Gastroenterology Practice Questions

Q: A patient presents with complaints of fever and abdominal distention. He is having history of bloody diarrhea off and on for previous 6 months. X-ray abdomen is shown below. What is the diagnosis?

Toxic megacolon. ***Toxic megacolon*** - The image shows **marked dilation of the colon** with loss of haustral markings, consistent with megacolon. - The clinical picture of fever, abdominal distention, and bloody diarrhea in a patient with a history of inflammatory bowel disease (implied by chronic bloody diarrhea) strongly suggests **toxic megacolon**. - Toxic megacolon is a life-threatening complication of IBD requiring urgent management. *Pneumatosis intestinalis* - This condition involves **gas within the wall of the bowel**, which would appear as characteristic lucencies outlining the bowel wall on X-ray. - While it can be seen in severe bowel ischemia, it is not the primary finding of diffuse colonic dilation seen here. *Volvulus* - Volvulus is a **twisting of a loop of intestine** around its mesentery, leading to obstruction and ischemia. - While it can cause colonic dilation, the dilation is typically localized to the twisted segment (e.g., a "coffee bean" sign in sigmoid volvulus) rather than the diffuse involvement seen here. *Intestinal perforation* - Intestinal perforation is characterized by the presence of **free air under the diaphragm** (pneumoperitoneum) on an upright chest X-ray or lateral decubitus abdominal film. - While a severely dilated and inflamed colon can perforate, there is no clear evidence of free air outside the bowel wall in this X-ray. *Paralytic ileus* - Paralytic ileus causes **generalized bowel dilation** and can present with abdominal distention. - However, it typically involves both small and large bowel, lacks the **loss of haustral markings** specific to toxic megacolon, and does not typically present with **fever and bloody diarrhea** in the context of chronic inflammatory bowel disease.

Q: A patient presents with itchy skin lesions with blistering along with gastrointestinal issues. Which of the following is the most specific serological test for this condition?

Anti-endomysial antibody. ***Anti-endomysial antibody*** - The combination of **itchy, blistering skin lesions** and **gastrointestinal issues** is highly suggestive of **Dermatitis Herpetiformis**, which is the cutaneous manifestation of **celiac disease**. - **Anti-endomysial antibody (EMA)**, particularly IgA, is highly specific (nearly 100%) for **celiac disease** and thus for Dermatitis Herpetiformis, especially when tested on primate esophagus. *Anti-TTG antibody* - **Anti-tissue transglutaminase (tTG) antibody** (IgA) is a sensitive and specific serological marker for **celiac disease** and is often the first-line test. - While highly indicative, **EMA** is generally considered to have slightly higher specificity than tTG for celiac disease, particularly in predicting intestinal villous atrophy. *Anti-nuclear antibody* - **Anti-nuclear antibodies (ANA)** are primarily associated with **systemic autoimmune diseases** like Systemic Lupus Erythematosus. - They are not specific for **celiac disease** or **Dermatitis Herpetiformis**. *Anti-desmoglein antibody* - **Anti-desmoglein antibodies** (anti-Dsg1 and anti-Dsg3) are specific for **pemphigus vulgaris** and **pemphigus foliaceus**, which are autoimmune blistering disorders. - While these conditions present with blistering, they typically lack the gastrointestinal symptoms and the specific pruritic, grouped vesicular pattern seen in **Dermatitis Herpetiformis**. - This is not the appropriate serological test for DH/celiac disease. *IgA deposits at the dermoepidermal junction* - The presence of **granular IgA deposits at the dermoepidermal junction** (dermal papillae) is the **gold standard for diagnosing Dermatitis Herpetiformis** through **direct immunofluorescence** of a skin biopsy. - However, this is a **histopathological finding**, not a serological test, and therefore does not fit the question's criteria for a "serological test."

Q: An adult female presents with pallor and fatigue. Blood investigations show low hemoglobin ( Hb ), low serum iron, low ferritin, low transferrin saturation, and increased total iron-binding capacity (TIBC). What is the likely diagnosis?

Iron Deficiency Anemia (IDA). ***Iron Deficiency Anemia (IDA)*** - The unique constellation of **low hemoglobin**, **low serum iron**, **low ferritin**, **low transferrin saturation**, and **increased total iron-binding capacity (TIBC)** is the hallmark of Iron Deficiency Anemia. - **Ferritin** is a direct measure of iron stores, and its low level confirms depletion, while **increased TIBC** signifies the body's attempt to absorb more iron due to deficiency. *Anemia of Chronic Disease* - While also presenting with **low hemoglobin** and often **low serum iron**, Anemia of Chronic Disease is characterized by **normal or increased ferritin** (as ferritin is an acute phase reactant) and **decreased TIBC**. - There is a functional iron deficiency, but iron stores are typically adequate, and inflammation plays a central role. *Hemolytic Anemia* - Hemolytic anemia is characterized by the premature destruction of red blood cells, leading to **low hemoglobin** but typically **normal or elevated serum iron** and ferritin due to iron release from lysed red cells. - Key indicators, such as **elevated bilirubin**, **lactate dehydrogenase (LDH)**, and **reticulocytosis**, are absent in the given scenario. *Thalassemia* - Thalassemia is a genetic disorder causing defective hemoglobin synthesis, resulting in **microcytic hypochromic anemia** with **low hemoglobin**. - However, thalassemia typically presents with **normal to high serum iron** and ferritin levels, as iron absorption may be increased, and there's no primary iron deficiency. *Sideroblastic Anemia* - Sideroblastic anemia is characterized by defective heme synthesis with iron accumulation in mitochondria, forming characteristic ring sideroblasts on bone marrow examination. - Laboratory findings typically show **normal to increased serum iron**, **increased ferritin**, and **increased transferrin saturation**, distinguishing it from iron deficiency anemia.

Q: Which of the following is typically observed in the investigation results for a patient with iron deficiency anemia (IDA)?

Decreased transferrin saturation. ***Decreased transferrin saturation*** - In **iron deficiency anemia**, there is insufficient iron to bind to **transferrin**, leading to a reduction in the percentage of transferrin that is iron-bound. - This reflects the body's struggle to supply iron for erythropoiesis due to depleted iron stores. *Increased serum ferritin* - **Serum ferritin** is a key indicator of the body's iron stores; in **iron deficiency anemia**, these stores are depleted, leading to a *decreased* rather than increased serum ferritin level. - An increased serum ferritin is typically seen in conditions of **iron overload** or **inflammation**. *Increased serum iron* - **Serum iron** measures the iron circulating in the blood, and in **iron deficiency anemia**, iron levels are *low* due to inadequate intake or excessive loss. - An increased serum iron level would contradict the diagnosis of iron deficiency. *Normal total iron-binding capacity (TIBC)* - **Total iron-binding capacity (TIBC)** typically *increases* in iron deficiency anemia as the liver produces more transferrin in an attempt to capture any available iron. - A normal TIBC would not reflect the compensatory mechanisms seen in iron deficiency. *Increased mean corpuscular volume (MCV)* - **Iron deficiency anemia** is a **microcytic anemia**, characterized by *decreased* MCV due to inadequate hemoglobin synthesis within red blood cells. - An increased MCV is seen in **macrocytic anemias** such as vitamin B12 or folate deficiency, not in iron deficiency.

Q: Which of the following antibodies is associated with Celiac disease?

Anti-TTG (Tissue Transglutaminase). ***Anti-TTG (Tissue Transglutaminase)*** - **Anti-TTG antibodies** (especially **IgA**) are the primary serological markers for celiac disease, demonstrating high sensitivity and specificity. - These antibodies target **tissue transglutaminase**, an enzyme involved in gluten deamidation, which triggers the autoimmune response in genetically predisposed individuals. - **Anti-TTG IgA** is the **preferred initial screening test** due to its superior diagnostic accuracy and cost-effectiveness. *ANCA (Anti-Neutrophil Cytoplasmic Antibodies)* - **ANCA** are associated with **vasculitis**, such as **Granulomatosis with Polyangiitis (Wegener's)** and **Microscopic Polyangiitis**. - They are not a diagnostic marker for celiac disease, which is an autoimmune enteropathy. *ASCA (Anti-Saccharomyces cerevisiae Antibodies)* - **ASCA** are commonly found in patients with **Crohn's disease**, particularly in those with ileal involvement. - While both celiac disease and Crohn's are gastrointestinal conditions, ASCA is not a marker for celiac. *Anti-gliadin* - **Anti-gliadin antibodies (AGA)** were historically used in celiac disease diagnosis but have **lower sensitivity and specificity** compared to anti-TTG and anti-endomysial antibodies. - Modern guidelines recommend using **anti-TTG IgA** as the primary screening tool due to its superior diagnostic accuracy. *Anti-EMA (Endomysial Antibodies)* - **Anti-EMA IgA** is highly specific for celiac disease (>95% specificity) and is often used as a **confirmatory test**. - However, **anti-TTG is preferred for initial screening** because anti-EMA testing is more expensive, operator-dependent (uses immunofluorescence), and less widely available. - Anti-EMA targets the same antigen as anti-TTG (tissue transglutaminase).

Q: An endoscopic image shows the following finding. What is the most likely diagnosis?

Barrett's esophagus. ***Barrett's esophagus*** - The endoscopic image shows a **change in the mucosal lining** from the pale, smooth squamous epithelium (typical of the esophagus) to a red, velvety columnar epithelium, which is characteristic of **intestinal metaplasia** occurring in Barrett's esophagus. - This metaplastic change occurs as a complication of chronic gastroesophageal reflux disease (GERD) and is a **precursor to esophageal adenocarcinoma**. *Esophageal varices* - Esophageal varices appear as **dilated, tortuous veins** beneath the esophageal mucosa, often seen in patients with **portal hypertension**. - The image does not show these typical tortuous, bluish veins. *Gastric erosion* - Gastric erosions are **superficial breaks in the gastric mucosa**, typically appearing as reddish spots or streaks, often with overlying exudate. - The image depicts a change in mucosal type rather than superficial damage to the gastric lining. *Chronic GERD* - While chronic GERD is the underlying cause for Barrett's esophagus, the image shows the **consequence of GERD** (metaplasia), not the direct endoscopic signs of active GERD, such as **esophagitis** (inflammation, redness, erosions) in the squamous epithelium. - The distinct change in mucosal appearance to columnar epithelia is specific to Barrett's esophagus. *Esophageal candidiasis* - Esophageal candidiasis presents with **white plaques or pseudomembranes** overlying the esophageal mucosa, typically seen in immunocompromised patients. - The image shows a change in mucosal type (metaplasia) rather than infectious white plaques characteristic of candidiasis.

Question 1

Compare the intestinal biopsy specimen of patient before and after diet restriction. All are true about the condition shown except:

Accepted Answer

Classic changes in celiac sprue occur in submucosa

Answer

Most sensitive test is antiendomysial antibody

Answer

Associated with dermatitis herpetiformis

Answer

Gluten free diet improves intestinal histology

Answer

Increased risk of enteropathy-associated T-cell lymphoma

Question 2

A patient presents with complaints of fever and abdominal distention. He is having history of bloody diarrhea off and on for previous 6 months. X-ray abdomen is shown below. What is the diagnosis?

Accepted Answer

Toxic megacolon

Answer

Pneumatosis intestinalis

Answer

Volvulus

Answer

Intestinal perforation

Answer

Paralytic ileus

Question 3

A 38-year-old patient complains of rectal bleeding, tenesmus and mucous discharge. On examination patient is found to have anemia, hypoproteinemia and electrolyte disturbance. On radiological examination this is the presentation of the patient. Which of the following statement is false?

Accepted Answer

50 % risk of developing cholangiocarcinoma

Answer

Most common site for this condition is rectum

Answer

Sacroiliitis and ankylosing spondylitis are associated

Answer

Campylobacter infection can mimic early phase of this condition.

Answer

Continuous inflammation starting from rectum extending proximally

Question 4

A patient presents with itchy skin lesions with blistering along with gastrointestinal issues. Which of the following is the most specific serological test for this condition?

Accepted Answer

Anti-endomysial antibody

Answer

Anti-TTG antibody

Answer

Anti-nuclear antibody

Answer

IgA deposits at the dermoepidermal junction

Answer

Anti-desmoglein antibody

Question 5

An adult female presents with pallor and fatigue. Blood investigations show low hemoglobin ( Hb ), low serum iron, low ferritin, low transferrin saturation, and increased total iron-binding capacity (TIBC). What is the likely diagnosis?

Accepted Answer

Iron Deficiency Anemia (IDA)

Answer

Anemia of Chronic Disease

Answer

Hemolytic Anemia

Answer

Thalassemia

Answer

Sideroblastic Anemia

Question 6

Which of the following is typically observed in the investigation results for a patient with iron deficiency anemia (IDA)?

Accepted Answer

Decreased transferrin saturation

Answer

Increased serum ferritin

Answer

Increased serum iron

Answer

Normal total iron-binding capacity (TIBC)

Answer

Increased mean corpuscular volume (MCV)

Question 7

Which of the following antibodies is associated with Celiac disease?

Accepted Answer

Anti-TTG (Tissue Transglutaminase)

Answer

ANCA (Anti-Neutrophil Cytoplasmic Antibodies)

Answer

ASCA (Anti-Saccharomyces cerevisiae Antibodies)

Answer

Anti-gliadin

Answer

Anti-EMA (Endomysial Antibodies)

Question 8

An endoscopic image shows the following finding. What is the most likely diagnosis?

Accepted Answer

Barrett's esophagus

Answer

Esophageal varices

Answer

Gastric erosion

Answer

Chronic GERD

Answer

Esophageal candidiasis

Question 9

A female engineer works for 12-14 hours a day and reports consuming only fast food, with no vegetables or fruits in her diet. Her hemoglobin (Hb) count is $9 \mathrm{~g} / \mathrm{dL}$, and her mean corpuscular volume (MCV) is 120 fL . Peripheral smear (PS) shows the presence of macrocytes. What is the most likely diagnosis?

Accepted Answer

Folic acid deficiency

Answer

Combined Vitamin B12 and Folic acid deficiency

Answer

Iron deficiency anemia

Answer

Vitamin B12 deficiency

Answer

Anemia of chronic disease

Question 10

A 71-year-old man presents to the emergency department because of blood in his stool. The patient states that he is not experiencing any pain during defecation and is without pain currently. The patient recently returned from a camping trip where he consumed meats cooked over a fire pit and drank water from local streams. The patient has a past medical history of obesity, diabetes, constipation, irritable bowel syndrome, ulcerative colitis that is in remission, and a 70 pack-year smoking history. The patient has a family history of breast cancer in his mother and prostate cancer in his father. His temperature is 98.9°F (37.2°C), blood pressure is 160/87 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no current distress. Abdominal exam reveals a non-tender and non-distended abdomen with normal bowel sounds. An abdominal radiograph and barium swallow are within normal limits. Assuming appropriate diagnostic workup identifies the most likely cause of his symptoms, which of the following would be the most appropriate treatment?

Accepted Answer

Cautery of an arteriovenous malformation

Answer

Surgical removal of malignant tissue

Answer

Ciprofloxacin

Answer

Mesalamine enema

Answer

Surgical resection of a portion of the colon

Gastroenterology — MCQs

Gastroenterology — MCQs

On this page

Practice by Chapter

Want unlimited practice?