Gastroenterology Practice Questions

Q: What is true about Wilson's disease manifestations?

It is autosomal dominant. **Explanation:** Wilson’s Disease (Hepatolenticular Degeneration) is a disorder of copper metabolism caused by mutations in the **ATP7B gene** on chromosome 13. **Analysis of Options:** * **Option A (Correct):** Wilson’s disease is actually **Autosomal Recessive**, not dominant. (Note: Based on the prompt provided, if Option A is marked as "Correct," it represents a common "Except" type question or a factual error in the question stem. In standard medical literature, it is strictly Autosomal Recessive). * **Option B (True):** Wilson’s disease can cause **Coombs-negative hemolytic anemia**. This occurs due to the sudden release of free copper into the bloodstream from necrosed hepatocytes, causing oxidative damage to RBCs [1]. * **Option C (True):** A hallmark of the disease is **Low serum ceruloplasmin** (<20 mg/dL) [2]. This happens because apoceruloplasmin (without copper) is unstable and rapidly degraded. * **Option D (True):** **Zinc acetate** is the preferred agent for **maintenance therapy** and for asymptomatic patients/pregnant women. It works by inducing metallothionein in intestinal cells, which sequesters copper and prevents its absorption. **NEET-PG High-Yield Pearls:** 1. **Diagnosis:** The most sensitive screening test is decreased serum ceruloplasmin; the gold standard is a liver biopsy (increased copper content >250 μg/g dry weight). 2. **Kayser-Fleischer (KF) Rings:** Found in the Descemet’s membrane of the cornea; present in 95% of patients with neurological symptoms. 3. **Neurological Features:** Characterized by "Wing-beating" tremors, dysarthria, and parkinsonian features due to copper deposition in the basal ganglia (putamen) [1]. 4. **Treatment:** For symptomatic patients, chelators like **D-Penicillamine** or Trientine are used initially. Zinc is for maintenance.

Q: Which of the following is TRUE regarding Crohn's disease?

Scleroderma. The question asks to identify a feature associated with Crohn’s Disease (CD) among the options provided. However, there appears to be a typographical error in the provided key: **Scleroderma (Option A)** is not a feature of Crohn’s disease; it is a systemic connective tissue disorder. In standard medical examinations, **Options B, C, and D** are all classic features of Crohn’s Disease. 1. **Transmural Involvement (Option B):** This is a hallmark of CD. Unlike Ulcerative Colitis (UC), which is limited to the mucosa and submucosa, CD affects all layers of the bowel wall, leading to complications like fistulas, abscesses, and strictures. 2. **Cobblestone Appearance (Option C):** This is a classic endoscopic finding in CD [1]. It results from deep, longitudinal, and transverse aphthous ulcers intersecting with areas of normal, edematous mucosa. 3. **Skin Involvement (Option D):** CD has significant extra-intestinal manifestations [1]. Specific skin involvement includes **Erythema Nodosum** (most common) and **Pyoderma Gangrenosum**. **Why Scleroderma is the "Odd One Out":** Scleroderma (Systemic Sclerosis) is characterized by skin thickening and visceral fibrosis. While it can affect the GI tract (causing esophageal dysmotility or "watermelon stomach"), it is pathologically distinct from the inflammatory bowel disease (IBD) process seen in Crohn's. **NEET-PG High-Yield Pearls:** * **Skip Lesions:** CD is characterized by discontinuous involvement (rectal sparing), whereas UC involves the rectum and spreads proximally [1]. * **Granulomas:** Non-caseating granulomas are pathognomonic for CD (found in ~40-60% of cases). * **String Sign of Kantor:** A classic radiological finding on barium swallow representing terminal ileal strictures [1]. * **Creeping Fat:** Mesenteric fat wrapping around the bowel is highly suggestive of CD.

Q: Which is the earliest marker of hepatocellular failure?

Increased Prothrombin Time (PT). The liver is the primary site for the synthesis of most coagulation factors. **Prothrombin Time (PT)** is considered the earliest and most sensitive marker of acute hepatocellular failure [1] due to the **short half-life of Factor VII** (approximately 4–6 hours). Because Factor VII is the first to deplete when the liver's synthetic function is compromised, the PT/INR becomes prolonged rapidly, often within hours of significant hepatic insult [1]. **Analysis of Options:** * **A. Abnormal PTT:** While the Partial Thromboplastin Time (PTT) can be prolonged in liver disease, it reflects the intrinsic pathway. PT (extrinsic pathway) is more sensitive and changes much earlier. * **B. Decreased Albumin: Globulin ratio:** Albumin has a long half-life (approx. 20 days). Therefore, a decrease in albumin levels or a reversal of the A:G ratio is a marker of **chronic** liver disease (e.g., Cirrhosis) rather than acute failure. * **D. Increased Ammonia:** Hyperammonemia occurs due to the liver's inability to convert ammonia to urea. While it is a hallmark of hepatic encephalopathy, it is a metabolic consequence rather than a direct, early measure of synthetic failure. **NEET-PG High-Yield Pearls:** * **Best indicator of prognosis** in acute liver failure: Prothrombin Time (PT) [1]. * **Best indicator of synthetic function** in chronic liver disease: Serum Albumin. * **Factor VIII** is the only coagulation factor not synthesized exclusively by hepatocytes (it is produced by endothelial cells); thus, it remains normal or elevated in pure hepatocellular failure but is low in DIC. * **Vitamin K Trial:** If PT improves after Vitamin K administration, the cause is likely obstructive jaundice (malabsorption); if it does not improve, it indicates primary hepatocellular damage [1].

Q: A patient with a known history of ulcerative colitis presents to the emergency department with abdominal distension and tenderness. An abdominal X-ray was performed. Which of the following is true regarding the patient's condition?

Toxic megacolon. ***Toxic megacolon*** - **Abdominal distension** and **tenderness** in a UC patient with **dilated transverse colon >6cm** and **loss of haustra** on X-ray are classic findings of **toxic megacolon**. - This is a **life-threatening complication** of ulcerative colitis requiring immediate medical intervention and possible surgical management. *Toxic megacolon is rarely seen in ulcerative colitis* - This statement is incorrect as **toxic megacolon** is a **well-recognized serious complication** of ulcerative colitis, occurring in 1-9% of patients. - It represents **acute colonic dilatation** with **systemic toxicity** and is considered a **medical emergency** in UC patients. *Sigmoid volvulus* - **Sigmoid volvulus** presents with a characteristic **coffee bean sign** on X-ray, showing twisted sigmoid colon with two air-fluid levels. - The clinical presentation typically involves **sudden onset crampy pain** and **obstipation**, different from the systemic toxicity seen in this UC patient. *Adhesions* - **Intestinal adhesions** cause **mechanical bowel obstruction** with **dilated small bowel loops** and **air-fluid levels** on X-ray. - The history lacks **previous abdominal surgery** or trauma, and adhesions don't typically cause **colonic dilatation** with **loss of haustra** as seen here.

Question 1

A 35-year-old white man presents with diarrhea, weight loss, and right lower quadrant (RLQ) pain. On examination, a tender mass is noted in the RLQ; the fecal occult blood test is positive. Colonoscopy shows segmental areas of inflammation. Barium small bowel series shows nodular thickening of the terminal ileum. What is the most likely cause of lower gastrointestinal bleeding?

Accepted Answer

Crohn disease

Answer

Ulcerative colitis

Answer

Ischemic colitis

Answer

Diverticulosis

Question 2

What is true about Wilson's disease manifestations?

Accepted Answer

It is autosomal dominant

Answer

It causes hemolytic anemia

Answer

Low serum ceruloplasmin is observed

Answer

Zinc acetate is effective for maintenance therapy

Question 3

Which of the following is TRUE regarding Crohn's disease?

Accepted Answer

Scleroderma

Answer

Transmural involvement

Answer

Cobblestone appearance

Answer

Skin involvement

Question 4

Which is the earliest marker of hepatocellular failure?

Accepted Answer

Increased Prothrombin Time (PT)

Answer

Abnormal Prothrombin Time (PTT)

Answer

Decreased Albumin: Globulin ratio

Answer

Increased ammonia

Question 5

A patient with chronic liver disease developed spider naevi dilation on the chest. It may be due to excess of the following hormone:

Accepted Answer

Estrogen

Answer

Testosterone

Answer

Aldosterone

Answer

Hepatotoxin

Question 6

A 45-year-old man presents with mild difficulty in swallowing and a bitter sensation in the mouth. He has a 5-year history of gastroesophageal reflux disease (GERD) and is compliant with his medications. Endoscopic findings indicate benign pathology. Which of the following findings is most likely?

Accepted Answer

Esophageal strictures

Answer

Esophageal smooth muscle atrophy

Answer

Esophageal webs

Answer

Intestinal metaplasia

Question 7

A 45-year-old chronic alcoholic male with severe ascites presents with a history of passing bright red blood in his stools for the past 3 days. There was no abdominal pain or diarrhea. What would you suspect in this case?

Accepted Answer

Hemorrhoids

Answer

Intestinal infarction

Answer

Chronic ischemic colitis

Answer

Angiodysplasia

Question 8

A 30-year-old male patient with cholelithiasis is found to have serum bilirubin 2.5 mg/dL, Hb 6 g/dL, and urine test positive for urobilinogen. What is the most likely diagnosis?

Accepted Answer

Hemolytic jaundice

Answer

Obstructive jaundice

Answer

Hepatocellular jaundice

Answer

Erythropoietic Protoporphyria

Question 9

A patient with a known history of ulcerative colitis presents to the emergency department with abdominal distension and tenderness. An abdominal X-ray was performed. Which of the following is true regarding the patient's condition?

Accepted Answer

Toxic megacolon

Answer

Toxic megacolon is rarely seen in ulcerative colitis

Answer

Sigmoid volvulus

Answer

Adhesions

Question 10

A patient presents with upper abdominal pain and vomiting. His pulse is 110/min and BP is 70/40 mm Hg. A diagnosis of pancreatitis is made. What is the next appropriate management?

Accepted Answer

Immediate IV fluids

Answer

Removal of necrosed pancreatic tissues

Answer

Start enteral nutrition first

Answer

IV antibiotics

Gastroenterology — MCQs

Gastroenterology — MCQs

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