Gastroenterology — MCQs

A 48-year-old female patient presented to the outpatient department with complaints of intermittent dysphagia limited to solids, accompanied by weakness, fatigue, and dyspnea, for 2 months. On examination, she exhibited angular cheilitis, glossitis, koilonychia, and pallor. Laboratory findings revealed iron deficiency anemia. A barium swallow was performed, followed by upper GI endoscopy. Which of the following is the most likely diagnosis?

Q1246

Referred pain to the inferior angle of the right scapula in acute cholecystitis is known as

Q1247

Which of the following is not included in the Child-Turcotte-Pugh scoring system?

Q1248

Kings' criteria are used in the prognosis of which of the following conditions?

Q1249

The most common cause of death in peptic ulcer patients is:

Q1250

A 60-year-old male presents with progressive difficulty in swallowing, vomiting, and occasional regurgitation for the past three months. Barium studies show marked dilatation of the upper esophagus with narrowing of the lower segment. Manometry shows absent esophageal peristalsis. Which of the following conditions is he most likely at risk of developing?

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 1241: Anti-transglutaminase antibody is seen in?

A. Celiac disease (Correct Answer)
B. Systemic lupus erythematosus (SLE)
C. Collagenous colitis (CC)
D. Tropical sprue (TS)

Explanation: ***Celiac disease*** - Anti-transglutaminase antibodies are **highly specific and sensitive** for celiac disease, indicating an autoimmune response to gluten [1]. - This antibody is associated with **intestinal damage** and the clinical features of malabsorption in affected individuals. *Collagenous colitis* - This condition typically involves **chronic diarrhea** without the elevation of anti-transglutaminase antibodies. - The main feature is a **thickened collagen layer** in the intestinal wall, not directly related to gluten intolerance. *SLE* - Systemic lupus erythematosus (SLE) is associated with multiple autoantibodies, but **not specifically** anti-transglutaminase antibodies [1]. - Key features include **butterfly rash** and **renal involvement**, which are not relevant to gluten sensitivity. *Tropical sprue* - Characterized by **malabsorption**, often in travelers to tropical areas, but does not involve the presence of anti-transglutaminase antibodies [1]. - It is linked to deficiencies in **vitamin B12** and **folate**, rather than gluten-related disorders.

Question 1242: What is the most common cause of chronic liver disease?

A. Hepatitis B
B. Hepatitis A
C. Hepatitis C (Correct Answer)
D. Hepatitis E

Explanation: ***Hepatitis C*** - **Hepatitis C virus** (HCV) infection is a major cause of **chronic liver disease**, leading to **cirrhosis**, liver cancer, and the need for liver transplantation. [1] - Its high propensity for developing into a **chronic infection** (in 75-85% of cases) makes it a predominant cause of long-term liver damage. [1] *Hepatitis B* - While **Hepatitis B virus** (HBV) can cause chronic liver disease, a large proportion of acute infections in adults resolve spontaneously. - The chronicity rate for HBV is significantly lower in adults compared to HCV, although it is a high concern in perinatal transmission. *Hepatitis A* - **Hepatitis A virus** (HAV) typically causes an **acute, self-limiting infection** and does not lead to chronic liver disease. - Recovery is complete, and individuals develop lifelong immunity. *Hepatitis E* - **Hepatitis E virus** (HEV) infection is usually **acute and self-limiting**, similar to Hepatitis A. - Chronic HEV infection can occur in **immunocompromised individuals**, but it is relatively uncommon in the general population and not considered the most common cause of chronic liver disease overall.

Question 1243: Obstruction of the hepatic vein by thrombosis or a membranous web is known as

A. Plummer Vinson Syndrome
B. Budd-Chiari syndrome (Correct Answer)
C. Caroli's disease
D. Schatzki's ring (esophageal narrowing)

Explanation: ***Budd-Chiari syndrome*** - **Budd-Chiari syndrome** is specifically defined as the obstruction of outflow from the liver due to occlusion of the **hepatic veins** or the suprahepatic inferior vena cava [1]. - This obstruction can be caused by **thrombosis** or a **membranous web**, leading to hepatomegaly, ascites, and abdominal pain [1]. *Schatzki's ring (esophageal narrowing)* - A **Schatzki's ring** is a benign circumferential stenosis of the distal esophagus, typically at the **squamocolumnar junction**. - It primarily causes **dysphagia** (difficulty swallowing) for solids and has no relation to hepatic vein obstruction. *Plummer Vinson Syndrome* - **Plummer-Vinson syndrome** is a rare condition characterized by the triad of **iron deficiency anemia**, **dysphagia** (due to esophageal webs), and **glossitis**. - It involves the **upper gastrointestinal tract** and is unrelated to liver or hepatic venous outflow obstruction. *Caroli's disease* - **Caroli's disease** is a rare congenital disorder characterized by multifocal, segmental dilatation of the **intrahepatic bile ducts**. - It is associated with recurrent **cholangitis** and an increased risk of cholangiocarcinoma, but does not involve hepatic vein obstruction.

Question 1244: A patient with biliary atresia is more prone to the deficiency of:

A. Vitamin K (Correct Answer)
B. Vitamin B12
C. Vitamin C
D. Niacin

Explanation: ***Vitamin K*** - Biliary atresia causes **impaired bile flow**, which is essential for the **absorption of fat-soluble vitamins** (A, D, E, K) from the small intestine [1], [2]. - **Vitamin K deficiency** leads to impaired synthesis of **prothrombin** and other clotting factors, increasing the risk of **bleeding diathesis** [1], [2]. *Vitamin B12* - **Vitamin B12 (cobalamin)** is a **water-soluble vitamin** whose absorption is not directly dependent on bile acids [4]. - Its absorption requires **intrinsic factor** secreted by gastric parietal cells, and is mainly affected in conditions like **pernicious anemia** or **Crohn's disease**. *Vitamin C* - **Vitamin C (ascorbic acid)** is a **water-soluble vitamin** and its absorption is not dependent on bile [3]. - Deficiency typically occurs due to **inadequate dietary intake** and leads to **scurvy** [3]. *Niacin* - **Niacin (Vitamin B3)** is a **water-soluble vitamin** and its absorption is not affected by biliary obstruction. - Deficiency mainly causes **pellagra**, characterized by the "3 Ds": **dermatitis**, **diarrhea**, and **dementia**.

Question 1245: A 48-year-old female patient presented to the outpatient department with complaints of intermittent dysphagia limited to solids, accompanied by weakness, fatigue, and dyspnea, for 2 months. On examination, she exhibited angular cheilitis, glossitis, koilonychia, and pallor. Laboratory findings revealed iron deficiency anemia. A barium swallow was performed, followed by upper GI endoscopy. Which of the following is the most likely diagnosis?

A. Plummer-Vinson syndrome (Correct Answer)
B. Pill-induced esophageal stricture due to medication use
C. Heterotopic gastric mucosa causing esophageal narrowing
D. Achalasia cardia with progressive dysphagia for solids and liquids

Explanation: ***Plummer-Vinson syndrome*** - This syndrome is characterized by the triad of **iron deficiency anemia**, **dysphagia** (due to esophageal webs), and **esophageal webs**. - The patient's symptoms of intermittent dysphagia for solids, angular cheilitis, glossitis, koilonychia, and pallor are all consistent with chronic **iron deficiency**. *Pill-induced esophageal stricture due to medication use* - This usually presents with a history of taking certain medications (e.g., NSAIDs, bisphosphonates, antibiotics) causing esophageal irritation and inflammation. - While it can cause dysphagia, it typically doesn't present with the systemic signs of iron deficiency such as angular cheilitis or koilonychia. *Heterotopic gastric mucosa causing esophageal narrowing* - This congenital condition ("inlet patch") is usually asymptomatic but can cause symptoms like dysphagia or heartburn if it becomes inflamed or causes stricture. - It does not explain the associated **iron deficiency anemia** and its systemic manifestations. *Achalasia cardia with progressive dysphagia for solids and liquids* - **Achalasia** features dysphagia for both solids and liquids due to impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax [1]. - While it causes dysphagia, it is not directly linked to **iron deficiency anemia** or its mucocutaneous manifestations like glossitis and koilonychia [2].

Question 1246: Referred pain to the inferior angle of the right scapula in acute cholecystitis is known as

A. Boa's sign (Correct Answer)
B. Murphy's sign
C. Naunyn's sign
D. Cullen's sign

Explanation: ***Boa's sign*** - This sign is characterized by **referred pain** to the **inferior angle of the right scapula** due to irritation of the **phrenic nerve** (C3-C5 dermatomes) by an inflamed gallbladder [1]. - The pain is typically felt unilaterally on the right side and is a classic presentation in **acute cholecystitis** [1]. *Murphy's sign* - This is a test for acute cholecystitis, characterized by **inspiratory arrest** upon deep palpation of the right upper quadrant under the costal margin [1]. - It indicates **visceral tenderness** of the gallbladder itself, rather than referred pain to the scapula. *Naunyn's sign* - This sign is not a recognized clinical sign associated with acute cholecystitis or referred pain patterns in common medical practice. - There might be confusion with other eponymous signs that are not directly related to gallbladder pathology and referred scapular pain. *Cullen's sign* - This sign refers to **periumbilical ecchymosis** (bruising around the umbilicus). - It is indicative of **retroperitoneal hemorrhage**, such as in acute pancreatitis [2] or ruptured ectopic pregnancy, not acute cholecystitis.

Question 1247: Which of the following is not included in the Child-Turcotte-Pugh scoring system?

A. Encephalopathy
B. ALT (Correct Answer)
C. Albumin
D. Ascites

Explanation: ***ALT*** - The **Child-Turcotte-Pugh (CTP) score** assesses the severity of **liver cirrhosis** and its prognosis, using parameters like bilirubin, albumin, INR, ascites, and encephalopathy. [1] - **Alanine aminotransferase (ALT)** levels are indicators of hepatocellular injury or inflammation but are not used in the CTP scoring system for chronic liver disease severity. [1] *Encephalopathy* - **Hepatic encephalopathy** is a crucial component of the CTP score, reflecting the liver's inability to detoxify harmful substances. [1] - Its presence and severity (graded 1-4) strongly correlate with a worse prognosis in **cirrhotic patients**. *Albumin* - **Albumin** levels are inversely correlated with the severity of liver dysfunction, as synthetic function of the liver declines. [1] - Low albumin (hypoalbuminemia) indicates poor **synthetic capacity** of the liver and is a prognostic marker in the CTP score. [1] *Ascites* - **Ascites**, the accumulation of fluid in the abdominal cavity, is a common complication of **portal hypertension** in advanced liver disease. [1] - Its presence and refractoriness are critical components of the CTP score, indicating significant fluid imbalance and circulatory dysfunction. [1]

Question 1248: Kings' criteria are used in the prognosis of which of the following conditions?

A. Acute liver failure (Correct Answer)
B. Acute renal failure
C. Acute respiratory failure
D. Acute heart failure

Explanation: ***Acute liver failure*** - **King's criteria** (also known as the **King's College Hospital criteria**) are used to assess the prognosis of patients with **acute liver failure** [1] and help determine the need for a **liver transplant** [3]. - These criteria consider factors such as the cause of liver failure, **bilirubin levels**, **prothrombin time** [1], and **encephalopathy** [2], providing a framework for management decisions. *Acute heart failure* - Prognostic tools for acute heart failure typically involve parameters like **ejection fraction**, **NYHA functional class**, and **biomarkers** such as brain natriuretic peptide (BNP). - Kings' criteria are specifically designed for liver dysfunction, not heart failure. *Acute renal failure* - Prognosis in **acute renal failure** (now often termed **acute kidney injury** or AKI) is assessed using staging systems like **KDIGO criteria** (Kidney Disease Improving Global Outcomes) or RIFLE criteria based on **creatinine levels** and **urine output**. - Kings' criteria are not applicable to the assessment of kidney function or failure. *Acute respiratory failure* - The prognosis of **acute respiratory failure** is often evaluated using criteria related to the underlying cause, **oxygenation status** (e.g., PaO2/FiO2 ratio), and the need for **mechanical ventilation**. - Kings' criteria focus on liver-specific parameters and are not used for respiratory conditions.

Question 1249: The most common cause of death in peptic ulcer patients is:

A. Pyloric stenosis
B. Perforation
C. Hemorrhage (Correct Answer)
D. Malignancy

Explanation: ***Hemorrhage*** - **Gastrointestinal bleeding** is the most frequent and life-threatening complication of peptic ulcers, leading to significant morbidity and mortality [1]. - Bleeding can range from occult blood loss to **massive hematemesis** or **melena**, which can quickly cause **hypovolemic shock** and death if not promptly managed [1]. *Perforation* - While a serious complication, leading to **peritonitis**, perforation is less common as a cause of death compared to hemorrhage [2]. - Perforation typically causes acute, severe abdominal pain and requires urgent surgical intervention [2]. *Pyloric stenosis* - This complication involves narrowing of the pyloric outlet due to **scarring from chronic ulceration**, causing **gastric outlet obstruction**. - Pyloric stenosis is more associated with chronic symptoms like **vomiting** and **weight loss**, and while debilitating, it is rarely a direct cause of immediate death. *Malignancy* - The risk of **malignant transformation** is primarily associated with **gastric ulcers**, particularly those due to *H. pylori* infection, but it is not a direct, immediate cause of death in the acute setting of peptic ulcer disease [2]. - **Duodenal ulcers** are almost never malignant.

Question 1250: A 60-year-old male presents with progressive difficulty in swallowing, vomiting, and occasional regurgitation for the past three months. Barium studies show marked dilatation of the upper esophagus with narrowing of the lower segment. Manometry shows absent esophageal peristalsis. Which of the following conditions is he most likely at risk of developing?

A. Mallory-Weiss syndrome
B. Peptic ulcer disease
C. Squamous cell carcinoma of the esophagus (Correct Answer)
D. Rupture of esophageal varices

Explanation: ***Squamous cell carcinoma of the esophagus*** - The patient's symptoms (dysphagia, regurgitation, esophageal dilation) and manometry findings (absent peristalsis) are characteristic of **achalasia** [1]. - Long-standing achalasia is a significant risk factor for developing **squamous cell carcinoma of the esophagus** due to chronic inflammation and irritation of the esophageal lining. *Mallory-Weiss syndrome* - This condition involves **longitudinal tears** in the esophageal mucosa, typically near the gastroesophageal junction, due to forceful vomiting or retching. - While the patient experiences vomiting, the underlying pathology of achalasia does not directly predispose to esophageal tears more than other conditions causing vomiting. *Peptic ulcer disease* - Peptic ulcers are typically caused by **Helicobacter pylori infection** or **NSAID use**, affecting the stomach or duodenum. - Achalasia is a primary motility disorder of the esophagus and does not directly increase the risk of developing peptic ulcers. *Rupture of esophageal varices* - Esophageal varices are **dilated submucosal veins** in the lower esophagus, almost always a result of **portal hypertension**, commonly due to liver cirrhosis. - Achalasia does not cause portal hypertension or directly lead to the formation of esophageal varices.

Practice by Chapter

Esophageal Disorders

Practice Questions

Peptic Ulcer Disease

Practice Questions

Inflammatory Bowel Disease

Practice Questions

Irritable Bowel Syndrome

Practice Questions

Malabsorption Syndromes

Practice Questions

Pancreatitis (Acute and Chronic)

Practice Questions

Gastrointestinal Bleeding

Practice Questions

Liver Diseases and Cirrhosis

Practice Questions

Viral Hepatitis

Practice Questions

Biliary Tract Disorders

Practice Questions

Gastrointestinal Motility Disorders

Practice Questions

Gastrointestinal Malignancies

Practice Questions

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