MCQs GENERAL MEDICINE: GASTRIC ABNORMALITIES

Question 1. The following statements are true: (a) Tylosis is associated with achalasia. (False) (b) On barium swallow, a 'bird's beak' appearance is suggestive of squamous carcinoma. (False) (c) Pneumatic dilatation is the treatment of choice for achalasia. (True) (d) Reduced lower oesophageal sphincter pressure is a common feature of gastro-oesophageal reflux disease . (True) (e) Oesophageal pH is usually less than 4. (False)

Question 2. The following is true of Barrett's oesophagus: (a) Columnar epithelium is replaced by squamous epithelium. (False) (b) It appears in an antegrade (top to bottom) direction. (False) (c) It is a premalignant condition. (True) (d) Severe dysplasia is an ominous sign. (True)(e) It is an indication for surveillance endoscopy. (True)

Question 3. Helicobacter pylori: (a) Causes ulceration in the duodenum. (True) (b) Causes Barrett's metaplasia in the oesophagus. (False) (c) Is associated with hypergastrinaemia. (True) (d) Is often resistant to certain antibiotics. (True) (e) Can convert urea to ammonia and carbon dioxide. (True)

Question 4. Gastric hypomotility (gastroparesis): (a) Is commonly associated with diabetes mellitus. (True) (b) Is a risk factor for gastro-oesophageal reflux disease. (True) (c) Is a feature of generalized scleroderma (systemic sclerosis). (True) (d) Occasionally responds to erythromycin. (True) (e) Is often secondary to duodenal ulcer disease. (False)

Question 5. The following are features of coeliac disease: (a) Hypocalcaemia. (True) (b) Hypercalcaemia. (False) (c) Normocytic anaemia. (False) (d) Hypoalbuminaemia. (True) (e) Positive antiparietal cell antibodies. (False)

Question 6. The following is true of Crohn's disease: (a) The rectum is always affected. (False) (b) Commonly affects the terminal ileum. (True) (c) More commonly occurs in smokers. (True) (d) Can result in vitamin B12 deficiency with a negative Schilling test. (True) (e) Commonly presents with bloody diarrhoea. (False)

Question 7. The following is true of giardiasis: (a) Diarrhoea abates with avoidance of dairy produce. (False) (b) Diarrhoea abates with avoidance of gluten. (False) (c) Diarrhoea requires treatment with metronidazole. (True) (d) Diarrhoea is usually accompanied by vomiting. (False) (e) Diarrhoea commonly results in vitamin B12 deficiency. (False)

Question 8. The following is true of inflammatory bowel disease: (a) Increased liver enzymes in the serum usually indicate the complication of carcinoma. (False) (b) Small bowel barium enema is the best radiological investigation for ulcerative colitis. (False) (c) It is occasionally complicated by carcinoma of the caecum. (True) (d) It is commonly associated with thyroiditis. (False) (e) It is sometimes complicated by iritis. (True)

Question 9. The following is true of viral hepatitis: (a) Hepatitis C commonly presents with jaundice. (False) (b) Hepatitis E is fatal particularly in pregnant women. (True) (c) Hepatitis BeAg is a marker of viral replication. (True) (d) Hepatitis A is a risk factor for hepatoma. (False) (e) Hepatitis D occurs only in association with hepatitis C. (False)

Question 10. The following drugs cause jaundice: (a) Methotrexate. (False) (b) Flucloxacillin. (True) (c) Metronidazole. (False) (d) Isoniazid. (True)e) Phenobarbitone. (False)

Question 11. Haemochromatosis: (a) Is a genetic defect resulting in copper overload in the liver. (False) (b) Is a risk factor for the development of hepatoma. (True) (c) Has an equal sex incidence but presents earlier in males than females. (True) (d) Is treated by avoiding meat products. (False) (e) Can cause hypogonadism in the absence of cirrhosis. (True)

Question 12. Colonic carcinoma: (a) Most commonly occurs in the right side of the colon. (False) (b) May present with iron deficiency anaemia in the absence of any gastrointestinal symptoms. (True) (c) Commonly arises in colonic polyps. (True) (d) Carries a 5-year survival of less than 10%. (False) (e) Is the cause of carcinoid syndrome. (False)

Question 13. The following is true of colon polyps and colon cancer: (a) The larger the polyp, the greater the risk of carcinoma. (True) (b) Malignant polyps can be successfully treated by colonoscopy and polypectomy alone. (True) (c) Hyperplastic polyps have a higher malignant potential than villous polyps. (False) (d) Polyps are most common in the ascending colon. (False) (e) Colonic polyps are often recurrent. (True)

Question 14. The following gastrointestinal diseases are associated with the renal conditions listed: (a) Crohn's disease and renal amyloidosis. (True) (b) Hepatitis B and glomerulonephritis. (True) (c) Gastric ulcer and nephrotic syndrome. (False) (d) Pancreatic neuroendocrine tumours and polycystic kidney disease. (False) (e) Liver cysts and glomerulosclerosis. (False)

Question 15. The following is true of villous atrophy in the small intestine: (a) If due to coeliac disease, it should recover completely on a gluten-free diet. (True) (b) It can be caused by tuberculosis. (True) (c) It can be associated with Giardi lamblia. (True) (d) It can be associated with Tropheryma whippelei. (True) (e) When associated with bacteria, it may cause a rise in serum folate. (True

Question 16. The following skin conditions are associated with the named GI diseases: (a) Dermatitis herpetiformis with coeliac disease. (True) (b) Pruritus with primary biliary cirrhosis. (True) (c) Pyoderma gangrenosum with gastric carcinoma. (False) (d) Bullous pemphigoid with pancreatitis. (False) (e) Erythema nodosum with Crohn's disease. (True)

Question 17. The following statements are true in relation to vomiting: (a) Vomiting occurring 12 hours after a suspicious meal is indicative of Salmonella poisoning. (False) (b) Vomiting in association with headache is a feature of migraine. (True) (c) Vomiting associated with weight loss can be indicative of malignant disease. (True) (d) Vomiting usually precedes the pain of biliary colic. (False) (e) Vomiting can be a feature of myocardial infarction. (True)

Question 18. Scleroderma can produce the gastrointestinal complications listed: (a) Diarrhoea due to bacterial overgrowth. (True) (b) Constipation due to gut hypomotility. (False) (c) Diarrhoea which is unresponsive to a gluten-free diet. (True) (d) Gastric ulcer due to chronic gastritis. (False)(e) Dysphagia due to abnormal peristalsis in the oesophagus. (True)

Question 19. Chronic pancreatitis: (a) Is a cause of diabetes mellitus. (True) (b) Can result from alcohol ingestion in moderate amounts. (True) (c) May be hereditary in a minority of cases. (True) (d) Can be diagnosed by a raised serum amylase. (False) (e) Is a cause of pancreas divisum. (False)

Question 20. The following is true of rectal bleeding: (a) In the absence of haemorrhoids, it is usually due to malignant disease. (False) (b) It occurs more commonly in Crohn's disease than in ulcerative colitis. (False) (c) If it occurs in a patient with ulcerative colitis, it usually indicates that carcinoma has developed. (False) (d) When it is due to diverticular disease, colectomy may be indicated to control it. (True) (e) It may be caused by ingestion of aspirin. (True)

Question 21. The following are risk factors for gastric carcinoma: (a) Pernicious anaemia. (True) (b) Coeliac disease. (False) (c) Partial gastrectomy. (True) (d) Helicobacter pylori infection. (True) (e) Ménétrière's disease. (True)

Question 22. The following statements are true: (a) Solitary rectal ulcers are commonly associated with Crohn's disease. (False) (b) Crypt abscesses are typical of coeliac disease. (False) (c) Fistula formation can be a feature of Whipple's disease. (False) (d) Anal fissure predisposes to faecal incontinence. (False) (e) Right iliac fossa pain is common with diverticular disease. (False)

Question 23. The following are true of hepatitis: (a) Hepatitis B is spread via the faecal-oral route. (False) (b) A vaccine is available for hepatitis C. (False) (c) Incubation time for hepatitis A is approximately 2-3 weeks. (True) (d) Hepatitis B is an RNA virus. (False) (e) Interferon treatment is required for hepatitis E infection. (False)

Question 24. The following is a risk factor for the Budd-Chiari syndrome: (a) Oral contraceptive pill. (True) (b) Malignancy. (True) (c) Ascites. (False) (d) Polycythaemia rubra vera. (True) (e) Constrictive pericarditis. (False)

Question 25. The following are true regarding prognostic factors for acute pancreatitis: (a) A low pAO2 indicates a poor prognosis. (True) (b) A high serum GGT has a poor prognosis. (False) (c) Age of over 55 years usually has a good prognosis. (False) (d) A low serum albumin indicates a poor prognosis. (True) (e) Abnormal clotting time has a poor prognosis. (True)

 

Question 1. The following is true of oesophageal pain: (a) It can occur in the absence of heartburn. (True) (b) It can mimic the pain of a myocardial infarction. (True) (c) It can be relieved by glyceryl trinitrate. (True)
(d) It is usually precipitated by exercise. (False) (e) It can be caused by candidiasis. (True)

Question 2. The following is true of postgastrectomy syndromes: (a) The anaemia can be corrected with ascorbic acid supplements. (True) (b) The risk of gastric cancer in the long term is increased. (True) (c) Sweating and palpitations can be due to hypoglycaemia. (True) (d) Biliary gastritis in the gastric remnant is common. (True) (e) Diarrhoea is commonly due to bacterial overgrowth. (True)

Question 3. The following is true of neoplastic disease in the stomach: (a) Maltoma can occasionally respond to antibiotic treatment in combination with a proton pump inhibitor. (True) (b) Ménétrière's disease is due to metaplasia of the gastric mucosa. (True) (c) Leiomyoma has a characteristic appearance at endoscopy. (True) (d) Gastric carcinoma produces abdominal pain that is often worse after eating. (True) (e) The most common gastric carcinoma is of squamous cell origin. (False)

Question 4. The following statements are true: (a) Iron absorption is reduced in hypochlorhydric states. (True) (b) Vitamin D absorption is often deficient in the presence of gastritis. (False) (c) Vitamin B12 supplements are often necessary following gastrectomy. (True) (d) Anaemia associated with chronic atrophic gastritis may respond to ascorbic acid supplements. (True) (e) Intestinal metaplasia in the stomach is a risk factor for gastric carcinoma. (True)

Question 5. The following clinical features are associated with coeliac disease: (a) Anaemia. (True) (b) Weight loss. (True) (c) Vomiting. (False) (d) Diarrhoea. (True) (e) Jaundice. (False)

Question 6. The following is true of Crohn's disease: (a) C-reactive protein mimics inflammatory activity. (True) (b) Normal albumin indicates remission. (False) (c) Large bowel barium enema is the most definitive radiological test. (False) (d) A small bowel biopsy can be helpful in making the diagnosis. (True) (e) A low blood urea is common. (True)

Question 7. The following is true of ulcerative colitis: (a) It commonly presents with pain in the right iliac fossa. (False) (b) It can be associated with ankylosing spondylitis. (True) (c) It is a risk factor for toxic dilatation of the colon. (True) (d) The occurrence of abdominal tenderness is an ominous sign. (True) (e) It often causes ischiorectal abscesses. (False)

Question 8. Acholuric jaundice without pain: (a) Is a common presentation of pancreatic carcinoma. (False) (b) Is a feature of Gilbert's disease. (True) (c) Can occur in hereditary spherocytosis. (True) (d) Is associated with pale-coloured stools. (False) (e) Is associated with pruritus. (False)

Question 9. The following is true of risk factors for the development of hepatocellular carcinoma: (a) Females are at greater risk than males. (False) (b) Excess iron is a recognized risk factor. (True) (c) Aflatoxin is a risk factor. (True) (d) Hepatitis A is a risk factor. (False)(e) Risk factors generally only operate in the presence of cirrhosis. (True)

Question 10. Alcoholic hepatitis: (a) Recovers rapidly on cessation of drinking. (False) (b) Is a risk factor for hepatorenal syndrome. (True) (c) Ascites is a feature. (True) (d) Coagulopathy is corrected with administration of vitamin K. (False) (e) Encephalopathy occurs only if infection is present. (False)

Question 11. Primary sclerosing cholangitis: (a) Occurs predominantly in middle-aged females. (False) (b) Is a major risk factor for cholangiocarcinoma. (True) (c) Occurs in 50% patients with ulcerative colitis. (False) (d) Has been treated with ursodeoxycholic acid. (True) (e) May require insertion of an endoprosthesis for its treatment. (True)

Question 12. The following GI conditions are associated with microcytic hypochromic anaemia: (a) Acute duodenal ulceration. (False) (b) Ankylostoma duodenale. (True) (c) Terminal ileitis due to Crohn's disease. (True) (d) Partial gastrectomy. (True) (e) Carcinoma of caecum. (True)

Question 13. These gastronomic terms are associated with the following gastroenterological conditions: (a) 'Rice water' diarrhoea with cholera. (True) (b) 'Anchovy sauce' discharge with amoebic dysentry. (False) (c) 'Redcurrent jelly' and intussusception. (True) (d) 'Apple core' lesion and diverticulitis. (False) (e) 'Coffee grounds' and oesophageal varices. (False)

Question 14. The following is true of breath tests used for investigation of the gastrointestinal tract: (a) The 14C urea breath test detects Helicobacter pylori infection. (True) (b) The 14C glycocholic acid breath test is used to detect bacterial overgrowth in the colon. (False) (c) A hydrogen breath test following ingestion of lactulose is used to detect bacterial overgrowth in the small intestine. (True) (d) A lactose breath test is used to detect disaccharidase deficiency. (True) (e) A 14C bile salt test can be used to identify bile duct obstruction. (False)

Question 15. The following autoantibodies are associated with the diseases listed: (a) Antiendomyseal antibodies are associated with coeliac disease. (True) (b) Anti-LKM antibodies are associated with Goodpasture syndrome. (False) (c) Antimitochondrial antibodies are associated with primary biliary cirrhosis. (True) (d) Antiparietal cell antibodies are associated with Wilson's disease. (False) (e) Antismooth muscle antibodies are associated with autoimmune chronic active hepatitis. (True)

Question 16. The following statements are true of colitis: (a) Granulomas are present in collagenous colitis. (False) (b) Rectal sparing is characteristic of Crohn's colitis. (True) (c) Caseating granulomas in the terminal ileum are diagnostic of Crohn's disease. (False) (d) Colitis in a smoker is more likely to be Crohn's than ulcerative colitis. (True) (e) Pain is a characteristic feature of CMV colitis. (True)

Question 17. The following statements are true of ascites: (a) A high protein content in ascites is usual in alcoholic liver disease. (False) (b) Ascites resistant to diuretics is characteristic of hepatic vein thrombosis. (True) (c) Ascites is sometimes associated with a pleural effusion. (True) (d) Ascites is a risk factor for bacterial peritonitis. (True) (e) Ascites due to constrictive pericarditis prevents pulsus paradoxus. (False)

Question 18. The following statements are true of non-steroidal anti-inflammatory drugs: (a) They can be given as suppositories to avoid gastrointestinal complications. (False) (b) They may have a role in the prevention of colon cancer. (True) (c) They can produce gastric erosions in elderly people causing occult blood loss. (True) (d) They cause gastric erosions by stimulating gastric acid secretion. (False) (e) They may exacerbate long-standing ulcerative colitis. (True)

Question 19. The following is true of pancreatic tumours: (a) Jaundice occurs only when carcinoma is present in the tail of pancreas. (False) (b) Presence of diabetes mellitus indicates that the tumour is of neuroendocrine origin. (False) (c) They are generally unresponsive to chemotherapy. (True) (d) They characteristically produce back pain when local invasion is present. (True) (e) They occur with increased frequency in patients with ulcerative colitis. (False)

Question 20. The following is true of haematemesis: (a) When it occurs in a patient with alcoholic liver disease, it is always due to oesophageal varices. (False) (b) A visible vessel seen at gastroscopy is a risk factor for further bleeding. (True) (c) When it occurs in patients over 70 years of age who may have arthritis, usually indicates malignancy. (False) (d) When it occurs after repeated retching, it is suggestive of an oesophageal tear. (True) (e) When it is caused by duodenal ulcer, a partial gastrectomy is usually necessary. (False)

Question 21. The following drugs can be used for treatment of GORD: (a) Metronidazole. (False) (b) Amoxycillin. (False) (c) Erythromycin. (False) (d) Metoclopramide. (True) (e) Omeprazole. (True)

Question 22. Which of the following is dependent on bile salts for its absorption: (a) Vitamin A. (True) (b) Vitamin B. (False) (c) Vitamin C. (False) (d) Vitamin D. (True) (e) Vitamin K. (True)

Question 23. The following are indications for liver biopsy: (a) Unexplained abnormal liver enzymes. (True) (b) Pyrexia of unknown origin with normal liver enzymes. (True) (c) Cirrhosis suspected on an ultrasound scan. (True) (d) Raised alkaline phosphatase in teenagers with acholuric jaundice. (False) (e) Abnormal liver enzymes in a patient with epilepsy on phenytoin. (False)

Question 24. The following precipitate portasystemic encephalopathy: (a) Infection. (True) (b) Diarrhoea. (False) (c) Gastrointestinal bleeding. (True) (d) Use of opioid drugs. (True) (e) Certain antibiotics. (False)

Question 25. The following drugs cause cholestatic jaundice: (a) Rifampicin. (False) (b) Isoniazid. (False) (c) Erythromycin. (True) (d) Halothane. (False) (e) Paracetamol. (False)