Gastroenterology Practice Questions

Q: Capsule endoscopy is used for which of the following conditions?

Gastrointestinal bleeding. **Explanation:** **Capsule Endoscopy (CE)** is a non-invasive diagnostic tool primarily used to visualize the **small intestine**, an area often referred to as the "black box" of the GI tract because it is difficult to reach via conventional upper endoscopy or colonoscopy. **Why Gastrointestinal Bleeding is Correct:** The primary indication for capsule endoscopy is **Obscure Gastrointestinal Bleeding (OGIB)**. When a patient presents with persistent GI bleeding (melena or hematochezia) but has negative findings on both gastroscopy and colonoscopy, the source is likely in the small bowel (e.g., angiodysplasia, Crohn’s disease, or small bowel tumors). CE allows for high-resolution mucosal imaging of the entire jejunum and ileum to identify these lesions. **Why Other Options are Incorrect:** * **GERD (Option A):** GERD is primarily a clinical diagnosis or evaluated via **Upper GI Endoscopy** (to check for esophagitis/Barrett’s) and **24-hour pH monitoring** (the gold standard). Capsule endoscopy is not the standard of care here. * **Motility Disorders (Option B):** While a capsule can track transit time, motility disorders are best diagnosed using **Manometry** (esophageal or anorectal) or **Gastric emptying studies** (scintigraphy). In fact, severe motility disorders are a relative contraindication for CE due to the risk of capsule retention. **High-Yield Clinical Pearls for NEET-PG:** * **Most common indication:** Obscure GI Bleeding. * **Most common complication:** **Capsule Retention** (especially in patients with known strictures or Crohn’s disease). * **Contraindications:** Intestinal obstruction, strictures, and pregnancy. * **Patency Capsule:** A dissolvable capsule used prior to the actual procedure if a stricture is suspected to ensure the device will pass safely.

Q: Which of the following is NOT seen in carcinoid syndrome?

Constipation. **Explanation:** Carcinoid syndrome is a paraneoplastic syndrome caused by the systemic release of vasoactive substances, primarily **Serotonin (5-HT)**, into the systemic circulation. **Why Constipation is the Correct Answer:** Carcinoid syndrome is characterized by **increased intestinal motility**. Serotonin stimulates the secretory and motor functions of the gut, leading to significant **secretory diarrhea** and abdominal cramping. Therefore, constipation is not a feature of this syndrome; rather, its opposite (diarrhea) is a hallmark symptom. **Analysis of Incorrect Options:** * **Diarrhea (Option A):** This is one of the most common clinical features (seen in >70% of cases) due to serotonin’s effect on the bowel. * **Liver Metastasis (Option C):** Carcinoid syndrome typically occurs only when the tumor has **metastasized to the liver**. In primary midgut tumors, the liver metabolizes bioactive substances (first-pass metabolism). Once liver metastases are present, these substances bypass metabolism and enter the systemic circulation via the hepatic veins. * **5-HT Secretion (Option D):** Serotonin (5-HT) is the primary mediator responsible for the clinical manifestations of the syndrome. Its metabolite, **5-HIAA**, is measured in a 24-hour urine collection for diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Flushing (most common), Diarrhea, and Right-sided Valvular Heart Disease (Tricuspid Regurgitation/Pulmonary Stenosis). * **Diagnosis:** Best initial screening test is **24-hour urinary 5-HIAA**. * **Localization:** **Somatostatin Receptor Scintigraphy (OctreoScan)** is the investigation of choice for locating the tumor. * **Management:** **Octreotide** (Somatostatin analogue) is used to control symptoms and manage carcinoid crisis.

Q: Punctate yellow exudates in the colon, found on endoscopic examination, are indicative of which of the following?

Antibiotic-associated colitis. ### **Explanation** The correct answer is **Antibiotic-associated colitis (Pseudomembranous colitis)**. **1. Why the Correct Answer is Right:** Antibiotic-associated colitis, most commonly caused by **_Clostridioides difficile_ (C. diff)** toxins, is characterized by the formation of **pseudomembranes**. On endoscopic examination (sigmoidoscopy or colonoscopy), these appear as classic **punctate yellow-white exudates** or plaques scattered over the colonic mucosa [1]. These plaques are composed of fibrin, inflammatory cells (neutrophils), and necrotic debris. As the disease progresses, these small punctate spots can coalesce to form larger membranes. **2. Why the Incorrect Options are Wrong:** * **Balantidium coli:** This parasitic infection typically causes **flask-shaped ulcers** (similar to Amoebiasis) rather than yellow exudative plaques. * **Ulcerative colitis:** Endoscopy typically reveals continuous mucosal inflammation starting from the rectum, characterized by **loss of vascular markings, friability, and "lead-pipe" appearance** in chronic cases [1]. It does not present with punctate yellow exudates. * **Gluten-induced enteropathy (Celiac Disease):** This primarily affects the **small intestine** (duodenum/jejunum). Endoscopic findings include scalloping of folds, fissuring, and a mosaic pattern, not colonic exudates. **3. High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** Most common after the use of **Clindamycin**, Fluoroquinolones, or 3rd generation Cephalosporins [1]. * **Diagnosis:** The gold standard for diagnosis is the detection of **C. diff toxin A and B** in the stool via PCR or EIA [1]. * **Histology:** Look for the characteristic **"Volcano lesion"** (an eruption of fibrin and PMNs from an ulcerated crypt). * **Treatment:** First-line treatment is oral **Vancomycin** or **Fidaxomicin**. Metronidazole is now reserved for non-severe cases where other options are unavailable.

Q: What is the usual maximum dose of furosemide and spironolactone in patients with cirrhosis and portal hypertension?

Furosemide 160 mg and spironolactone 400 mg. In patients with cirrhosis and portal hypertension, ascites develops due to secondary hyperaldosteronism and sodium retention. The standard medical management involves a combination of **Spironolactone** (an aldosterone antagonist) and **Furosemide** (a loop diuretic). **1. Why Option A is Correct:** The goal of therapy is to maintain a **100:40 ratio** of Spironolactone to Furosemide. This specific ratio is clinically proven to maintain normokalemia by balancing the potassium-sparing effect of spironolactone with the potassium-wasting effect of furosemide. * **Starting Dose:** 100 mg Spironolactone and 40 mg Furosemide. * **Maximum Dose:** The doses are titrated every 3–5 days if weight loss is inadequate, up to a maximum of **400 mg Spironolactone and 160 mg Furosemide**. **2. Why Other Options are Incorrect:** * **Options B & C:** These violate the established 100:40 ratio. Using disproportionate doses increases the risk of electrolyte imbalances (hyperkalemia if spironolactone is too high, or hypokalemia if furosemide is too high). * **Option D:** While 200 mg/80 mg is a common intermediate step in titration, it is not the "maximum" dose defined by clinical guidelines (AASLD/EASL). **Clinical Pearls for NEET-PG:** * **Weight Loss Goal:** Aim for 0.5 kg/day in patients without edema and 1.0 kg/day in those with peripheral edema. * **Side Effect:** Gynecomastia is a common side effect of spironolactone; if it occurs, it can be switched to **Amiloride**. * **Refractory Ascites:** Defined when ascites cannot be mobilized despite the maximum doses (400mg/160mg) or when diuretic-induced complications (e.g., encephalopathy, creatinine >2.0 mg/dL) occur. Note: Although references discuss portal hypertension and sodium retention [1][2], they do not explicitly define the 400mg/160mg dosage maximum in the provided snippets.

Question 1

Isolated conjugated hyperbilirubinemia is seen in all of the following conditions except?

Accepted Answer

Gilbert syndrome

Answer

Hemolysis

Answer

Crigler-Najjar syndrome

Answer

Dubin-Johnson syndrome

Question 2

Capsule endoscopy is used for which of the following conditions?

Accepted Answer

Gastrointestinal bleeding

Answer

Gastroesophageal reflux disease (GERD)

Answer

Motility disorder

Answer

None of the above

Question 3

Which of the following management procedures of acute upper gastrointestinal bleed should possibly be avoided?

Accepted Answer

Intravenous vasopressin

Answer

Intravenous b-blockers

Answer

Endoscopic sclerotherapy

Answer

Balloon tamponade

Question 4

A 20-year-old woman presents with a 4-week history of dry mouth, fatigue, fever, and yellow sclerae. Physical examination shows mild jaundice and hepatomegaly. Serum total bilirubin is 3.3 mg/dL. Serologic markers for viral hepatitis are negative. The anti-mitochondrial antibody test is negative. A liver biopsy discloses parenchymal and periportal inflammatory cell infiltrates composed primarily of lymphocytes and plasma cells. The patient's signs and symptoms abate following 2 months of treatment with steroids. Which of the following is the most likely diagnosis?

Accepted Answer

Autoimmune hepatitis

Answer

Extrahepatic jaundice

Answer

Primary biliary cirrhosis

Answer

Primary sclerosing cholangitis

Question 5

Which of the following is NOT seen in carcinoid syndrome?

Accepted Answer

Constipation

Answer

Diarrhea

Answer

Liver metastasis

Answer

5-HT secretion

Question 6

Which of the following statements are true about Budd-Chiari syndrome?

Accepted Answer

Ascites may be present and hepatic vein thrombosis is associated

Answer

Cirrhosis may occur and ascites may be present

Answer

Hepatic vein thrombosis is associated and good prognosis

Question 7

What is the investigation of choice in upper GI bleeding?

Accepted Answer

Endoscopy

Answer

Barium swallow

Answer

X-ray

Answer

Ultrasound

Question 8

A 22-year-old woman presents with a 3-day history of dark urine and abdominal distension. On examination, she is alert with icterus and normal heart and lung sounds. Laboratory findings include: Hematocrit: 26%, Reticulocytes: 5%, Platelets: 1.3 lakhs, Alkaline Phosphatase: 30 units/L, ALT: 110 units/L, AST: 220 units/L, Total Bilirubin: 13 mg% (Direct: 4 mg). HBsAg is positive, while Hepatitis A and C are negative. Urine drug screen is negative. Abdominal ultrasound shows a nodular liver and an enlarged spleen. What is the most likely diagnosis?

Accepted Answer

Wilson disease

Answer

Acetaminophen intoxication

Answer

Acute viral hepatitis

Answer

Primary biliary cirrhosis

Question 9

Punctate yellow exudates in the colon, found on endoscopic examination, are indicative of which of the following?

Accepted Answer

Antibiotic-associated colitis

Answer

Balantidium coli

Answer

Ulcerative colitis

Answer

Gluten-induced enteropathy

Question 10

What is the usual maximum dose of furosemide and spironolactone in patients with cirrhosis and portal hypertension?

Accepted Answer

Furosemide 160 mg and spironolactone 400 mg

Answer

Furosemide 80 mg and spironolactone 400 mg

Answer

Furosemide 160 mg and spironolactone 200 mg

Answer

Furosemide 80 mg and spironolactone 200 mg

Gastroenterology — MCQs

Gastroenterology — MCQs

On this page

Practice by Chapter

Want unlimited practice?