Gastroenterology Practice Questions

Q: Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension?

Upper gastrointestinal bleeding. **Explanation:** **Non-Cirrhotic Portal Hypertension (NCPH)** refers to a group of disorders characterized by an increase in portal pressure (HVPG > 5 mmHg) in the absence of cirrhosis [1]. The two most common types are **Extrahepatic Portal Venous Obstruction (EHPVO)** and **Non-Cirrhotic Portal Fibrosis (NCPF)**. **Why Upper Gastrointestinal (UGI) Bleeding is correct:** In NCPH, the liver's synthetic function remains preserved, but the portal pressure is significantly elevated. This leads to the formation of large, high-pressure esophageal and gastric varices [2]. Because these patients do not have the systemic decompensation seen in cirrhosis, they typically remain asymptomatic until a varix ruptures. Therefore, **painless, massive hematemesis (UGI bleeding)** is the most common and often the first presenting symptom [2]. **Why other options are incorrect:** * **Chronic Liver Disease (CLD):** By definition, NCPH occurs in the absence of cirrhosis. Stigmata of CLD (like palmar erythema or spider nevi) are typically absent. * **Ascites:** Since serum albumin and liver function are preserved, ascites is rare [3]. If present, it is usually transient and follows an episode of UGI bleed or infection. * **Encephalopathy:** Hepatic encephalopathy is extremely rare in NCPH because the liver's metabolic and detoxification functions are intact. **High-Yield Clinical Pearls for NEET-PG:** * **Hallmark of NCPH:** Massive Splenomegaly + Variceal Bleed + Preserved Liver Function. * **EHPVO:** Most common cause of portal hypertension in children; often associated with a history of neonatal umbilical sepsis. * **Investigation of Choice:** Color Doppler Ultrasound (shows "Cavernoma" formation in EHPVO) [3]. * **Prognosis:** Much better than cirrhotic portal hypertension because the liver is healthy.

Q: Which of the following is true regarding classical spontaneous bacterial peritonitis?

Ascitic fluid neutrophil count is > 250/cumm. Spontaneous Bacterial Peritonitis (SBP) is an acute bacterial infection of ascitic fluid, occurring in the absence of an identifiable intra-abdominal source of infection (like a perforated viscus). It is a common and serious complication of cirrhosis. **Why Option A is Correct:** The diagnosis of SBP is established by an **absolute neutrophil count (ANC) ≥ 250 cells/mm³** (0.25 x 10⁹/L) in the ascitic fluid. This is the most sensitive indicator of infection. Even if the culture is negative (Culture-Negative Neutrocytic Ascites), a patient with an ANC > 250 should be treated empirically with antibiotics (e.g., Cefotaxime). **Why Other Options are Incorrect:** * **Option B & D:** These are features of **Secondary Peritonitis**. SBP occurs without a surgically treatable source like bowel perforation. Clinical signs of "board-like rigidity" and "rebound tenderness" are typical of surgical peritonitis; SBP often presents subtly with vague abdominal pain or worsening encephalopathy. * **Option C:** SBP is typically **monomicrobial**. The most common organisms are *E. coli*, *Klebsiella*, and *Streptococcus pneumoniae*. Isolation of multiple organisms (polymicrobial) suggests Secondary Peritonitis due to a gut wall breach. **High-Yield Clinical Pearls for NEET-PG:** * **Most common organism:** *Escherichia coli*. * **Treatment of choice:** Third-generation cephalosporins (Cefotaxime). * **Albumin Therapy:** Administering IV albumin (1.5g/kg on day 1 and 1g/kg on day 3) reduces the risk of Hepatorenal Syndrome and mortality [1]. * **Prophylaxis:** Indicated for patients with low ascitic protein (<1.5 g/dL) or a prior episode of SBP (usually with Norfloxacin or Rifaximin) [2].

Q: Which of the following is NOT a feature of Celiac disease?

Biopsy findings are pathognomonic for the disease.. **Explanation:** The correct answer is **D**. While small bowel biopsy is a cornerstone of diagnosis, the findings (villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes) are **not pathognomonic** [1]. These histological features can also be seen in Tropical Sprue, Giardiasis, Common Variable Immunodeficiency (CVID), and Autoimmune Enteropathy. Diagnosis requires a combination of clinical features, positive serology (anti-tTG IgA), and biopsy findings that improve on a gluten-free diet [1]. **Analysis of Incorrect Options:** * **Option A:** Celiac disease typically presents with malabsorptive symptoms [1]. Iron deficiency anemia (refractory to oral iron) is a classic "silent" presentation due to primary involvement of the duodenum, where iron is absorbed [1]. * **Option B:** It is an immune-mediated enteropathy triggered by the ingestion of **gluten** (specifically the gliadin fraction) found in wheat, barley, and rye [1]. * **Option C:** Over 95% of patients express **HLA-DQ2** (most common) or **HLA-DQ8** [1]. The absence of these alleles has a high negative predictive value, effectively ruling out the disease. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Small bowel biopsy (D2 part of the duodenum). * **Best Initial Screening Test:** IgA Anti-tissue Transglutaminase (anti-tTG) antibody. * **Dermatological Association:** **Dermatitis Herpetiformis** (itchy, vesicular rash on extensors; biopsy shows IgA deposits at dermal papillae). * **Associated Malignancy:** Increased risk of **Enteropathy-associated T-cell lymphoma (EATL)**. * **Marsh Classification:** Used to grade the severity of histological changes on biopsy.

Q: A 50-year-old male presented with a history of hematemesis of 500ml of blood. On examination, his BP was 90/60 mmHg, PR was 110 bpm, and he had splenomegaly 5 cm below the lower costal margin. What is the most probable diagnosis?

Portal hypertension. ### Explanation The correct diagnosis is **Portal Hypertension**, likely leading to esophageal variceal bleeding [1]. **1. Why Portal Hypertension is correct:** The clinical presentation features a classic triad: **Massive Hematemesis** (500ml), **Hemodynamic Instability** (Hypotension 90/60 mmHg and Tachycardia 110 bpm), and **Splenomegaly** [2]. In the context of upper GI bleeding, the presence of splenomegaly is a hallmark sign of portal hypertension (congestive splenomegaly) [3]. This suggests that the bleeding source is most likely esophageal or gastric varices resulting from underlying cirrhosis or non-cirrhotic portal fibrosis [1]. **2. Why other options are incorrect:** * **Mallory-Weiss tear:** This involves a mucosal tear at the gastroesophageal junction, typically following forceful vomiting or retching. While it causes hematemesis, it is **not associated with splenomegaly**. * **Duodenal Ulcer:** This is a common cause of upper GI bleed (peptic ulcer disease). However, it does not cause splenomegaly unless there is a co-existing liver disease. * **Gastritis:** Erosive gastritis can cause hematemesis, but the bleeding is usually less massive, and like the other incorrect options, it **does not explain the presence of an enlarged spleen**. **Clinical Pearls for NEET-PG:** * **Splenomegaly + Hematemesis = Portal Hypertension** until proven otherwise [2]. * **Initial Management:** The first step in any massive hematemesis is hemodynamic stabilization (IV fluids/resuscitation), followed by an urgent Upper GI Endoscopy [2]. * **Drug of Choice:** Octreotide or Terlipressin is used to reduce portal pressure in suspected variceal bleeds. * **Prophylaxis:** Propranolol (non-selective beta-blocker) is used for primary prophylaxis of variceal bleeding.

Q: Which oral lesion is associated with ulcerative colitis?

Pyostomatitis vegetans. **Explanation:** **Pyostomatitis vegetans (PV)** is a rare, highly specific oral manifestation of Inflammatory Bowel Disease (IBD), most commonly associated with **Ulcerative Colitis (UC)** (and occasionally Crohn’s disease). It is considered the oral counterpart of *Pyoderma gangrenosum*. * **Mechanism:** It is characterized by multiple "snail-track" ulcers (friable, yellowish-white pustules) on an erythematous base in the oral mucosa. These lesions often mirror the activity of the intestinal disease; they flare when the colitis is active and typically resolve once the underlying UC is treated or a colectomy is performed. **Analysis of Incorrect Options:** * **Pemphigus:** This is an autoimmune blistering disorder (Type II hypersensitivity) involving antibodies against desmogleins. While it causes oral ulcers, it has no specific association with UC. * **Scleroderma:** Characterized by microvascular damage and fibrosis. Oral findings include a widened periodontal ligament space and microstomia (limited mouth opening), not vegetative pustules. * **Sarcoidosis:** A multisystem granulomatous disease. Oral involvement is rare but usually presents as asymptomatic nodules or salivary gland enlargement (Heerfordt syndrome), not pustular lesions. **NEET-PG High-Yield Pearls:** * **Most common oral lesion in IBD:** Aphthous ulcers (seen in both UC and Crohn’s). * **Most specific oral lesion for UC:** Pyostomatitis vegetans. * **Skin counterpart:** Pyoderma gangrenosum (associated with UC) and Erythema nodosum (more common in Crohn’s). * **Histology of PV:** Intraepithelial abscesses filled with **eosinophils** and neutrophils.

Question 1

Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension?

Accepted Answer

Upper gastrointestinal bleeding

Answer

Chronic liver disease

Answer

Ascites

Answer

Encephalopathy

Question 2

A 23-year-old female presented with symptoms of severe pancreatitis. All of the following are considered bad prognostic signs in this patient, EXCEPT:

Accepted Answer

Prothrombin time > 2 times the control

Answer

TLC > 16000

Answer

Calcium < 8 mg/dL

Answer

Glucose > 200 mg%

Question 3

A 30-year-old female patient presents with non-progressive dysphagia for both solids and liquids. What is the characteristic finding on barium swallow that will confirm the probable diagnosis?

Accepted Answer

Multiple sacculations and pseudodiverticula (corkscrew esophagus)

Answer

Dilated esophagus with a narrow lower end (rat tail esophagus)

Answer

Narrow and irregular esophageal lumen

Answer

Stricture ulcer in the esophagus

Question 4

Which of the following is true regarding classical spontaneous bacterial peritonitis?

Accepted Answer

Ascitic fluid neutrophil count is > 250/cumm

Answer

Bowel perforation should be present

Answer

Multiple organisms are isolated from ascitic fluid

Answer

Board-like rigidity is present in the abdomen

Question 5

A 9-month-old pregnant lady presents with jaundice, abdominal distension, and pedal edema after delivering a normal baby. Her clinical condition deteriorates with increasing abdominal distension and severe ascites. Her bilirubin is 5 mg/dL, S. alkaline phosphatase is 450 U/L, and ALT is 345 U/L. There is tender hepatomegaly 6 cm below the costal margin, and the ascitic fluid shows protein less than 2 mg%. What is the most likely diagnosis?

Accepted Answer

Budd-Chiari syndrome

Answer

Acute fatty liver of pregnancy

Answer

HELLP syndrome

Answer

Acute fulminant liver failure

Question 6

A 47-year-old man presents to the emergency room with sudden onset of severe upper abdominal pain with vomiting. The pain is focused in the epigastrium with radiation to the back. Serum amylase levels are 2000 U/L. Which of the following are the most commonly encountered predisposing factors for this condition?

Accepted Answer

Alcohol use and gallstones

Answer

Helicobacter pylori infection and excess gastric acid secretion

Answer

Hepatitis B infection and iron overload

Answer

Obesity and high serum cholesterol

Question 7

Which of the following is NOT a feature of Celiac disease?

Accepted Answer

Biopsy findings are pathognomonic for the disease.

Answer

Diarrhea, malabsorption, and iron deficiency anemia are common symptoms.

Answer

It is a condition characterized by sensitivity to gluten.

Answer

Individuals with Celiac disease often express HLA DQ2 or DQ8.

Question 8

A 50-year-old male presented with a history of hematemesis of 500ml of blood. On examination, his BP was 90/60 mmHg, PR was 110 bpm, and he had splenomegaly 5 cm below the lower costal margin. What is the most probable diagnosis?

Accepted Answer

Portal hypertension

Answer

Mallory-Weiss tear

Answer

Duodenal ulcer

Answer

Gastritis

Question 9

Thickened gastric folds are not seen in which of the following conditions?

Accepted Answer

Peptic ulcer disease

Answer

Carcinoma stomach

Answer

Menetrier disease

Answer

Eosinophilic gastritis

Question 10

Which oral lesion is associated with ulcerative colitis?

Accepted Answer

Pyostomatitis vegetans

Answer

Pemphigus

Answer

Scleroderma

Answer

Sarcoidosis

Gastroenterology — MCQs

Gastroenterology — MCQs

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