Gastroenterology Practice Questions

Q: Initial treatment for management of mild to moderate Crohn's disease is:

Budesonide. ***Budesonide*** - **Budesonide** is a **steroid** with high first-pass metabolism, meaning it works locally in the gastrointestinal tract with minimal systemic effects, making it suitable for mild to moderate Crohn's disease. - It is effective in inducing remission for mild to moderate ileocolonic Crohn's disease, with a better safety profile than systemic corticosteroids. *Mesalamine* - **Mesalamine (5-ASA)** is primarily used for **ulcerative colitis** and has limited efficacy in Crohn's disease, especially for moderate disease. - While it can be considered for very mild Crohn's disease, its role is often debated and not a first-line agent for moderate cases. *Infliximab* - **Infliximab** is a **biologic agent (anti-TNF-α)** used for moderate to severe Crohn's disease or for patients who have failed conventional therapy. - It works by blocking a key inflammatory cytokine and is not typically used as initial treatment for mild disease due to its potency and potential side effects. *Sulfasalazine* - **Sulfasalazine** is more effective in **colonic Crohn's disease** and **ulcerative colitis**, and its efficacy in small bowel Crohn's disease is limited [1]. - Many patients experience side effects such as **nausea**, **headaches**, and **allergic reactions**, limiting its use as a first-line agent.

Q: Gold standard method of diagnosing celiac disease is

Small bowel biopsy. ***Small bowel biopsy*** - A **small bowel biopsy** is considered the **gold standard** for diagnosing celiac disease as it directly visualizes the characteristic damage to the intestinal lining. - The biopsy reveals histologic changes like **villous atrophy**, crypt hyperplasia, and increased intraepithelial lymphocytes, which are pathognomonic for celiac disease [1]. *Blood picture* - A blood picture (complete blood count) might show **anemia** (often iron-deficiency anemia) due to malabsorption, but this is a non-specific finding and not diagnostic for celiac disease [1]. - It does not provide direct evidence of intestinal damage caused by gluten. *Anti-endomysial antibodies* - **Anti-endomysial antibodies (EMA)** are highly specific for celiac disease, but they are still a serological test, not the definitive diagnostic method. - Serological tests like EMA and **tissue transglutaminase (tTG) antibodies** are used for screening and monitoring but require biopsy confirmation. *Biochemical test* - Biochemical tests might show abnormalities related to **malabsorption**, such as low iron, calcium, or vitamin D levels, but these are secondary effects and not diagnostic of celiac disease itself [1]. - These tests indicate nutritional deficiencies but do not identify the underlying cause.

Q: The highest life time risk of pancreatic malignancy is seen with:

Peutz-Jeghers syndrome. ***Peutz-Jeghers syndrome*** - **Peutz-Jeghers syndrome** is an autosomal dominant disorder characterized by **hamartomatous polyps** in the gastrointestinal tract and mucocutaneous pigmentation. - It significantly increases the lifetime risk of various cancers, including **pancreatic cancer**, with estimates as high as 11-36% by age 70 [1]. *Familial adenomatous polyposis* - **Familial adenomatous polyposis (FAP)** is primarily associated with a very high lifetime risk of **colorectal cancer** [2]. - While there is a slightly increased risk of pancreatic cancer in FAP patients, it is considerably lower than the risk seen in Peutz-Jeghers syndrome. *Hereditary nonpolyposis colorectal cancer* - **Hereditary nonpolyposis colorectal cancer (HNPCC)**, also known as **Lynch syndrome**, is mainly associated with a high risk of **colorectal** and **endometrial cancers**. - While it does increase the risk of other extra-colonic cancers like gastric, ovarian, and urinary tract cancers, the lifetime risk of pancreatic cancer is lower compared to Peutz-Jeghers syndrome. *Li-Fraumeni syndrome* - **Li-Fraumeni syndrome** is caused by a germline mutation in the **TP53 tumor suppressor gene**, leading to a high predisposition to a wide variety of cancers at a young age. - Common cancers include soft tissue sarcomas, osteosarcomas, breast cancer, brain tumors, and adrenocortical carcinomas; however, the lifetime risk for **pancreatic cancer** is not as prominently high as in Peutz-Jeghers syndrome.

Q: Which of the following is a type of inflammatory bowel disease primarily affecting the small intestine? a) Coeliac disease b) Tropical sprue c) Regional ileitis d) Cystic fibrosis e) Ulcerative colitis

Regional ileitis. ***Regional ileitis*** - **Regional ileitis** is another name for **Crohn's disease** when it primarily affects the **ileum**, which is part of the small intestine [1]. - Crohn's disease is a type of **inflammatory bowel disease (IBD)** [1] characterized by **transmural inflammation** that can affect any part of the gastrointestinal tract, but most commonly involves the small intestine. *Ulcerative colitis* - **Ulcerative colitis** is an **inflammatory bowel disease** that exclusively affects the **large intestine (colon and rectum)** [2]. - Unlike Crohn's disease, it involves continuous inflammation of the mucosa and submucosa, usually starting in the rectum and extending proximally [2]. *Cystic fibrosis* - **Cystic fibrosis** is a **genetic disorder** that affects the lungs, pancreas, liver, and intestine, leading to the production of **thick, sticky mucus**. - While it can cause malabsorption and intestinal issues due to pancreatic insufficiency, it is not primarily an inflammatory bowel disease in itself. *Tropical sprue* - **Tropical sprue** is a malabsorption syndrome thought to be caused by **environmental factors and microbial changes** in the small intestine, typically affecting individuals in tropical regions [3]. - It results in abnormal small intestinal architecture and nutrient malabsorption, but it is not classified as an inflammatory bowel disease like Crohn's or ulcerative colitis. *Coeliac disease* - **Coeliac disease** is an **immune-mediated condition** triggered by the ingestion of **gluten**, leading to damage of the small intestinal villi [3]. - While it affects the small intestine and involves an immune response, it is distinct from inflammatory bowel diseases which are characterized by chronic, relapsing inflammation of the GI tract.

Q: The obstruction of two or more major hepatic veins is seen in:

Budd-Chiari syndrome. ***Budd-Chiari syndrome*** - This syndrome is defined by **obstruction of hepatic venous outflow**, typically affecting two or more major hepatic veins or the inferior vena cava [2]. - The obstruction leads to **hepatic congestion**, liver enlargement, and potentially liver failure [2]. *Crigler-Najjar syndrome* - This is a rare genetic disorder characterized by a deficiency of the enzyme **uridine diphosphate glucuronosyltransferase (UGT1A1)**, leading to unconjugated hyperbilirubinemia [1]. - It primarily affects **bilirubin metabolism** and is not associated with obstruction of hepatic veins [1]. *Reye's syndrome* - Reye's syndrome is a rare but severe condition causing **fatty liver with encephalopathy**, commonly seen in children who have taken aspirin during a viral infection. - It involves **mitochondrial dysfunction** and liver damage, but not direct obstruction of hepatic veins. *Rotor syndrome* - This is a rare, benign autosomal recessive disorder characterized by **chronic, conjugated hyperbilirubinemia** due to a defect in hepatic excretion of conjugated bilirubin into bile. - It results from impaired transport of bilirubin within the liver cells and does not involve mechanical obstruction of hepatic veins.

Q: The most common location of spider nevi is:

Neck and shoulder. ***Neck and shoulder*** - **Spider nevi**, or **spider angiomas**, are most commonly found on the **face, neck, upper chest, and arms** due to their association with areas drained by the superior vena cava. - This distribution is thought to be related to higher blood flow and hormonal influences in these regions. *Abdomen* - While spider nevi can appear on the trunk, they are **less common** on the abdomen compared to the upper body. - Their presence on the abdomen, especially in large numbers, might suggest severe **liver disease**. *Upper and lower extremities* - Spider nevi are **less frequently observed** on the extremities, particularly the lower limbs. - When present on the extremities, they may be isolated and are less indicative of systemic conditions compared to those on the upper body. *Back* - The back is **not a primary location** for spider nevi. - Their occurrence on the back is generally isolated and less common than on the face, neck, or chest.

Q: All of the following are true about Crohn's disease except.

It is superficial inflammation involving mucosa. ***It is superficial inflammation involving mucosa*** - Crohn's disease is characterized by **transmural inflammation**, meaning it affects all layers of the bowel wall, not just the superficial mucosa [1]. - This **full-thickness inflammation** contributes to complications like **fistulas** and **strictures** [2]. *Cobble stone appearance* - The **cobblestone appearance** on endoscopic examination is a classic finding in Crohn's disease, resulting from deep longitudinal ulcers and intervening edematous mucosa. - This is a direct consequence of the **transmural inflammation**. *Perianal fistula is seen* - **Perianal fistulas** are common manifestations of Crohn's disease, occurring due to the transmural inflammation extending into the perianal tissues [2]. - These are formed when an inflamed crypt gland ruptures into the perianal tissue, creating a tract. *Skip lesions seen* - **Skip lesions** refer to discontinuous areas of inflammation, where segments of diseased bowel are separated by healthy, uninvolved segments [1]. - This **patchy pattern** is a hallmark feature distinguishing Crohn's disease from ulcerative colitis [1].

Q: Which of the following is true regarding Hepatitis A?

Causes mild illness in children. ***Causes mild illness in children*** - Hepatitis A infection in children is typically **asymptomatic or a mild, self-limiting illness**, often mistaken for a common gastrointestinal bug [1]. - This contrasts with adults, who tend to experience more severe symptoms and a higher incidence of **jaundice** [1]. *Sexual route common* - While **fecal-oral transmission** is the primary route, sexual transmission (especially via anal-oral contact) can occur but is not considered the **most common or primary mode** of spread for Hepatitis A. - The virus is present in high concentrations in the feces of infected individuals, leading to easy spread via **contaminated food, water, or person-to-person contact**. *3% incidence of carrier state* - Hepatitis A **does not cause a chronic carrier state**; the virus is cleared from the body after the acute infection. - The concept of a carrier state is primarily associated with **Hepatitis B** and **Hepatitis C** viruses, which can establish chronic infections. *10% transform into HCC* - Hepatitis A is an **acute infection** and does not lead to **chronic liver disease or hepatocellular carcinoma (HCC)**. - **HCC** is a complication of chronic liver damage, mainly seen with chronic **Hepatitis B** and **Hepatitis C** infections.

Q: Which of the following is not used for diagnosing celiac disease?

Anti-nuclear antibody. ***Anti-nuclear antibody*** - **Anti-nuclear antibodies (ANAs)** are primarily associated with **systemic autoimmune diseases** like systemic lupus erythematosus (SLE), not celiac disease. - While a patient with celiac disease might coincidentally have a positive ANA, it is not a diagnostic marker for **celiac disease** itself. *Anti-endomysial antibody* - **Anti-endomysial antibodies (EMA)** are highly specific and sensitive for **celiac disease**, especially in IgA-sufficient individuals. - They target the same antigen as anti-tissue transglutaminase antibodies. *Anti-gliadin antibody* - **Anti-gliadin antibodies (AGA)** were historically used for celiac diagnosis but are less specific and sensitive than other serological markers. - Their use has largely been replaced by **anti-tissue transglutaminase (tTG)** and **anti-endomysial antibodies (EMA)**. *Anti-tissue transglutaminase antibody* - **Anti-tissue transglutaminase (tTG) IgA antibodies** are the **primary screening test** recommended for celiac disease due to their high sensitivity and specificity. - A positive result often leads to endoscopic biopsy for confirmation.

Question 1

Initial treatment for management of mild to moderate Crohn's disease is:

Accepted Answer

Budesonide

Answer

Mesalamine

Answer

Infliximab

Answer

Sulfasalazine

Question 2

Gold standard method of diagnosing celiac disease is

Accepted Answer

Small bowel biopsy

Answer

Blood picture

Answer

Anti-endomysial antibodies

Answer

Biochemical test

Question 3

The highest life time risk of pancreatic malignancy is seen with:

Accepted Answer

Peutz-Jeghers syndrome

Answer

Familial adenomatous polyposis

Answer

Hereditary nonpolyposis colorectal cancer

Answer

Li-Fraumeni syndrome

Question 4

Which of the following is a type of inflammatory bowel disease primarily affecting the small intestine? a) Coeliac disease b) Tropical sprue c) Regional ileitis d) Cystic fibrosis e) Ulcerative colitis

Accepted Answer

Regional ileitis

Answer

Ulcerative colitis

Answer

Cystic fibrosis

Answer

Tropical sprue

Answer

Coeliac disease

Question 5

The obstruction of two or more major hepatic veins is seen in:

Accepted Answer

Budd-Chiari syndrome

Answer

Crigler-Najjar syndrome

Answer

Reye's syndrome

Answer

Rotor syndrome

Question 6

The most common location of spider nevi is:

Accepted Answer

Neck and shoulder

Answer

Upper and lower extremities

Answer

Abdomen

Answer

Back

Question 7

All of the following are true about Crohn's disease except.

Accepted Answer

It is superficial inflammation involving mucosa

Answer

Cobble stone appearance

Answer

Perianal fistula is seen

Answer

Skip lesions seen

Question 8

Which of the following is true regarding Hepatitis A?

Accepted Answer

Causes mild illness in children

Answer

Sexual route common

Answer

3% incidence of carrier state

Answer

10% transform into HCC

Question 9

Which of the following is not used for diagnosing celiac disease?

Accepted Answer

Anti-nuclear antibody

Answer

Anti-endomysial antibody

Answer

Anti-gliadin antibody

Answer

Anti-tissue transglutaminase antibody

Question 10

Post hepatic Portal Hypertension is caused by

Accepted Answer

Budd-Chiari syndrome

Answer

Portal vein thrombosis

Answer

Veno occlusive disease

Answer

Congenital hepatic fibrosis

Answer

Chronic hepatic venous congestion

Answer

Right heart failure

Gastroenterology — MCQs

Gastroenterology — MCQs

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