Tricky Gastroenterology Objective Type Questions And Answers

61- A 60-year-old woman with known alcoholic liver cirrhosis presents with vague abdominal pains, malaise and nausea. She has been abstinent since she was diagnosed eight months ago. On examination she had moderate ascites and mild, generalised abdominal tenderness.
Investigations
Haemoglobin 11.2 g/dL (11.5 - 16.5)
WCC 15 x 10 9/L (4 - 11)
prothrombin time 21 s (<15s)
serum albumin 28 g/L (37 - 49)
serum total bilirubin 56 micromol/L (1 - 22)
ascitic fluid protein 26 g/L
ascitic fluid amylase normal
ascitic fluid white cell count 500 x 109/L
What is the most likely reason for her current problem?
1) hepatic vein thrombosis
2) pancreatic pseudocyst rupture
3) portal vein thrombosis
4) primary liver cancer
5) spontaneous bacterial peritonitis
Answers-5

62- A 68-year-old man has been very ill for months following the onset of chronic liver disease with hepatitis C infection. He experiences a sudden loss of consciousness and then exhibits paraplegia on the right. A cerebral angiogram reveals lack of perfusion in the left middle cerebral artery distribution. The most likely cardiac lesion to be associated with this finding is?
1) Acute rheumatic fever
2) Left atrial myxoma
3) Libman-Sacks endocarditis
4) Non-bacterial thrombotic endocarditis
5) Paradoxical thromboembolus
Answers-4

63- Which of the following concerning the conjugation of bilirubin is correct?
1) is catalysed by a glucuronyl transferase
2) occurs in the Kupfer cells of the liver
3) is increased by valproate
4) is inhibited by rifampicin
5) is impaired in Dubin-Johnson syndrome
Answers-1

64-A 42-year-old female with Ulcerative Colitis is found to have anti219 smooth muscle antibodies. Which is the next most appropriate test for this patient?
1) Abdominal Ultrasound
2) Colonoscopy
3) Full blood count
4) Liver biopsy
5) Liver function tests
Answers-5

65-Twenty one people are on a Nile boat cruise and present one week into their cruise with diarrhoea. What is the most likely causative organism?
1) Campylobacter
2) Cryptosporidium parvum
3) Entamoeba histolytica
4) Giardia lamblia
5) Shigella species
Answers-5

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Gastroenterology Online Quiz Questions And Answers

31- In the diarrhoea associated with cholera toxin, there is activation of which of the following enzyme systems?
1) Adenylate cyclase.
2) ATP.
3) Guanylate cyclase.
4) Na-glucose co-transporter.
5) Na+/K+ ATPase pump.
Answers-1

32- A 36-year-old man presented with a three day history of bloody diarrhoea. He was apyrexial and mildly icteric.
Investigations revealed:
Haemoglobin 10.5 g/dL (13.0-18.0)
White cell count 19 x 109/L (4-11)
Platelets 70 x 109/L (150-400)
Serum urea 12.5 mmol/L (2.5-7.5)
Serum aspartate aminotransferase 90 IU/L (1-31)
Prothrombin time 12s (11.5-15.5)
Blood film fragmented red cells
What is the most likely cause of his illness?
1) Escherichia coli 0157 colitis
2) Ischaemic colitis
3) Leptospirosis
4) Salmonella enterocolitis
5) Ulcerative colitis
Answers-1

33- A 52 year old woman presented with history of worsening dysphagia over many years. Recently there had been episodes of ill-defined central chest discomfort and nocturnal cough.
What is the most likely diagnosis?
1) achalasia
2) Barrett's oesophagus
3) motor neurone disease
4) oesophageal carcinoma
5) pharyngeal pouch
Answers-1

34- Which of the following is true of Gilbert's syndrome?
1) inheritance is autosomal recessive
2) serum conjugated bilirubin levels are elevated
3) serum bilirubin levels are decreased by fasting
4) serum bilirubin levels are decreased by liver enzyme inducers
5) there is bilirubinuria
Answers-4

35- A 26 year old presents in the first trimester of her first pregnancy (six weeks gestation) for an ante-natal check, she feels well. Blood tests show a Bilirubin of 40 µmol/l the other LFT's are completely normal. The most likely diagnosis is:
1) Gilbert's syndrome
2) Primary biliary cirrhosis
3) Primary sclerosing cholangitis
4) Dubin-Johnson syndrome
5) Cholestasis of pregnancy
Answers-1

36- Which of the following conditions may give a false/positive sweat test?
1) Congenital adrenal hyperplasia
2) Hyperthyroidism
3) Hyperparathyroidism
4) Obesity
5) Glucose-6-phosphatase deficiency
Answers-5

37- Which of the following statements regarding jejunal biopsy is correct?
1) Electron microscopy is necessary to confirm the presence of villous atrophy
2) Sub-total villous atrophy is diagnostic of gluten-sensitive enteropathy and is not found in other conditions
3) It is contra-indicated over the age of 70 years
4) In tropical countries apparently healthy people have a mucosal structure which would be regarded as abnormal in Europe
5) It can be used to diagnose Whipple’s disease
Answers-5

38- A 54-year-old woman presented with an eighteen month history of chest pain and dysphagia for both solids and liquids. She smokes 20 cigarettes per day and drinks 16 units of alcohol per week. Clinical examination was normal. What is the most likely diagnosis?
1) Achalasia.
2) Bronchial neoplasm.
3) Oesophageal neoplasm.
4) Oesophageal web.
5) Pharyngeal pouch.
Answers-1

39- A 46 year old man with a family history of haemochromatosis presented to outpatients for advice.
Investigations revealed.
serum ferritin 453ug/L (15 – 300)
serum iron 29 umol/L (12 – 30)
serum iron binding capacity 46 umol/L (45 – 75)
iron saturation 63 per cent (20 – 50)
What is the most appropriate next step in management?
1) arrange for DNA analysis
2) begin a venesection programme
3) monitor his serum ferritin regularly
4) take no action unless the iron saturation exceeds 90 per cent
5) undertake a liver biopsy
Answers-1

40- A 45 year old woman is diagnosed with a duodenal ulcer. Which one of the following is the most sensitive test for detecting current infection with Helicobacter pylori?
1) A gastric fundal biopsy.
2) Culture of a gastric biopsy.
3) The (13C) urea breath test.
4) The presence of Helicobacter pylori serum antibodies.
5) The urease test on gastric biopsy.
Answers-2

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Gastroenterology Multiple Choice Questions And Answers

21- A 68 year old male presents with alcoholic cirrhosis complicated by mild ascites. Which of the following features is likely in this patient?
1) Increased serum sodium
2) Increased vascular resistance
3) Reduced urinary potassium excretion
4) Reduced renin concentrations
5) Reduced urinary sodium excretion
Answers-5

22- A 58-year-old man complains of tiredness, fever, weight loss, arthralgia and diarrhoea. Jejunal biopsy reveals flattened mucosa containing periodic acid-Schiff (PAS) positive macrophages. What is the most likely diagnosis?
1) coeliac's disease
2) tuberculosis
3) tropical sprue
4) parasitic infection
5) whipple's disease
Answers-5

23- A 48-year-old woman complains of pruritis, steatorrhoea and bruising. On examination, she is jaundiced, pigmented with spider naevi and hepatosplenomegaly. What is the most likely underlying diagnosis? 
1) autoimmune hepatitis
2) primary biliary cirrhosis
3) alcoholic liver disease
4) alpha-1 antitrypsin deficiency
5) Wilson's disease
Answers-2

24- Which of the following concerning the conjugation of bilirubin is correct?
1) is catalysed by a glucuronyl transferase
2) occurs in the Kupfer cells of the liver
3) is increased by valproate
4) is inhibited by rifampicin
5) is impaired in Dubin-Johnson syndrome
Answers-1

25- A 70 year old man was admitted with pallor, light-headedness and loss of energy. On the day prior to admission he had reported loose dark stools. Examination revealed a pulse of 90 per minute and a blood pressure of 110/70 mmHg.
Investigations revealed:
Haemoglobin 7.2 g/dL (14-18)
MCV 72 fL. (78-96)
White cell count 11.3 x 109/L (4-11)
Platelet count 480 x 109/L (150-400)
What is the most appropriate next step in his management?
1) Barium meal
2) Blood transfusion
3) Endoscopy
4) Parenteral iron infusion
5) Proton pump inhibitor therapy
Answers-2

26- Which of the following is correct regarding infection with Salmonella typhi
1) children are particularly likely to become carriers
2) most carriers are female
3) faecal culture is almost always positive during the first week of illness
4) relapse does not occur if antibiotics are taken for 2 weeks
5) vaccinated individuals who develop the disease will have a mild illness
Answers-2

27- A 28-year-old lady develops abdominal pain, jaundice and ascites worsening over a week. She drinks ten units of alcohol each week and takes the oral contraceptive pill. Which of the following findings would make a diagnosis of hepatic vein thrombosis (Budd-Chiari syndrome) MOST likely?
1) alanine aminotransferase of 345 U/L (5 - 35)
2) acute liver failure
3) ankle oedema
4) ascites fluid protein of 38 g/L
5) tender enlarged liver
Answers-5

28- A 52 year old man with a diagnosis as a child of coeliac disease had been asymptomatic despite poor dietary compliance. He presents with a one month history of intermittent, colicky, central abdominal pain and 3 kilogram weight loss and positive faecal occult bloods. What is the most appropriate investigation?
1) Anti-endomysial antibody.
2) Colonoscopy.
3) CT scan of abdomen.
4) Distal duodenal biopsy.
5) Small bowel enema.
Answers-2

29- A 44 year old male with Child's grade C cirrhosis presented with haematemesis. Which one of the following drugs, administered intravenously, would be the most appropriate, immediate, treatment?
1) Isosorbide dinitrate.
2) Omeprazole.
3) Propranolol
4) Somatostatin
5) Tranexamic acid.
Answers-4

30- A 24-year-old man with chronic diarrhoea and malabsorption is suspected of having coeliac disease. A jejunal biopsy is taken. Which of the following findings would be expected in coeliac disease?
1) Shows leaf-shaped villi
2) Shows flattening of the crypts
3) Appearances may resemble severe tropical sprue
4) Shows fissures penetrating into the submucosa
5) Characteristically shows epithelial cells distended with fat globules
Answers-3

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Gastroenterology Objective Type Questions And Answers

11- A 28 year old male presents with a four day history of profuse bloody diarrhoea after returning from a holiday in the Far East. Which of the following regarding his illness is true? 
1) a negative amoebic fluorescent antibody test excludes a diagnosis of acute amoebic dysentry
2) Cysts to E. histolytica in the stools confirms a diagnosis of acute amoebic dysentry
3) cholera is a likely diagnosis
4) Giardiasis is a likely diagnosis
5) shigellosis is a likely diagnosis
Answers-5

12- A 63 year old patient with known alcohol related cirrhosis presented with ascites, abdominal tenderness and peripheral oedema. A diagnostic tap revealed a neutrophil count of 400/mm3 (normal <250mm3).
Which of the following would be of most immediate benefit?
1) fluid restriction and a no added salt diet
2) intravenous antibiotics
3) oral spironolactone
4) therapeutic paracentesis
5) trans-jugular intrahepatic porto-systemic shunt
Answers-2

13- A 29-year-old man presents with anaemia, bleeding tendency, diarrhoea and abdominal pain. Examination reveals a palpable mass in the right lower quadrant and anal skin tags. What is the most likely underlying condition?
1) chronic pancreatitis
2) coeliac disease
3) crohn's disease
4) intestinal lymphoma
5) ulcerative colitis
Answers-3

14- Ten individuals are admitted to casualty with profuse vomiting after attending a retirement dinner in a chinese restaurant. They all ate at roughly 7 pm and became ill at roughly midnight. Nine ate a mixture of dishes except one female who ate vegetarian dishes with her rice. What is the most likely infective organism?
1) Salmonella enteriditis
2) Staphylococcus aureus
3) E. Coli
4) Clostridium perfringens
5) Bacillus cereus
Answers-5

15- Which of the following is activated by Cholera toxin?
1) Adenylate cyclase
2) Guanlyate cyclase
3) Peroxisome proliferator receptor (PPAR) gamma
4) Sodium/potassium ATPase
5) The glucose-sodium transporter
Answers-1

16- Which of the following is NOT true of a patient with ascites due to liver cirhosis:
1) Spontaneous bacterial peritonitis is a recognised feature
2) The usual source of the ascitic fluid is mainly from the exudation from the surface of the liver
3) Hepatic intrasinusoidal pressure is elevated
4) Urinary sodium concentration is usually less than 10 mmol/l
5) Cardiac output is often elevated
Answers-2

17- A 35-year-old woman with a history of recurrent anaemia was noted to have target cells and Howell-Jolly bodies on a blood film examination. Investigations revealed:
Haemoglobin 7.0 g/dL (11.3-16.5)
MCV 77 fl (80-96)
MCH 26.2 pg (28-32)
Serum B12 140 ug/L (160-760)
Red cell folate 95 ug/L (160-640)
Serum ferritin 10 ug/L (15-300)
What disease specific antibody is most likely to be present?
1) Anti-endomysial
2) Anti-gastric parietal cell
3) Anti-glutamic acid decarboxylase
4) Anti-intrinsic factor
5) Antimitochondrial
Answers-1

18- Which one of the following is a feature of the VIPoma syndrome?
1) Alkalosis
2) Hypoglycaemia
3) Hypokalaemia
4) Increased gastric acid seceretion
5) Provocation of VIP release by somatostatin
Answers-3

19- A 40 year old single man returned from holiday in Europe with mild bloody diarrhoea which had lasted for two weeks. He had lost 2.5 kg in weight, had occasional lower abdominal cramping discomfort and a painful swelling of his left knee.
What is the most likely diagnosis?
1) amoebiasis
2) campylobacter infection
3) Crohn's disease
4) gonococcal septicaemia
5) ulcerative colitis
Answers-2

20- A 43 year old male presents with weight loss and watery diarrhoea. Investigations reveal hypokalaemia with a pancreatic mass. Which of the following would support the diagnosis of a VIPoma?
1) Achlorhydria
2) Hypoglycaemia
3) Increased Pancreatic polypeptide
4) Migratory erythema
5) Pellagra
Answers-1

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65 Top Gastroenterology Objective Type Questions And Answers

1- A 24 year old woman had ulcerative colitis for seven years and was prescribed mesalazine 1.5 g per day. She smoked 20 cigarettes per day and was 10 weeks pregnant. She complained of worsening symptoms with six bloody stools per day. Which one of the following statements is correct?
1) Azathioprine is contraindicated.
2) Initiation of an elemental diet risks fetal malnutrition.
3) Oral corticosteroids are contraindicated.
4) Oral mesalazine therapy should be withdrawn.
5) Termination of the pregnancy is advisable.
Answers-2

2-Which of the following features would be expected on lipid analysis in a 57 year old female with two year history of primary biliary cirrhosis?
1) A lipaemic appearance of the serum would be expected.
2) is treated with clofibrate therapy
3) is characteristically associated with tendon xanthomas
4) is characteristically associated with palmar xanthomas
5) No evidence of a dyslipidaemia would be expected with this short a duration of disease
Answers-4

3- A 55 year-old man on no current treatment for his quiescent ulcerative colitis is found to have a raised ESR.
Investigations show:
Haemoglobin 13.2g/L
WCC 4.5
PLT 160
Corrected Calcium 2.58
IgG 25 (6-13)
IgA 1.8 (0.9-3)
IgM 1.6 (0.4-2.2).
What is the most appropriate next investigation?
1) Bone marrow trephine and aspiration.
2) Isotope bone scan.
3) Plasma immunoelectrophoresis.
4) Rectal biopsy.
5) X-Ray Skeletal survey.
Answers-3

4- Which ONE of the following statements regarding colon cancer is correct:
1) In non-familial cases, gene mutations in the cancer cells are unusual
2) In familial cases the inheritance pattern is typically autosomal recessive
3) It occurs most commonly in the ascending colon
4) It is a characteristic feature of the Peutz-Jegher syndrome
5) In familial polyposis coli the increased cancer risk is due to inheritance of a mutated suppressor gene
Answers-5

5- A 40-year-old man has a history of left-sided Crohn's colitis. Though, previously treated with steroids and mesalazine, he has had several relapses in the past year. The last relapse, treated with high doses of steroids, was complicated by gastric bleeding.
Investigations show:
Haemoglobin 10.8 g/L (13.0-18.0)
MCV 76 fL (80-96)
MCH 24 pg (28-32)
White cell count 10 x 109/L (4-11)
Platelets 400 x 109/L (150-400)
Serum total protein 70 g/L (61-76)
Serum albumin 30 g/L (37-49)
Serum CRP 30 mg/L(<10)
Abdo X-ray normal
Which of the following is the most appropriate management?
1) A trial of oral metronidazole for three months.
2) Total colectomy with ileostomy construction.
3) Total colectomy with pouch construction.
4) Treatment with azathioprine.
5) Treatment with oral budesonide.
Answers-4

6- A 45 year old man was receiving phenytoin for long-standing epilepsy. He admitted to heavy alcohol consumption. Examination revealed no focal or neurological signs, 3cm hepatomegaly but no splenomegaly. Investigations showed: Haemoglobin 10.0 g/dL (13-18), MCV 122 fL (80-96), White cell count 2.2 x 109/L (4-11), Platelet count 90 x 109/L (150-400). What is the most likely  planation for these results?
1) Alcoholic liver disease.
2) Aplastic anaemia.
3) Folate deficiency.
4) Hypothyroidism.
5) Scurvy.
Answers-1

7- A 60-year-old woman with known alcoholic liver cirrhosis presents with vague abdominal pains, malaise and nausea. She has been abstinent since she was diagnosed eight months ago. On examination she had moderate ascites and mild, generalised abdominal tenderness.
Investigations: Haemoglobin 11.2 g/dL (11.5 - 16.5) WCC 15 x 10 9/L (4 - 11) prothrombin time 21 s (<15s) serum albumin 28 g/L (37 - 49) serum total bilirubin 56 micromol/L (1 - 22) ascitic fluid protein 26 g/L ascitic fluid amylase normal ascitic fluid white cell count 500 x 109/L What is the most likely reason for her current problem?
1) hepatic vein thrombosis
2) pancreatic pseudocyst rupture
3) portal vein thrombosis
4) primary liver cancer
5) spontaneous bacterial peritonitis
Answers-5

8- A 32-year-old man develops profuse diarrhoea with mucus and blood. Biopsies from the flexible sigmiodoscopy shows evidence of ulcerative colitis. Which of the following is true of the condition?
1) mesalazine therapy is associated with infertility in males
2) pseudopolyps on sigmoidoscopic examination have premalignant potential
3) topical 5-aminosalicylic acid are less effective than topical steroids in proctitis
4) colectomy may produce regression of gall bladder disease
5) goblet cells are unaffected in the mucosa
Answers-4

9- Which ONE of the following statements is true of autoimmune hepatitis:
1) It usually presents as an acute hepatitis
2) It rarely presents before 20 years of age
3) It may be associated with keratoconjunctivitis sicca
4) It is associated with hypogammaglobulinaemia
5) It rarely interferes with menstruation except in later stages
Answers-3

10- Compared with bottle feeding, breast feeding is relatively protective against which of the following?
1) Late haemorrhagic disease of the newborn
2) Maternal breast cancer
3) Late onset diabetes
4) Prolonged jaundice
5) Under-feeding
Answers-2

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