Chapter III / Gastro-Enterology

Q1: In gut hormones, all of the followings are true, except:

a- Gastrin is mainly secreted by the gastric antral G cells.
b- Sectretin inhibits gastric acid secretion.
c- Somatostatin stimulates insulin secretion.
d- Motilin secretion is stimulated by dietary fat.
e- Gastric inhibitory polypeptide is secreted from deuodenum and jujenum to inhibit
gastric acid secretion and stimulate insulin secretion.
Q2: Contrast radiology is commonly used in clinical gastroenterology, all of the
followings are true, except:
a- The main limitations of barium swallow are risk of aspiration and poor mucosal
details.
b- The main limitations of barium meal are the low sensitivity to detect early cancer
and inability to assess H pylori status.
c- The main limitations for barium follow through are being time consuming and
greater risk of radiation exposure.
d- The main limitations for barium enema are being difficult in elderly or those with
incontinence and being some what uncomfortable.
e- Barium enemas usually miss polyps less than 5 cm in size.
Q3: In upper Gastrointestinal endoscope, all of the followings are
contraindications, except:
a- Severe shock.
b- Recent myocardial infarction.
c- Severe respiratory disease.
d- Possible visceral perforation.
e- Anemia.
Q4: Complications of upper GIT endoscope, all of the followings are true,
except:
a- Aspiration pneumonia.
b- Visceral perforation.
c- GIT bleeding.
d- Cardiopulmonary depression due to over sedation.
e- Very minor risk of infective endocarditis.
Q5: Dynamic tests are used in the diagnosis of many GIT diseases, all of the
followings are true, except:
a- Lactose hydrogen breath test is used for lactose intolerance and although being non
invasive and accurate but it may provoke abdominal pain diarrhea in sufferers.
b- 14C triolein breath test is used for fat malabsorption, although being fast and
noninvasive
but is non quantitative.

c- 75SeHCAT test is used in fat malabsorption and is accurate and specific but
requires 2 visits and involves radiation.
d- Pancreolauryl test is used as a test for pancreatic exocrine function and is accurate
and avoids duodenal intubation but needs accurate collection of urine.
e- 14C glycocholate breath test is a useful screening test for bacterial overgrowth.
Q6: Radio-isotope tests are still used in clinical gastroenterology, all of the
followings are true, except:
a- 13C and 14C urea breath test is used in H pylori detection.
b- 99mTc pertechnetate is used for the detection of Meckel's diverticulum.
c- 99mTc HMPAO labeled leukocytes is used for the detection of visceral abscesses.
d- 51Cr-albumin is used a test for epithelial permeability.
e- 99Tc-sulphur is used a test for protein losing enteropathy.
Q7: In Barrette's esophagus, all of the followings are true, except:
a- Is a pre-malignant condition increases the risk of esophageal adenocarcinoma by
90-150 folds.
b- Is always symptomatic with heartburn and regurgitation.
c- It is due to long standing gastric acid reflux.
d- The risk of malignancy is particularly very high when the metaplastic tissue is of
intestinal with goblet cells origin.
e- Long term acid suppression is not useful in reversing the histological abnormality.
Q8: Complications of long standing gastro-esophageal reflux disease (GERD), all
of the followings are true, except:
a- Iron deficiency anemia.
b- Benign stricture formation.
c- Barrette's esophagus.
d- Esophagitis.
e- Esophageal squamous cell carcinoma.
Q10: In Achalasia of the cardia, all of the followings are true, except:
a- A similar picture may be seen in Chaga's disease.
b- May result in esophageal squamous cell carcinoma even after treatment.
c- Hear burn is prominent.
d- Usually seen in middle age women, although no age is exempt.
e- Treatment with botulinum toxin is effective, yet the effect is transient.
Q11: Etiological factors in the development of esophageal carcinoma include all
of the followings, except:
a- Coeliac disease.
b- Tylosis.
c- Smoking and alcoholism.
d- Chewing tobacco.
e- Ulcerative colitis.

Q12: Causes of acute gastritis includes all of the followings, except:

a- Iron medications.
b- Bile reflux following gastric surgery.
c- CMV infection.
d- Acute infection with H. pylori.
e- Pernicious anemia.
Q13: The following diseases are associated with H pylori infection, except:
a- Gastric ulcer.
b- Duodenal ulcer.
c- Gastric MALTOMA.
d- Gastric adenocarcinoma.
e- Gastro-esophageal reflux disease.
Q14: Regarding methods to diagnose H pylori infection, all of the followings are
true, except:
a- H pylori serology although being rapid and useful for population studies but it can
not differentiate between acute and past infections and lacks sensitivity and
specificity.
b- Although urea breath test has a high sensitivity and specificity but 14C requires
radio-activity and 13C requires mass spectrometer.
c- Rapid urease test on an antral biopsy specimen has a high sensitivity and is cheap
and quick.
d- Microbiological culture of an antral biopsy specimen is the gold standard method
and defines antibiotic sensitivity but it is slow and lacks sensitivity.
e- Histopahtological examination of an antral biopsy specimen although sensitive and
specific yet false negative results are still seen and takes several days to process,
Q15: Risk factors for NSAIDs induced peptic ulceration, all of the followings are
true, except:
a- Past history of peptic ulcer.
b- High dose or multiple NSAIDs.
c- Concomitant steroid therapy.
d- Age blow 50 years.
e- Treatment with azapropazone.
Q16: Side effects encountered during treatment with anti H. pylori medications,
all are true, except:
a- Diarrhoa is uncommonly seen.
b- Metallic taste in the mouth is commonly seen with metronidazole.
c- Headache.
d- Skin rashes.
e- Abdominal cramps and vomiting.
Q17: Side effects of individual anti H. pylori medications, all are true, except:
a- Cimetidin can cause confusion.

b- Omprazole can cause hypergastrenemia.

c- Sucralfate can enhance the effect of digoxin and warfarin.
d- Misopristol causes diarrhea up to 20 % of cases.
e- Colloidal bismuth blackens teeth, tongue and stool.
Q18: In Zollinger Ellison syndrome, all of the followings are true, except:
a- Accounts for about 0.1 % of all cases of peptic ulceration.
b- Commonly seen between 30-50 years of age.
c- 90% are due to gastrin secreting pancreatic tumors.
d- 50-70% are malignant.
e- 20-60 % of cases are part of MEN type II.
Q19: In Zollinger Ellison syndrome, all of the followings are true, except:
a- Should be suspected whenever there is severe, multiple peptic ulceration.
b- Diarrhoea is common and may the presenting feature up to 30 % of cases.
c- Ulcer bleeding and perforations are common.
d- Barium meal may reveal thin mucosal folds.
e- The ulcers may occur at atypical sites like the jejunum and esophagus.
Q20: Regarding the management of Zollinger Ellison syndrome, all of the
followings are true, except:
a- Some patients present with metastatic disease and hence surgery is inappropriate.
b- Proton pump inhibitors should be given in large doses to be effective.
c- Octreotide has been shown to be of value in the treatment.
d- The overall 5 years survival is 10-15%.
e- All patients should be monitored for the future development or other features of
MEN type I.
Q21: Predisposing factors to gastric cancer includes all of the followings, except:
a- Previous partial gastrectomy.
b- Autoimmune gastritis.
c- Adenomatous gastric polyps.
d- Familial adenomatous polyposis.
e- Tylosis.
Q22: In gastric cancer, all are true, except:
a- The incidence of gastric cancer is rising in the western world like UK.
b- The overall prognosis remains very poor.
c- Almost all tumors are adenocarcinomas.
d- Clinical examination may reveal nothing.
e- Dyphagia is seen in tumors near the cardia.
Q23: In Celiac Disease, all of the followings are true, except:
a- The disease may occur at any age.
b- The presentation is highly variable depending on the severity and extent of the
small bowel involvement.

c- An association with HLA B8, DR17, DQ2.

d- The earliest histological finding is an increase in the intra-epithelial lymphocyte.
e- The disease is seen world wide but is very rare in northern Europe.
Q24: In the treatment of celiac disease, all of the followings are true, except:
a- Gluten free diet should be taken infinitely.
b- Dietary restriction of wheat, rye, barely and possibly oats should be encouraged.
c- Rice, maize and potatoes should be restricted.
d- Minerals and vitamins may be given but in practice this is uncommon.
e- Poor compliance with dietary advices remains the commonest cause of treatment
failure.
Q25: Complications of celiac disease, all of the followings are true, except:
a- Ulcerative jejunitis.
b- Esophageal adenocarcinoma.
c- Small bowel T cell lymphoma.
d- Intensely itchy skin rash.
e- Small bowel carcinoma.
Q26: In diagnosis of celiac disease, all of the followings are true, except:
a- Of all detected antibodies, IgA anti-endomysium antibodies have the highest
sensitivity and specificity.
b- Small bowel biopsy is the gold standard.
c- Barium follow through will reveal non specific findings of dilated loops with
coarse folds and contrast clumping.
d- Dimorphic blood picture may be seen.
e- Co-existent IgA deficiency will not affect the serological tests.
Q27: The followings are associated with celiac disease, except:
a- Type II diabetes.
b- Splenic atrophy.
c- Hypothyroidism.
d- Primary biliary cirrhosis.
e- Inflammatory bowel disease.
Q28: In Tropical sprue, all of the followings are true, except:
a- The disease occasionally occurs in epidemics and hence an infective etiology has
been suggested.
b- Partial villous atrophy is much more common than total villous atrophy in small
bowel biopsy.
c- The most important differential diagnosis in endemic areas is an infective diarrhea.
d- Tetracycline for 28 days will produce cure or long term remission and is the
treatment of choice.
e- The disease is rare in Malaysia and Indonesia.
Q29: In Bacterial overgrowth syndrome, all of the followings are true, except:

a- May be caused by pernicious anemia.

b- 14C-glycocholate breath test is a good screening test.
c- Serum B12 and serum folates are low.
d- The treatment of choice in most patients is tetracycline for 1 week.
e- Patients usually present with watery diarrhea and or steatorrhoea.
Q30: Whipples disease, all of the followings are true, except:
a- Caused by a small gram negative bacilli.
b- Usually seen in middle aged men with clubbing, low grade fever and hyper
pigmentation.
c- Almost any organ can be involved.
d- Almost fatal if not treated.
e- Following successful therapy, follow up is very important as up 30% of cases will
relapse.
Q31: In short bowel syndrome, all of the followings are true, except:
a- May be caused by nectrotizing enterocolitis in children and by Crohn's disease in
adults.
b- Dehydrations and weight loss are common.
c- Some patients need treatment with octreotide to lessen the bowel secretions and
diarrhea volume.
d- Anti-diarrheal agents are contraindicated.
e- Some patients need total parenteral nutrition for survival.
Q32: Radiation enteritis, all of the followings are true, except:
a- Usually occurs in the context of radiotherapy for abdominal or pelvic malignancy.
b- The terminal ileum, sigmoid and rectum are the usual victims.
c- May produce malabsorption through different mechanisms.
d- Small bowel adhesions and fistulae may occur.
e- Cholestyramin is totally useless.
Q33: Protein losing enteropathy, all of the followings are true, except:
a- The usual picture is peripheral edema with hypoalbuminemia and normal liver
function test and normal 24 urinary protein excretion.
b- Treatment is that of the underlying disorder.
c- Nutritional support is important.
d- The diagnosis is confirmed by the rate of fecal clearance of intravenous
radiolabelled albumin.
e- Can be caused by very few GIT diseases.
Q34: Intestinal lymphangiectasia, all of the followings are true, except:
a- May be caused by Whipple's disease, filariasis, lymphoma and constrictive
pericarditis.
b- Prominent lymphocytosis is present.
c- Hypogammaglobulinemia is seen.
d- Small bowel biopsy reveals dilated lacteals.

e- Medium chain triglyceride supplements are given.

Q35: Eosinophilic gastroenteritis, all of the followings are true, except:
a- Any part of the GIT may be involved.
b- The inflammatory process may involve the mucosa, muscular and or serosal layer.
c- Peripheral blood eosinophilia is present in 80 % and up to 50 % have some form of
allergy.
d- Full thickness intestinal biopsy is usually used for the diagnosis although multiple
endoscopic biopsies are used in clinical practice.
e- The prognosis is unfortunately poor in the majority.
Q36: Inflammatory bowel disease, all of the followings are true, except:
a- It is more common in Jewish people.
b- HLA DR103 is seen in those with severe ulcerative colitis.
c- Associated with low residue and high refined sugar diet.
d- There is a possible and query association with measles and atypical mycobacterial
infection.
e- Crohn's disease is usually seen in ex-smokers.
Q37: Signs of severity in active Ulcerative colitis, all of the followings are true,
except:
a- Stool volume more than 400 gram / day.
b- Hemoglobin less than 10 g/ dl.
c- Daily bowel motions more than twice a day
d- ESR more than 30 mm/hr.
e- Serum albumin less than 30 g/ L
Q39: Systemic complications of inflammatory bowel disease that tend to occur
during an active relapse include all of the followings, except:
a- Mouth ulceration.
b- Episcleritis.
c- Pyoderma gangrenosum.
d- Deep venous thrombosis.
e- Sacroiliitis.
Q40: Management of inflammatory bowel disease, all of the followings are true,
except:
a- Salphasalazine side effects are usually dose dependent and reversible.
b- Specific nutritional therapy in Crohn's disease can be very effective but it is
expensive and poorly tolerated by most patients.
c- The most important indication for surgery is the impairment of the quality of life
including schooling, occupation, social and family life.
d- Colectomy should be done when the diameter of the transverse colon in an acute
attack exceeds 6 cm as this indicates impending perforation.
e- Total colectomy is rarely curative in ulcerative colitis.

Q41: Irritable bowel syndrome, all of the followings are true, except:
a- Diarrhea predominant type should be differentiated from microscopic colitis,
lactose intolerance and bile salt diarrhea.
b- The commonest presentation is abdominal pain.
c- 1% of cases only will meet criteria of a psychiatric disease.
d- Reassurance of the patient has a very important aspect in the management.
e- Amitriptylin may be used in selected patient.
Q42: Indicators of malignancy in adenomatous polyps, all of the followings are
true, except:
a- The presence of dysplastic changes on histology.
b- The presence of multiple polyps.
c- Large size polyps, of more than 2 cm.
d- The presence of a villous architecture on histology.
e- The presence of metaplastic polyps.
Q43: Familial adenomatous polyposis (FAP), all of the followings are true,
except:
a- It is has been shown to be due to a germ line mutation in the APC gene on
chromosome 5.
b- 50% of cases have adenomatous polyps in the stomach and 90% in the duodenum.
c- Congenital hypertrophy of the retinal pigment epithelium when found in an at risk
patient, it is a 100% predictive for the presence of FAP.
d- It has many variants like Gardner syndrome, Turcot's Syndrome and an attenuated
form called attenuated FAP.
e- Desmoid tumors are malignant tumors, usually in the abdominal wall; occur up to
10% of cases.
Q44: All of the following statements are true, except:
a- Although the hamartomatous polyps of Peutz-Jegher syndrome have no malignant
potential, but still there is a risk of small bowel carcinoma and carcinomas of the
pancreas, ovary, endometrium and breasts.
b- Juvenile polyposis has no risk of colorectal cancer.
c- In Cowden's disease there is a risk of thyroid cancer with polyps through out the
GIT.
d- In Cronkhite-Canada syndrome, there hair loss, skin pigmentation and nail
dystrophy with polyps through out the GIT.
e- Of all GIT polyposis syndromes, esophageal polyps are found only in CronkhiteCanada syndrome and Cowden's disease.
Q45: Risk factors for the development of colorectal cancer, all of the followings
are true, except:
a- Acromegaly.
b- Pelvic irradiation.
c- There is a weak association with alcohol and smoking.
d- Diet rich in meat and fats.

e- Diet rich in fibers and fruits.

Q46: The commonest causes of acute pancreatitis are all of the followings,
except:
a- Alcoholism.
b- Post ERCP.
c- Idiopathic.
d- Gall stones.
e- Viral infections.
Q47: Adverse prognostic factors in acute pancreatitis (Glasgow's Criteria), all of
the followings are true, except:
a- PaO2 less than 8 kPa.
b- Blood sugar more than 10 mmol/ L.
c- Serum calcium (corrected) less than 2.00 mmol/L.
d- Very high serum amylase.
e- Serum albumin less than 30 g/L.
Q48: The following statement about acute pancreatitis are true, except:
a- Serum amylase are only useful in the first 24-48 hours of the illness, otherwise after
that urinary amylase: creatine ratio is used.
b- Necrotizing pancreatitis is better assessed and suggested by CT scan.
c- Any visible gases in the pancreatic tissue suggests the development of abscess
formation.
d- Persistently elevated serum amylase suggests the development of a pancreatic
pseudocyst.
e- C reactive protein has a very limited role in the follow up.
Q49: Chronic pancreatitis, all of the followings are true, except:
a- The commonest cause is alcoholism.
b- Up to 20% of patients are opiates dependent.
c- 15% of cases only presents with steatorrhea but no abdominal pain.
d- Pancreatic ascites is an indicator for terminal pancreatectomy.
e- Most patients fortunately stop drinking alcohol after the diagnosis.
Q50: In chronic pancreatitis, all of the followings are true, except:
a- The over all incidence of diabetes is 30% but this rises to 70% in calcific
pancreatitis.
b- Steatorrhea occurs only after 90% of the exocrine function had been destroyed.
c- Unfortunately pain may continue despite total pancreatectomy.
d- Chronic pancreatitis is a risk factor for pancreatic carcinoma.
e- Pancreatic enzymes supplements are useful in malabsorption but have no effect on
abdominal pain.