Medicine- Gastroenterology Exam Prep MCQ Test

Cullen's sign refers to a faint blue discoloration around the umbilicus. It is a clinical finding that may be observed in patients with acute pancreatitis. This discoloration occurs due to the leakage of blood from the inflamed pancreas into the peritoneal cavity, resulting in hemoperitoneum. Therefore, Cullen's sign can be used as an indicator of internal bleeding in patients with acute pancreatitis.

A serum ascites-to-albumin gradient (SAAG) of > 1.1 g/dL indicates that the most likely cause of the ascites is cirrhosis with portal hypertension. This is because cirrhosis leads to increased pressure in the portal vein, causing fluid to accumulate in the abdomen. The SAAG value helps differentiate between causes of ascites, with a high SAAG indicating portal hypertension-related causes such as cirrhosis. Infection, malignancy, and renal failure are less likely to cause a high SAAG.

Emergency surgery should not be considered in the management of UGI bleeding after initial stabilization and resuscitation of the patient. The priority in managing UGI bleeding is to determine the source of bleeding, stop acute bleeding, and prevent rebleeding. Emergency surgery is usually reserved for cases where non-operative interventions have failed to control the bleeding or in cases of severe and life-threatening bleeding. However, it is not the first-line approach and should only be considered when other measures have been unsuccessful.

Mucosa-associated lymphoid tissue (MALT) is a type of lymphoma that is commonly found in the stomach. The given answer states that MALT is strongly associated with H. pylori infection. This is because H. pylori is a bacterium that can cause chronic inflammation in the stomach, leading to the development of MALT lymphoma. Studies have shown that the eradication of H. pylori can lead to the regression of MALT lymphoma in some cases. Therefore, the strong association between MALT lymphoma and H. pylori infection makes this answer the correct choice.

Ascending cholangitis is the correct diagnosis for a patient presenting with biliary pain, jaundice, spiking fevers, and chills (Charcot's triad). Ascending cholangitis is an infection of the bile ducts that occurs when bacteria from the intestines travel up the bile ducts. This can lead to obstruction, inflammation, and infection, causing symptoms such as biliary pain, jaundice, and systemic signs of infection like fevers and chills. Prompt diagnosis and treatment with antibiotics and biliary drainage are essential to prevent complications and improve outcomes.

Alcoholism is the most common cause of clinically apparent chronic pancreatitis. Excessive and chronic alcohol consumption can lead to inflammation and damage to the pancreas, resulting in the development of pancreatitis. Alcohol-induced pancreatitis is characterized by abdominal pain, digestive problems, and potentially severe complications. It is important to note that while alcoholism is the most common cause, other factors such as gallstone disease, hypertriglyceridemia, and diabetes mellitus can also contribute to the development of chronic pancreatitis.

The most effective approach once the index ulcer has healed in a patient with an NSAID-related gastric ulcer complicated by UGI bleeding and a positive H. pylori test is to eradicate H. pylori, shift to a COX-2 selective NSAID, and continue maintenance PPI. This approach addresses both the underlying cause of the ulcer (H. pylori infection) and minimizes the risk of further gastric ulceration by switching to a COX-2 selective NSAID, which has a lower risk of gastrointestinal complications compared to non-selective NSAIDs. Maintenance PPI therapy is also important to further reduce the risk of recurrent ulcers.

Emergent endoscopy with variceal ligation is the most likely to provide definitive treatment in this case. The patient's presentation of frank hematemesis and hemodynamic instability is consistent with bleeding from esophageal varices, which is a common complication of alcoholic liver disease. Variceal ligation is a procedure performed during endoscopy that can effectively stop bleeding from esophageal varices by placing rubber bands around the varices to constrict them. This procedure is considered the gold standard for the treatment of acute variceal bleeding and has been shown to improve outcomes and reduce mortality rates.

Mirizzi's syndrome is a condition where a gallstone becomes impacted in the cystic duct or neck of the gallbladder, leading to compression of the common bile duct (CBD). This compression can cause obstruction of the bile flow and result in symptoms such as jaundice, abdominal pain, and fever. It is important to differentiate Mirizzi's syndrome from other similar conditions like Bouveret syndrome, Boerhaave syndrome, and double duct syndrome, as the management and treatment approaches may differ.

The most important risk factors in the development of alcoholic liver disease are the quantity and duration of alcohol consumption. This means that the amount of alcohol consumed and the length of time it is consumed are key factors in determining the risk of developing this disease.

The patient's symptoms and radiographic findings suggest the presence of pneumoperitoneum, which is the abnormal presence of air in the peritoneal cavity. This is most commonly caused by bowel perforation, where there is a rupture or hole in the wall of the bowel. The sudden severe epigastric pain, fever, diffuse abdominal tenderness, and rigidity are all consistent with acute peritonitis, which occurs when the contents of the bowel leak into the peritoneal cavity, leading to inflammation and infection. Therefore, the correct answer is Bowel Perforation.

Pyoderma gangrenosum is a rare skin condition characterized by the development of painful pustules that rapidly progress to ulcers and become violaceous in color. It is commonly associated with inflammatory bowel diseases such as ulcerative colitis. Dermatitis herpetiformis is a skin manifestation of celiac disease, while erythema nodosum is a skin condition associated with various underlying causes. Sweet's syndrome is a rare inflammatory condition characterized by fever, neutrophilic infiltrates in the skin, and various systemic symptoms.

The most discriminating symptom in duodenal ulcer is pain that awakens the patient at night. This symptom is characteristic of duodenal ulcers and is often described as a burning or gnawing sensation in the epigastric area. Discomfort precipitated by food is also a common symptom of duodenal ulcers, but it is not as specific as pain at night. Nausea and vomiting may occur in some cases, but they are not as common or specific to duodenal ulcers as nocturnal pain.

The X-ray images showing distention of fluid- and gas-filled bowel arranged in a "staircasing" pattern and an absence or paucity of colonic gas are characteristic findings of small intestinal obstruction. This pattern occurs because the small bowel becomes dilated proximal to the obstruction, causing a buildup of fluid and gas. The "staircasing" appearance is due to the fluid and gas filling the valvulae conniventes, which are the transverse folds in the small intestine. This finding is not specific to other conditions mentioned in the options.

The urea breath test is the preferred test for documenting eradication of H. pylori. This test involves the patient ingesting a small amount of radioactive urea, which is then metabolized by H. pylori in the stomach. The bacteria produce an enzyme called urease, which breaks down the urea and releases carbon dioxide. The carbon dioxide is then absorbed into the bloodstream and exhaled through the breath. By measuring the amount of radioactivity in the breath, the test can determine if H. pylori is present or not. This test is non-invasive, highly accurate, and can be used to confirm eradication after treatment.

The most likely cause of the patient's jaundice is biliary obstruction. This is indicated by the elevated levels of direct bilirubin and alkaline phosphatase. Biliary obstruction can occur due to various reasons such as gallstones, tumors, or strictures in the bile ducts. In this case, the elevated direct bilirubin suggests that there is a blockage in the bile ducts preventing the normal flow of bile from the liver to the intestines, leading to jaundice. The other options such as hemolysis, biliary atresia, and liver cirrhosis do not explain the specific laboratory findings in this patient.

Mesenteric angiography is the most effective management strategy in this case. Severe hematochezia, hypotension, and anemia suggest active bleeding in the gastrointestinal tract. Both upper gastroscopy and colonoscopy were not diagnostic, indicating that the source of bleeding is not visible through these procedures. The patient's stabilized vital signs and maintained hematocrit level suggest that resuscitation has been successful. Mesenteric angiography is a minimally invasive procedure that can accurately identify the source of bleeding and guide further intervention or embolization to stop the bleeding.

The correct answer is "Outpatient bleeds." Outpatient bleeds are not considered a risk factor associated with a poor outcome in acute upper GI bleeding. Increasing age, comorbidities, and hematemesis are all known risk factors that can contribute to a worse outcome in this condition. However, outpatient bleeds, which occur outside of a hospital or healthcare setting, are not typically associated with a higher risk of poor outcome.

The ideal management for a 94-year-old diabetic female with congestive heart failure who suddenly developed right upper quadrant pain and fever, along with a dilated gallbladder with multiple stones and pericholecystic fluid, would be cholecystostomy and tube drainage. This is because the patient's age, comorbidities, and the presence of pericholecystic fluid indicate a high risk for complications with surgical interventions such as laparoscopic or open cholecystectomy. Cholecystostomy and tube drainage can provide temporary relief by draining the infected fluid and decompressing the gallbladder, allowing for stabilization of the patient's condition before considering further definitive management options.

A history of a calcified or porcelain gallbladder is a strong indication for cholecystectomy. A calcified or porcelain gallbladder is a rare condition in which the wall of the gallbladder becomes calcified, increasing the risk of gallbladder cancer. Therefore, it is recommended to remove the gallbladder in these cases to prevent any potential complications.

Administering safe, aggressive intravenous fluid resuscitation is the most important treatment intervention for acute pancreatitis because it helps to maintain adequate fluid balance and prevent complications such as hypovolemia and organ failure. Adequate fluid resuscitation also helps to reduce inflammation and support the healing process of the pancreas. NPO (nothing by mouth) is also important to rest the pancreas and reduce pancreatic stimulation, but fluid resuscitation takes priority in order to maintain hydration and prevent further complications. IV antibiotics may be used if there is evidence of infection, but they are not the most important intervention. Adequate analgesia is also important for pain control, but it is not the primary treatment intervention.

The correct answer is recurrent right lower quadrant pain and diarrhea. Crohn's disease is a chronic inflammatory bowel disease that commonly affects the terminal ileum and the colon. The most common clinical presentation of Crohn's disease includes abdominal pain, typically in the right lower quadrant, and diarrhea. Other symptoms may include weight loss, fatigue, and occasionally rectal bleeding. However, the presence of recurrent right lower quadrant pain and diarrhea is the most characteristic and specific presentation of Crohn's disease.

ERCP (Endoscopic Retrograde Cholangiopancreatography) is the next appropriate test to perform within 24-48 hours. This procedure combines endoscopy and fluoroscopy to examine the bile ducts and pancreatic ducts. In this case, the patient's symptoms of severe abdominal pain, fever, vomiting, and jaundice, along with the findings of right upper quadrant tenderness, elevated WBC count, SGPT, and serum amylase, suggest a possible complication of gallstones such as choledocholithiasis or cholangitis. ERCP can help diagnose and treat these conditions by removing gallstones from the bile ducts or placing stents to relieve obstruction.

Patients with hepatic encephalopathy often experience constipation, which can worsen their condition. Lactulose is a commonly prescribed medication in these patients to help soften the stools and promote regular bowel movements. The aim is to have 2-3 bowel movements per day when giving lactulose. This frequency helps to prevent the buildup of toxins in the gut, which can contribute to hepatic encephalopathy symptoms.

The patient's presentation of black tarry stools suggests upper gastrointestinal bleeding. The drop in blood pressure and increase in heart rate after sitting up indicates orthostatic hypotension, which further supports the possibility of significant blood loss. Therefore, the initial management should focus on fluid resuscitation to restore intravascular volume and blood product infusion to replace the lost blood. This approach aims to stabilize the patient's hemodynamic status and prevent further complications. Urgent endoscopy may be considered later to identify and treat the source of bleeding, but it is not the initial management in this case. Urgent surgical intervention would only be necessary if conservative measures fail or if there are signs of active ongoing bleeding.

A Mallory-Weiss tear is the most likely cause of massive hematemesis in a 41-year-old male with a history of chronic alcoholism following prolonged vomiting. Mallory-Weiss tears occur due to a tear in the mucosal lining of the esophagus and stomach, usually caused by forceful or prolonged vomiting. This tear can result in significant bleeding, leading to the presentation of hematemesis. Hiatal hernia, esophageal variceal bleeding, and Boerhaave's syndrome are less likely causes in this scenario.

Type B chronic gastritis is characterized by predominantly antral involvement and is strongly correlated with H pylori infection. H pylori is a bacterium that infects the stomach lining and causes inflammation, leading to chronic gastritis. This type of gastritis typically affects the antrum, which is the lower part of the stomach. It is important to identify and treat H pylori infection in patients with type B chronic gastritis to alleviate symptoms and prevent complications such as peptic ulcers and gastric cancer.

Transient lower esophageal sphincter relaxation is the mechanism that accounts for some degree of normal gastroesophageal reflux. This refers to the temporary relaxation of the muscle at the lower end of the esophagus, allowing stomach acid and contents to flow back into the esophagus. This relaxation is a normal physiological process that occurs in everyone to some extent. It is different from conditions like esophageal spasm or impaired clearance of gastric juice, which are abnormal and can cause more severe reflux symptoms.

Empyema of the gallbladder is the correct answer because it is a condition that occurs when acute cholecystitis (inflammation of the gallbladder) progresses and leads to persistent obstruction of the cystic duct. This obstruction causes bile to become stagnant, which can then become superinfected. The term "empyema" refers to the presence of pus in a body cavity, in this case, the gallbladder. Therefore, empyema of the gallbladder accurately describes the condition resulting from the progression of acute cholecystitis with persistent cystic duct obstruction to superinfection of the stagnant bile.

During the "window period" or "gap" when both HbsAg and anti-HBs are negative, the presence of Anti-HBc IgM can be the only serologic evidence of recent or current HBV infection. This is because Anti-HBc IgM is an antibody that is produced early in the infection and is usually detectable before other antibodies like HbsAg and anti-HBs. Therefore, if both HbsAg and anti-HBs are negative, but Anti-HBc IgM is positive, it suggests that the person may have a recent or ongoing HBV infection.

Endotracheal intubation for airway protection is necessary in patients with altered mental status and ongoing hematemesis. These patients may have compromised airways due to their altered mental status and the ongoing hematemesis increases the risk of aspiration. Intubation helps to secure the airway and prevent aspiration of blood into the lungs, which can lead to further complications. Therefore, in these specific patients, endotracheal intubation is crucial for their management.

Clotting factors are proteins that play a role in the blood clotting process. They are primarily produced by hepatocytes, which are liver cells. However, Factor VIII is not produced by hepatocytes. Instead, it is primarily produced by endothelial cells, which line the blood vessels. Therefore, Factor VIII is the correct answer as it is the only clotting factor that is not produced by hepatocytes.

The correct answer is Vascular ectasia and diverticulosis. Severe hematochezia refers to the passage of fresh blood through the rectum, which can be a sign of serious underlying conditions. Vascular ectasia refers to the dilation of blood vessels in the gastrointestinal tract, which can lead to bleeding. Diverticulosis is the presence of small pouches in the colon that can become inflamed or infected, causing bleeding. These two conditions are commonly associated with severe hematochezia requiring hospitalization.

Angiography would be the best imaging modality for this patient because the symptoms and history suggest a possible vascular issue. The patient's age, severe abdominal pain, and bloody stools may indicate a potential gastrointestinal bleed. Angiography can help identify the source of the bleeding by visualizing the blood vessels and detecting any abnormalities or areas of active bleeding. This imaging modality can provide valuable information for further diagnosis and treatment planning.

When a patient is receiving vasopressin infusion for hematochezia (blood in the stool), it is important to watch for the complication of intestinal ischemia. Vasopressin is a vasoconstrictor that works by narrowing blood vessels, which can potentially reduce blood flow to the intestines and lead to ischemia (inadequate blood supply). This can cause damage to the intestinal tissue and potentially lead to further complications if not monitored closely. Therefore, it is crucial to be vigilant for signs and symptoms of intestinal ischemia in patients receiving vasopressin infusion.

The presence of HBsAg indicates an active Hepatitis B infection. The presence of Anti HBc IgM suggests recent infection, as IgM antibodies are produced during the acute phase of the infection. The presence of HbeAg indicates high viral replication and infectivity. Therefore, the interpretation of these results is Acute Hepatitis B, high infectivity.

An ulcer crater with a flat pigmented spot is the most reassuring finding that the patient will not have a significant rebleeding episode within the next 3 days. This is because a flat pigmented spot indicates that the ulcer has already undergone a healing process, suggesting that the bleeding has stopped and the risk of rebleeding is low. Adherent clot on ulcer, Dieulafoy lesion, and esophageal varices with red color sign are all findings that indicate a higher risk of rebleeding.

Empiric therapy is recommended for the 35-year-old patient with recurrent bloatedness who has tried alternative medicine techniques. This is because empiric therapy involves treating a condition based on the symptoms alone, without a confirmed diagnosis. In this case, the patient's recurrent bloatedness suggests an underlying acid peptic disorder, and since alternative medicine techniques have not been effective, empiric therapy can be used to provide relief from the symptoms. However, it is important to note that a proper diagnosis should be sought if the symptoms persist or worsen.

Congenitally anomalous GB refers to a gallbladder that has a structural abnormality present from birth. This can include variations in size, shape, or position of the gallbladder. Prophylactic cholecystectomy, or the removal of the gallbladder as a preventive measure, may be indicated in cases of congenitally anomalous GB to prevent potential complications such as gallstone formation, inflammation, or obstruction. The other indications listed, such as stone size, diabetes, and multiple stones, are not specifically related to congenital anomalies and do not provide a sufficient explanation for the correct answer.

Mesenteric ischemia refers to the restricted blood supply to the intestines, which can lead to tissue damage and potentially life-threatening complications. The rectosigmoid colon is the most common location for mesenteric ischemia because it is the area where the blood vessels supplying the colon are most prone to blockage or narrowing. This is due to the complex vascular anatomy and the presence of multiple branches in this region. When blood flow is compromised in the rectosigmoid colon, it can result in severe abdominal pain, bloody stools, and other symptoms associated with mesenteric ischemia.

In the laboratory diagnosis of alcoholic fatty liver and alcoholic hepatitis, the AST (aspartate aminotransferase) to ALT (alanine aminotransferase) ratio is usually greater than 1. This means that the AST levels are higher than the ALT levels. This is a characteristic finding in these conditions and can help differentiate them from other liver diseases. The increased AST levels suggest liver damage, while the increased ALT levels indicate ongoing inflammation. Therefore, a higher AST/ALT ratio is indicative of alcoholic liver disease.

Hepatorenal Syndrome (HRS) is a form of functional renal failure without renal pathology that occurs in patients with advanced liver disease. It is characterized by intense renal vasoconstriction, which leads to reduced blood flow to the kidneys and subsequent renal dysfunction. The overall prognosis for HRS is usually poor. However, HRS Type 2 is actually associated with stable renal function and carries a more favorable prognosis compared to HRS Type 1, which is associated with unstable renal function. Therefore, the statement that HRS Type 2 is associated with unstable renal function and carries a less favorable prognosis is not true.

The presence of Anti-HBs antibodies and the absence of HbsAg, Anti-HAV IgM, Anti-HBc IgM, and Anti-HCV indicate that the individual has been immunized against Hepatitis B. This means that she has received the Hepatitis B vaccine and has developed antibodies against the virus, providing protection against future infections.

Based on the given information, the patient has severe liver dysfunction with multiple complications, including hepatic encephalopathy, uncontrolled ascites, and abnormal laboratory values such as INR of 5, serum albumin of 1 g/dl, and total bilirubin of 5 mg/dl. These findings indicate that the patient falls under the Child-Pugh Class C classification. Class C represents the most severe stage of liver disease, indicating poor liver function and a high risk of complications.

According to Goodsall's rule, a posterior external fistula will enter the anal canal in the posterior midline. This means that the fistula tract will be located towards the back of the anal canal, rather than on the sides (lateral) or towards the front (anterior midline). The presence of a perianal mass with draining purulent discharge suggests the possibility of a fistula, and based on its location, it is likely to be a posterior midline fistula.

Based on the patient's symptoms of vague abdominal pain, easy fatigability, and chest heaviness, along with the physical examination findings of pale skin, tachycardia, and hypochromic, microcytic anemia, the most likely diagnosis is iron deficiency anemia. Iron deficiency anemia is commonly caused by chronic blood loss, which can occur from gastrointestinal bleeding. The location of the lesion causing the bleeding is most likely in the ascending colon, as this is the first part of the colon where blood enters after passing through the small intestine. A colonoscopy is necessary to confirm the diagnosis and locate the exact site of bleeding.

Liver biopsy is considered the criterion standard in the evaluation of patients with liver disease because it provides direct and accurate information about the liver tissue. It involves removing a small sample of liver tissue for examination under a microscope to assess the severity and type of liver disease, determine the extent of liver damage, and guide treatment decisions. Ultrasound and triphasic CT scans can provide valuable information about the liver's size, shape, and structure, but they cannot provide detailed information about the cellular and histological changes occurring in the liver. Serum albumin, while an important marker of liver function, is not specific enough to diagnose or evaluate liver disease comprehensively.

Moderately severe acute pancreatitis is the correct answer because it is characterized by transient organ failure or local/systemic complications that resolve within 48 hours. These patients may or may not have necrosis, but may develop a local complication such as a fluid collection that requires a prolonged hospitalization greater than 1 week. This distinguishes it from mild pancreatitis, which does not have these complications, and severe pancreatitis, which has persistent organ failure. Severe complicated pancreatitis is not a recognized classification.

The treatment of choice for patients with uncomplicated acute cholecystitis is laparoscopic cholecystectomy within 72 hours. This surgical procedure involves the removal of the gallbladder using minimally invasive techniques. It is preferred over antibiotic therapy alone because it provides definitive treatment by removing the source of infection and preventing future episodes of cholecystitis. Performing the surgery within 72 hours helps to minimize the risk of complications and improve outcomes for the patient.