Gastroenterology and hepatology MCQ

Question 1

Answer 1

C

Question 2

Answer 2

C

Question 3

Answer 3

E (non invasive test for checkup)

Question 4

Answer 4

C

Question 5

Answer 5

C (protective levels of antibody to HAV could be present for at least 25y in adults and at least 14-20y in children)

Question 6

Answer 6

B

D is not likely as asymptomatic

Question 7

Answer 7

Ans: C

A – ascitic protein classically <10
B – usu G- or streptococci, or may be -ve
D – pH <7.3 suspicious; pH <7.15 a/w poor prognosis
E – diagnostic paracentesis always needed!

Question 8

Answer 8

C

Question 9

Answer 9

E

Question 10

Answer 10

Ans: C

A (esophageal web in Plummer Vinson syndrome)

Question 11

Answer 11

Ans: C

Pathophysiology incl:
* Altered gastric motility and compliance
* Visceral hypersensitivity
* Helicobacter pylori infection, altered gut microbiome
* Psychosocial dysfunction

Question 12

Answer 12

Ans: A

Question 13

Answer 13

Ans: C. HEV infection

Question 14

Answer 14

Ans: D

E (mitral stenosis resulting in enlargement of left atrium which can cause compression of the recurrent laryngeal nerve (dysphagia/hoarsness in voice) –> Ortner syndrome)

Question 15

Answer 15

Ans: C

Question 16

Answer 16

Ans: B (day 3 CT scan used to detect necrosis: may need further management)

Question 17

Answer 17

C.

A: reversed de Ritis ratio 2:1 typical
D: histological features incl lipogranuloma, neutrophil infiltration, Mallorys hyaline, pericellular fibrosis
E: Maddrey score based on PT, bilirubin

Question 18

Answer 18

Ans: A

Question 19

Answer 19

C
Obstructive jaundice: cholestatic component leading to vit K deficiency
Painless jaundice more likely to be malignant cause (but HCC CBD obstruction usually uncommon)

Question 20

Answer 20

Ans: A

B, C, D – in Glasgow criteria
E – part of SIRS

Question 21

Answer 21

Ans: C

Question 22

Answer 22

Ans: C

Question 23

Answer 23

Ans: A

Inflammatory exudation – IBD, GI malignancy, CD colitis, multiple ulcer
Mucosal condition – celiac disease, Whipple disease, Menetrier disease, lupus enteritis
Lymphatic obstruction – primary lymphangiectasis, constrictive pericarditis, Rt HF, portal HT

Question 24

Answer 24

Ans: A

Question 25

Answer 25

Ans: C (will actually exacerbate HE)

Question 26

Answer 26

Ans: A

Question 27

Answer 27

Ans: E (for HE prophylaxis)

Question 28

Answer 28

Ans: E (PSA)

Question 29

Answer 29

Ans: B (increased absorption of ammonia into the mesenteric blood supply due to slow transit constipation --> such absorption most likely overwhelemd hepatic excretion) C: hypoK

Question 30

Answer 30

Ans: B

Question 31

Answer 31

Ans: A

Question 32

Answer 32

Ans: B

Question 33

Answer 33

Ans: B

Question 34

Answer 34

Ans: E

Question 35

Answer 35

Ans: A

Question 36

Answer 36

Ans: D * 5y: low-risk adenoma (1-2 polyps, tubular, <1cm, ≤moderate dysplasia), low-risk sessile (SSP <1cm + no dysplasia) * 3y: high-risk adenoma (≥3 polyps, villous element, ≥1cm, severe dysplasia), high-risk sessile (SSP ≥1cm or dysplastic or TSA) * <3y: >10 adenoma

Question 37

Answer 37

Ans: C

Question 38

Answer 38

Ans: B (HSV associated with shallow ulcers) A: candida (whitish patches) C: CMV (deep longitudinal ulcers)

Question 39

Answer 39

Ans: C

Question 40

Answer 40

C. (TAF first line, TDF only reserved for pregnancy)

Question 41

Answer 41

Ans: D (PT included in Kings criteria)

Question 42

Answer 42

Ans: B (should add PPI too)

Question 43

Answer 43

Ans: E (hyperplastic polyp risk not increased)

Question 44

Answer 44

Ans: E

Question 45

Answer 45

Ans: E

Question 46

Answer 46

Ans: E

Question 47

Answer 47

Ans: B RF: immune tolerance phase, no treatment, amle sex, HCV/HDV coinfection, alcoholism

Question 48

Answer 48

Ans: A

Question 49

Answer 49

Ans: C

Question 50

Answer 50

Ans: A

Question 51

Answer 51

Ans: A Causes of AST>ALT are acute cholangiohepatitis and alcoholic hepatitis. For alcoholic hepatitis, ALT AST typically <500. For acute cholangiohepatitis it can be of any level.

Question 52

Answer 52

Ans: A (sustained virologic response defined by undetectable HCV RNA 12w after completion i.e. means that is cleared already)

Question 53

Answer 53

Ans: C

Question 54

Answer 54

Ans: B Cholestasis: OCP, steroids, chlorpromazine Mixed cholestatic hepatitis; *Augmentin*, erythromycin, ACEI, NSAID Hepatitis: Panadol, isoniazid, rifampicin, allopurinol Steatosis: tetracycline, valproate, amiodarone, tamoxifen, TPN, glucocorticoid, metoprolol

Question 55

Answer 55

Ans: B (PBC)

Question 56

Answer 56

Ans: D

Question 57

Answer 57

Ans: A Most commonly * fluoroquinolone * clindamycin * broad-spectrum penicillin/cephalosporin

Question 58

Answer 58

Ans: A

Question 59

Answer 59

Ans: C

Question 60

Answer 60

Ans: A

Question 61

Answer 61

Ans: A

Question 62

Answer 62

Ans: B MRA is 1st line (e.g. spironolactone)

Question 63

Answer 63

Ans: A

Question 64

Answer 64

Ans: E

Question 65

Answer 65

Ans: D

Question 66

Answer 66

Ans: C

Question 67

Answer 67

Ans: D

Answer 68

Ans: B

Question 69

Answer 69

Ans: A

Question 70

Answer 70

Ans: E (most common cause of renal impairment in cirrhosis is not hepatorenal syndrome, but hypovolemia due to excessive diuretics. In case of renal function worsening, stop or reduce diuretics first)

Question 71

Answer 71

Ans: C

Question 72

Answer 72

Ans: D

Question 73

Answer 73

Ans: A

Question 74

Answer 74

Ans: C

Question 75

Answer 75

Ans: A

Question 76

Answer 76

Ans: C

Question 77

Answer 77

Ans: B (non invasive test)

Question 78

Answer 78

Ans: A

Question 79

Answer 79

Ans: B

Question 80

Answer 80

Ans: C

Question 81

Answer 81

Ans: C

Question 82

Answer 82

Ans: B Alternatives are ceftriaxone, cefazolin, ceftazidime All similar efficacy

Question 83

Answer 83

Ans: B

Question 84

Answer 84

Ans: A (HBV DNA high)

Question 85

Answer 85

Ans: D

Question 86

Answer 86

Ans: D

Question 87

Answer 87

Ans: metronidazole

Question 88

Answer 88

Ans: A

Question 89

Answer 89

Ans: B

Question 90

Answer 90

Ans: D

Question 91

Answer 91

Ans: A

Question 92

Answer 92

Ans: A

Question 93

Answer 93

Ans: A

Question 94

Answer 94

Ans: E (sky high ALT and AST usu suggest ischemic or toxic liver injury. The reversed de Ritis ratio here may suggest more to ischemic cause (as AST being released from other ischemic organs)

Question 95

Answer 95

Ans: D

Question 96

Answer 96

Ans: D

Question 97

Answer 97

Ans: B (reduces ammonia production by eliminating ammonia producing colonic bacteria)

Question 98

Answer 98

Ans: D

Question 99

Answer 99

Ans: A

Question 100

Answer 100

Ans: A

Question 101

Answer 101

Ans: C (increasing clarithromycin resistance)

Question 102

Answer 102

Ans: B

Question 103

Answer 103

Ans: C

Question 104

Answer 104

Ans: B assess response to intravenous corticosteroid by third day; consider rescue therapy incl infliximab or cyclosporine if fail to show significant improvement within 3–5d