1. to normal solid food is always present if oesphageal 10. All are causes of odynophagia except diameter is less than ? a. Steak-house syndrome a. 1.3 cm b. Carcinoma oesophagus b. 2 cm c. Caustic ingestion c. 2.5 cm d. Severe GERD d. 4 cm 11. The following manoeuvres aggravate heart burn except 2. Postural dysphagia for liquids is seen in a. Straining at stool a. Scleroderma b. Lifting heavy objects b. Achalasia c. Stationery bike riding c. Diffuse oesophageal spasm d. Running d. None 12. The symptom that does not suggest reflux induced asthma is 3. Sitophobia is seen in a. Late age of onset a. Crohn’s disease b. Worsening after meals b. Viral c. Relieved with bronchodilators c. Chronic mesenteric vascular ischaemia d. Steroid dependent asthma d. A+C 13. The most common development anomaly of oesophagus is 4. In achalasis, basic abnormality is a. Isolated oesophageal atresia a. Inhibitory neural degeneration localized to nerve processes b. Oespohageal atresia + distal type of TOF b. Inhibitory neural degeneration localized to nerve cell bodies c. Oesophageal stenosis + distal type of TOF c. Excitatory neural degeneration localized to nerve processes d. Oesophageal stenosis d. Excitatory neural degeneration localized to nerve cell bodies 14. Diet modification is the primary therapeutic approach for 5. All are features on oesophageal manometry in scleroderma a. Hiatal except b. oesophageal rings a. Abnormal sphincter relaxation c. dysphagia lusoria b. Low amplitude peristalsis d. oesophageal webs c. Hypotensive LES d. Low amplitude simultaneous onset contractions 15. True statement regarding schatzki’s ring a. It represents the proximal border of oesophageal vestibule 6. Severity of radiation oesophagitis is increased by all drugs b. Contains only mucosa and submucosa except c. This is seen in 40% of patients on routine UGI series a. Doxorubicin d. Surgery is the most definitive treatment b. Bleomycin c. Indomethacin 16. All the following have effect on LES except d. Cisplatin a. Truncal vagotomy b. Fat 7. All are secondary causes of achalasia except c. peppermint a. Gastric carcinoma d. diazepam b. African trypanosomiasis c. Neuropathic intestinal pseudo- obstruction 17. The most common neoplasm associated with achalasia d. Lymphoma a. Oesophageal squamous cell carcinoma b. Gastric squamous cell carcinoma 8. All the following provoke oesophageal contractions in D.O.S. except c. Gastric adenocarcinoma a. Cold water d. Gastiric lymphoma b. solid food 18. Barrett’s epithelium has all the following histological c. Edrophonium characters except d. Ergonovine a. Absence of goblet cells b. Lack of intestinal absorptive capacity 9. In the clinical evaluation of , the symptom that has no significant statistical difference among cardiac and c. Presence of villous structure oesophageal causes is d. Presence of parietal and chief cells a. Radiation to left arm 19. Regarding tLESRs (Transient lower oesophageal sphincter b. Pain lasting several hours relaxation), false statement c. Pain awakens at night a. Occur in patients with normal LES pressure d. Provoked by recumbency b. Appear without fixed temporal relation to pharyngeal contractions GASTROENTEROLOGY 1169 A

Chronic achalasia Achalasia VIP Rabies Achalasia AIDS a. syndrome Vinson Plummer b. Deficiency of zinc, molybdenum, vit c. Cigarette smoking d. Gastro oesophageal reflux disease e. alcohol consumption Excessive a. b. stricture Corrosive c. and plantaris Palmaris Tylosis d. e. Radiation stricture a. of oespophagus Leiomyoma b. Schatzki’s ring c. Aberrant subclavian artery d. Diffuse oesophageal spasm e. All the above a. Cervical oesophagus b. part of oesophagus Middle c. of oesophagus third Lower d. location can be made No such a. b. Carcinoma c. gravis Myasthenia d. Scleroderma a. Gastrin b. Motilin c. d. P Substance a. b. Tetanus c. Hysteria d. Achalasia a. debris oropharyngeal Swallowed b. Pill oesophagitis c. CMV infection d. Aspergillus infection a. b. Oesophagial Carcinoma c. d. Post transplant patients Adenocarcinoma b. Adenocarcinoma c. oesophagitis Allergic d. infection Parasitic All are premalignant for squamous cell carcinoma except All are premalignant for squamous All are premalignant conditions for carcinoma oesophagus for carcinoma conditions are premalignant All except Chest pain with dyspagia occurs in Chest pain with dyspagia occurs Hiccups with dysphagia suggest lesion in which part of lesion in which suggest dysphagia with Hiccups oesophagus Transfer dysphagia is seen in Transfer dysphagia is seen in LES pressure is decreased by is decreased LES pressure Phagophobia (fear of swallowing) may occur in all except may occur in all swallowing) Phagophobia (fear of Plaque like lesions resembling candidal infection are seen like lesions resembling candidal Plaque except with all the following Low prevalence of candidal oesophagitis is seen in oesophagitis of candidal Low prevalence 38. 37. 36. 35. 34. 33. 32. 31. 30.

GERD CMV HSV CMV HSV a. a. Chronic cough b. c. Globus sensation d. Headache a. Progesterone b. NSAIDs c. Adrenergic agonists d. Adrenergic antagonists a. Lung b. Melanoma c. Thyroid d. Beast a. Hypopharynx b. Oesophagus c. d. intestine Small a. 3 months b. 6 months c. 1 year d. 2 year a. 30 Gy b. 40 Gy c. 50 Gy d. 75 Gy a. Epidermolysis bullosa b. perphigoid Bullous c. Cicatricial Pemphigoid d. et palmaris Tylosis a. b. candida c. d. Pill induced a. b. Candida c. d. Pill induced c. LESRs induced swallow than for shorter duration Persists d. of food/gas. to gastric distension Occur physiologically Commonest cause of tissue eosinophilia in oesophagus Commonest cause of tissue eosinophilia All are extra oesophageal manifestations of GERD except All are extra oesophageal manifestations All the following drugs decrease LES except All the following drugs decrease Most frequent primary metastasizing to oesophagus Most common extra pulmonary site for small cell carcinoma Most common extra pulmonary site for small Minimum period from exposure of radiation to oesophageal stricture formation is The incidence and severity of oesophageal damage increase damage of oesophageal severity and The incidence with radiation doses greater than Skin condition that is not pre-malignant for oesophageal that is not pre-malignant for oesophageal condition Skin carcinoma “Volcano lesions” on oesophagogram are seen in oesophagitis in are seen oesophagogram on lesions” “Volcano due to “Pseudo-ulcerations” on oesophagogram are seen in are seen oesophagogram on “Pseudo-ulcerations” due to oesophatitis 29. 28. 27. 26. 25. 24. 23. 22. 21. 20. MCQ's 1170 39. 40. 41. 42. 43. 44. 45. 46. 47. All aggravate heartburnexcept Odynophagia ischaracteristic ofallexcept Water brashis Oesophageal peristalsisisbest studiedin Orophayngeal paralysiscauses allexcept Globus pharyngeus is Metaclopramide hasallthese effectsexcept Necrotizing oesophagitisiscaused by Oesophagitis in AIDS iscaused by Nicotine e. Metoclopramide d. Dopamine c. Secretin b. a. . Causticinjury e. d. Achalasia Carcinomawithperiesophagealinvolvement c. Barrett’sulcer b. Monilialesophagitis a. . Effortless a. . Alltheabove e. Salivary d. Associated withachalasisordiverticulum c. . Leftlateralposition d. Rightlateralposition c. Uprightposition b. Recumbentposition a. Because b. Tracheobronchial aspiration d. Chestpain c. Nasalregurgitation b. Dysphagia a. . Associated withGERD e. Treatmentispharyngomyotomy d. Bariumstudiesandmanometryareabnormal c. b. Difficultyinswallowing a. . Hasactiononsmallintestineand colon e. Extrapyramidaleffects d. Increasedoesophagealclearance c. Increasedgastricemptying b. IncreasedLESpressure a. . Alltheabove e. Candidaloesophagitis d. CMVoesophagitis c. Varicella zosteroesophagitis b. HSVoesophagitis a. Alltheabove. d. Mycobacterium tuberculosis c. Pneumocystis carinii b. Cryptosporidium a. CCK More commoninmen peptic sphincter mouth

of hyper appearance incompetence secreation, of gastic of which upper or esophageal occurs and lower in response contents esophageal to in 50. 48. 51. 49. 52. 53. 54. 55. 56. 57. except hypergastrinemia All thefollowingarenonGIcausesof Commonest siteofforeignbodyimpaction Pepsin ismaximallyactive atapHof H. pylori causesalltheseeffects ongastricsecretionexcept Confirmation ofH.pyloriConfirmation eradicationaftertreatmentisby Duodenal ulcersareleastlikelytopenetrate factory relatedtostressulcers Gastric acidhypersecretionisthemechanisminoneof except All areassociatedwithincreased incidence of peptic ulcer Most commoncauseofhypergastricnemia Medical therapy forZEsyndromeismonitoredby . Allthestatementsarecorrect e. Pheochromocytoma d. Porphyria c. Vitiligo b. Renalfailure a. . Cure d. d. Above LES c. Nearaorticarch b. CervicaloesophagusjustbelowUES a. d. 2.5 c. b. 2 a. . The c. Suppression b. Fastingserumgastrinlevels arehigherby35-45% a. Histology d. Ureabreathtest c. Serology b. Rapidureasetest a. d. Colon Biliarytract c. b. a. d. Shock Sepsis c. Cushing’sulcers b. Curling’sulcers a. d. Systemicsclerosis c. CRF b. a. Hypochlorhydria d. Renalfailure c. ZEsyndrome b. AntralG-cellhyperplasia a. b. BAO Clinicalsymptoms a. 3 1 Alcoholic COPD levels compared tocontrols controls plasma restored

of gastrin fasting meal stimulated and concentration GRP gastrin stimulated after release GRP serum is more is gastrin high than GASTROENTEROLOGY 1171

Scleroderma Nickel Cardia a. Duodenal bicarbonate secretion b. Apical barrier c. blood flow Mucosal d. Anti oxidant mechanisms a. b. Diabetes c. Amyloidosis d. Multiple sclerosis a. Gnotobiotic piglet b. Zinc c. d. Copper a. Cisapride + metaclopramide b. + ondansetron Cisapride c. Ondansetron + erythromycin d. Cisapride + erythromycin a. metaclopramide I.V. b. erythromycin I.V. c. Cisapride d. Ondansetron a. Antrum b. Fundus c. Midportion of greater curvature d. of lesser curvature Midpart a. b. stenosis pyloric Hypertrophic c. Gastric atresia d. Microgastria a. Duodenal atresia b. stenosis Hypertrophic pyloric c. Gastric d. a. Fundus b. Body c. d. Incisura angularis a. junction oesophageal Gastro b. duodenal junction Gastro c. Posterior part of antrum d. Posterior part of incisura First line of gastric / duodenal mucosal defense is First line of gastric / duodenal Auto vagotomy is seen in vagotomy Auto The metal present in the enzyme urease elaborated by H. enzyme urease the in metal present The is pylori Torsades –de-pointes occurs due to drug interaction of Torsades –de-pointes occurs due Drug of choice in acute episodes of gastric stasis Drug of choice in acute episodes Functional pace maker of stomach is located at Functional pace Congenitalanomaly of stomach that is associated with turner’s turner’s with associated is that stomach of Congenitalanomaly syndrome is Most common indication for abdominal surgery within first 6 months of life is Most fixed portion of stomach is Most fixed Bare area of stomach is of stomach Bare area 77. 76. 75. 74. 73. 72. 71. 70. 69. 68.

A

PGE Alcohol 1.5 cm 2 cm 2.5 cm 3 cm a. Cryptosporidium b. CMV c. Lymphoma d. MAC a. Misoprostol b. Nizatidine c. Lansoprazole d. None a. Calcium b. PGF c. d. Aspirin b. Agonists c. Calcium d. Acetazolamide a. a. Stomach b. c. d. Liver a. Antrum b. Body c. Fundus d. a. b. c. d. a. b. Endoscopy and biopsy c. ultrasonography Endoscopic d. Chromoendoscopy a. Cuture b. RUT c. Histology d. PCR a. Lymphocytic b. Eosinophilic gastritis c. Type d. Type D c. Endoscopy d. Ultrasound Most common cause of gastric outlet obstruction in AIDS Most common cause of gastric outlet obstruction in Drug that can prevent bleeding from NSAID induced Drug that can prevent gastropathy is Gastric bicarbonate is inhibited by Gastric bicarbonate is inhibited Gastric bicarbonate is stimulated by Most common extranodal site for GI lymphoma Gastric sarcomas are located most commonly at Gastric sarcomas are located most commonly Malignant gastric polyps are usually of size Malignant gastric Gastric leiomyomas are best diagnosed by Gastric leiomyomas are H. pylori is best diagnosed by diagnosed by is best H. pylori Type of gastritis seen with celiac sprue seen with celiac Type of gastritis 67. 66. 65. 64. 63. 62. 61. 60. 59. 58. MCQ's 1172 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. Third lineofmucosaldefenseincludes n o te olwn i nt nldd n h differential the in included not is diagnosis forpostbulbarulcers following the of One Poor prognostic factorincarcinomastomachis Poor prognostic has highestmortalityrate? gastric carcinoma Which ofthefollowingsurgicaloptionfor Poor prognostic indicatorofgastriclymphomasis Poor prognostic CARNEY’s triadincludesall except Pre-malignant gastricpolyps are Commonest siteofhyperplasticpolypsstomachis Most commoncauseofdeath inZEsyndromeis Most commoncauseofacutegastric dilatationis Antioxidantmechanisms d. Mucosal bloodflow c. Apicalbarrier b. Duodenalbicarbonatesecretion a. Adhesive bands d. c. Annularpancreas b. a. Nodalinvolvement inEGC d. Ageofthepatient c. EarlyTNMstage b. Upperthirdtumors a. d. None Palliative resection c. Anastomoticleak b. Curative resection a. Musshoff stageIIEI d. Presentationwithacuteabdomen c. Diffuseorlargecelltype b. Tumors <10cm a. . Pulmonarychondroma d. Gastriccarcinoid c. Smooth muscle/stromaltumorofstomach b. Extraadrenalparaganglioma a. . Fundicglandpolyps d. Hyperplasticpolyps c. b. Adenomas Peutz-jegher polyps a. Antrum d. Pylorus c. Fundus b. Body a. . Othercomorbidillness d. c. Malignanttumorinvasion b. Complicationsofulcerdisease a. Peptic ulcer d. Idiopathic c. Carcinomastomach b. Diabetes a. Carcinoids 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. except All thefollowingsurgeriescancausedumpingsyndrome n o te olwn i a or rgotc niao i ZE in indicator prognostic poor syndrome a is following the of One The followingisnotacomplication ofsucralfate Duration ofactionomeprazoleisapproximately False statement regardingtherapy ofH.pylori Five year survival inZEsyndrome withoutliver metastasesis All thesedrugs aregastricprokinetic agentsexcept Mostfrequent extranodallocationoflymphomais are morethan contents gastric fasting when significant is retention Gastric Gastroscopy isthe investigation ofchoiceforallexcept . Pyloroplasti d. Ramsted’soperation c. Nissenfundoplication b. Highlyselective vagotomy a. . Primaryduodenalwall tumor d. Isolatedlymphnodetumor c. Undetectabletumoronsurgicalexploration b. Presenceofcushing’ssyndrome a. Elevated transaminases d. Hypophosphatemia c. b. GastricBezoar a. d. c. b. a. . Eradication c. Tripletherapyfor14 dayshasgreatestefficary b. Dualtherapyisnotrecommendedroutinely a. . Triple d. 95% d. 75% c. 60% b. 50% a. Domperidone e. verapamil d. Erythromycin c. Metaclopramide b. Cisapride a. e. Pancreas Liver d. c. Smallintestine b. Stomach a. 100ml d. c. 50ml b. 30ml a. er Erosive gastritis b. Malloryweiss tear a. 36 hrs 18 hrs 12 hrs 6 hrs Colon 75 ml perforation more than50%ofpatientsinfectedwithresistantstrain

therapy of the is effective organism in has eradicating significant the impact organism on ulcer in GASTROENTEROLOGY 1173

indicator red phenol with pH the increases test group in H2 receptor blockers light orange to red turning from All are common a. Dizziness, syncope b. Light headedness c. Palpitation a. Iron deficiency anaemia b. Folate deficiency c. B12 deficiency d. a. vagotomy Incomplete b. infection H. pylori c. Reflux of into stomach d. None of the above a. b. c. Hemetemesis d. Fatigue, anorexia e. loss Weight a. rests Pancreatic b. leiomyoma Gastric c. Malignant melanoma d. Varices Gastirc a. Malignant ulcer b. ulcer Gaint c. with duodenal ulcer Associated d. gastritis Associated a. 4-6 weeks b. 6-8 weeks c. 8-12 weeks d. weeks 12-16 a. + magnesium hydroxide Aluminium hydroxide b. trisilicate Magnesium hydroxide + magnesium c. carbonate + magnesium hydroxide Calcium d. bicarbonate Calcium hydroxide + sodium a. in both groups Is same b. Better c. group treated rate is less than 15% in H. pylori Relapse d. done studies No comparative c. is 100% Sensitivity and specificity d. Requires endoscopy a. pylori of H. for identification method and reliable Simple b. Positive Latedumping syndrome includes all these clinical features ex- features clinical these all includes syndrome Latedumping cept Anaemia which is common with afferent loop syndrome is Commoncause of stomal ulcer includes all except Most common symptom of stomal ulcer is ‘Bull’s eye’ lesion of the stomach on barium study is seen in ‘Bull’s eye’ Non-healing of gastric ulcer after treatment indicates Non-healing of gastric ulcer after Duration of therapy for gastric ulcer is Most widely used antacid preparation is preparation Most widely used antacid One year relapse rate of ulcer in those treated with H2 blockers in those treated with relapse rate of ulcer One year eradication H. pylori or those for Regarding rapid urease test false statement is false statement urease test rapid Regarding 116. 115. 114. 113. 112. 111. 110. 109. 108. 107. degenerative and stroke to secondary Artery dysphasia Artery diseases chief cells ECL cells a. Poly hydramnious is associated in 50% of patients b. is usually non-bilious Emesisi c. associated with down’s syndrome Commonly d. Double – bubble sign is seen on plain radiographs a. 23 mEq/I b. 59 mEq/I c. 15 mEq/I d. 30 mEq/I d. Magna Pancreatica a. hepatic artery Common b. Spleni c. Gastroduodenal a. cells Parietal b. c. d. cells Mucous e. Cells Paneth a. Carbohydrates b. Proteins c. Fats d. equal response All have a. Dysphagia b. fibromyalgia Localised c. or functional GI disorder Peptic d. of epigastirc pain on bending or twisting Worsening a. Esophageal malignancy b. malignancy Gastric c. Colonic malignancy d. malignancy Pancreatic c. cerebral injury causing dysphasia Diffuse d. Gastric malignancy e. a. to head and neck neoplasm’s with dysphasia due Patients b. Transfer a. Barium study b. Endoscopy and biopsy c. Endoscopic ultrasound d. CT Scan abdomen c. Gastroparesis d. ulcer stomal Post-operative e. Alkaline reflux gastritis Wrong statement regarding duodenal atresia is Wrong statement regarding duodenal Mean maximum acid output in normal males is upto Mean maximum acid output in Artery involved in duodenal ulcer bleeding is in duodenal Artery involved Intrinsic factor is secreted by Major stimulants of gastric acid secretion are Major stimulants of gastric acid ‘Back-gut’ syndrome includes all except includes ‘Back-gut’ syndrome Endoscopic ultrasound can detect staging of all except ultrasound can detect Endoscopic Percutaneous Percutaneous endoscopic gastrostomy (PEG) is useful in all except Investigation of choice for leiomyoma and pancreatic rests is and pancreatic rests choice for leiomyoma of Investigation 106. 105. 104. 103. 102. 101. 100. 99. 98. MCQ's 1174 117. 118. 119. 120. 121. 122. 123. 124. 125. istreatedby Vitamin B12dificiencyafterpepticulcersurgeryisseenin Iron deficiencyanaemiaafterbillrothIIistreatedby sult. Massive haemorrhageduetostressulcersoccurafter acutein- Phlegmonous gastritisiscaused byallexcept Most commonsiteofinvolvement ofeosinophilicgastritisis Most common symptom of eosinophilic gastritisis Most commonsymptomofeosinophilic Menetrier’s diseaseshowall these featuresexcept Most ofthegastrinomasarelocated in . Confusion,diaphoresis e. d. Diarrhoea . Alltheabove e. Octreotide(50ugsctid)improves severe symptoms d. Eatingoffrequentsmallmeals c. Eliminationofliquidsatmealtime b. Limitationofsimplesugarcontainingliquidsandsolid a. . AlltheseconditionscancausevitaminB12dificiency d. Hypochlorohydriaandbacterialovergrowth c. Gastritiscausinggastricatrophyaftersurgery b. Totalgastrectomy a. Pancreatic enzymesupplementation e. Supplyintrinsicfactor d. IMpreparationsofiron c. Antibiotics b. Oralironpreparation a. After2weeks e. After1week d. After48hours c. in48hours b. Infirst24hours a. e. Proteusspecies d. c. Staphylococci b. Streptococci a. Incisuraangularis d. Antrum c. Body b. Fundus a. Hemetemesis d. Distensionofabdomen c. Loss b. Epigasticpainwithvomiting a. . Deep a. . Allarecorrect e. Severe d. Gastriccarcinomaisvery commoncomplication c. . Anticholinergics b. Tail ofpancreas c. Body ofpancreas b. Headofpancreas a. E. coli Salmonella gastrectomy the proteinloss of appetite mucosal disease

biopsy with and and H2 persistent blockers cytology protein are is required reported

loss require for to diagnosis

decrease total 126. 127. 128. 129. 130. 131.

Most commoninvolvement inMEN1is ingastrinomaisseen in Vit B12malabsorptioningastrinoma isdueto not anobstructive causeofdysphagia? swallowingthe followingis solidsbutnotliquids.Whichof weight loss and the patient experiences symptoms when month historyofdysphagia. There isnohistoryofdrastic A 47-year-old womanpresentstoyourclinicwithathree- epigastric region.Themostlikelydiagnosisis: soft and experiences moderate discomforton palpation of the bowelOn examination,hisabdomenis habitsarenormal. questioning, there is no history of weight loss and the patient’s worse in the mornings and is relieved after meals.Ondirect of epigastric dull abdominal pain. He states that the pain is You see a 47-year-old man in clinic with a three-month history treatment is: appropriate and hasnoknowndrugallergies.Themost history medical past no has patient The test. (CLO) organism a duodenalulcercoupledwithpositive campylobacter-like demonstrate results The (PPIs). inhibitors four-month pump proton and a following history ofepigastric pain despite treatmentwith antacids endoscopy (GI) gastrointestinal A 55-year-old womanisreferredbyher GPforupper . Stomach,lymphnodes e. Wall ofduodenum d. . Seven-day e. Hyperthyroidism e. Hypopitutarism d. Hyperparathyroidism c. Insulinoma b. Gastrinoma a. 75% d. 50% c. 20% b. 10% a. . Alltheseareinvolved e. Impairedabsorption interminalileum d. Bacterialovergrowth c. Inactivation ofpancreaticenzymesatlowpH b. Decreasedsecretionofintrinsicfactor a. . Seven-day d. e. Achalasia Peptic stricture d. Retrosternalgoitre c. Oesophagealweb b. Pharyngealcarcinoma a. . Gastritis e. Gastriccarcinoma d. Duodenalulcer c. Gastro-oesophagealrefluxdisease (GORD) b. Gastriculcer a. . Seven-day c. Seven-day courseoftwicedailyomeprazole20mg b. Seven-day a. mg clarithromycin clarithromycin amoxicillin amoxicillin and500mgclarithromycin course course course course of of of of twice twice twice twice daily daily daily daily 1 omeprazole omeprazole g omeprazole amoxicillin 20 20 20 mg and mg mg, and and 500 1 500 mg 1 g g GASTROENTEROLOGY 1175 spp. spp. Crohn’s disease a. Co-amoxiclav b. Bendroflumethiazide c. Ramipril d. Amlodipine e. Aspirin a. Abdominal x-ray b. Abdominal ultrasound c. Abdominal CT d. Magnetic resonance imaging (MRI) e. Endoscopic retrograde cholangiopancreatography (ERCP) a. b. hepatitis Viral c. d. of the head of the pancreas Carcinoma e. hepatitis Autoimmune a. Reassure and discharge b. a course of oral steroids Start on c. Request abdominal ultrasound d. MRCP Request e. Refer to Haematology Shigella d. Shigella e. Stapylococcus a. Iron deficiency anaemia b. syndrome Budd–Chiari c. Ulcerative d. e. heart failure Left-sided You You see a 47-year-old woman history of . assess You who her liver function tests ALT (LFTs) iu/L, presents 45 AST iu/L, 350 at with raised is iu/L ALP the that a see and 3-day in herself, 50 iu/L and bilirubin 50 iu/L. The patient feels well dark become quite noticed that her urine has has she although and her stools quite pale. You assess her medication history. Which of the following drugs from the patient’s medication history may be responsible for the ? You You are asked woman with jaundice and by for a 49-yearold investigation your registrar of gallstones abdominal pain. She has a past medical history to request an same problem. The of the a recurrence is this you suspect and imaging is: most appropriate imaging investigation You You see a emergency through her GP, 54-year-old with a week’s history of jaundice woman, referred Associated abdominal pain. right upper quadrant and to accident and There is no symptoms include dark urine and pale stools. loss and the patient does not consume history of weight mol/L, 40 of bilirubin a reveal tests function liver Her alcohol. ALT of 40 iu/L, AST 50 iu/L and ALP of 350 likely diagnosis is: iu/L. The most You You see a 19-year-old Caucasian direct On jaundice. of transient a history with presents man in your is noticeable the jaundice that you ascertain questioning, clinic who after physical activity and subsides after periods of increased has no other symptoms and physical a few days. The patient (with normal is count blood Full unremarkable. is examination a reveal tests function liver and reticulocyte count) a normal management is: bilirubin of 37 ìmol/L. The most appropriate A 69-year-old man present with a 2-week history of history of with a 2-week man present A 69-year-old last few days. the has worsened over pain which abdominal is and the abdomen the patient is jaundiced On examination, region. In addition, tenderness in the epigastric with distended Which dullness. shifting and smooth a is there is a cause of hepatomegaly? of the following

142. 141. 140. 139. 138. 138. spp. spp. Escherichia coli Crohn’s disease Campylobacter a. Campylobacter Salmonella b. Salmonella c. a. Full blood count b. Urea and electrolytes c. Stool sample for microscopy, culture and sensitivities d. Abdominal x-ray e. function tests Liver a. discharge home Oral rehydration advice, anti-emetics and b. therapy and discharge home Oral antibiotic c. fluid rehydration intravenous for Admission d. antibiotic therapy for intravenous Admission e. No treatment required a. syndrome Irritable bowel b. c. colitis Ulcerative d. abuse Laxative e. a. (CT) scan Computer tomography b. Chest x-ray c. endoscopy Upper GI d. Barium meal e. Ultrasound a. NSAIDs b. Helicobacter pylori c. Alcohol abuse d. therapy Chronic corticosteroid e. Zollinger–Ellison syndrome You You are questioned by diarrhoea. From the blood-stained for causing responsible your registrar list below, the organism which is not responsible for select regarding bacteria causing blood-stained diarrhoea. A 56-year-old man presents with a 2-week history of diarrhoea with a 2-week man presents A 56-year-old poisoning’. ‘food of episode an following settled not has which most appropriate the be would following of the Which investigation? A 35-year-old woman presents with a 24-hour history of woman presents A 35-year-old nine times her bowels diarrhoea. She has opened watery diagnose gastroenteritis since the onset of her symptoms. You family all ate at a her and patient the that after learning similar had rest of her family have the and restaurant new is: problems. The most appropriate management history of watery states that she has opened diarrhoea. She history of watery Associated of symptoms. onset her since times 11 bowels her with abdominal symptoms include and vomiting following a in the evening started cramps and pain which is alert meal in the afternoon that day. The patient barbeque rate of include a pulse and orientated and her observations 69, blood pressure of 124/75 and temperature of 37.1°C. On marked tenderness examination, her abdomen is soft, there is The are hyperactive. sounds bowel and region epigastric the in patient is normally fit andwell with no past medical history. The most likely diagnosis is: You You see a 48-year-old lorry driver, who presents to you with has not of after meals which a three-month history been settling with antacids and PPIs. The most appropriate investigation patient has a hiatus hernia. You suspect that the hernia is: for diagnosing a hiatus Which of the following is the most common cause of duodenal of duodenal cause most common is the the following of Which ulcers?

137. 136. 135. 135. 134. You see a 25-year-old woman who presents with a 24-hour 133. 132. MCQ's 1176 143. 144. 145. 147. 148. 149. 149.

treatment? to prescribeanosmoticlaxative. Whatisthemostappropriate you asks who registrar Youyour empty. consult is the iliac fossa. Bowel sounds are presentand on PR examination, at theleft the abdomenissoftandtheremilddiscomfort On examination,herobservations arewithinnormalrange, last 4 days. She is not known to have a history ofconstipation. woman onthe ward whohas not opened her bowels for the During youron-call,youarebleepedtoseean80-year-old give risetofingerclubbing? Which ofthefollowinggastroenterologicalconditionswould cause ofupperGIbleeding? of the listbelow,whichoffollowingismostcommon episode acute causes ofupperGIbleeding. From round aboutthecommon andis an ward the on before asked Youare endoscopy. with GI night upper an awaiting the man admitted was 75-year-old who haematemesis, a see You a rebleedfromhisoesophagealvarices? following medicationswouldactasprophylaxis inpreventing is discharged after 2weeks in-hospital stay. Which of the The patientundergoes endoscopic variceal banding and with anupper GI bleedsecondarytooesophageal varices. admitted was disease liver alcoholic with man 60-year-old A derangement inthepatient’sliver function? Which history. the followingdrugsbelowislikelytohaveof causedthe medication patient’s the at travel. look of a history no have You is There iu/L. 98 ALP iu/L, and liver iu/L 111 55 AST ALT iu/L, her 41 of bilirubin assess a shows You which function hepatomegaly. reveals Physical hypertension. examination and fibrillation atrial longstanding week’s a history ofjaundice. Her past medical history includes with clinic your to presents woman 46-year-old A of chronicliver disease? part the followingclinical signs does notform tests. Whichof and hispastmedical historyshowsderangedliver function general malaise.Hementionsa long historyofalcoholabuse A 67-year-old man presents feeling unwell and complaining of . Methylcellulose e. d. Senna Lactulose c. Docusatesodium b. Ispaghulahusk a. . Pancreatic carcinoma e. Hepatocellularcarcinoma d. Irritablebowel syndrome c. b. Hepatocellularcarcinoma a. . Malignancy e. Druginduced d. Oesophagealvarices c. Peptic ulcers b. Mallory–Weiss tear a. . Irbesartan e. Propranolol d. Ramipril c. Amlodipine b. Frusemide a. . Amlodipine e. Bendroflumethiazide d. c. Amiodarone Ramipril b. Aspirin a. . Finger clubbing a. 150. 151. 152. 153. 154.

a diagnosisofalcoholic-relatedliver disease? iu/L. 100 ALP and iu/L 75 would support Which ofthefollowingbloodtestparameters ALT iu/L, 150 of AST suspected iu/L, 36 with of clinic your bilirubin a reveal tests in function . liver alcoholic man 56-year-old a see You (AMA) positive. Themostlikelydiagnosisis: addition, In iu/L. she was also found to be serum anti-mitochondrial antibody 300 at high abnormally be to found were levels ALP her after GP in her by referred arthritis was She rheumatoid clinic. your with woman 52-year-old a see You venous hypertension? fluid a with secondaryto thrill. Whichoffollowingisnotacause distension abdominal an is there examination A 47-year-oldweightman presentscomplaining of gain,on o -nirpi dfcec. eet h ms lkl modeof likely inheritance fromthelistbelow: most the Select deficiency. 1-antitrypsin to registrar Your havesuspects that thispatientmay liver diseasesecondary ascites. and jaundice of history one-month a A 56-year-old man,diagnosed withemphysema,presents treatment is: decide to startthispatient ontreatment.Themostappropriate Youdetected. (SLA)is antigen liver anti-soluble and normal is serology Viral well. and fit been has patient the symptoms, to heronsetof soft andthereisasmoothhepatomegaly.Prior the trunk.Herabdomenis and backof naevi onthefront spider are several There clubbing. finger has is and patient jaundiced the examination, On iu/L, 104. ALP 46 175, ALT of 200, bilirubin AST a reveal LFTs Her polyarthralgia. and history ofjaundice. Associated symptoms includelethargy two-month a with presents Youwho woman 56-year-old a see . Jaundice e. Koilonychia d. Spidernaevia c. Palmer erythema b. e. d. Normalmeancellhaemoglobin(MCH) c. b. Normalmeancellvolume(MCV) a. . Alcoholicliver disease e. Primarysclerosing cholangitis d. Heriditaryhaemochromotosis c. b. Primarybiliarycirrhosis a. . Nephroticsyndrome e. Budd–Chiari syndrome d. Constrictive pericarditis c. b. Cirrhosis Congestive heartfailure a. . Noneoftheabove e. Polygenic d. Autosomal recessive c. X-linkeddominant b. Autosomal dominant a. . Antivirals e. Cyclosporin d. c. Prednisolone Methotrexate b. Liver transplantation a. Raised MCV Low MCH Low MCV Wilson’s disease GASTROENTEROLOGY 1177 + of and large amounts amounts amounts treatment enemas with amounts therapy no large large large day large steroid fluid with with with per with + with day day day day per per home per 5-ASA motions per intravenous oral for bowel motions + motions motions motions discharge six bowel bowel bowel hospital and and bowel therapy to four five four six four than than than than steroid steroids discharge required rectal bleeding of rectal bleeding of rectal bleeding amounts of rectal bleeding of rectal bleeding b. Oral c. and refer to surgeons for further assessment Admission d. Oral steroid therapy and discharge home e. Reassurance a. Cigarette smoking reduces incidence b. Fistulae formation c. Abscess formation d. Non-caseating granuloma formation e. with transmural inflammation Associated a. Admission a. Colonoscopy b. Sigmoidoscopy c. Barium follow through d. CT Abdominal e. Abdominal ultrasound e. More a. Fewer d. More c. More d. colitis Ulcerative e. inconclusive report is diagnosis – the No b. Between You You see a 40-year-old Crohn’s disease woman ten who years was Crohn’s ago. which failed to respond to Due diagnosed medical therapy, she had to with a a small severe bowel resection. registrar Your tells you that she attackis at of risk of developing vitamin B12 deficiency as a result is responsible for the surgery. Which part of the small bowel of her absorption of vitamin B12? A 29-year-old anxious man is diagnosed with mild to come asked was the patient to time constraints, Due disease. Crohn’s back for a follow-up appointment to discuss Crohn’s disease in more detail. The patient returns with a list of complications he researched on the internet. Which of the following are not associated with Crohn’s disease? You You are asked to see a the last 4 days she has 29-year-old ago. Over colitis 18 months ulcerative woman diagnosed with her abdominal cramps, opening slight been experiencing passing been has approximately 4–5 times a day and bowels alert and is patient of blood per rectum. The small amounts 67, blood pressure orientated and on examination her pulse is is soft with mild 127/70, temperature 37.3°C and her abdomen tests of note. Blood nil PR examination is tenderness. central reveal haemoglobin of 13.5 g/dL and a CRP of patient is: most appropriate management plan for this 9 mg/L. The You read a report which was handwritten in a patient’s medical patient’s a in handwritten was which report a read You notes who you suspect has inflammatory bowel disease. The of the terminal ileum ‘… there is cobblestoning report reads, with the appearance of are rose suggestive thorn of ulcers. Crohn’s These from: derived that this report was disease’. investigation findings Select the most likely You are told by your registrar that one of the clinic patients has patients clinic the of one that registrar your by told are You Which (UC. colitis ulcerative of up’ ‘flare a with admitted been below, the list of answers From as being severe. he reports select the parameters which are likely to reflect a severe flare colitis: up of ulcerative 165. 164. 163. 162. 161. Crohn’s disease CA 125 a. b. Pseudomembranous colitis c. syndrome Irritable bowel a. Abdominal x-ray b. Abdominal CT c. MRI of the abdomen d. Abdominal ultrasound e. ERCP a. fetoprotein b. antigen (CEA) Carcinoembryonic c. CA 15-3 d. HcG e. a. Angiosarcoma b. Fibrosarcoma c. Adenoma d. Hepatoblastoma e. Leiyomyosarcoma a. Hepatocellular carcinoma b. Cholangiocarcinoma c. fibroma Hepatic d. Hepatic haemangioma e. carcinoma Pancreatic a. disease Thyroid b. Systemic sclerosis c. Rheumatoid arthritis d. colitis Ulcerative e. syndrome Irritable bowel A 28-year-old man undergoes a sigmoidoscopy for sigmoidoscopy a undergoes man 28-year-old A visualization On loss. weight diarrhoea and longstanding of the rectum, the mucosa appears inflamedmucosal ulcers the histology shows and rectal biopsy is taken and friable. A with inflammatory infiltrate, crypt abscesses with goblet cell most is the below, which From the list of answers depletion. likely diagnosis describing the histology report? A 64-year-old woman attends your clinic with a 2-week history 2-week a with clinic your attends woman 64-year-old A lost has patient the months three last the Over of jaundice. appetite, decreased Associated symptoms include 10 kg. the patient is dark urine and pale stools. On examination, a painless palpate you can abdomen is soft and her jaundiced, From the list of answers quadrant. mass in the right upper that below, select the initial most appropriate investigation you would request for this patient: A patient on your ward is diagnosed with hepatocellular is diagnosed A patient on your ward carcinoma. You are asked to perform a tumour marker level on this patient. Which of the following tumour markers are in hepatocellular carcinoma? elevated During a ward round, you are questioned about tumours that about tumours that round, you are questioned a ward During parenchyma. Which of the following may arise from the liver tumours is considered to be benign? liver A 68-year-old man presents to his GP with signs of drastic signs to his GP with presents man A 68-year-old an The GP suspects PSC. to have loss. He is known weight following tumours of the Which malignancy. underlying more be cholangitis primary sclerosing with patient a would at risk of developing? You are You told by your registrar that one of your inpatients has been diagnosed with primary associated an sclerosing have may patient the that suspects registrar cholangitis Your (PSC). with associated is cholangitis sclerosing Primary condition. following diseases? which of the

160. 159. 158. 157. 156. 155. MCQ's 1178 166. A 47-year-old womanhas been experiencing a four-month 167. 168. 170. 169.

amgoi o 93 /L n MV 0 L Wih f the of patient’s Which the diagnosis? fL. in helpful 70 be MCV would investigations and following d/gL 9.3 of haemoglobin include lethargy andweight loss. Full blood countreveals history ofdiarrheaandbloating. Associated symptoms lately. Themostappropriatemanagementis: he has normal bowel habits and has been feeling quite tired note. Thepatientstatesthat and perrectumexamisnilof unremarkable is examination Abdominal fL. 71 is MCV the and ago) year one g/dL 13.5 was haemoglobin (previous g/dL appetite. A fullbloodcount reveals thathis haemoglobin is 9.0 athree-month with clinic history ofweightapproximately 9kgdespiteanormal lossof your attends man 65-year-old A one ofthefollowingstatementsiscorrect? worsening symptomswithsixbloodystoolsperday.Which of cigarettes per day and was 10 weeks pregnant. She complained and was prescribed mesalazine 1.5g per day.She smoked 20 A 24 year old woman had ulcerative colitis for seven years is themostappropriatenextinvestigation? Corrected 160, PLT Calcium 2.58, IgG 4.5, 25 (613), IgA 1.8 (0.93), IgM 1.6 (0.42.2). WCC What 13.2g/L, Haemoglobin show: ESR.Investigations raised a have to found is colitis ulcerative A 55 yearoldman on no currenttreatmentforhis quiescent primary biliarycirrhosis? analysis ina57year oldfemalewithtwoyear historyof Whichof thefollowingfeatureswouldbeexpected on lipid . Noneoftheabove e. Terminal ileum d. c. Proximalileum b. Jejunum a. . Anti-neutrophilcytoplasmicantibodies e. Anti-nuclearantibodies d. Anti-tissuetransglutaminaseantibodies c. Anti-smoothmuscleantibodies b. Anti-mitochondrialantibodies a. . Arrangeanabdominalx-ray e. Arrangeanabdominal ultrasound d. Prescribeirontabletsupplementation c. Arrangeanupperandlower GIendoscopy b. Reassureanddischarge a. . Termination ofthepregnancyisadvisable. e. Oralmesalazinetherapy shouldbewithdrawn. d. Oralcorticosteroidsarecontraindicated. c. Initiationofanelemental dietrisksfetalmalnutrition. b. Azathioprineiscontraindicated. a. . XRaySkeletal survey. e. Rectalbiopsy. d. Plasma immunoelectrophoresis. c. Isotopebonescan. b. Bonemarrowtrephineand aspiration. a. No e. ischaracteristicallyassociatedwithpalmarxanthomas d. ischaracteristicallyassociated withtendonxanthomas c. istreatedwithclofibratetherapy b. Alipaemicappearanceoftheserumwouldbeexpected. a. this shortadurationofdisease evidence of a dyslipidaemia would be expected with 172. 173. 174. 171. 175.

is themostappropriatemanagement? mg/L(<10), 30 CRP following the of Which XrayNormal. Abdo Serum (150400), 109/L total protein 70 g/L x (6176), Serum albumin 30 400 g/L (3749), PlateletsSerum (411), cell 109/L White x (2832), 10 pg count 24 MCH (8096), fL 76 MCV (13.018.0), g/L 10.8 Haemoglobin show: Investigations bleeding. gastric treated withhigh dosesofsteroids,was complicatedby he hashadseveral relapsesinthepastyear. The lastrelapse, colitis. leftsidedCrohn’s Though, previously treatedwithsteroidsandmesalazine, of history a has man old year 40 A ht cl cut . x 0/ (1) Paee cut 0 109/L x 90 count Platelet (150400). Whatisthemostlikelyplanationfortheseresults? (411), 109/L x 2.2 count cell (8096), White fL 122 MCV alcohol (1318), g/dL 10.0 Haemoglobin showed: heavy to signs, 3cm hepatomegalybutnosplenomegaly.Investigations neurological or admitted focal no revealed Examination consumption. He longstandingepilepsy. A 45year oldmanwas receiving phenytoin for problem? whitecell fluid ascitic count 500 x normal 109/L What is the amylase most likely reason for her fluid current ascetic g/L 26 49), serum total bilirubin (37 56 micromol/L (1 22), ascitic g/L fluid protein 28 11), albumin (4 serum (<15s), 9/L s 10 21 time x prothrombin 15 WCC 16.5), (11.5 g/dL 11.2 Haemoglobin mild, generalised abdominal tenderness. Investigations: months ago.Onexaminationshehadmoderateascitesand She hasbeenabstinentsinceshewas diagnosed eight presents withvague abdominalpains,malaiseandnausea. A 60year oldwomanwithknownalcoholicliver cirrhosis hc OE f h floig ttmns eadn colon regarding statements following cancer iscorrect: the of ONE Which the condition? evidence of ulcerative colitis. Which of thefollowing istrueof shows sigmiodoscopy flexible the from Biopsies blood. and A 32yearoldman develops profusediarrhoeawithmucus . Treatmentwithoralbudesonide. e. Treatmentwithazathioprine. d. Totalcolectomywithpouchconstruction. c. Totalcolectomywithileostomy construction. b. Atrialoforalmetronidazoleforthreemonths. a. In e. ItisacharacteristicfeatureofthePeutzJeghersyndrome d. Itoccursmostcommonlyintheascendingcolon c. . Scurvy. e. Hypothyroidism. d. Folatedeficiency. c. Aplasticanaemia. b. Alcoholicliver disease. a. In b. . gobletcells areunaffected inthemucosa e. colectomymayproduceregressionofgall bladderdisease d. topical c. spontaneousbacterialperitonitis e. primaryliver cancer d. portalvein thrombosis c. pancreaticpseudocystrupture b. hepaticvein thrombosis a. . In a. . pseudopolyps b. mesalazinetherapyisassociated withinfertilityinmales a. inheritance ofamutatedsuppressorgene autosomal recessive unusual premalignant potential steroids inproctitis familial non familial familial 5aminosalicylicacid polyposis cases cases, on the coli sigmoidoscopic gene inheritance the mutations are increased less effective in pattern cancer examination the cancer risk than is typically is cells topical due have are to GASTROENTEROLOGY 1179 the mmol/l from 10 than mainly less is fluid usually is ascitic the ATPase of concentration

source sodium usual liver the surface of the exudation from Crohn’s disease a. Increased serum sodium b. resistance Increased vascular c. Reduced urinary potassium excretion d. Reduced renin concentrations e. Reduced urinary sodium excretion a. b. Hypoglycaemia c. polypeptide Increased Pancreatic d. Migratory erythema e. Pellagra a. amoebiasis b. infection campylobacter c. d. septicaemia gonococcal e. colitis ulcerative a. Alkalosis b. Hypoglycaemia c. Hypokalaemia d. gastric acid seceretion Increased e. Provocation of VIP release by somatostatin a. is a recognised feature bacterial Spontaneous b. The a. Antiendomysial b. Antigastricparietal cell c. Antiglutamicacid decarboxylase d. Antiintrinsicfactor e. Antimitochondrial c. pressure is elevated Hepatic intrasinusoidal d. Urinary d. Sodium/potassium e. glucosesodiumtransporter The e. is often elevated Cardiac output A 68 year old male presents with alcoholic cirrhosis A 68 year of the following features complicated by mild ascites. Which is likely in this patient? A 43 year old male presents with weight loss and watery loss and watery with weight old male presents A 43 year hypokalaemia with a reveal diarrhoea. Investigations the support would following of the Which mass. pancreatic diagnosis of a VIPoma? A 40 year old single man returned from fortwo weeks. lasted with mild bloody diarrhoea which had holiday in Europe abdominal had occasional lower in weight, He had lost 2.5 kg left knee. of his a painfulswelling discomfort and cramping What is the most likely diagnosis? Whichone of the following is a feature of the VIPoma Whichone of the following is a feature syndrome? Which of the following is NOT true of a patient with ascites of a patient with ascites is NOT true of the following Which cirhosis: due to liver with a history of recurrent anaemia was oldwoman A 35 year a blood on bodies HowellJolly and target cells have to noted film examination.Investigations revealed: Haemoglobin 7.0 g/dL (11.316.5), MCV 77 fl (8096),MCH 26.2 pg (2832), Serum B12 140 ug/L (160760), Red cell folate 95 ug/L (160640), Serum most is antibody specific disease What (15300). ug/L 10 ferritin likely to be present?

188. 187. 186. 185. 183. 184. a of excludes diagnosis a test confirms antibody stools the in fluorescent amoebic histolytica E. to negative dysentry diagnosis of acute amoebic acute amoebic dysentry E. Coli crohn’s disease a. cyclase Adenylate b. cyclase Guanlyate c. gamma proliferator receptor (PPAR) Peroxisome a. Salmonella enteriditis b. aureus Staphylococcus c. d. Clostridium perfringens e. Bacillus cereus a. chronic b. c. d. intestinal lymphoma e. colitis ulcerative a. fluid restriction and a no added salt diet b. antibiotics intravenous c. oral spironolactone d. paracentesis therapeutic e. transjugularintrahepatic portosystemicshunt b. Cysts a. a c. cholera is a likely diagnosis d. is a likely diagnosis Giardiasis e. shigellosis is a likely diagnosis a. disease of the newborn Late haemorrhagic b. Maternal breast cancer c. diabetes Late onset d. Prolonged jaundice e. Underfeeding a. hepatitis as an acute usually presents It b. of age 20 years It rarely presents before c. sicca with keratoconjunctivitis It may be associated d. hypogammaglobulinaemia It is associated with e. later stages menstruation except in It rarely interferes with Which of the following is activated by Cholera toxin? Which of the following is activated Tenindividuals are admitted to casualty with profuse vomiting profuse with casualty to admitted are Tenindividuals after attending a retirement dinner became ill at roughly They all ate at roughly 7 pm and in a chinese restaurant. midnight. Nine ate a mixture of one female dishes except who most likely the is What rice. her with dishes vegetarian ate organism? infective A 29 year old man presents with anaemia, bleeding tendency, bleeding anaemia, with presents man old year 29 A palpable a Examinationreveals pain. abdominal and diarrhoea tags. What is quadrant and anal skin mass in the right lower the most likely underlyingcondition? A 63 year old patient with known alcohol related cirrhosis old patient with known alcohol A 63 year and peripheral presented with ascites, abdominal tenderness of 400/ count a neutrophil revealed tap diagnostic A oedema. mm3 (normal <250mm3). Which of the following would be of most immediate benefit? A 28 year old male presents with a four day history of profuse presents with a four day history of profuse old male A 28 year the Far holiday in from a returning bloody diarrhoea after regarding his illness is true? East. Which of the following Comparedwith Comparedwith bottle feeding, breast against which of the following? protective feeding is relatively Which ONE of the following statements is true of autoimmune autoimmune of true is statements following the of ONE Which hepatitis:

182. 181. 180. 179. 178. 177. 176. MCQ's 1180 189. 190. 191. 194. 192. 193.

mucosa containing periodic acidSchiff(PAS) positive acidSchiff(PAS) periodic macrophages. Whatisthemostlikelydiagnosis? containing flattened reveals biopsy mucosa Jejunal diarrhoea. and arthralgia A 58year oldmancomplainsoftiredness,fever, weight loss, underlying diagnosis? spider naevi and . Whatisthemostlikely bruising. On examination, she is jaundiced, pigmented with A 48yearand pruritis, steatorrhoea old womancomplainsof is correct? bilirubin Whichof thefollowingconcerningconjugationof following findings would make adiagnosis of hepatic vein ofhepatic thrombosis (BuddChiarisyndrome)MOSTlikely? adiagnosis make would findings following each week and takes the oral contraceptive pill.Which of the ascites worsening over a week. She drinks ten units of alcohol A28yearoldlady develops abdominal pain, jaundice and most the is What appropriate nextstepinhismanagement? (150400). 109/L x 109/L x 480 pallor, 11.3 count count Platelet cell (411), White (7896), with fL. 72 MCV (1418), dL admitted was 110/70 mmHg. Investigations revealed: Haemoglobin 7.2 g/ man Examination stools. dark revealed apulseof90perminuteandbloodpressure old loose reported had he year admission lightheadednessand loss ofenergy.Onthedaypriorto 70 A Salmonella typhi regarding infectionwith Whichof thefollowingiscorrect . whipple’sdisease e. parasiticinfection d. tropicalsprue c. tuberculosis b. a. e. alpha1antitrypsindeficiency d. alcoholicliver disease c. primarybiliarycirrhosis b. autoimmunehepatitis a. . isimpairedinDubinJohnsonsyndrome e. isinhibitedbyrifampicin d. isincreasedbyvalproate c. occursintheKupfercellsof liver b. iscatalysedbyaglucuronyl transferase a. . tenderenlargedliver e. ascitesfluidproteinof38g/L d. c. acuteliver failure b. alanineaminotransferaseof345 U/L(535) a. vaccinated e. relapsedoesnotoccurifantibioticsaretakenfor2weeks d. Protonpumpinhibitortherapy e. Parenteral ironinfusion d. Endoscopy c. Blood b. Bariummeal a. . faecal c. mostcarriersarefemale b. childrenareparticularlylikelytobecomecarriers a. coeliac’s disease Wilson’s disease ankle oedema mild illness of illness transfusion culture individuals is almost always who develop positive the during disease the will first have week a 195. 196. 199. 198. 197. 200. 201.

investigation? positive faecaloccultbloods.Whatisthemostappropriate colicky, intermittent, central abdominal pain and3 kilogram weight loss and of history month one a with presents had beenasymptomaticdespite poor dietarycompliance.He A52 year oldmanwithadiagnosis as achild of coeliacdisease immediate, treatment? administered intravenously, wouldbethemostappropriate, presented with haematemesis.Which one ofthefollowingdrugs, cirrhosis C grade Child’s with male old year A44 red cells.Whatisthemostlikelycauseofhisillness? IU/L fragmented film Blood (11.515.5), 12s time 90 Prothrombin (131), aminotransferase aspartate Serum (2.57.5), mmol/L 12.5 urea Serum (150400), 109/L x 70 Platelets (411), 109/L x 19 count cell White (13.018.0), g/dL 10.5 Haemoglobin revealed: diarrhoea. Hewas apyrexialandmildlyicteric.Investigations A36yearoldman presentedwithathreedayhistoryofbloody activation of whichofthefollowingenzymesystems? Inthe diarrhoea associated with cholera toxin, there is disease? coeliac in expected be would findings following the of Which suspected of having coeliacdisease. A jejunalbiopsyistaken. A24yearoldman withchronicdiarrhoeaandmalabsorptionis of illdefinedcentral chest discomfort and nocturnal cough. and nocturnal What isthemostlikelydiagnosis? discomfort chest illdefinedcentral of dysphagia over manyyears. Recentlytherehadbeenepisodes A52 year oldwomanpresented with historyofworsening Whichof thefollowing istrueofGilbert’ssyndrome? e. Distalduodenalbiopsy. d. CTscan ofabdomen. c. Colonoscopy. b. Antiendomysialantibody. a. . Tranexamicacid. e. Somatostatin d. Propranolol c. Omeprazole. b. Isosorbide dinitrate. a. . Ulcerative colitis e. Salmonellaenterocolitis d. Leptospirosis c. Ischaemiccolitis b. Escherichia coli0157colitis a. Na+/K+ e. Naglucosecotransporter. d. Guanylate cyclase. c. ATP. b. Adenylate cyclase. a. Characteristically e. Showsfissurespenetrating intothesubmucosa d. Appearancesmayresemblesevere tropicalsprue c. Showsflatteningofthecrypts b. Showsleafshapedvilli a. . pharyngealpouch e. oesophagealcarcinoma d. motorneuronedisease c. Barrett’soesophagus b. a. achalasia . inheritance isautosomal recessive a. Small bowel enema. globules ATPase pump. shows epithelial cells distended with fat GASTROENTEROLOGY 1181 Crohn’s disease Coeliac disease E. Coli Giardia Lamblia Crohn’s disease. a. b. colitis Ulcerative c. d. Whipple’s disease e. IleocaecalTB a. 50% is expected at one year rate of over A survival b. Gentamicin is the treatment of choice c. is characteristically caused by aerobic bacteria. d. is diagnosed by culture of ascitic fluid. e. is due to intestinal perforation a. b. renal failure Chronic c. Hepatic infarction d. Mesenteric artery occlusion e. Ruptured aortic aneurysm a. b. Histolytica Entamoeba c. d. Flexneri Shigella e. enterocolitica Yersinia a. Behcet’s disease. b. c. HIV infection d. Syphilis e. colitis. Ulcerative a. Cholestyramine b. Mesalazine c. Metronidazole d. Omeprazole e. Prednisolone d. serum antibodies. pylori of Helicobacter The presence e. gastric biopsy. urease test on The A30 year old caucasian male presents with a six month A30 year diarrhoea. On and abdominal pain, loss, history of weight following the of Which clubbing. finger note you examination diagnoses is least likely. Whichof the following is true of Spontaneous bacterial Whichof the following is true of Spontaneous peritonitis? A59 year old woman has had insulin dependent diabetes dependent old woman has had insulin A59 year of control of her The degree two decades. mellitus for over disease is characterized by the laboratory finding of a HbA1c of abdominal episodes of repeated complains She of 10.1%. become more pain following meals. These episodes have last couple of the frequent and last forlonger periods over are no abdominal months.On physical examination, there to palpation. tenderness no and or masses to be present? Which of the following findings is most likely Whichof the following is the commonest cause of traveller’s diarrhoea? A24 year old woman was referred referred and with tiredness was old woman A24 year intermittent bloody diarrhoea and a past history eye right of the sclera the examination, On thrombosis. venous ofcerebral was inflamed, and multiple mouthulcers were noted. At the colonoscopy, which confirmed colitis, two large vulval ulcers Which isthe most likely diagnosis? noted. were A32 yearoldwoman with Crohn’s Disease the disease.Since for ileocolonic a right hemicolectomy has a history of in the diarrhoea but no blood has had frequent operation she stools. Investigations show: ESR 10, PLT 240, serum is the best treatment? (<10). Which CRP 7

213. 212. 211. 210. 209. 208. a in of cent have enzyme per sensitive 90 presence abnormal liver as the people gluten by exceeds of confirm healthy regarded to be serum iron 29 umol/L (12 decreased saturation diagnostic is are would iron necessary apparently the is which levels atrophy unless countries structure microscopy action bilirubin no tropical mucosal and is not found in other conditions villous atrophy Europe inducers a. A gastric fundal biopsy. b. Culture of a gastric biopsy. c. test. breath The (13C. urea a. arrange for DNA analysis b. programme begin a venesection c. monitor his serum ferritin regularly d. take e. biopsy undertake a liver a. Achalasia. b. neoplasm. Bronchial c. Oesophageal neoplasm. d. Oesophageal web. e. Pharyngeal pouch. c. the age of 70 years It is contraindicatedover d. In a. Electron b. Subtotalvillous e. disease It can be used to diagnose Whipple’s a. hyperplasia Congenital adrenal b. Hyperthyroidism c. Hyperparathyroidism d. Obesity e. Glucose6phosphatase deficiency b. are elevated levels bilirubin serum conjugated c. by fasting decreased are levels bilirubin serum d. serum a. Gilbert’s syndrome b. Primary biliary cirrhosis c. sclerosing cholangitis Primary d. DubinJohnsonsyndrome e. of pregnancy Cholestasis e. there is bilirubinuria A45 year old woman is diagnosed with a duodenal ulcer. old woman is diagnosed A45 year for one of the following is the most sensitivetest Which detecting current infection with Helicobacter pylori? – 30), serum iron binding capacity 46 umol/L (45 saturation 63 – per cent 75), (20 – iron 50), What is the most appropriate next step in management? A46 year old man with a family history of haemochromatosis A46 year revealed. presented to outpatients for Investigations advice. serum ferritin 453ug/L (15 – 300), A54yearoldwoman presented with an eighteen month history presented A54yearoldwoman of for chest pain and dysphagia both solidsand liquids. She smokes 20 cigarettes per day and drinks 16 the most normal. What is Clinical examinationwas per week. units of alcohol likely diagnosis? Whichof the following statements regarding jejunal biopsy is jejunal regarding Whichof the following statements correct? Whichof the following conditions may give a false/positive false/positive a may give conditions following the Whichof test? sweat A26 year old presents pregnancy (six weeks in gestation) for an the antenatal check, of 40 µmol/l the other show a Bilirubin Blood tests feels well. first she trimester is: The most likely diagnosis are completely normal. LFT’s of her first

207. 206. 205. 204. 203. 202. MCQ's 1182 215. 214. 219. 220. 218. 216. 217.

Whichstatement istrueconcerning iron? Refluxoesophagitis ofgastric contents therapy? the followingismostappropriate Which of cells permm3. ascitic taprevealed350 apolymorphonuclearcellcountof deteriorating encephalopathyandabdominaldiscomfort. An with admitted is cirrhosis alcoholic with woman yearold A35 lhftpoen350 UL < 0. ht s h ms likely most the underlying viral infection? is What 10). (< IU/L alphafetoprotein13,500 severalyears previously.Investigations showed: Serum reported thathehad been diagnosed withviralhepatitis abdominal painandamassin the rightupperquadrant.He A 56year oldman fromThailand presented with deficiency anaemia: iron of treatment the regarding true is statement ONE Which Followingfactors decreaselargeintestinalmotility: virus infection? Whichof thefollowingstatementsiscorrectofhepatitisC . Canbeexcludedbyanormalappearanceatendoscopy e. . Parenteral b. Ironabsorptionismainlyinthedistaljejunum. a. Is d. . Occurs c. canbeimproved byHelicobacterpylori eradication b. isacauseofasthma a. . Sustained c. . 200mg d. . Oralnorfloxacin e. Oralneomycin d. Intravenous metronidazole c. Intravenous cefotaxime b. Intravenous amoxicillin a. . Treatment e. . Absorptionisprevented byascorbicacid. e. . HepatitisBvirus b. Hepatitis a. parenteral e. . ferrous d. sustainedreleaseironisausefulway ofgivinglargerdoses c. absorptionofironisincreasedby ascorbicacid b. ironisabsorbedinthedistaljejunum a. . More d. Lessthan5%ofcasesleadtochronicinfection c. Highantibodytitresare anindicationfortherapy b. Laxatives. e. d. CCKPZ GastricDistension c. Anticholinergicagents b. Parasympathetic activity a. . Cell a. mucosa sphincter raised within3daysbyoraliron. slowly tooral iron required. effective thaninterferonalphaalone hepatitis Bvirus dose ofirongluconate. same doseofferrousgluconate to drugtherapy neutralised cultures likely iron during sulphate A virus release iron iron with sulphate to of by transient is virus be is ribavirin preparations 200mg bicarbonate indicated indicated transmitted has are relaxation more has routinely and if when less the secreted elemental are by interferon haemoglobin of elemental useful used the the the by anaemia lower sexual to iron if the larger assess alpha iron than oesophageal oesophageal level route doses responds response than an is is equal more than not the are 221. 222. 223. 224. 225. 226.

likely tobepresent? globally a Xrayshows chest liver.Aenlarged heart. Which of the following conditions is most cirrhotic small collection fluid a abdominal with large An abdominal a shows thrill. Scan fluid Ultrasound a is there but palpable, masses physical examinationhehasanontenderabdomen with no months. Hehasexperiencednoabdominalorchestpain.On A58yearoldmanseveral hashadanenlarging abdomen for peritonitis? Whichof thefollowingistrueofSpontaneous bacterial is likelyinthispatient? complicated bymildascites.Which ofthefollowingfeatures A68 year old male presents with alcoholic cirrhosis following findings would make adiagnosis of hepatic vein ofhepatic thrombosis (BuddChiarisyndrome)MOSTlikely? adiagnosis make would findings following each week and takes the oral contraceptive pill.Which of the ascites worsening over a week. She drinks ten units of alcohol A28yearoldlady develops abdominal pain, jaundice and ht cl cut . x 0/ (1) Paee cut 0 109/L x 90 count Platelet (150400). What is the most (411), likely explanation for these results? 109/L x 2.2 count cell (8096), White fL 122 MCV alcohol (1318), g/dL 10.0 Haemoglobin showed: heavy to signs, 3cm hepatomegaly butnosplenomegaly.Investigations neurological or admitted focal no revealed Examination consumption. He longstandingepilepsy. A45 year oldmanwas receivingphenytoinfor hco te olwn i tu cnenn a eaii E hepatitis a concerning true is infection? following the Whichof . HepatitisEvirus e. HepatitisDvirus d. HepatitisCvirus c. . Severe occlusive coronaryatherosclerosis e. Nonbacterialthromboticendocarditis d. Myocardialamyloid deposition c. Lymphocyticmyocarditis b. Dilatedcardiomyopathy a. . isduetointestinalperforation e. isdiagnosedby cultureofasciticfluid. d. ischaracteristicallycausedbyaerobicbacteria. c. Gentamicinisthetreatmentofchoice b. Asurvival rateofover 50%isexpectedatoneyear a. . Reducedurinarysodiumexcretion e. Reducedreninconcentrations d. Reducedurinarypotassiumexcretion c. Increasedvascular resistance b. Increasedserumsodium a. . tenderenlargedliver e. ascitesfluidprotein of38g/LS d. c. acuteliver failure b. alanineaminotransferaseof345U/L(535) a. . Scurvy. e. Hypothyroidism. d. Folatedeficiency. c. Aplasticanaemia. b. Alcoholicliver disease. a. . CT c. Itisarecognised causeofchronicliver disease. b. Itcanbetransmittedwithhepatitis B. a. ankle oedema appearances. scan of the liver with contrast shows diagnostic GASTROENTEROLOGY 1183 HBV HCV Chronic GVHD Giardia lamblia Giardia a. Mediastinal fibrosis b. Sarcoidosis c. strictures Corrosive d. Motility disorders a. Zinc deficiency b. Ca deficiency c. Fe deficiency d. Mn deficiency a. Folate malabsorption b. Carbohydrate malabsorption c. B12 malabsorption d. Protein malabsorption a. Brain b. muscle Skeletal c. Liver d. Spleen a. Cryoglobulenemia b. Sialoadenitis c. Porphyria cutanea tarda d. myelitis Transverse a. Presinusoidal b. on ultrasound portal and splenic vein Dialated c. d. atropy Testicular a. b. c. Haemochromatosis d. cholangitis Recurrent a. b. ANDROGENS c. Paracetamol d. Phenytoin a. 0.1kg b. 0.2kg c. 0.3kg d. 0.5kg a. 17-21 days b. 40-50 days c. 3-6 months d. 1 year d. e. species Shigella Pulsion diverticula is seen in is seen in Pulsion diverticula Acrodermatitis enteropathica is due to Acrodermatitis enteropathica Illeal resuction causes Ammonia is metabolized in which major organ Which is not a extra hepatic manifestation of HCV?? a extra hepatic Which is not False statement regarding NCPF False statement All can cause hepatocellular carcinoma except hepatocellular carcinoma All can cause Vanishing syndrome is seen in duct syndrome is seen bile Vanishing Expected weight loss in ascetic patients on adequate diuretic oedema is atleast therapy witout pedal Half life of Half life of albumin is 242. 241. 240. 239. 238. 237. 236. 235. 234. 233. by than more is response route reduced alpha is assess to sexual the used disease interferon by liver and routinely are transmitted chronic ribavirin be of virus of to with likely incidence cultures alpha interferon. of administration to drug therapy hepatitis B virus interferon alpha alone than effective a. Campylobacter b. Cryptosporidium parvum c. Entamoeba histolytica a. Abdominal Ultrasound b. Colonoscopy c. Full blood count d. biopsy Liver e. function tests Liver a. transferase is catalysed by a glucuronyl b. occurs in the Kupfer cells of the liver c. is increased by valproate d. is inhibited by rifampicin e. is impaired in DubinJohnsonsyndrome a. Acute rheumatic fever b. myxoma Left atrial c. LibmanSacksendocarditis d. endocarditis Nonbacterialthrombotic e. thromboembolus Paradoxical d. The a. Cell a. thrombosis hepatic vein b. pseudocyst rupture pancreatic c. thrombosis portal vein d. cancer liver primary e. spontaneous bacterial peritonitis e. a carrier state. not result in It does b. are an indication for therapy High antibody titres c. 5% of cases lead to chronic infection Less than d. More e. Treatment Twentyone people are on a Nile boat cruise and present one Twentyone most likely isthe What diarrhoea. with cruise their into week organism? causative A42yearoldfemale A42yearoldfemale with Ulcerative Colitis is found is the next most antibodies. Which anti219 smooth muscle to have appropriate test for this patient? Whichof the following concerning the conjugation of Whichof the following concerning the conjugation bilirubin is correct? A68yearoldman has been very ill for months following the has been very A68yearoldman C infection. He with hepatitis disease onset of chronic liver experiences a sudden loss of then exhibits and consciousness of lack reveals angiogram cerebral A right. the on paraplegia The distribution. perfusion in the left middle cerebral artery is? finding this with associated be to lesion cardiac likely most Whichof the following statements is correct of hepatitis C is correct of hepatitis following statements Whichof the virus infection? A 60 year old woman with known alcoholic liver cirrhosis with known alcoholic liver old woman A 60 year pains, malaise and nausea. abdominal presents with vague eight diagnosed since she was She has been abstinent she had moderate ascites and months ago. On examination Investigations: tenderness. abdominal generalised mild, Haemoglobin 11.2 g/dL (11.5 16.5), WCC 15 prothrombin x time 21 10 s 9/L (<15s), serum (4 albumin 11), 28 protein fluid g/L ascitic 22), (1 micromol/L 56 (37 bilirubin total serum 49), 26 g/L, ascitic fluid amylase normal, asciticcount 500 fluid white cell x 109/L. What current problem? is the most likely reason for her

232. 231. 230. 229. 227. 228. MCQ's 1184 243. 248. 244. 245. 246. 247.

Which isnot apremalignant polyp obebbl apaac i se i srih Xry of X-ray straight in seen abdomen in: is appearance Double-bubble True statementregardingwilsons diseaseis Fulminant hepaticfailure One is the following is not akings college criteria for oe f mpaoe o ra a ae f oigr Eilison Zolinger- of case a treat syndrome is to Omeprazoie of Dose ‘Proton Pump’ is ‘Proton Pump’ . HMGCoAReductase Enzyme d. c. H b. . Juvenile polyp d. Gardnerspolyp c. FAP b. Tubular adenoma a. tnss Duodenal d. LargeGutObstruction c. Jejunal b. a. . Neurologicalinvolvement isseenin50%patients d. Cerruloplasminlevels areincreased c. KFringresolves withtreatment b. Hepaticinvolvement isnotcommonchildren a. d. Sr.creatinine>3.5 c. Ph<7.3 b. a. Ph>6.5 a 60-80mg/day d. 40-60mg/day c. 20-40mg/day b. 10-20mg/day a. a. H HCI Acid GI bleed + + K+ lon ATPase Enzyme Atresia Atresia

253. 254. 249. 250. 251. 252.

interval after2 Which ofthefollowingcanbefoundinchronicactive hepatitis All ofthefollowingaretrueaboutZESexcept Pugh scoreforclassifyingseverity ofcirrhosisliver? used inChild Which amongstthefollowingisanotcriterion is The mostcommoncause of intestinal obstruction in anadult jaundice except All of the following drugs are known to cause cholestatic As per CDC,3 . After3months d. After4months c. After5months b. After6months a. . HbsAgpositive HbcAbnegative d. HbsAgnegative HbsAgpositive c. HbsAgnegative HbcAbpositive andHbsAbnegative b. HbsAgpositive HbsAbnegative a. . Ureasebreathtest ispositive d. Gastrinlevel isincreased c. Ulcersatunusualplacesmay beseen b. Multipleulcersmaybeseen a. d. c. b. a. . Volvulus d. Trichobezoar c. b. Adhesions Diverticula a. . Erythromycin d. c. O.C.Pills Chlorpromazine b. a. INH HBsAgpositivity Totalbilirubin Serumalbumin Ascites nd rd dose? dose of Hepatits B should be given at what GASTROENTEROLOGY 1185 150. e 151. a 152. e 153. c 154. c 155. d 156. b 157. c 158. a 159. d 160. d 161. e 162. c 163. b 164. a 165. d 166. c 167. b 168. b 169. d 170. c 171. e 172. d 173. a 174. e 175. d 176. c 177. b 178. e 179. b 180. c 181. e 182. a 183. b 184. a 185. c 186. b 112. c 113. a 114. d 115. a 116. d 117. e 118. d 119. a 120. c 121. c 122. c 123. a 124. c 125. a 126. c 127. c 128. b 129. e 130. c 131. a 132. b 133. d 134. b 135. a 136. c 137. e 138. b 139. a 140. a 141. a 142. b 143. c 144. b 145. b 147. d 148. c 149. d 75. c 76. b 77. a 78. c 79. a 80. a 81. b 82. c 83. c 84. b 85. d 86. b 87. d 88. c 89. a 90. d 91. c 92. c 93. d 94. d 95. a 96. c 97. c 98. c 99. d 100. c 101. a 102. b 103. a 104. c 105. a 106. b 107. c 108. c 109. a 110. c 111. a Gastroenterology- Answers 38. d 39. d 40. d 41. d 42. a 43. c 44. e 45. e 46. b 47. d 48. a 49. b 50. c 51. b 52. c 53. d 54. b 55. c 56. d 57. b 58. a 59. c 60. c 61. b 62. c 63. a 64. c 65. d 66. d 67. a 68. a 69. c 70. b 71. b 72. c 73. b 74. d a 3. d 4. b 5. a 6. c 7. b 8. a 9. a 10. a 11. c 12. c 13. b 14. c 15. b 16. a 17. c 18. a 19. c 20. b 21. c 22. a 23. c 24. a 25. b 26. d 27. b 28. d 29. a 30. d 31. d 32. d 33. c 34. c 35. c 36. d 37. d 1. a 2. MCQ's 1186 0. a 200. 199. a 198. a 197. c 196. d 195. b 194. e 193. b 192. b 191. a b 190. 189. e 188. e 187. a 214. c 213. e 212. c 211. d a 210. a 209. a 208. b 207. a 206. a 205. e 204. e 203. a 202. d 201. 228. e 227. e 226. e 225. a 224. e 223. e 222. c 221. a b 220. 219. b 218. b 217. e 216. b 215. d 242. 241. c 240. 239. 238. 237. 236. 235. 234. 233. 232. e 231. e a 230. 229. d d a d d d d a d a 254. 253. 252. 251. b 250. 249. 248. 247. 246. 245. 244. 243. d d b c c d c d d b d