MCQs in Gastrointestinal system

MCQs in Gastrointestinal system

MOUTH

1. Following are not associated with glossodynia except:

a)Herpes zoster b)Ranula           c)Candidiasis    d)Leukoplakia

2.Macroglssia may be seen in

a) Grebe syndrome                    b) Cohen syndrome

c) Prader-Willi syndrome d) Beckwith-Moon-Biedl Syndrome

3.Commonest precancerous lesion in the mouth

a) Leukoplekia                           b) Submucous fibrosis

c) Bowen’s disease                    d) Syphilitic glossitis

4.Commonest cause of xerostomia

a) Vitamin A deficiency  b)Kwarshiorkar  c)Viral infections    d)Drugs

OESOPHAGUS

5.Dysphagia is an early symptom of

a) a/c rheumatic fever                b) a/c cholecystitis

c) Scleroderma                              d) Leiomyoma of the oeosophagus

6.Character of Paterson-Kelly syndrome:

a) Spontaneous rupture of oesophagus            b) Hypochromic anaemia

c) Oesophageal diverticulae                             d) Gingivitis

7.Most common complication of achalasia cardia

a) Recurrent pulmonary infections        b) Oesophageal stricture

c) Pleurisy                                                        d) Peptic ulcer

8.Gold standard investigation in the diagnosis of reflux oesophagitis is

a) 24 hour pH monitoring            b) Endoscopy

c) Biopsy                                  d) Oesophaphageal manometry

STOMACH

9.Regarding congenital hypertrophic pyloric stenosis , all are true except:

a) Metabolic acidosis                                 b) Inconstant lump

c) Regurgitation and vomiting                   d) Hypocholermic alkalosis

10.Consider the following regarding gastric acid release

(i)       Hyperglycaemia inhibits gastric acid secretion

(ii)     Somatostatin stimulates release of paracrine effect

(iii)Gastrin is a potent stimulator of gastric acid secretion

(iv)Principal form of gastrin in antral mucosa is its hepatadecapeptide form (G-17)

Of these the correct statements are

a) ii, iii, iv          b) i,iii, iv            c) i,ii,iii              d) i,ii,iv

11. pH of gastric acid

a) 1.5-2             b) 0.5-2.5          c) 2.5-3             d) 3-3.5

12.Well-marked periodicity of complaints is seen in

a) Gastric ulcer                          b) Duodenal ulcer

c) Mallory-Weiss syndrome   d)Zollinger-Ellison syndrome

13.True about Helicobacter pylori is all except

a) Splits urea & produces NH ₃ to survive            b) Produces CA stomach

c) Cag-A gene is not associated with the risk of duodenal ulcer

d) With c/c infection, urease breath test becomes negative

e) Gastric mucosa is resistant to high levels of acid in its absence

14.Peptic ulcer is associated with all except

a) Hyperparathyroidism              b) Cirrhosis

c) Z-E syndrome                                    d) Pernicious anaemia

15.All are true about duodenal ulcer except:

a) Well-marked periodicity           b) Pain occurs 2 hours after food
c)common in ‘O’ blood group    d) Vomiting is the main feature   e) Melena more common than haematemesis

16.Commonest cause of Haematemesis is

a) CA duodenum                                    b) CA stomach  c) a/c lymphatic leukaemia

d) Idiopathic thrombocytopenia    e) Portal hypertension

17.Which of the following is precancerous

a) c/c gastritis                           b) Gastric ulcer

c) Pernicious anaemia                d) Zollinger-Ellison syndrome

18.Most common site of gastric carcinoma is

a) Cardia           b) Fundus          c) Body d)Pylorus

19.Diarrhoea is a presentation in which type of gastric malignancy-

a) Ulcerative    b) Diffuse infiltrative    c) Localised infiltrative    d) Fungating mass

20.Most sensitive technique for early diagnosis of CA stomach

a) Gastric lavage                       b) Clinical history

c) Fibro-optic endoscopy            d) Physical examination

21.A 26-year old in the first trimester of pregnancy has been admitted in the hospital with retching & repeated vomiting with large haematemesis. Her pulse rate is 126/mt and BP is 80 mm of Hg systole. The most likely diagnosis is

a) Mallory-Weiss syndrome                     b) Bleeding from oesophageal varices

c) Peptic ulcer                                       d) Hiatus hernia

SMALL INTESTINE

22.Commonest cause of a/c intestinal obstruction in a 30-year-old Indian lady is

a) CA colon                   b) TB intestine               c) Foreign body  d) Polyp

23.False about Coeliac disease

a) Occurs between the ages of 1 and 3    b) Jejunal biopsy shows subvillous atrophy

c) Abnormal schilling test                                   d) Normal D-xylose test

24.Xylose absorption tests are a good screen for

a) Fat absorption                        b) Pernicious anaemia

c) Carbohydrate absorption         d) Amino acid absorption

25.Small intestinal biopsy is needed for the diagnosis of

a) Coeliac disease                     b) Regional ileitis           c)Argentaffinoma of intestine

d) Lymphoma of intestine           e) none

26.Clinical features of Whipple’s disease includes all except

a) Episodic inflammatory arthritis of large joints    b) Ophthalmoplegia

c) Skin pigmentation      d) Usually affects females          e) Oculomasticatory myoclonus

LARGE INTESTINE

27.In which is seen “Gut dysfunction in the absence of demonstrable organic pathology”

a) Cholera                     b)Dysentery                  c)IBS                d)Diverticulitis coli

28.Irritable Bowel Syndrome includes all the following except

a) Diarrhoea      b) Constipation  c) Abdominal distress     d) UnderlyingCA

29.Which has the least chance of malignancy

a) Adenomatous polyp                            b) Villous adenoma

c) Peutz-Jegher’s syndrome                d)Familial colonic polyposis

30.Crohn’s disease is characterised by all except

a) Predominatly males are affected       b)Pyoderma gangrenosa

c) Migratory polyarthritis                         d)Skip lesions

31.Toxic megacolon occurs in patients with

a) Cholera         b) Tropical sprue            c)Typhoid fever  d) Ulcerative colitis

32.Indications for colonoscopy include

a) Lower GIT bleeding                            b) Inflammatory bowel disease

c) Removal of polyp or foreign bodies      d) All

RECTUM

33.Amount of stercobilinogen excreted in the stool/day is about

a) 10-20 mg                   b) 50-80 mg                    c) 100-200 mg       d) 250-300 mg

34.Steatorrhoea occurs in all except

a) Coeliac disease                     b) Lactose intolerance                c) Chronic liver disease

d) c/c pancreatitis                      d)Blind loop syndrome

35.Currant jelly stools are usually associated with

a) Appendicitis                          b) Intussusception

c) Enterocolitis                         d) Hirschsprung’s disease

36.Aluminium paint stool is characteristic of

a) Hirschsprung’s disease          b) GastricCA    c) periampullary cancer  d)all

APPENDIX

37.In Murphy’s triad, the order of appearance of symptoms is

a) Pain first, vomiting next, fever last

b) Vomiting first, fever next, pain last

c) Fever first, pain next, vomiting last

d) Pain first, fever next, vomiting last

LIVER

38.Menghini’s needle is used in doing

a) Pleural aspiration    b) Lumbar puncture   c) Sternal puncture   d) Liver biopsy

39.Triad of Schultz consists of the following except:

a) Jaundice              b) Cholestasis                c) Gangrenous         d) Leukopenia

40.Antimitochondrial antibody occurs in about % of patients of primary biliary cirrhosis

a) 60       b) 70        c) 85         d) 95

41.Frequency of Enterohepatic circulation is about:

a) 1/day       b) 5/day       c) 10/day       d) 20/day

42.Amount of urobilinogen passed in urine/day is about:

a) 1 mg       b) 4 mg        c) 8 mg          d) 12 mg

43.Charcot’s triad includes all except:

a) Fluctuating jaundice                          b) Recurrent pain

c) Bilious vomiting                               d) Intermittent fever with rigors

44.Triad of portal hypertension include all except:

a) Ascites     b) Hepatomegaly      c) Splenomegaly        d) Oesophageal varices

45.In Indian childhood cirrhosis, the most common biochemical change seen is that:

a) S. Cu level increased while S. Zn level decreased

b) Both S. Cu and S. Zn levels decreased

c) S. Cu level decreased while S. Zn level increased

d) Both S. Cu level and S. Zn level increased

46. Parameter in LFT suggestive of a/c parenchymal liver damage is

a) Decreased S. albumin                                 b) increased alkaline phosphatase

c) Increased SGPT                            d) increased acid phosphatase

47.Characteristic feature of ascites due to uncomplicated cirrhosis:

a) Protein < 10 g/L   b) Protein < 25g/L  c) Protein > 25g/L   d) Protein > 50g/L

48.Ascites in cirrhosis of liver is due to:

(i) Portal hypertension

(ii) Hypoalbuminaemia

(iii) Inappropriate ADH secretion

(iv) Secondary hyperaldosteronism

a) i, ii, iii are correct                             b) i, ii, iv are correct

c) ii, iii, iv are correct                           d) i, iii, iv are correct

49.The difference between c/c active and c/c persistent hepatitis, the former has all the features except:

a) +ve hepatitis B surface antigen                    b)presence of renal tubular acidosis

c) Liver biopsy showing mononuclear infiltration around portal zones

d)+ve antinuclear factor                                   e)two times elevation of transaminases

50.In a patient with liver cirrhosis, haematemesis and melena occur due to

(i)Bleeding oesophageal varices (ii) Abnormal clotting mechanism

(ii)Duodenal ulceration               (iv) Hepatic vein thrombosis

a) i, ii, iii          b) ii, iii, iv          c) i, iii, iv           d) i, ii, iv

51.Clinical features of fulminant hepatitis include all of the following except

a) Very high serum bilirubin                     b)Evidenceof hepatic encephalopathy

c) Sudden decrease in size of liver

d) Increase in prothrombin time not responsive to vitamin K

d) High fever, severe abdominal pain & vomiting several days after initiation of bed rest

GALL BLADDER

52.Saint’s triad includes all of the following except

a)Gall stones     b)Hiatus hernia  c) Diverticulosis d)Cirrhosis of the liver

53.Leucine aminopeptidase is elevated with the obstruction of the

a) Small intestine           b) large intestine            c) common bile duct       d) portal vein

SPLEEN

54.Increase in spleen size, reticulocytosis and unconjugated hyperbilirubinemia is:

a) Haemolytic anaemia                b) Splenic vein thrombosis

c) Proceeding liver failure           d) Myelofibrosis

55.Onion skin spleen is seen in :

a) ITP           b) Thalassemia          c) SLE            d) Scleroderma

56.Splenic infarction is associated with

a) Paroxysmal nocturnal haemoglobinuria               b) c/c myeloid leukaemia

c) Infectious mononucleosis                                           d) Typhoid fever

PANCREAS

57.Malabsorption of pancreatic origin is characterised by

a) Iron deficiency anaemia          b) High faecal fat content               c) High urinary indicans

d)< than 20% excretion in urine of an oral load of D-Xylose    e)Low serum B₁₂

58.In a/c pancreatitis, the false statement is

a)       Serum amylase levels are within normal limits in about 1/5^th of the patients

b)       Hypocalcaemia implies poor prognosis

c)       Pain is always present         d) progressing to a fatal outcome

59.Following are signs of grave prognosis of a/c pancreatic insufficiency except

a) Age < 40yrs                           b) WBC count > 10,000/mm³

c) Base deficit > 4mg/L              d) Rise in BUN > 5mg% in 24 hrs

60.Which vitamin is deficient in pancreatic insufficiency?

a) Vit A b) Vit B₁                        c) Vit B₁₂           d) Vit C

61.Lundh test determines

a) Tryptic activity of pancreatic juice b) Unconjugated bilirubin

c) Conjugated bilirubin                            d) LDL level in serum

62.Major criteria for the diagnosis of cystic fibrosis of pancreas (CF) include all except

a) Sweat chloride exceeding 60 meq/L in children & 80 meq/L in adults

b) Evidence of renal involvement             c) Obstructive azoospermia    d) none

63.In CA of ampulla of vater , the earliest symptom is usually

a) Melena                                              b) pain radiating to the back

c) Obstructive jaundice               d) diabetes

INFECTIONS

64.Infection by all the following agents can result in cirrhosis of liver except:

a) Hepatitis A virus        b) Hepatitis B virus        c) Hepatitis c virus         d) Schistosomiasis

65.In amoebic dysentery, most important for diagnosis is

a) Isolation of E. histolytica on examination of stool

b) Isolation of vegetative forms of EH in stool

c) Determination of pH of stool

d) Presence of pus cells in stool

66.Pathogenesis of cholera is by

a) Stimulating small intestine to secrete large quantities of fluid

b) Ulceration of mucosa of intestine        c) Inhibition of absorption of fluids

d) none

67.Indicator of active replication of hepatitis B virus is

a) HbsAg                      b)HbcAg                       c)HbeAg         d)none

MISC

68.Menetrier’s disease is characterized by

a) Dysphagia      b) Giant hypertrophy of gastric rugae

c) Diverticulosis of the gastric mucosa         d)  Autosonmal dominant inheritance

69.Match the following

A) Crohn’s disease                       (i) Double bubble sign

B) Ulcerative colitis                     (ii) Bernstein test

C) Duodenal atresia                     (iii) Lead pipe colon

D)  Reflux oesophagitis               (iv) String sign

a) A- iii, B- iv, C- ii, D – i

b) A-iv, B- iii, C – i, D- ii

c) A – iii, B – i, C- iv, D- ii

d) A – iv, B – i, C- ii, D- iii

70.The following causes distension of abdomen:

a) Hirschsprung’s disease                      b) hypokalaemia

c) Hyperkalaemia                                   d)hypomagnesmia

71.Lactase deficiency may be seen in the following except

a)Rota virusinfection                  b)Giardiasis                   c)CF                 d)cholera

72.High concentrations of S. alkaline phosphatase is found in all except

a) Obstructive jaundice   b)Paget’s disease of bone

c)Hyperparathyroidism   d) Metastatic tumours in bone                 e) none

73.Substance responsible for GIT disturbances of carcinoid syndrome

a)Pancreozymin             b) Secretin                    c) Serotonin                   d)Gastrin

74. Pruritis is seen in all except:

a) Hodgkin’s lymphoma                                   b) Obstructive jaundice

c) Primary biliary cirrhosis                    d) Lead poisoning

75.Useful investigation in patients with jaundice

a) Oral cholecystography            b)Percutaneous transhepatic cholangiography

b) ERCP                                   d) I.V cholangiography    e) any of the above

ANSWERS

MOUTH

1. a
2. d
3. a
4. d

OESOPHAGUS

5. c
6. b
7. a (Heller’s operation gives sustained relief)
8. a

STOMACH

9. a (metabolic alkalosis)
10. a
11. a
12. b
13. c,d
14. d
15. d
16. b
17. c
18. d
19. b
20. c
21. a

SMALL INTESTINE

22. b
23. d (Jejunal biopsy shows abnormality in coeliac disease, tropical sprue,Whipple’s disease)
24. c
25. a
26. d

LARGE INTESTINE

27. c
28. d
29. c (Familial colonic polyposis has a complete tendency to develop malignancy)
30. a (Loss of haustration is in ulcerative colitis)
31. d
32. d

RECTUM

33. c
34. b (Steatorrhoea is excretion of fat in stool more than 6 gm/day)
35. b
36. c

APPENDIX

37.a

LIVER

38. d

39. b

40. d

41. c

42. b

43. c

44. b

45. a

46. c

47. b

48. b

49. e

50. a

51. a

GALL BLADDER

52. d

53. c

SPLEEN

54. a
55. c
56. b

PANCREAS

57. b

58. d

59. c

60. a

61. a (Trypsin is the principle enzyme present in pancreatic secretion)

62. b (evidence of pulmonary involvement)

63. c (Ulceration and bleeding from the growth can cause melena ; diabetes is seen in CA pancreas affecting body & tail)

INFECTIONS

64. a

65. b

66. a

67. c

MISC

68. b

69. b

70. c

71. d

72. e

73. c

74. d

75. b

Prepared by Dr Mridula Anand