Gastroenterology Practice Questions

Q: Which of the following is not a component of prognostic index of Nazer in the patient whose naked eye examination is shown below?

Urine copper. ***Urine copper*** - The image shows a **Kayser-Fleischer ring**, which is a hallmark of **Wilson's disease**, a disorder of copper metabolism. - While urinary copper excretion is a diagnostic test for Wilson's disease, it is **not** a component of the **Nazer prognostic index**, which is used to assess the severity of Wilson's disease-related acute liver failure. *Serum bilirubin* - **Serum bilirubin** is a crucial component of the **Nazer prognostic index**, reflecting the severity of **liver dysfunction**. - Elevated bilirubin levels indicate impaired bile excretion and significant liver damage. *Serum aspartate aminotransferase* - **Serum aspartate aminotransferase (AST)** is another essential component of the **Nazer prognostic index**. - Markedly elevated AST levels, particularly with a high AST/ALT ratio, are characteristic of acute liver failure in Wilson's disease. *Prothrombin time* - **Prothrombin time (PT)** is included in the **Nazer prognostic index** to assess the liver's synthetic function. - A prolonged PT indicates impaired production of clotting factors by the liver, signifying severe liver damage.

Q: Consider the following statements regarding Plummer-Vinson syndrome : I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia. II. It is a rare disease, mainly affecting middle-aged women. III. There is predisposition to postcricoid, cervical oesophageal cancer. IV. Treatment is usually surgical. Which of the statements given above are correct?

I, II and III. **I, II and III** - **Plummer-Vinson syndrome** is characterized by the triad of **dysphagia**, **iron deficiency anemia**, and an **esophageal web**, typically in the **cervical esophagus**. - It predominantly affects **middle-aged women** and is associated with an increased risk of **postcricoid esophageal cancer**. *I, II and IV* - While statements I and II are correct, statement IV is incorrect because the primary treatment for Plummer-Vinson syndrome is usually medical management of **iron deficiency** and endoscopic dilation of the web, not surgery. - Surgical intervention is generally reserved for complications or malignancy. *II, III and IV* - While statements II and III are correct, statement IV is incorrect as surgery is not the usual first-line treatment for Plummer-Vinson syndrome. - Statement I, which describes the characteristic findings of the syndrome, is also correct and is excluded from this option. *I, III and IV* - While statements I and III are correct, statement IV regarding surgical treatment is incorrect. - The syndrome is indeed rare and mainly affects middle-aged women, making statement II correct, which is excluded from this option.

Q: Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?

High resolution manometry. ***High resolution manometry*** - **High-resolution manometry (HRM)** is considered the **gold standard** for diagnosing oesophageal motility disorders because it provides detailed, real-time pressure topography of the entire oesophagus during swallowing [1]. - It allows for precise identification and classification of conditions such as **achalasia**, diffuse oesophageal spasm, and **scleroderma oesophagus** based on objective metrics [1]. *Upper GI endoscopy* - While essential for evaluating **mucosal abnormalities** and ruling out structural causes (e.g., tumours, strictures), it does not directly assess oesophageal motility [1]. - An **endoscopy** provides visual information but cannot quantify or characterize the contractile function of the oesophageal muscle [1]. *Contrast enhanced CT scan (CECT) oesophagus* - A **CECT scan** is primarily used for evaluating **extramural compression**, mediastinal involvement, or the presence of mass lesions, not for assessing the functional contractions of the oesophagus. - It provides anatomical information but offers very limited insight into the dynamic pressure changes associated with **oesophageal peristalsis**. *Barium swallow* - A **barium swallow** can suggest motility disorders by visualizing the passage of contrast and identifying abnormalities like **tertiary contractions** or delayed emptying, but it is less precise than manometry [1]. - It provides an anatomical overview and may show gross motility disturbances, but it lacks the quantitative and detailed pressure data that **HRM** offers for definitive diagnosis [1].

Q: A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Kayser-Fleisher rings in the cornea. Detailed clinical features point towards Wilson's disease. ***Kayser-Fleisher rings in the cornea*** - The history of **recurrent jaundice** and **facial grimacing** (likely dystonia/tremors) points towards a **neuropsychiatric disorder** with liver involvement, which is characteristic of **Wilson's disease** [1]. - **Kayser-Fleisher rings** are copper deposits in the Descemet's membrane of the cornea, a pathognomonic sign of Wilson's disease. *Adenoma sebaceum in the mid face* - **Adenoma sebaceum** (facial angiofibromas) is a characteristic skin lesion associated with **tuberous sclerosis complex**, which typically presents with seizures, intellectual disability, and characteristic skin lesions, not recurrent jaundice or facial grimacing indicative of movement disorders. - This condition does not primarily involve recurrent jaundice or movement disorders like facial grimacing. *Erythema nodosum on the skin* - **Erythema nodosum** is an inflammatory condition characterized by painful, red nodules, typically on the shins. - It is often associated with conditions like **sarcoidosis**, inflammatory bowel disease, infections, or drug reactions, and does not commonly present with recurrent jaundice and facial grimacing. *Osler's nodes at the finger tips* - **Osler's nodes** are painful, tender, red or purple lesions found on the fingertips and toes, indicative of **infective endocarditis**. - This symptom is related to immune complex deposition and systemic infection, rather than genetic disorders causing liver disease and neurological dysfunction.

Q: Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Sinusoidal - Veno-occlusive disease. ***Sinusoidal - Veno-occlusive disease*** - **Veno-occlusive disease** (also known as sinusoidal obstruction syndrome) specifically affects the blood flow within the **sinusoids** of the liver [1]. - This obstruction at the sinusoidal level directly leads to **sinusoidal portal hypertension** [1]. *Post-hepatic - Schistosomiasis post sinusoidal* - **Schistosomiasis** primarily causes **presinusoidal portal hypertension**, specifically due to periportal fibrosis in the liver. - **Post-hepatic portal hypertension** typically involves obstruction *after* the liver sinusoids, such as in **Budd-Chiari syndrome** or right heart failure [1]. *Pre-hepatic - Portal vein presinusoidal thrombosis* - **Portal vein thrombosis** occurring *before* the liver sinusoids would indeed be classified as **pre-hepatic portal hypertension** [2]. - However, the description **"presinusoidal thrombosis"** describes the *location* of the thrombosis but does not inherently define it as pre-hepatic versus intrahepatic. **Pre-hepatic** explicitly means before the liver substance. *Intrahepatic - Cirrhosis presinusoidal* - **Cirrhosis** is a classic cause of **intrahepatic portal hypertension**, but the obstruction in cirrhosis is predominantly **sinusoidal and post-sinusoidal**, due to fibrosis and regenerating nodules [2]. - While some early fibrotic changes may have presinusoidal components, the dominant site of obstruction in established cirrhosis is at the sinusoidal and perisinusoidal levels, not strictly presinusoidal.

Q: Which one of the following is a contraindication to wireless capsule endoscopy?

Small bowel stricture. ***Small bowel stricture*** - A **small bowel stricture** is a major contraindication for wireless capsule endoscopy due to the significant risk of the capsule becoming **retained** at the narrowed segment [1]. - Capsule retention can lead to **obstruction** requiring surgical intervention, thus posing a serious safety concern. *Small bowel Crohn's disease* - While Crohn's disease *can* cause strictures, the existence of Crohn's disease itself is not an absolute contraindication unless a **significant stricture** is already known or highly suspected [1]. - Capsule endoscopy is often used to *diagnose* and *monitor* small bowel Crohn's disease [1]. *Coeliac disease* - **Coeliac disease** is not a contraindication; in fact, capsule endoscopy can be a useful tool in evaluating the small bowel mucosa in refractory cases or for confirming diagnosis [1]. - There is no increased risk of capsule retention or other adverse events directly attributable to coeliac disease itself. *Obscure gastrointestinal bleeding* - **Obscure gastrointestinal bleeding** is considered a primary *indication* for wireless capsule endoscopy, rather than a contraindication [1]. - The capsule can visualize the entire small bowel, often identifying bleeding sources that are not accessible by conventional endoscopy [1].

Q: The single most important treatment and prognostic factor in alcohol-related liver disease is

Cessation of alcohol consumption. ***Cessation of alcohol consumption*** - **Abstinence from alcohol** is the fundamental and most effective intervention for halting the progression of **alcohol-related liver disease (ARLD)** and significantly improving patient prognosis [1]. - Continued alcohol intake directly fuels liver damage, whereas stopping consumption allows the **liver to regenerate** and reduces inflammation, often leading to clinical improvement [1]. *N-acetyl cysteine* - While **N-acetyl cysteine (NAC)** is used in some liver conditions, particularly paracetamol overdose, its routine use for chronic ARLD is not supported by strong evidence as a primary treatment [3]. - It functions as an antioxidant and glutathione precursor, but **does not address the root cause** of alcohol-induced liver injury. *High dose vitamin E* - **High-dose vitamin E** is an antioxidant that has been investigated for various liver diseases, particularly non-alcoholic fatty liver disease (NAFLD) [2]. - However, there is **insufficient evidence** to support its widespread use as a primary or prognostic treatment in **alcohol-related liver disease** [2]. *Liver transplantation* - While **liver transplantation** can be a definitive treatment for end-stage ARLD, it is a **major surgical procedure** with strict criteria and is only considered after prolonged alcohol abstinence (typically 6 months) [1]. - It is a **salvage therapy** for irreversible damage, not the "single most important treatment and prognostic factor" in managing the disease from its earlier stages [1].

Q: Consider the following with regard to Gilbert Syndrome : I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme II. Elevation of unconjugated bilirubin III. No stigmata of chronic liver disease other than jaundice IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome Which of the above are correct?

II and III only. ***II and III only*** - **Gilbert Syndrome** is characterized by an **elevation of unconjugated bilirubin** [1] due to reduced activity of the UGT1A1 enzyme [2]. - Patients typically present with **no stigmata of chronic liver disease** other than mild, fluctuating jaundice, often triggered by stress or fasting [2]. *I and II only* - While it involves **elevation of unconjugated bilirubin (II)** [1], Gilbert syndrome is an **autosomal recessive** condition due to a **polymorphism** in the promoter region of the **UGT1A1 gene**, leading to reduced enzyme activity [2], not a mutation that completely abolishes it. - The reduced enzyme activity is typically mild, resulting in only intermittent, mild hyperbilirubinemia. *III and IV* - **No stigmata of chronic liver disease other than jaundice (III)** is correct [2]. However, **early liver biopsy (IV)** is **not recommended** in patients with suspected Gilbert Syndrome. - Gilbert syndrome is a benign condition [1], and a liver biopsy is generally unnecessary and invasive for diagnosis in the absence of other liver disease signs. *I, II and III* - Although it features **elevation of unconjugated bilirubin (II)** and **no stigmata of chronic liver disease (III)**, the description of **I** is partially incorrect. - Gilbert syndrome is due to a **polymorphism** in the UGT1A1 gene promoter resulting in reduced enzyme activity [1], and it follows an **autosomal recessive inheritance pattern**, but the core issue is the **polymorphism**, not a standard mutation that significantly impairs the enzyme.

Q: Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Transabdominal ultrasound. ***Transabdominal ultrasound*** - It is an **accurate, non-invasive, and cost-effective** imaging modality for detecting gallstones [1]. - Ultrasound can visualize the stones, their size, number, and any associated complications like **gallbladder wall thickening** or **pericholecystic fluid**. *Capsule endoscopy* - This procedure is primarily used to visualize the **small intestine** and is not suitable for evaluating the gallbladder. - It works by capturing images as it passes through the digestive tract, an area where the gallbladder is not directly accessible. *Computed Tomography* - While CT can sometimes detect gallstones, especially those that are calcified, it is **less sensitive than ultrasound** for non-calcified stones [1]. - CT also exposes the patient to **ionizing radiation**, making it less favorable as a primary diagnostic tool for gallstones compared to ultrasound. *Erect X ray of abdomen* - An erect X-ray of the abdomen is **poor at detecting gallstones** as only about 10-20% of gallstones are radiopaque (calcified) and visible on X-ray. - This imaging technique is more useful for detecting conditions like **bowel obstruction** or **perforations**, rather than gallbladder pathology.

Question 1

Which of the following is not a component of prognostic index of Nazer in the patient whose naked eye examination is shown below?

Accepted Answer

Urine copper

Answer

Serum bilirubin

Answer

Serum aspartate aminotransferase

Answer

Prothrombin time

Question 2

Which one of following statements is correct regarding Budd-Chiari Syndrome (BCS)?

Accepted Answer

Abdominal discomfort and ascites are the main presenting features.

Answer

Venous drainage of the liver is occluded by IVC thrombus.

Answer

It principally affects young males.

Answer

Quadrate lobe (Segment 4) undergoes hypertrophy.

Question 3

Consider the following statements regarding Plummer-Vinson syndrome :
I. Findings include cervical oesophageal web, iron deficiency anaemia and dysphagia.
II. It is a rare disease, mainly affecting middle-aged women.
III. There is predisposition to postcricoid, cervical oesophageal cancer.
IV. Treatment is usually surgical.

Which of the statements given above are correct?

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Question 4

Which one of the following is considered the gold standard for the diagnosis of oesophageal motility disorders?

Accepted Answer

High resolution manometry

Answer

Upper GI endoscopy

Answer

Contrast enhanced CT scan (CECT) oesophagus

Answer

Barium swallow

Question 5

A 32 year old man presents with history of recurrent jaundice over the previous decade. Family gives history of the patient having episodes of facial grimacing. Which one of the following is a clinical clue to the diagnosis?

Accepted Answer

Kayser-Fleisher rings in the cornea

Answer

Adenoma sebaceum in the mid face

Answer

Erythema nodosum on the skin

Answer

Osler's nodes at the finger tips

Question 6

Which one of the following is correctly matched regarding classification of portal hypertension according to site of vascular obstruction?

Accepted Answer

Sinusoidal - Veno-occlusive disease

Answer

Post-hepatic - Schistosomiasis post sinusoidal

Answer

Pre-hepatic - Portal vein presinusoidal thrombosis

Answer

Intrahepatic - Cirrhosis presinusoidal

Question 7

Which one of the following is a contraindication to wireless capsule endoscopy?

Accepted Answer

Small bowel stricture

Answer

Small bowel Crohn's disease

Answer

Coeliac disease

Answer

Obscure gastrointestinal bleeding

Question 8

The single most important treatment and prognostic factor in alcohol-related liver disease is

Accepted Answer

Cessation of alcohol consumption

Answer

N -acetyl cysteine

Answer

High dose vitamin E

Answer

Liver transplantation

Question 9

Consider the following with regard to Gilbert Syndrome :
I. Autosomal recessive trait of a mutation in gene for UDPglucuronyl transferase enzyme
II. Elevation of unconjugated bilirubin
III. No stigmata of chronic liver disease other than jaundice
IV. Early Liver biopsy recommended in patients with possible Gilbert Syndrome

Which of the above are correct?

Accepted Answer

II and III only

Answer

I and II only

Answer

III and IV

Answer

I, II and III

Question 10

Which one of the following is the investigation of choice for diagnosing the presence of stones in the gallbladder?

Accepted Answer

Transabdominal ultrasound

Answer

Capsule endoscopy

Answer

Computed Tomography

Answer

Erect X ray of abdomen

Gastroenterology — MCQs

Gastroenterology — MCQs

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