Gastroenterology & Hepatology

Topics in this chapter

• Chronic Liver Disease and Hepatitis
• Portal Hypertension and Ascites
• Hepatic Encephalopathy and Variceal Bleeding
• Gallbladder and Biliary Disorders
• Acute Pancreatitis and Classification
• Peptic Ulcer Disease and H. pylori
• Inflammatory Bowel Disease and Diarrhea

Practice questions

1. Question 1Q-9F8C56

   A 45-year-old chronic alcoholic male presents with massive hematemesis. On examination, he has jaundice, massive ascites, and asterixis. Upper GI endoscopy reveals actively bleeding esophageal varices. Which of the following is the most effective initial pharmacological therapy to control acute variceal bleeding?

   1. A.Terlipressin
   2. B.Propranolol
   3. C.Spironolactone
   4. D.Lactulose
   See the answer and solution
2. Question 2Q-8C0FAC

   A 35-year-old female presents with fatigue, pruritus, and right upper quadrant discomfort. Laboratory investigations reveal elevated alkaline phosphatase and gamma-glutamyl transferase. Serum bilirubin is mildly elevated, and transaminases are normal. Antimitochondrial antibody (AMA) is strongly positive. Which of the following is the hallmark histological finding in this patient's liver biopsy?

   1. A.Granulomatous destruction of interlobular bile ducts
   2. B.Concentric periductal fibrosis ("onion-skinning")
   3. C.Mallory-Denk bodies and neutrophilic lobular inflammation
   4. D.Caseating granulomas with central necrosis
   See the answer and solution
3. Question 3Q-1795E4

   A 60-year-old male with long-standing cirrhosis of the liver presents with confusion, slurred speech, and inverted sleep-wake cycle. On examination, he has grade 2 hepatic encephalopathy and asterixis. Serum ammonia is significantly elevated. Which of the following is the primary mechanism of action of lactulose in the management of this condition?

   1. A.Acidification of the colonic lumen converting NH3 to NH4+
   2. B.Direct systemic inhibition of urease-producing bacteria in the stomach
   3. C.Competitive inhibition of GABA receptors in the central nervous system
   4. D.Chelation of circulating blood ammonia in the portal circulation
   See the answer and solution
4. Question 4Q-A1DBB7

   A 28-year-old male presents with chronic, recurrent abdominal pain, non-bloody diarrhea, and low-grade fever. Colonoscopy reveals patchy areas of inflammation with cobblestone appearance, deep linear ulcers, and skip lesions involving the terminal ileum. Biopsy shows transmural inflammation and non-caseating granulomas. What is the most likely diagnosis?

   1. A.Crohn disease
   2. B.Ulcerative colitis
   3. C.Intestinal tuberculosis
   4. D.Ischemic colitis
   See the answer and solution
5. Question 5Q-2CB12B

   A 50-year-old male is evaluated for refractory ascites. Paracentesis is performed, and ascitic fluid analysis shows a serum-ascites albumin gradient (SAAG) of 1.6 g/dL and an ascitic fluid total protein of 2.8 g/dL. Which of the following is the most likely underlying cause of ascites in this patient?

   1. A.Cardiac ascites (e.g., constrictive pericarditis or heart failure)
   2. B.Cirrhosis of the liver
   3. C.Spontaneous bacterial peritonitis
   4. D.Tuberculous peritonitis
   See the answer and solution