Gastritis and Peptic Ulcer Disease — MCQs
What is the treatment of choice in duodenal ulcer without any complications of hemorrhage?
Which of the following is the MOST common complication associated with GERD?
Which of the following conditions is least likely to be associated with Helicobacter pylori infection?
A 45-year-old gentleman has undergone truncal vagotomy and pyloroplasty for bleeding duodenal ulcer seven years ago. Now he has intractable recurrent symptoms of peptic ulcer. All of the following suggest the diagnosis of Zollinger-Ellison syndrome, except:
Which of the following statements is true regarding pernicious anemia?
A 30-year-old male presents with nausea, vomiting, and abdominal discomfort after consuming large amounts of alcohol. What is the most likely diagnosis?
Which of the following is NOT a common complication of acute pancreatitis?
The histopathological image shows a section of colon. What histological feature seen in the image is more characteristic of Ulcerative Colitis than Crohn's Disease?
Which histological feature is more characteristic of ulcerative colitis than Crohn's disease?
Skip lesions with non-caseating granulomas is characteristic of
Gastritis and Peptic Ulcer Disease Indian Medical PG Practice Questions and MCQs
Question 1: What is the treatment of choice in duodenal ulcer without any complications of hemorrhage?
- A. Highly selective vagotomy
- B. Trunkal vagotomy
- C. Proton pump inhibitors (Correct Answer)
- D. None of the options
Explanation: ***Proton pump inhibitors*** - **Proton pump inhibitors (PPIs)** are the first-line and most effective treatment for uncomplicated duodenal ulcers due to their potent and sustained acid suppression [1]. - They work by irreversibly inhibiting the **H+/K+-ATPase pump** in the stomach's parietal cells, reducing acid secretion and allowing the ulcer to heal [1]. *Highly selective vagotomy* - This is a surgical procedure that was historically used to reduce acid secretion by denervating the acid-producing parietal cells of the stomach, but it is **not the primary treatment** for uncomplicated ulcers today due to the availability of effective medical therapy [1]. - It carries surgical risks and is generally reserved for **refractory cases** or those with complications not amenable to endoscopic or medical management [1]. *Trunkal vagotomy* - **Trunkal vagotomy** involves cutting the main vagal trunks, which leads to significant side effects such as **gastric stasis** (delayed emptying) and diarrhea, often requiring a drainage procedure (e.g., pyloroplasty). - It was used in the past but is **rarely performed** for uncomplicated duodenal ulcers due to its associated morbidity and the effectiveness of modern medical treatments [1]. *None of the options* - This option is incorrect because **proton pump inhibitors** are indeed a highly effective and standard treatment for uncomplicated duodenal ulcers [1].
Question 2: Which of the following is the MOST common complication associated with GERD?
- A. Chronic cough
- B. Dental erosion
- C. None of the options
- D. Esophagitis (Correct Answer)
Explanation: ***Esophagitis*** - **Reflux of gastric acid** into the esophagus directly irritates the esophageal lining, leading to inflammation and cellular damage, commonly presenting as esophagitis [1]. - This recurrent irritation causes histological changes such as **basal cell hyperplasia** and **elongation of papillae**, which are hallmarks of reflux-induced injury [1]. *Chronic cough* - While chronic cough can be a symptom of GERD, it is considered an **extraesophageal manifestation** rather than a direct complication of esophageal mucosal damage. - Its prevalence is lower than esophagitis among GERD complications and it's less direct consequence of acid exposure to the esophagus itself. *Dental erosion* - **Acid reflux** can lead to dental erosion due to the direct contact of acidic gastric contents with tooth enamel. - However, this is less common than esophagitis, which is a direct and frequent consequence of **mucosal acid exposure** within the esophagus [1].
Question 3: Which of the following conditions is least likely to be associated with Helicobacter pylori infection?
- A. Atrophic gastritis
- B. Intestinal metaplasia of stomach
- C. Pyloric metaplasia of duodenum
- D. Barrett's esophagus (Correct Answer)
Explanation: ***Barrett's esophagus*** - **Barrett's esophagus** is characterized by the replacement of the normal **squamous epithelium** of the esophagus with **columnar epithelium with intestinal metaplasia** (goblet cells), primarily due to chronic **gastroesophageal reflux disease (GERD)**. - While *H. pylori* can affect the stomach and duodenum, it is **not directly associated** with the pathogenesis of Barrett's esophagus. [1] - Barrett's is a complication of **chronic acid reflux**, not *H. pylori* infection. *Pyloric metaplasia of duodenum* - **Pyloric metaplasia** (gastric metaplasia) in the duodenum is often seen in the presence of an **active duodenal ulcer**, which is strongly associated with *H. pylori* infection. - *H. pylori* can colonize these metaplastic cells, perpetuating inflammation and ulcer formation in the duodenum. *Atrophic gastritis* - **Atrophic gastritis** is a common consequence of chronic *H. pylori* infection, leading to the **loss of gastric glands** and replacement by intestinal-type epithelium. [1] - This condition is a significant risk factor for the development of **gastric cancer**. *Intestinal metaplasia of stomach* - **Intestinal metaplasia** in the stomach is a precursor lesion for gastric cancer and is frequently observed in individuals with **chronic *H. pylori* gastritis**. [1] - *H. pylori* infection drives the inflammatory process that can lead to this metaplastic change in the gastric mucosa. [2] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 770-771. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 356-357.
Question 4: A 45-year-old gentleman has undergone truncal vagotomy and pyloroplasty for bleeding duodenal ulcer seven years ago. Now he has intractable recurrent symptoms of peptic ulcer. All of the following suggest the diagnosis of Zollinger-Ellison syndrome, except:
- A. Ulcers in proximal jejunum and lower end of esophagus
- B. Basal acid output of 15 meq/hour
- C. Serum gastrin value of 500 pg/ml
- D. Serum gastrin value of 200 pg/ml with secretin stimulation (Correct Answer)
Explanation: ***Serum gastrin value of 200 pg/ml with secretin stimulation*** - A **positive secretin stimulation test** for Zollinger-Ellison syndrome (ZES) is indicated by a rise in serum gastrin of **≥ 200 pg/mL (or 110 pg/mL depending on the reference range)** above baseline after secretin administration. - A value of 200 pg/ml with secretin stimulation is not diagnostic if the baseline is not known or if the rise from baseline is not significant (i.e., less than 200 pg/ml absolute rise or less than 110 pg/ml rise depending on the specific criteria used). In the context of the other options, this relatively lower value is the *least* indicative of ZES. *Basal acid output of 15 meq/hour* - In a patient with prior vagotomy, a **basal acid output (BAO) of 15 meq/hour** is significantly elevated and highly suggestive of Zollinger-Ellison syndrome, as vagotomy aims to reduce acid secretion. - Normal BAO is typically < 5 mEq/hr, and a BAO > 15 mEq/hr (or > 6 mEq/hr in patients who have undergone prior acid-reducing surgery) is strongly indicative of excessive gastric acid production characteristic of ZES [1]. *Serum gastrin value of 500 pg/ml* - A **fasting serum gastrin level of 500 pg/ml** is markedly elevated (> 150-200 pg/mL is often considered suspicious), especially in the presence of recurrent ulcers, and is a strong indicator for Zollinger-Ellison syndrome [1]. - This value is well above the normal range (typically < 100 pg/ml) and falls into the range where gastrinoma should be highly suspected [1]. *Ulcers in proximal jejunum and lower end of esophagus* - The presence of **ulcers in unusual locations** such as the **proximal jejunum** is highly characteristic of Zollinger-Ellison syndrome due to the profound acid hypersecretion. - Esophageal ulcers, particularly at the lower end, are also common due to severe gastroesophageal reflux caused by high acid output overwhelming esophageal protective mechanisms.
Question 5: Which of the following statements is true regarding pernicious anemia?
- A. Chronic atrophic gastritis
- B. Elevated serum levels of methyl malonic acid
- C. Increased risk of gastric carcinoma
- D. Increased red cell MCV (Correct Answer)
Explanation: ***Increased risk of gastric carcinoma is unlikely*** - **Pernicious anemia** significantly increases the risk of **gastric carcinoma** due to the chronic inflammation from atrophic gastritis. - This association is well-documented and highlights the **precancerous potential** of the condition. *Increased red cell MCV* - In pernicious anemia, there is often a **macrocytic anemia** characterized by an **increased mean corpuscular volume (MCV)**. - This occurs due to impaired DNA synthesis caused by vitamin B12 deficiency [2]. *Elevated serum levels of methyl malonic acid* - Patients with pernicious anemia will have **elevated levels of methylmalonic acid** due to decreased vitamin B12, impacting the metabolism of certain fatty acids. - This biochemical marker helps in differentiating deficiency of vitamin B12 from other forms of anemia. *Chronic atrophic gastritis* - Chronic atrophic gastritis is a **common feature** in pernicious anemia, leading to gastric mucosal atrophy and impaired intrinsic factor production [1]. - This condition is directly related to the **autoimmune nature** of pernicious anemia, further compromising vitamin B12 absorption [1].
Question 6: A 30-year-old male presents with nausea, vomiting, and abdominal discomfort after consuming large amounts of alcohol. What is the most likely diagnosis?
- A. Esophagitis
- B. Cholecystitis
- C. Peptic ulcer disease
- D. Acute gastritis (Correct Answer)
Explanation: A 30-year-old male presents with nausea, vomiting, and abdominal discomfort after consuming large amounts of alcohol. What is the most likely diagnosis? ***Acute gastritis*** - The patient's symptoms of **nausea**, **vomiting**, and **abdominal discomfort** after acute alcohol consumption are classic for **acute gastritis**. - **Alcohol** is a common irritant that can damage the stomach lining, leading to inflammation [2]. *Esophagitis* - While alcohol can contribute to esophagitis, the primary symptoms typically include **heartburn**, **dysphagia**, and **odynophagia**, which are not described [1]. - Nausea and vomiting originating from the esophagus are usually prominent only with severe inflammation or obstruction. *Cholecystitis* - **Cholecystitis** presents with **right upper quadrant pain**, often radiating to the back or shoulder, and can be associated with fever and leukocytosis. - While nausea and vomiting can occur, the primary symptom is usually localized pain, not diffuse abdominal discomfort following alcohol ingestion. *Peptic ulcer disease* - **Peptic ulcer disease** typically causes **epigastric pain** that can be relieved or exacerbated by food, and symptoms are often chronic or recurrent, not acutely related to a single alcoholic binge [3]. - Though an ulcer can be symptomatic after alcohol, acute gastritis is a more immediate and common consequence of heavy drinking.
Question 7: Which of the following is NOT a common complication of acute pancreatitis?
- A. Subcutaneous fat necrosis
- B. Hyperlipidemia
- C. Hypercalcemia (Correct Answer)
- D. Increased amylase level
Explanation: ***Hypercalcemia*** - Acute pancreatitis is primarily associated with **increased amylase levels** and **hyperlipidemia**, while hypercalcemia is generally a separate condition. - It is not a classical complication or result of acute pancreatitis, but rather might be a cause in cases like **hyperparathyroidism** [1]. *Subcutaneous fat necrosis* - This occurs as a result of **lipolysis** during acute pancreatitis due to the release of **lipases** into circulation [1]. - It is characterized by the presence of **fat necrosis** on the abdomen or buttocks. *Increased amylase level* - A hallmark of acute pancreatitis is **elevated levels of amylase** and sometimes lipase, indicating pancreatic inflammation [1]. - The rise typically occurs within the first 24 hours of the onset of pancreatitis. *Hyperlipidemia* - This is often found in acute pancreatitis due to excess **lipolysis**, leading to elevated triglycerides in the blood [1]. - It can be both a cause and a consequence of pancreatic inflammation, contributing to the disease process [1].
Question 8: The histopathological image shows a section of colon. What histological feature seen in the image is more characteristic of Ulcerative Colitis than Crohn's Disease?
- A. Presence of pseudopolyps
- B. Mucosal edema present
- C. Presence of crypt abscesses (Correct Answer)
- D. Lymphoid aggregates in the mucosa present
Explanation: ***Crypt abscess*** - **Crypt abscesses** are a hallmark of ulcerative colitis, where there is **inflammation and necrosis** within the intestinal crypts [1]. - This feature is distinct from Crohn's disease, which does not typically present with crypt abscesses but rather with **transmural inflammation** [2,3]. *Diffuse distribution of pseudopolyps* - While pseudopolyps can occur in ulcerative colitis, they are not a **distinct histological feature** that differentiates it from Crohn's. - Pseudopolyps are **proliferative tissue islands** due to mucosal regeneration, and their presence is not exclusive to either condition. *Mucosal edema* - Mucosal edema is a common feature in various forms of colitis but is **not specific** to differentiate ulcerative colitis from Crohn's disease. - Both conditions can exhibit **mucosal edema**, making it insufficient for definitive diagnosis. *Lymphoid aggregates in the mucosa* - Lymphoid aggregates can be found in Crohn's disease, particularly in the **intestinal lymphoid tissue** [2], but they are **not a defining feature** of ulcerative colitis. - Ulcerative colitis primarily involves **continuous mucosal inflammation** without these prominent aggregates [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 809. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-368. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 806-807.
Question 9: Which histological feature is more characteristic of ulcerative colitis than Crohn's disease?
- A. Crypt abscess (Correct Answer)
- B. Mucosal edema
- C. Diffuse distribution of pseudopolyps
- D. Lymphoid aggregates in the mucosa
Explanation: ***Crypt abscess*** - **Crypt abscesses** are formed by neutrophils infiltrating and accumulating within glandular crypts, a hallmark of acute mucosal inflammation [1]. - While crypt abscesses **can occur in both ulcerative colitis and Crohn's disease**, they are **far more characteristic and frequent in ulcerative colitis** due to the diffuse, continuous mucosal involvement [1]. - In UC, crypt abscesses are seen in the acute phase and reflect the superficial mucosal inflammation pattern. - **Note:** The true distinguishing features of Crohn's disease include **transmural inflammation** [2], **non-caseating granulomas** (50% of cases) [3], and **skip lesions** [4], none of which are present in UC [5]. *Mucosal edema* - **Mucosal edema** is a non-specific inflammatory change present in both ulcerative colitis and Crohn's disease. - It occurs in many inflammatory bowel conditions and does not help differentiate between UC and CD. *Diffuse distribution of pseudopolyps* - **Pseudopolyps** (inflammatory polyps) result from repeated cycles of mucosal ulceration and regeneration. - While more common in **chronic ulcerative colitis**, they can also occur in Crohn's disease. - This is primarily a **macroscopic/endoscopic feature** rather than a microscopic histological finding [1]. *Lymphoid aggregates in the mucosa* - **Lymphoid aggregates** represent chronic immune activation and are found in **both UC and CD** [2]. - They reflect the underlying chronic inflammatory process but are not specific to either disease. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, p. 809. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 366-367. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 806-807. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-366. [5] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 367-368.
Question 10: Skip lesions with non-caseating granulomas is characteristic of
- A. Hodgkin's lymphoma
- B. Ulcerative colitis
- C. Sarcoidosis
- D. Crohn's disease (Correct Answer)
Explanation: ***Crohn's disease*** - **Skip lesions** involve discontinuous areas of inflammation in the GI tract, which is a hallmark of Crohn's disease, unlike the continuous inflammation seen in ulcerative colitis [2], [3]. - The presence of **non-caseating granulomas** (often referred to as tuberculoid granulomas due to their resemblance to tuberculosis granulomas) is a characteristic histological finding in approximately 50% of Crohn's disease cases [1], [2]. *Hodgkin's lymphoma* - This is a type of cancer originating from lymphocytes and typically presents with **lymphadenopathy** and systemic symptoms. - While granulomas can sometimes be found in association with Hodgkin's lymphoma (secondary granulomas due to immune response), **skip lesions** in the GI tract and primary tuberculoid granulomas are not characteristic diagnostic features. *Ulcerative colitis* - Ulcerative colitis is characterized by **continuous inflammation** that starts in the rectum and can extend proximally through the colon, contrasting with the skip lesions of Crohn's [3]. - It primarily affects the **mucosa and submucosa** and typically does not feature transmural inflammation or the formation of granulomas [3]. *Sarcoidosis* - Sarcoidosis is a systemic inflammatory disease characterized by the formation of **non-caseating granulomas** in multiple organs, most commonly the lungs and lymph nodes [4]. - Although it can rarely affect the GI tract, **skip lesions** specific to the patterns seen in inflammatory bowel disease are not a defining feature; its granulomas are found within affected organs generally rather than as discontinuous intestinal lesions. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Gastrointestinal Tract, pp. 806-807. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 366-367. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Alimentary System Disease, pp. 365-366. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 198-200.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free