Gastroenterology Practice Questions

Q: At present, treatment is recommended for H. pylori in association with the following except:

Functional dyspepsia without alarm features. ***Functional dyspepsia without alarm features*** - While *H. pylori* eradication can be considered for some patients with **functional dyspepsia**, it is not universally recommended as a primary treatment given the **variable and often limited symptomatic improvement**. - The decision to treat in this specific scenario often depends on individual patient factors and local epidemiology, and it's not a standard indication compared to other *H. pylori*-associated conditions. *MALT lymphoma* - **Eradication of *H. pylori*** is a cornerstone of treatment for **gastric MALT lymphoma**, often leading to remission [1]. - This is a well-established indication for *H. pylori* therapy due to the direct pathogenic link [1]. *Duodenal ulcer* - All patients with **duodenal ulcers** who test positive for *H. pylori* should receive eradication therapy [2]. - *H. pylori* infection is a major cause of **duodenal ulcers**, and eradication significantly reduces recurrence [2]. *Peptic ulcer disease* - **Eradication of *H. pylori*** is strongly recommended for all patients with **peptic ulcer disease** (gastric or duodenal) found to be *H. pylori* positive [2]. - This intervention is crucial for **healing ulcers** and preventing future recurrences and complications [2].

Q: A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:

CTP–B. CTP–B - This patient scores 2 points for bilirubin (3.5-5 mg%), 1 point for albumin (>3.5 gm%), 2 points for INR (1.7-2.3), 1 point for no encephalopathy, and 1 point for no ascites. This sums to **7 points**, which falls into the **CTP Class B** range (7-9 points). - The CTP classification is used to assess the prognosis of **chronic liver disease**, primarily **cirrhosis**, based on five clinical and laboratory criteria [1]. CTP–D - The CTP classification only includes A, B, and C; there is no CTP–D class. - This option is incorrect as it represents a classification that does not exist within the CTP scoring system. CTP–A - CTP Class A requires a total score of 5-6 points, indicating **mild liver dysfunction**. - This patient's calculated score of 7 points places him beyond the Class A category. CTP–C - CTP Class C requires a total score of 10-15 points, indicating **severe liver dysfunction**. - This patient's score of 7 points is considerably lower than the range for Class C.

Q: A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:

Crohn disease. ### Crohn disease - **Colicky abdominal pain**, **diarrhea**, **fever**, and **weight loss** are classic symptoms of Crohn disease, indicating chronic inflammation of the gastrointestinal tract [1]. - The presence of **discharging perineal sinuses** is highly characteristic of Crohn disease, as it commonly manifests with **perianal disease** including fistulas and abscesses [1]. ### Ileocaecal Tuberculosis - While ileocaecal tuberculosis can present with abdominal pain, diarrhea, fever, and weight loss, **perianal sinuses** are a less common feature compared to Crohn disease. - Diagnosis typically requires **histopathological evidence** of granulomas with caseous necrosis and acid-fast bacilli, which is not suggested by the initial presentation. ### Ulcerative colitis - **Ulcerative colitis** primarily affects the colon and rectum, leading to bloody diarrhea, abdominal pain, and tenesmus, but rarely causes **perianal fistulas** or sinuses [1]. - The disease typically presents with **continuous inflammation** extending proximally from the rectum, unlike the skip lesions seen in Crohn disease. ### Amoebic colitis - **Amoebic colitis** is an infectious cause of diarrhea, often bloody, with abdominal pain, but typically presents with a more **acute course** and is less commonly associated with chronic weight loss or perianal disease. - Diagnosis is confirmed by identifying **_Entamoeba histolytica_ trophozoites** or cysts in stool or tissue, and the presence of chronic discharging sinuses is not typical.

Q: A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:

Gastric outlet obstruction. ***Gastric outlet obstruction*** - The combination of a long history of **periodic upper abdominal pain** followed by **projectile, non-bilious vomiting** containing undigested food is highly characteristic of gastric outlet obstruction. [1] - **Weight loss** and **dehydration** are common due to inadequate nutrient absorption and persistent vomiting. [1] *Superior mesenteric artery syndrome* - This syndrome is characterized by compression of the **duodenum** between the superior mesenteric artery and the aorta. - While it can cause vomiting and weight loss, the presenting symptoms are typically more acute or chronic pain related to postural changes, and not usually preceded by a long history of periodic upper abdominal pain suggesting prior peptic ulcer disease. *Carcinoma stomach* - While carcinoma of the stomach can cause weight loss and vomiting due to obstruction, the long history of **relieving periodic pain** prior to the onset of projectile vomiting is less typical. - Vomiting in carcinoma stomach might be bilious if the tumor is distal to the ampulla of Vater. *Gastro-oesophageal reflux with oesophagitis* - This condition primarily causes **heartburn**, regurgitation, and sometimes difficulty swallowing or chest pain. - It does not typically lead to repeated **projectile vomiting** of undigested food or significant weight loss in the absence of severe complications like stricture formation, which would present differently.

Q: Spontaneous bacterial peritonitis occurs due to:

acute bacterial infection of ascites. ***acute bacterial infection of ascites*** - **Spontaneous bacterial peritonitis (SBP)** is a common and serious complication in patients with **cirrhosis and ascites**, characterized by an infection of the **ascitic fluid** without an obvious source within the abdominal cavity. - The infection typically arises from the **translocation of bacteria** from the gut lumen into the mesenteric lymph nodes and then into the ascitic fluid. *duodenal stump blowout* - A **duodenal stump blowout** is a rare but severe complication following gastric surgery (e.g., gastrectomy with Billroth II reconstruction) where the closed end of the duodenum ruptures. - This complication leads to **peritonitis**, but it is a **secondary bacterial peritonitis** due to leakage of GI contents, not spontaneous. *infection via fallopian tubes* - While bacteria can access the peritoneal cavity via the fallopian tubes, leading to **pelvic inflammatory disease (PID)** or **peritonitis**, this mechanism is specific to females and typically involves sexually transmitted infections ascending from the lower genital tract. - This pathway does not describe the typical pathogenesis of SBP, which is primarily associated with **ascites** in cirrhotic patients and gut bacterial translocation. *peptic ulcer perforation* - A **perforated peptic ulcer** involves a breach in the wall of the stomach or duodenum, leading to the leakage of gastric or duodenal contents into the peritoneal cavity. - This causes an acute abdomen and **secondary bacterial peritonitis**, which is distinguishable from SBP as it has an identifiable intrabdominal source of infection.

Q: Which of the following are correct regarding splenic artery aneurysm? 1. Main arterial trunk is the common site 2. Palpable thrill can be felt 3. It is symptomless unless it ruptures Select the correct answer using the code given below:

1 and 3 only. ***1 and 3 only*** - The **main arterial trunk** is indeed the most common site for splenic artery aneurysms, accounting for approximately 60% of cases. - Splenic artery aneurysms are typically **asymptomatic** until rupture, which can be a life-threatening event. *1, 2 and 3* - While the main arterial trunk is a common site and these aneurysms are often symptomless until rupture, a **palpable thrill** is generally not a feature of splenic artery aneurysms. - Thrills are usually associated with **arteriovenous fistulas** or very large, superficial aneurysms with turbulent flow, which is less common for the splenic artery. *2 and 3 only* - A **palpable thrill** is not a typical finding for splenic artery aneurysms. - While they are often symptomless until rupture, the statement that the **main arterial trunk is a common site** is also correct and should be included. *1 and 2 only* - Although the main arterial trunk is a common site, a **palpable thrill** is not a characteristic sign of splenic artery aneurysms. - The crucial point that they are **symptomless unless they rupture** is omitted from this option.

Q: Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?

Treatment is with oral antibiotics alone. ***Treatment is with oral antibiotics alone*** - This statement is incorrect because pyogenic liver abscesses typically require **drainage** (percutaneous or surgical) in addition to **intravenous antibiotics** initially. Oral antibiotics alone are generally insufficient for definitive treatment. - The goal is to eradicate the infection, which often involves both source control (drainage) and systemic antimicrobial therapy. *It is more common in elderly, diabetics and immunocompromised patients* - This statement is correct. Factors such as **age**, **diabetes mellitus**, and **immunocompromised states** weaken the immune response, making individuals more susceptible to developing pyogenic liver abscesses [1]. - These conditions can impair the body's ability to clear bacteria effectively, increasing the risk of infection and abscess formation. *Streptococcus milleri and escherichia coli are the most common causative organisms* - This statement is correct. **_Streptococcus milleri_ (now _Streptococcus anginosus_)** is frequently implicated due to its ability to form abscesses, while **_Escherichia coli_** is common because many liver abscesses arise from biliary or enteric sources. - Other common pathogens include other **Gram-negative bacilli** and **anaerobes**, reflecting the varied etiologies. *Anorexia, fever, malaise and right upper quadrant abdominal discomfort are the most common presenting features* - This statement is correct. These are classic symptoms of liver abscess, reflecting the inflammatory process and the location of the infection [1]. - **Fever** and **right upper quadrant pain** are particularly prominent and should raise suspicion for a liver abscess [1].

Q: The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:

Serum creatinine. ***Body Mass Index (BMI)*** - The Child-Turcotte-Pugh (CTP) score is an established clinical tool for assessing prognosis in **chronic liver disease**, and it does not include **Body Mass Index (BMI)** as one of its parameters. - The CTP score focuses on liver function and complications of portal hypertension, which are reflected by specific laboratory values and clinical signs, not nutritional status as measured by BMI [1]. *International Normalized Ratio (INR)* - **INR** is a crucial component of the Child-Turcotte-Pugh (CTP) score, as it reflects the liver's synthetic function, specifically its ability to produce clotting factors [1]. - An elevated INR indicates **impaired liver synthetic function** and contributes to a higher CTP score, signifying more severe liver disease. *Serum bilirubin* - **Serum bilirubin** is a key laboratory parameter included in the Child-Turcotte-Pugh (CTP) score [1]. - Elevated bilirubin levels indicate **impaired liver excretory function** and hepatocellular damage, directly correlating with the severity of liver disease. *Serum albumin* - **Serum albumin** is a vital component of the Child-Turcotte-Pugh (CTP) score, reflecting the liver's synthetic capacity [1]. - Low serum albumin levels indicate **reduced liver synthesis**, often seen in advanced liver disease, and contribute to a higher CTP score [1].

Q: Following complete ileal and partial jejunal resection, the patient is most likely to have-

Vitamin B12 Deficiency. ***Vitamin B12 Deficiency*** - The **terminal ileum** is the primary site for **vitamin B12 absorption**, complexed with intrinsic factor [3]. Resection of this segment significantly impairs this process. - Patients with **ileal resection** are highly susceptible to developing **megaloblastic anemia** and neurological complications due to **vitamin B12 deficiency** [3]. *Constipation* - Complete ileal and partial jejunal resection is **more likely to cause diarrhea** rather than constipation, particularly due to malabsorption of bile salts and fats [2]. - **Bile salt malabsorption** in the colon often leads to secretory diarrhea [1]. *Gastric ulcer* - Gastric ulcers are typically associated with *Helicobacter pylori* infection or NSAID use, and are **not a direct consequence** of ileal and jejunal resection. - While short bowel syndrome can sometimes lead to increased gastric acid secretion, peptic ulcer formation is not the most likely or direct complication. *Folic acid deficiency* - **Folic acid** is primarily absorbed in the **jejunum**, and while partial jejunal resection occurred, complete ileal resection is less directly implicated in folate deficiency. - Other sections of the small intestine can often compensate for partial jejunal loss in folate absorption, making B12 deficiency a more immediate and severe concern after complete ileal resection.

Question 1

Match List-I with List-II and select the correct answer using the code given below the Lists:

Accepted Answer

A→1  B→3  C→2  D→4

Answer

A→1  B→2  C→3  D→4

Answer

A→3  B→2  C→4  D→1

Answer

A→4  B→3  C→2  D→1

Question 2

At present, treatment is recommended for H. pylori in association with the following except:

Accepted Answer

Functional dyspepsia without alarm features

Answer

MALT lymphoma

Answer

Duodenal ulcer

Answer

Peptic ulcer disease

Question 3

A gentleman of 48 years was being worked up for hepatocellular function. He had no history or signs of encephalopathy. His serum bilirubin was 5 mg%, serum albumin was 3.9 gm%, International normalized ratio was 1.6. On ultrasound no free fluid was detected inside abdomen. As per Child-Turcotte-Pugh (CTP) classification, he was in:

Accepted Answer

CTP–B

Answer

CTP–D

Answer

CTP–A

Answer

CTP–C

Question 4

A 40 year old female patient presents with colicky abdominal pain associated with episodes of mild diarrhoea for last 6 months accompanied with intermittent fever and weight loss. There are multiple discharging sinuses on perineal examination. The most likely clinical diagnosis in this patient is:

Accepted Answer

Crohn disease

Answer

Ileocaecal Tuberculosis

Answer

Ulcerative colitis

Answer

Amoebic colitis

Question 5

A gentleman of 36 years presented with a long history of upper abdominal pain which was periodic and often occurred early morning. For last 3 months, he is having projectile vomiting, which is non bilious, unpleasant in nature with undigested food materials. On examination he appears unwell, dehydrated and seemed to have lost weight. Probably he is suffering from:

Accepted Answer

Gastric outlet obstruction

Answer

Superior mesenteric artery syndrome

Answer

Carcinoma stomach

Answer

Gastro-oesophageal reflux with oesophagitis

Question 6

Spontaneous bacterial peritonitis occurs due to:

Accepted Answer

acute bacterial infection of ascites

Answer

duodenal stump blowout

Answer

infection via fallopian tubes

Answer

peptic ulcer perforation

Question 7

Which of the following are correct regarding splenic artery aneurysm?

1. Main arterial trunk is the common site
2. Palpable thrill can be felt
3. It is symptomless unless it ruptures

Select the correct answer using the code given below:

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 8

Which one of the following statements is NOT correct regarding Pyogenic Liver Abscess?

Accepted Answer

Treatment is with oral antibiotics alone

Answer

It is more common in elderly, diabetics and immunocompromised patients

Answer

Streptococcus milleri and escherichia coli are the most common causative organisms

Answer

Anorexia, fever, malaise and right upper quadrant abdominal discomfort are the most common presenting features

Question 9

The Child-Turcotte-Pugh (CTP) score for quantifying the severity of chronic liver disease includes all variables EXCEPT:

Accepted Answer

Serum creatinine

Answer

INR (International Normalised Ratio)

Answer

Serum bilirubin

Answer

Serum albumin

Question 10

Following complete ileal and partial jejunal resection, the patient is most likely to have-

Accepted Answer

Vitamin B12 Deficiency

Answer

Constipation

Answer

Gastric ulcer

Answer

Folic acid deficiency

Gastroenterology — MCQs

Gastroenterology — MCQs

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