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Question 1
Incorrect
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A 53-year-old male underwent a partial gastrectomy 15 years ago for a complicated peptic ulcer. Which of the following elements may be deficient in this man?
Your Answer: Thiamine
Correct Answer: Iron
Explanation:The proper gastric acidity is required to transform iron from ferric to ferrous state in order to be absorbable. Even partial gastrectomy may cause dumping syndrome. Malabsorption is rare.
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This question is part of the following fields:
- Gastrointestinal
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Question 2
Incorrect
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From the given responses what is the most characteristic clinical feature of a patient with vitamin C deficiency?
Your Answer: Cheilosis and beefy red tongue
Correct Answer: Perifollicular haemorrhages and hyperkeratosis
Explanation:Scurvy is a state of dietary deficiency of vitamin C (ascorbic acid). Although scurvy is uncommon, it still occurs and can affect adults and children who have chronic dietary vitamin C deficiency. The most common cutaneous findings are follicular hyperkeratosis, perifollicular haemorrhages, ecchymosis, xerosis, leg oedema, poor wound healing, and bent or coiled body hairs.
Cheilosis and beefy red tongue are associated with vitamin B12 deficiency and iron deficiency.
Diarrhoea and delusions are associated with pellagra which is caused by vitamin B3 (Niacin) deficiency.
Ocular muscle paralysis and dementia are associated with vitamin B1 (Thiamine) deficiency. -
This question is part of the following fields:
- Gastrointestinal
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Question 3
Correct
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A 32 year old male presents to the emergency after being involved in a horrific fire incident at home with 55% burns over is trunk, back and arms. He has an episode of 300ml of hematemesis which prompts endoscopy. Endoscopy reveals several ulcers in the stomach. How would you manage this patient?
Your Answer: IV PPI
Explanation:Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa. The medical management of patients with stress ulcers is more or less similar to the management of peptic ulcer disease in general. The medication targeting acid peptic disease includes proton pump inhibitors, antihistamines, and ulcer-healing drugs like sucralfate. Patients with overt GI bleeding from ulceration will require endoscopic evaluation and management of the stress ulcers. Endoscopic therapies may include epinephrine injection, electro-cauterization, or clipping of the bleeding vessels. Bleeding ulcers refractory to localized endoscopic treatment may need embolization of the culprit vessel or rarely surgical intervention as a last resort. Surgical interventions are commonly indicated for patients with refractory bleeding despite endoscopic or angiographic treatment or patients with unstable hemodynamics to undergo endoscopic or angiographic procedures. Surgeries are performed as an ultimate life-saving approach.
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This question is part of the following fields:
- Gastrointestinal
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Question 4
Incorrect
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A 22 year old male presents with loose stools and abdominal pain that is vague in nature. He previously had an episode of lower abdominal pain that was associated with pyrexia which settled on its own. He has also experienced mild weight loss recently. On examination, he is pale and has an ill defined mass in the right iliac fossa. What is the most likely diagnosis?
Your Answer: Appendicular mass
Correct Answer: Crohn’s disease
Explanation:Crohn’s Disease (CD) is an inflammatory bowel disease, the pathogenesis of which is not fully understood. The clinical presentation of CD may be similar to ulcerative colitis (UC), the other most common inflammatory bowel disease. CD mostly affects young adults and adolescents between the ages of 15 and 35. It is typically located in the terminal ileum, but can discontinuously affect the entire gastrointestinal tract and commonly leads to complications such as fistulas, abscesses, and stenosis. Clinical features include diarrhoea, weight loss, and abdominal pain in the right lower quadrant (RLQ), as well as extraintestinal manifestations in the eyes, joints, or skin. It is often difficult to diagnose because there is no confirmatory test. Diagnosis is therefore based on the patient’s medical history, physical examination, lab tests, imaging (e.g., MRI), endoscopy, and serological testing. Acute episodes are treated with corticosteroids, and in severe cases, immunosuppressants may be indicated. Antibiotics and surgical intervention may be needed to help treat complications. Because the entire gastrointestinal tract may be affected, Crohn disease cannot be cured (in contrast to ulcerative colitis). The goal of treatment is thus to avoid the progression and recurrence of inflammatory episodes.
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This question is part of the following fields:
- Gastrointestinal
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Question 5
Correct
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A 40-year-old female presented with fever, jaundice, and pain in the middle and upper abdomen. Her stools are clay-coloured. Which of the following should be done now?
Your Answer: Endoscopic retrograde cholangio pancreatography (ERCP)
Explanation:ERCP is necessary to look for any obstruction or compression of the extra-hepatic bile duct. The clay-coloured stools are a result of impaired bilirubin movement into the duodenum.
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This question is part of the following fields:
- Gastrointestinal
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Question 6
Incorrect
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A 40-year old male presented to the OPD with a history of difficulty swallowing and blood-stained vomit. History of weight loss is also present. The abdominal X-ray was normal. Which of the following should be done next?
Your Answer: Oesophagogastroduodenoscopy
Correct Answer:
Explanation:An esophagogastroduodenoscopy (OGD) should be ordered to visualize and identify the source of bleeding. This procedure can harvest tissue samples for histological analysis and can also treat varices that may be causing the bleeding.
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This question is part of the following fields:
- Gastrointestinal
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Question 7
Incorrect
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Which of the following options is true of patients with oesophageal varices?
Your Answer: Octreotide and terlipressin have the same outcome profile in terms of variceal bleed mortality
Correct Answer:
Explanation:Spironolactone has been shown to have no effect on the mechanisms of portal hypertension. Also, chronic use of propranolol can reduce the risk of variceal bleeding. The banding of large varices has been shown to be effective, too. Octreotide and terlipressin are also both used to prevent secondary haemorrhage. Cefotaxime is the most commonly used cephalosporin when treating spontaneous bacterial peritonitis. Spironolactone helps to combat secondary hyperaldosteronism which is related to liver failure. It also helps to treat salt and water retention, which both contribute to portal hypertension.
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This question is part of the following fields:
- Gastrointestinal
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Question 8
Correct
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A young woman complains of constipation and pain on defecation. The pain is anorectal and a digital rectal examination was impossible due to pain and spasm. What is most likely the diagnosis?
Your Answer: Anal fissure
Explanation:Symptoms of anal fissure include sharp pain in the anal area upon defecation or anal stimulation. It may also cause burning or itching as well as visible fresh blood on the stools or on the toilet paper. It is usually visible upon inspection.
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This question is part of the following fields:
- Gastrointestinal
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Question 9
Incorrect
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The digital rectal examination and flexible sigmoidoscopy of a 30-year-old woman are normal. However, she still complains of recurrent and brief episodes of severe rectal pain. What is the most likely diagnosis?
Your Answer: Anal fissure
Correct Answer: Proctalgia fugax
Explanation:The digital rectal examination and sigmoidoscopy are normal, a fact that excludes all the other possible diagnoses. Proctalgia fugax is a functional anorectal disorder characterized by severe, intermittent episodes of rectal pain that are self-limiting. The diagnosis of proctalgia fugax requires exclusion of other causes of rectal or anal pain.
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This question is part of the following fields:
- Gastrointestinal
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Question 10
Incorrect
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All of the following statements regarding iron metabolism are correct EXCEPT?
Your Answer: One unit of blood contains 200 mg of iron
Correct Answer: In iron deficiency anaemia total iron binding capacity and transferrin saturation will both be decreased
Explanation:Iron deficiency anaemia is characterised by decreased iron stores, however there is increased iron binding capacity. Transferrin is the iron transporting protein. Because of the decreased presence of iron in blood, the transferrin saturation is decreased. Ferritin is an iron storage protein that is affected according to the iron stores but its also an acute phase reactant and levels can be effected by other conditions. Each unit of packed RBCs transfused to an adult contains 200 ml of RBCs and 200mg of iron. Only 5-10% of dietary iron is absorbed in the portal circulation which can be increased by the intake of vitamin C, animal foods and amino acids.
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This question is part of the following fields:
- Gastrointestinal
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Question 11
Incorrect
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Tumour suppressor genes MLH1 and MSH2 are affected in which familial cancer?
Your Answer: Li-Fraumeni syndrome
Correct Answer:
Explanation:In hereditary non-polyposis colonic carcinoma (HNPCC), mutations in MSH2, MSH6, PMS2 or MLH1 genes are found.
Ataxia telangiectasia – ATM gene is affected.
Familial adenomatous polyposis – APC gene is affected.
Li-Fraumeni syndrome – mutation of the TP53 tumour suppressor gene. Neurofibromatosis – mutation in or a deletion of the NF1 gene -
This question is part of the following fields:
- Gastrointestinal
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Question 12
Correct
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A 57-year-old male presented to the OPD with a complaint of yellow discoloration of his skin. On examination, he was found to have digital clubbing, jaundice, an enlarged and nodular liver, as well as caput medusa. Clinical investigations revealed normal electrolyte levels but low albumin levels. Which of the following is the appropriate management of this patient's fluid intake?
Your Answer: Albumin infusion
Explanation:This patient has an accumulation of fluid inside his body which, along with the lowered albumin level, tells us that the oncotic pressure of the blood is very low in this patient. Therefore, albumin infusion is the best option for him because albumin is the key human protein that contributes the most to the oncotic pressure.
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This question is part of the following fields:
- Gastrointestinal
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Question 13
Correct
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Which of the following does the inferior mesenteric artery supply?
Your Answer: From the splenic flexure to the first third of the rectum
Explanation:The coeliac axis supplies the liver and stomach and from the oesophagus to the first half of the duodenum.
The second half of the duodenum to the first two thirds of the transverse colon is supplied by the superior mesenteric artery.
The inferior mesenteric supplies the last third of the transverse colon (approximately from the splenic flexure) to the first third of the rectum.
The last two thirds of the rectum are supplied by the middle rectal artery.
The greater curvature of the stomach is supplied by branches of the splenic artery, which itself comes from the coeliac axis. -
This question is part of the following fields:
- Gastrointestinal
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Question 14
Correct
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A 40 year old lady who underwent a recent subtotal gastrectomy for peptic ulcer disease has now developed anaemia with a haemoglobin of 6.4, tiredness, fatigue and loss of vibration sensation in both legs. What is the underlying cause of her symptoms?
Your Answer: B12 deficiency
Explanation:Vit B12 needs intrinsic factor to be absorbed, which is secreted in the stomach. Its deficiency is characterised by macrocytic anaemia with peripheral neuropathy.
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This question is part of the following fields:
- Gastrointestinal
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Question 15
Incorrect
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A 28 year old male who has undergone splenectomy for an abdominal trauma presents on the 3rd post operative day with acute abdominal pain and distension in the upper abdominal area with hypotension. 2 litres of coffee ground fluid was aspirated on insertion of ryles tubes. Which of the following is the most likely diagnosis?
Your Answer: Left lower lobe atelectasis
Correct Answer: Acute gastric dilatation.
Explanation:Acute gastric dilation leading to ischemia of the stomach is an under-diagnosed and potentially fatal event. Multiple aetiologies can lead to this condition, and all physicians should be aware of it. Acute gastric dilation occurs as a result of eating disorders, trauma resuscitation, volvulus of hiatal hernias, medications, electrolyte abnormalities, psychogenic polyphagia, superior mesenteric artery syndrome, and a myriad of other conditions. Without proper and timely diagnosis and treatment, gastric perforation, haemorrhage, and other serious complications can occur.
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This question is part of the following fields:
- Gastrointestinal
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Question 16
Incorrect
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A 25-year-old woman is presenting with diarrhoea and abdominal bloating over the last 4 months. On examination, she has a blistering rash over her elbows. Biochemical investigation showed that she has low serum albumin, calcium and folate concentrations. On jejunal biopsy there is shortening of the villi and lymphocytosis. What is the most likely cause?
Your Answer: Crohn's disease
Correct Answer: Coeliac disease
Explanation:Celiac disease has characteristic shortened intestinal villi. When patients with celiac disease eat products containing gluten, they are unable to absorb the nutrients due to flattened or shortened intestinal villi. The blistering rash present on the patient’s elbows strongly suggests celiac disease. This rash is a sign of the condition Dermatitis Herpetiformis which is associate with celiac disease. Therefore, it is also often called ‘gluten rash’.
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This question is part of the following fields:
- Gastrointestinal
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Question 17
Incorrect
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A 4 year old baby was brought in by her mother with complaints of generalized pallor, loss of weight and loose stools. The baby's stools were frothy in nature and difficult to flush. Which investigation can help in diagnosing this patient?
Your Answer: US abdomen
Correct Answer: Anti-endomysial antibodies
Explanation:The presence of anti-endomysial antibodies confirms the diagnosis of Celiac disease, which is the primary cause of illness in this patient. The sweat chloride test is performed with cystic fibrosis.
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This question is part of the following fields:
- Gastrointestinal
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Question 18
Incorrect
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A 31 year old woman presents with complaints concerning her bowel habits. She claims that occasionally she sees blood in her stools but she's more concerned about having chronic abdominal and pelvic pain, tenesmus and intermittent diarrhoea. What would be the most probable cause of her condition?
Your Answer: Diverticulosis
Correct Answer: Inflammatory bowel disease
Explanation:Inflammatory bowel disease (IBD) includes both ulcerative colitis and Crohn’s disease. Both of them present with similar symptomatology including diarrhoea, fatigue, abdominal and pelvic pain, blood in the stools, weight loss and occasional fever. In diverticulosis, symptoms are less profound with alternating diarrhoea and constipation.
UTIs might produce abdominal or pelvic pain but they do not interfere with the quality of the stools.
Adenomyosis affects the uterus and presents with mainly menstrual complaints. -
This question is part of the following fields:
- Gastrointestinal
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Question 19
Correct
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A 50-year-old heavy drinker is brought to the A&E in a drowsy state. He is responding to questions however on examination he has nystagmus and hyper-reflexia. His MCV is 103fL.What is the most likely cause for his cognitive impairment?
Your Answer: B1 Deficiency
Explanation:Thiamine deficiency is very common with alcoholism. It manifests by Wernicke-Korsakoff encephalopathy. The patient is usually agitated, with an abnormal gait and amnesia.
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This question is part of the following fields:
- Gastrointestinal
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Question 20
Correct
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A 58 year old male patient complains of emesis, fatigue, palpitations and weight loss. His blood group is type A. Clinical examination revealed an enlarged liver, ascites and a left supraclavicular lump which is palpable. What is the most probable diagnosis?
Your Answer: Gastric carcinoma
Explanation:Gastric carcinoma may present as atypical general symptoms including emesis, fatigue and weight loss. It may also result in anaemia which might be responsible for the palpitations. The left supraclavicular swelling is referring to Virchow’s node, strongly associated with gastric cancer. Ascites and hepatomegaly generally appear late in the course of the disease and Blood group A has been shown to be associated with gastric cancer.
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This question is part of the following fields:
- Gastrointestinal
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Question 21
Correct
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Conjugated bilirubin is converted and metabolised into urobilinogen before excretion. This metabolism takes place in which part of the body?
Your Answer: Large intestine
Explanation:Unconjugated bilirubin is conjugated to glucuronic acid in the hepatocyte. Conjugated bilirubin passes into the enterohepatic circulation and the bilirubin which evades this system is metabolised by bacteria, primarily in the large intestine, to urobilinogen, then stercobilinogen and eventually oxidised to stercobilin. Stercobilin gives faeces its brown colour.
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This question is part of the following fields:
- Gastrointestinal
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Question 22
Correct
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A woman complains of diarrhoea, experiencing watery stools 10 daily. She also complains of abdominal bloating, cramps, flatulence, and recent weight loss. She has now developed signs of iron deficiency anaemia. What is the most likely cause of her condition?
Your Answer: Malabsorption
Explanation:Diarrhoea, iron deficiency anaemia and folic acid deficiency are suggestive of malabsorption. Malabsorption leads to a decrease in the solid content of the stools resulting in diarrhoea. Decrease in the absorption of folic acid causes folic acid deficiency, and iron deficiency in the body leads to iron deficiency anaemia.
Jejunal villous atrophy is characterized with pain and weight loss as well, which this patient does not have.
A patient with increased catabolism has sudden weight loss along with deficiencies of nutrients. -
This question is part of the following fields:
- Gastrointestinal
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Question 23
Correct
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A 20-year-old girl is presented to the OPD with her mother. Her mother reports that she eats very large portions of food most of the time, but takes diet pills and remains depressed because she thinks she is overweight. However, on general physical examination, she appears to be very thin and her blood pressure is lower than normal. Investigations reveal that she has hypokalaemia. What is this girl most likely suffering from?
Your Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging in an attempt to stay thin despite eating a lot of food. Frequent vomiting can cause electrolyte imbalance that manifests as hyperkalaemia and may lead to hypotension.
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This question is part of the following fields:
- Gastrointestinal
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Question 24
Incorrect
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From the list of options, choose the least useful therapy in preventing oesophageal variceal bleeding in portal hypertension.
Your Answer: Nadolol
Correct Answer: Variceal sclerotherapy
Explanation:Selective beta blockade and nitrates help to reduce portal pressure and therefore reduce the risk of bleeding (as does banding). Moreover, sclerotherapy, despite its use, has not actually been shown to reduce the risk of bleedings as primary prevention – however, it may reduce the risk of rebleeding after an index bleed. The mortality of variceal bleedings is known to be 50% at each episode.
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This question is part of the following fields:
- Gastrointestinal
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Question 25
Incorrect
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A 55 year old female presents with complaints of retrosternal chest pain and dysphagia (which is intermittent and unpredictable in nature). When she swallows, food very suddenly 'sticks' in her chest. She is able to clear it when she drinks water, and then can finish the meal without any further incidence. A barium meal shows she has a corkscrew oesophagus. What is the most likely type of dysphagia here?
Your Answer: Plummer-Vinson syndrome
Correct Answer: Oesophageal spasm
Explanation:All of the symptoms observed in this patient are typical of uncoordinated irregular oesophageal peristalsis – this is characteristic of oesophageal spasm. The cork-screw oesophagus is also diagnostic of the condition.
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This question is part of the following fields:
- Gastrointestinal
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Question 26
Correct
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A 60 year old male has been taken to the doctor with dysphagia and pain when swallowing. A barium meal shows he has gross dilation of the oesophagus, with a smooth narrowing at the lower end. Choose the single most likely cause of his symptoms.
Your Answer: Achalasia
Explanation:Finding it difficult to swallow both food and drink with a narrow oesophagus is consistent with a diagnosis of achalasia.
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This question is part of the following fields:
- Gastrointestinal
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Question 27
Correct
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A 45 year old male presented with chronic diarrhoea and right lower abdominal pain. On examination he was febrile and there was tenderness over the right lower quadrant and an anal fissure. Which of the following is the most probable cause for his abdominal pain?
Your Answer: Inflammatory bowel disease (IBD)
Explanation:From the given answers, IBD and IBS are the causes for chronic diarrhoea. Pyelonephritis and ureteric colic are associated with urinary symptoms. Tenderness of pyelonephritis is at the loin region. Perianal disease is associated with fifty percent of patients with Crohn’s disease.
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This question is part of the following fields:
- Gastrointestinal
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Question 28
Correct
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A 72 year old male presents complaining of having intermittent trouble with swallowing. He has also been regurgitating stale food material. He sometimes wakes up in the middle of the night feeling like he is suffocating. Choose the most likely diagnosis.
Your Answer: Pharyngeal pouch
Explanation:In benign stricture, oesophageal carcinoma, and systemic sclerosis, there is persistent dysphagia (rather than intermittent). In oesophageal spasm, there is no regurgitation of stale food material. The symptoms described are consistent with pharyngeal pouch.
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This question is part of the following fields:
- Gastrointestinal
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Question 29
Correct
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A 1-day-old baby started having pallor and jaundice. The mother's first child did not have jaundice at birth. On clinical investigations, direct Coombs test is positive. Mother's blood group is A negative. Baby's blood group is O positive. What is the most probable cause of the condition of this new-born?
Your Answer: Rhesus incompatibility
Explanation:Jaundice in a new-born on the day of delivery is most likely due to Rh incompatibility. This occurs when the mother is Rh-negative and the baby is Rh-positive. Antibodies in the mother against the Rh factor in the baby will destroy the red blood cells in the baby, increasing the bilirubin in the blood. Breast milk jaundice and Galactosemia do not occur immediately after birth, and congenital rubella syndrome and formula feeding does not cause jaundice in babies.
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This question is part of the following fields:
- Gastrointestinal
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Question 30
Incorrect
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Which of the following options is true regarding H. pylori bacteria?
Your Answer: A urea breath test is more reliable than a urease test
Correct Answer: It is the cause of ≥60% of gastric ulceration
Explanation:It is the cause of gastric ulcers in more than 60% of the cases. It is a gram negative bacteria and does not cause oesophageal carcinoma.
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This question is part of the following fields:
- Gastrointestinal
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SESSION STATS - PERFORMANCE PER SPECIALTY
