Gastroenterology Practice Questions

Q: D-xylose absorption test is used to assess which of the following conditions?

Celiac disease. Celiac disease - The **D-xylose absorption test** assesses the functional integrity of the **small intestinal mucosa**, which is damaged in celiac disease. [1] - In celiac disease, the damaged villi impair the absorption of D-xylose, leading to **low urinary excretion** of the sugar. *Colon cancer* - Colon cancer primarily affects the **large intestine** and does not typically interfere with small intestinal D-xylose absorption. [2] - Diagnosis commonly involves **colonoscopy** and biopsy, not absorption tests. *PUD* - **Peptic ulcer disease (PUD)** affects the stomach or duodenum and does not impair the absorptive function of the small intestine. [3] - The primary diagnostic tool for PUD is **endoscopy** with biopsy for H. pylori. *Ulcerative colitis* - **Ulcerative colitis** is an inflammatory condition predominantly affecting the **large intestine** and rectum. [2] - It does not cause malabsorption in the small intestine, and therefore, D-xylose absorption would typically be normal.

Q: Erosive gastritis commonly affects which part of the stomach?

Stomach antrum. ***Stomach antrum*** - The **antrum** is the most common site for erosive gastritis due to its role in regulating gastric emptying and exposure to gastric acid and pepsin [1]. - While gastritis can affect any part of the stomach, inflammation and erosion are often pronounced in the antrum due to its location relative to the pylorus and continuous exposure to luminal contents [1]. *Stomach fundus* - The **fundus** is the upper part of the stomach and is less commonly affected by erosive gastritis compared to the antrum and body. - It plays a significant role in accumulating gas during digestion. Its location and functions make it less susceptible to the type of chronic inflammation that leads to erosions [2]. *Stomach body* - The **stomach body (corpus)** is responsible for producing acid and pepsin and can be affected by gastritis, but it is less frequently the primary site of erosions than the antrum [1]. - Inflammatory changes in the body are often associated with other forms of gastritis, such as autoimmune gastritis, which typically does not manifest with widespread erosions [1]. *Pylorus* - The **pylorus** is the muscular valve connecting the stomach to the duodenum; while it is adjacent to the antrum, erosions are typically described as occurring in the antrum itself rather than within the pyloric channel. - Inflammation affecting the pylorus directly might lead to issues with gastric emptying but is usually secondary to disease in the antrum or duodenum.

Q: Crohn's disease can be seen in which of the following locations?

Mouth to anus. ***Mouth to anus*** - Crohn's disease is a **transmural inflammatory condition** that can affect any part of the gastrointestinal tract, from the mouth to the anus [1]. - This pan-GI involvement is a key characteristic, distinguishing it from other inflammatory bowel diseases [1]. *Jejunum only* - While Crohn's can affect the **jejunum**, it is rarely confined to this segment alone [1]. - Such limited involvement is atypical for the widespread nature of Crohn's disease [1]. *Colon only* - If inflammation were restricted to the **colon only**, it would be more suggestive of **ulcerative colitis**, not Crohn's disease [1]. - Crohn's disease often presents with "skip lesions," meaning affected areas are interspersed with healthy tissue, which is uncommon in diffuse colonic involvement [1]. *Terminal ileum and right side* - Involvement of the **terminal ileum and right colon** is the most common presentation of Crohn's disease [1]. - However, it is not the *only* location, nor does it encompass the full potential extent of the disease throughout the GI tract [1].

Q: Which of the following can cause toxic megacolon in a 36-year-old lady?

Ulcerative colitis. ***Ulcerative colitis*** - **Ulcerative colitis** is a well-known cause of **toxic megacolon**, a severe complication characterized by acute colonic distension and systemic toxicity [1]. - The inflammatory process in ulcerative colitis can lead to deep ulcerations and transmural inflammation, compromising the enteric nervous system and causing acute colonic dysfunction. *Amoebic dysentery* - While **amoebic dysentery** can cause severe colonic inflammation and necrosis, it is **less commonly associated with toxic megacolon** compared to inflammatory bowel diseases. - The primary concern with amoebic dysentery is often **amoebic liver abscess** or colonic perforation rather than toxic megacolon. *Irritable bowel syndrome (IBS)* - **IBS** is a **functional gastrointestinal disorder** and does **not cause structural changes or significant inflammation** in the colon. - It is characterized by symptoms like abdominal pain, bloating, and altered bowel habits, but it is **not associated with toxic megacolon**. *Viral diarrhea* - **Viral diarrhea** typically causes **acute, self-limiting gastroenteritis** and does **not involve the severe, transmural inflammation** required to induce toxic megacolon. - The primary concern with viral diarrhea is **dehydration**, especially in vulnerable populations.

Q: In modified Pugh's classification score of 8, what is the line of management?

Conservative management. Conservative management - A modified Child-Pugh score of 8 falls into Child-Pugh class B, indicating **moderate liver dysfunction**. - At this stage, **medical management** aimed at addressing complications and improving liver function is the primary line of treatment. *Orthotopic liver transplant* - Liver transplantation is generally considered for patients with **Child-Pugh class C** (scores 10-15) or those with class B who are unresponsive to medical therapy and have a high risk of mortality [1]. - While a score of 8 indicates significant disease, it's not immediately indicative of the need for transplant without failure of conservative measures or other specific indications [1]. *Sclerotherapy* - **Sclerotherapy** is a procedure primarily used to treat **esophageal varices** to prevent or treat bleeding [2]. - It is a targeted intervention for a specific complication of portal hypertension, not a general management strategy for a Child-Pugh score of 8. *Shunt surgery* - **Shunt surgery**, such as a Transjugular Intrahepatic Portosystemic Shunt (TIPS), is used to decompress the **portal venous system** in cases of severe portal hypertension [3]. - It's typically reserved for patients with recurrent variceal bleeding or refractory ascites, and not a primary management for a Child-Pugh score of 8 as a whole [3].

Q: Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?

Arthritis. ***Arthritis*** - **Peripheral arthritis** associated with inflammatory bowel disease (IBD) often **worsens with intestinal disease exacerbations** and improves with resolution of flares [1]. - This type of arthritis typically affects larger joints and is **non-deforming and asymmetric**. *Erythema nodosum* - **Erythema nodosum**, a skin manifestation, is generally **correlated with IBD activity** and usually improves as the bowel disease is treated [1]. - It presents as **tender, red nodules** on the shins and is not consistently one of the symptoms that *worsens* with exacerbation, but rather is *present* during active disease. *Primary sclerosing cholangitis* - **Primary sclerosing cholangitis (PSC)** is a chronic liver condition that is **associated with IBD**, particularly ulcerative colitis. - However, the progression of PSC is largely **independent of the intestinal disease activity** and does not necessarily worsen during IBD exacerbations. *Uveitis* - **Uveitis**, an inflammation of the eye's middle layer, is an extra-intestinal manifestation of IBD that can occur **independently of intestinal disease activity**. - It does not consistently worsen during IBD exacerbations and may require separate focused treatment.

Q: A 67-year-old woman complains of paresthesias in the limbs. Examination shows loss of vibratory sense, positional sense, and sense of light touch in the lower limbs. She is found to have pernicious anemia. Endoscopy reveals an ulcer in the body of the stomach. What vitamin deficiency does she most likely have?

Cancer of the stomach. **Cancer of the stomach** - The presence of **pernicious anemia** with an **ulcer in the body of the stomach** in an elderly patient suggests an increased risk of **gastric adenocarcinoma** [2]. - **Atrophic gastritis** associated with pernicious anemia is a **precursor lesion** for gastric cancer, and a stomach ulcer in this context warrants suspicion for malignancy [2]. *Chronic atrophic gastritis* - While **chronic atrophic gastritis** is the underlying cause of pernicious anemia, the question specifies an **ulcer in the body of the stomach** [3]. - An ulcer in the setting of atrophic gastritis should raise concern for **malignancy**, especially in an older patient, rather than just chronic inflammation [2]. *Gastric sarcoma* - **Gastric sarcomas** are mesenchymal tumors of the stomach, which are **rare** compared to gastric adenocarcinomas. - While they can present as ulcers, the strong association with **pernicious anemia** points more directly towards adenocarcinoma. *Deficiency of vitamin B12* - The patient clearly has **vitamin B12 deficiency** due to pernicious anemia, which explains the neurological symptoms like **paresthesias** and loss of vibratory/positional sense [1]. - However, the question asks what new pathology is suggested by the **ulcer in the stomach body** given the underlying pernicious anemia, rather than about the deficiency itself.

Q: In a patient with liver disease, which maneuvers may lead to the development of hyperammonemia?

The use of loop diuretics.. ***The use of loop diuretics.*** - Loop diuretics can lead to **hypokalemia** and **metabolic alkalosis**, which promotes the conversion of NH4+ to NH3, the un-ionized form that can cross the blood-brain barrier. [2] - They also can induce **prerenal azotemia** due to volume depletion, increasing protein catabolism and ammonia production. *Protein restriction may help in managing hyperammonemia.* - **Protein restriction** is a strategy to *reduce* ammonia production in the gut, especially in patients with hepatic encephalopathy. [1] - This statement describes a management strategy, not a maneuver that *leads* to hyperammonemia. *A branched-chain amino acid-enriched protein mixture can help lower ammonia levels.* - **Branched-chain amino acids (BCAAs)** are often used as nutritional support in liver disease to *improve* nitrogen balance and reduce ammonia levels. - They compete with aromatic amino acids for transport into the brain, which can help in *reducing* ammonia's neurotoxic effects. *The use of neomycin can help reduce ammonia levels.* - **Neomycin** is an antibiotic that *reduces* ammonia production by killing ammonia-producing bacteria in the gut. - Therefore, using neomycin would *decrease* ammonia levels, not cause hyperammonemia.

Q: A 60-year-old male presents with hypotension (90/50 mm Hg), tachycardia (100 beats per minute), and a history of hypertension and coronary artery disease. He has been passing black, tarry stools while on aspirin, atenolol, and sorbitrate. What is the most likely diagnosis?

Gastric ulcer with bleeding. ***Gastric ulcer with bleeding*** - The patient's presentation with **hypotension** and **tachycardia** indicates **hypovolemia**, which is consistent with significant blood loss [1]. - **Black, tarry stools (melena)** are a classic sign of **upper gastrointestinal bleeding**, often originating from a gastric ulcer, especially given the patient's use of **aspirin**, a known risk factor [1]. *Acute MI with cardiogenic shock* - While the patient has a history of coronary artery disease, **cardiogenic shock** would typically present with signs of **poor tissue perfusion** secondary to pump failure, not primarily with melena [2]. - Melena is not a typical symptom of myocardial infarction itself, though GI bleeding can exacerbate cardiac ischemia [1]. *Acute CVA* - An **acute cerebrovascular accident (CVA)** would present with focal neurological deficits, such as hemiparesis, aphasia, or vision changes. - The patient's symptoms of melena, hypotension, and tachycardia are not characteristic of a CVA [1]. *Pulmonary embolism* - A **pulmonary embolism (PE)** typically presents with acute onset of **dyspnea, pleuritic chest pain**, and sometimes hemoptysis. - While it can cause hypotension and tachycardia, **melena is not a symptom** of pulmonary embolism.

Question 1

D-xylose absorption test is used to assess which of the following conditions?

Accepted Answer

Celiac disease

Answer

Colon cancer

Answer

PUD

Answer

Ulcerative colitis

Question 2

Erosive gastritis commonly affects which part of the stomach?

Accepted Answer

Stomach antrum

Answer

Stomach fundus

Answer

Stomach body

Answer

Pylorus

Question 3

Crohn's disease can be seen in which of the following locations?

Accepted Answer

Mouth to anus

Answer

Jejunum only

Answer

Colon only

Answer

Terminal ileum and right side

Question 4

Which of the following can cause toxic megacolon in a 36-year-old lady?

Accepted Answer

Ulcerative colitis

Answer

Viral diarrhea

Answer

Amoebic dysentery

Answer

Irritable bowel syndrome (IBS)

Question 5

In modified Pugh's classification score of 8, what is the line of management?

Accepted Answer

Conservative management

Answer

Sclerotherapy

Answer

Shunt surgery

Answer

Orthotopic liver transplant

Question 6

Which extra-intestinal symptom of inflammatory bowel disease worsens with exacerbation of disease activity?

Accepted Answer

Arthritis

Answer

Primary sclerosing cholangitis

Answer

Uveitis

Answer

Erythema nodosum

Question 7

A 50-year-old gynecologist complains of dysphagia, regurgitation, and weight loss, and reports feeling as if food is stuck at the level of the xiphoid. An upright chest X-ray shows a dilated esophagus with an air-fluid level. Which of the following statements is false regarding achalasia?

Accepted Answer

Upper endoscopy should be avoided because of the risk of complications.

Answer

Medical treatment includes nitrates and calcium channel blockers.

Answer

A barium swallow will show a "bird's beak" deformity

Answer

Manometry will demonstrate that the LES fails to relax during swallowing.

Question 8

A 67-year-old woman complains of paresthesias in the limbs. Examination shows loss of vibratory sense, positional sense, and sense of light touch in the lower limbs. She is found to have pernicious anemia. Endoscopy reveals an ulcer in the body of the stomach. What vitamin deficiency does she most likely have?

Accepted Answer

Cancer of the stomach

Answer

Gastric sarcoma

Answer

Chronic atrophic gastritis

Answer

Deficiency of vitamin B12

Question 9

In a patient with liver disease, which maneuvers may lead to the development of hyperammonemia?

Accepted Answer

The use of loop diuretics.

Answer

Protein restriction may help in managing hyperammonemia.

Answer

A branched-chain amino acid-enriched protein mixture can help lower ammonia levels.

Answer

The use of neomycin can help reduce ammonia levels.

Question 10

A 60-year-old male presents with hypotension (90/50 mm Hg), tachycardia (100 beats per minute), and a history of hypertension and coronary artery disease. He has been passing black, tarry stools while on aspirin, atenolol, and sorbitrate. What is the most likely diagnosis?

Accepted Answer

Gastric ulcer with bleeding

Answer

Acute MI with cardiogenic shock

Answer

Acute CVA

Answer

Pulmonary embolism

Gastroenterology — MCQs

Gastroenterology — MCQs

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