxalate metabolism are more significant drivers. *Chronic active hepatitis* - While various hepatic manifestations can occur in Crohn's disease, **chronic active hepatitis** is not one of the well-established extraintestinal manifestations directly linked to disease activity. - Other liver conditions like **fatty liver disease** or **drug-induced liver injury** are more commonly seen, but their presence doesn't typically parallel intestinal inflammation.

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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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