Git Exam 2015 PDF

‫بسم هللا الرحمن الرحيم‬
Al-Quds University
School of medicine
Gastrointestinal system disorders- course
“Practical multiple choice Questions(MCQs) for final exam-2015”.
Supervisor: Dr. Raed Titi

These McQs were collected by : Class 2010
“Through hard work, perseverance and a faith in God, you can live your dreams”. Benjamin Carson
1- In FMF, colchicine is used mainly to prevent :
1- Renal failure
2-Hepatic Failure.
3-Cardiomyopathy.
4-Amyloidosis.
2- All of the following are true about FMF, except:
1- The preeminent feature of familial Mediterranean fever (FMF) is the paroxysm.
2- the classic onset of which occurs without warning.
3- Almost all patients with FMF experience abdominal episodes.
4- The joints are normal between attacks, and permanent damage is usual.
3- Celiac disease is associated with increased risk of the following cancers except:
1. Enteropathy-associated T-cell lymphoma
2. Small bowel carcinoma
3. Gastric carcinoma
4. Squamous carcinoma of the oesophagus
4- In Dermatitis Herpetiformis, all of the following are true, except:

1. Characterized by non-pruritic blisters over the elbows, knees, back and buttocks
2. Almost all patients have partial villous atrophy on jejunal biopsy
3. They usually have no gastrointestinal symptoms
4. The rash usually responds to a gluten-free diet
5- All of the following biochemical manifestations are usually found in celiac disease patients, except:
1. Iron deficiency anemia
2. Folate deficiency anemia
3. Vitamin D deficiency
4. B12 deficiency
6- Patient came to your clinic, having unexplained iron deficiency anemia. You did upper and lower endoscope
but nothing can explain, what you think:
1. Celiac disease
2. Atrophic gastritis
3. Hiatal hernia
4. All of the above are true
7- A 43 year old woman comes to the physician for chronic weight loss and fatigue. She has a history of bulky,
floating, foul-smelling stool and bone pain. She said that few months ago started to have symmetric arthralgia
in her knees. Laboratory studies showed iron deficiency anemia and elevated PT. Which of the following is
most likely associated with this patient condition
1. Anti-nuclear antibodies
2. Anti-endomysial antibodies
3. Anti-centromere antibodies
4. Anti-mitochondrial antibodies
8- All of the following diseases are associated with celiac disease, except:
1. Pernicious anemia
2. Primary biliary cirrhosis
3. Diabetes mellitus type II
4. Splenic atrophy
9- A 45 year old male comes to your office for evaluation of diarrhea of 8 months duration. He says that he has
lost almost 7 kg during the past 8 months. He denies any blood in stool. Stool microscopy reveals no
pathogens or leucocytes. D-xylose test was performed which shows that less than 2 grams of D-xylose is
excreted in urine in 5 hours. D-xylose was re-performed after 4 week treatment with antibiotics but excretion
is still less than 2 grams in 5 hours. Based on these findings, what is the most likely diagnosis in this patient?
1. Lactose intolerance
2. Bacterial overgrowth
3. Pancreatic insufficiency
4. Celiac disease
10- Which of the following is the recommended single serologic test for celiac disease screening in the primary
care setting
1. Tissue transglutaminase antibodies, IgA class
2. Tissue transglutaminase antibodies, IgG class
3. Anti-gliadin antibodies
4. Anti-endomysial antibodies
11- What are the main infiltrating cells seen in jejunal biopsy in patient with celiac disease?
1. Macrophages
2. Eosinophils
3. Lymphocytes
4. Plasma cells
12- All of the following can cause intestinal villous atrophy, except:
1. Giardiasis
2. Celiac disease
3. Tropical sprue
4. Eosinophilic gastroenteritis
13- HASAN is your patient , he was recently diagnosed to have FMF, he asks you and wants to know
more about his disease, you can tell him all of the following except:
1- FMF is a recessive genetic disease associated with missense and nonsense mutations in
the MEFV gene.
2- The MEFV gene is located on the Long arm of chromosome 12.
3- Hasan will complain of brief recurrent episodes of peritonitis, pleuritis, and arthritis, usually with
accompanying fever.
4- FMF is more prevalent in men than in women, with a male-to-female ratio of 1.5-2:1.
14- According to amyloidosis in FMF, all of the following is true, except:

1- The typical progression is proteinuria, followed by nephrotic syndrome, and, inevitably, death from
renal failure.
2- One third of patients with amyloidosis develop renal vein thrombosis.
3- Deposits in other organs are always reported as significant.
4- Some patients have intestinal involvement, which may lead to malabsorption and death.
15- Currently, renal failure develops only in FMF patients who are not compliant with therapy or
those who cannot tolerate adequate doses of colchicine.
1- TRUE.
2-FALSE.
16- The most frequent cause of UGI bleeding is:
A. Esophageal varices
B. Peptic ulcer disease
C. Angiomata
D. Mallory Weiss tear
E. Gastritis
17- An 82-year-old debilitated woman with coronary artery disease and breast cancer presents with hematochezia
requiring 4 units of blood. Following colonic preparation, colonoscopy demonstrates fresh blood in the left colon with
marked diverticulosis. The right colon is normal and bilious material is seen in the cecal pole. Upon withdrawal of the
colonoscope, there was active oozing of blood from the neck of a diverticulum in the distal sigmoid colon. The most
appropriate management now is
A. supportive care with transfusion requirements as necessary
B. technetium RBC scan
C. angiography
D. endoscopic therapy of the bleeding diverticulum
E. immediate surgical therapy
18. After initial stabilization and resuscitation of the patient, each of the following options should be considered in the
management of UGI bleeding except:
A. Determine the source of bleeding
B. Stop acute bleeding
C. Treat the underlying abnormality
D. Prevent rebleeding
E. Emergency surgery.
19. An important risk factor for peptic ulcer hemorrhage includes:
A. Gastric acid hypersecretion
B. Corticosteroid use
C. Cigarette smoking
D. Non-sterioidal anti-inflammatory drug use
20. A sixty-six-year old man presents to the emergency department with a history of one episode of hematemesis and
melena. Past history includes coronary artery disease, hypertension and abdominal aortic aneurysm repair. He is on
one baby aspirin daily. An urgent upper endoscopy is negative. What is the most appropriate next step?
A. UGI series with small bowel follow-through
B. Colonoscopy
C. Angiography
D. Red blood cell tagged technetium scan
E. Abdominal CT scan with contrast
21. A fifty-eight year old female patient presents to the emergency department with a 24-hour history of several
bloody bowel movements. She denies any abdominal pain but complains of light headedness. She is found to be
hypotensive and anemic. Resuscitative measures are instituted. What is the most appropriate next step?
A. Nasogastric tube placement
B. Anoscopic examination
C. Colonoscopic examination
D. Scintigraphy
E. Angiography .
22. In the patient described above, question 21, with severe hematochezia, hypotension, and anemia, both the upper
panendoscopy and colonoscopy are not diagnostic. The patient continues to pass clots per rectum. Resuscitation has
normalized her vital signs and maintained her Hct at 32%. What is the most effective management strategy?
A. Abdominal CT scan with contrast
B. Magnetic resonance imaging
C. Scintigraphy and angiography
D. Emergency surgery
E. Barium enema
23. A 73 year old man presents with several episodes of hematemesis. Examination shows signs of orthostatic
hypotension and melena. What is the first priority in caring for this patient?
A. Nasogastric tube placement and gastric lavage
. B. Resuscitation with adequate IV access and appropriate fluid and blood product fusion.
C. Intravenous infusion of H2-receptor antagonists to stop the bleeding.
D. Urgent upper panendoscopy.
E. Urgent surgical consultation.
24. For the patient who is now stable after a severe UGI bleed associated with NSAID ingestion, and who is found to
be H.pylori positive, what is the most effective management strategy?
A. Stop NSAIDS, eradicate H.pylori, H2RA full dose or daily PPI maintenance therapy
B. Stop NSAIDs, full dose H2RA or daily PPI maintenance therapy
C. Stop NSAIDs
D. Eradicate H.pylori, full dose H2RA or daily PPI maintenance therapy
F. Full dose H2-receptor antagonist or daily PPI maintenance therapy
25. For the patient with an UGI bleed and the endoscopic finding of a clean ulcer, the most appropriate management
includes:
A. Endoscopic hemostasis with multipolar or heater probe or injection treatment
B. Endoscopic hemostasis with combination therapy
C. Emergent surgery
D. Medical therapy, early refeeding, same day discharge if stable(medically) and reliable
E. Medical therapy alone in a monitored setting for three days
26- An 18-year-old male college freshman is referred to a gastroenterologist for evaluation of painless jaundice.
He initially presented to a campus health center for evaluation of a flu-like illness with high fevers, where mild
scleral icterus was noted. Initial laboratory studies revealed a normal complete blood count, normal alkaline
phosphatase level, and normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels as
well as a total serum bilirubin of 4 mg/dL and direct serum bilirubin of 0.4 mg/dL. Serologic testing for hepatitis
was negative. At this visit, the flu-like illness has spontaneously resolved, and repeat laboratory testing reveals
that total serum bilirubin has returned to normal. He has not taken any medications for his illness.
What is the most likely cause of this patient’s elevated serum bilirubin level?
(A) Acute viral hepatitis
(B) Gilbert’s syndrome
(C) Primary biliary cirrhosis (PBC)
(D) Primary sclerosing cholangitis (PSC)
(E) Transient biliary obstruction caused by a gallstone
27- A 42-year-old female nurse is referred to a gastroenterologist for evaluation of jaundice. The patient was
made aware that she looked jaundiced by her coworkers. She also complains of intense pruritus that has not
been relieved by over-the-counter agents such as diphenhydramine. Her appetite and weight are stable, and she
has no abdominal symptoms. Physical examination is remarkable for xanthomas on her upper eyelids near the
bridge of her nose but is otherwise unremarkable except for jaundice. She takes no medications. Laboratory
testing reveals normal ALT and AST levels, a total serum bilirubin level of 7 mg/dL, and an alkaline
phosphatase level of 733 U/L. The patient is referred for ERCP due to concern for obstruction, but the
cholangiogram is normal. What is this patient’s most likely diagnosis?
(A) Acute hepatitis A
(B) Choledocholithiasis
(C) PBC
(D) PSC
(E) SSC
28- A 62-year-old woman presents for evaluation of sudden-onset, severe, painless jaundice. The patient has
developed anorexia with a 20-lb weight loss over a 3-month period and recently was diagnosed with diabetes
mellitus. Complete blood count is normal, total serum bilirubin is 8.9 mg/dL, direct serum bilirubin is 8.3
mg/dL, alkaline phosphatase is 550 U/L, AST is 120 U/L, and ALT is 134 U/L. The patient undergoes magnetic
resonance imaging of the abdomen, but she is unable to tolerate the examination due to claustrophobia. ERCP is
performed, which reveals significant intra- and extrahepatic ductal dilation and a tight distal biliary stricture
.What is this patient’s most likely diagnosis?
(A) Ampullary cancer
(B) Cholangiocarcinoma
(C) Cholecystitis
(D) Pancreatic adenocarcinoma
(E) Postoperative biliary stricture
29. Which of the following is not a common site for gastrinoma?
a) 1st part of duodenum.
b) 2nd part of duodenum
c) 3rd part of duodenum
d) 4th part of duodenum
30. Which of the following investigations has the highest sensitivity to diagnose gastrinoma?
a ) CT scan Abdomen
b) Portal Venous Sampling
c) Arteriography
d) Somatostatin receptor scintigraphy
31. Symptoms of diarrhea, hypokalemia and Achlorhydria are associated with
a) Somatostatinoma
b) VIPoma
c) Glucagonoma
d) Gastrinoma
32. Which of the following serum gastrin values is not indicative of gastrinoma
a) 5000pg/ml
b)1000pg/ml
c) 500pg/ml
d) 100 pg/ml
33. Which of the following has least incidence of malignancy?
a. Insulinoma
bGastrinoma
cVIPoma
d. Glucagonoma
34- Most common cause of recurrent oral ulcers is:
A. Bahcet’s disease
B. Recurrent aphthous oral ulcers
C. Crohn’s disease
D. Ulcerative colitis
E. SLE
35- Most common cause of aphthous oral ulcers disease is:
A. DM
B. Crohn’s disease
C. Idiopathic
D. SLE
E. Drugs
36- Oral thrush is a frequent finding in all of following except:
A. Antibiotic therapy
B. Oral contraceptive use
C. Diabetes mellitus
D. HIV infection
37- Oral ulcers are common in all of the following except:
A. Diverticular disease
B. Coeliac disease
C. Crohn’s disease
38- All patients with Oral ulcers give them:
A. Vit A
B. steroids
C. Zinc
D. Colchicine
E. A+C
39- We can distinguish clinically between Crohn’s disease and Bahcet’s disease by:
A. Oral ulcers
B.GI symptoms
C. Genital ulcers
D.None
E. All of the above
40 -Liver Cirrhosis indicates a condition of :
A-Irreversible Parynchymal disease of liver resulting from the necrosis of liver cells followed by fibrosis .
B-Acute inflammatory process of liver parynchyma .
C-Irreversible Parynchymal disease of liver resulting from the necrosis of liver cells followed by fibrosis and
nodule formation that interfere with liver blood flow and hepatic function .
D-Inflammation in liver cells that lead to hepatic insufficiency .
41- The most common cause of liver cirrhosis in our countries is :
A- Alcohol
B- Chronic hepatitis due to hepatitis B & C .
C- Metabolic diseases .
D- Drug-induced
E- Biliary obstruction – Primary/secondary biliary cirrhosis .
42- All of the following are features/consequences of Portal hypertension except :
A- Spleenomegaly
B- Hypersplenism
C- Ascites
D- Spider nevi
E- Caput Medusae
43- 55 years old man is known to have chronic liver disease-cirrhosis since two years .
All of the following indicate poor prognosis except :
A- Serum Albumin : 2 mg/dl .

B- Previuos bleeding from varices .
C- PT time : 12 sec .
D- Serum Billirubin : 3 mg/dl .
E- Hepatic encephalopathy .
44 - 57 years old man is a known case of liver cirrhosis since one year due to heavy drinking of Alcohol. Presented
to the ER with massive hematemesis , but no melena . BP was 95/68 , Pulse : 130 . I/V canulla passed and given
Plasma expander (Haemaccel) , N/G tube also passed . He was found to have PT of 12 sec so was given FFP . Bleeding
stoped and the patient became relatively stable .
What is the best next step in management and evaluation of this patient ?
A- Octreotide injection .
B- Propranolol .
C- Just observe the patient for other hematemesis , measure his BP and pulse every 2 hours , and give
plasma expander when needed .
D- Urgent Endoscope .
45 - 50 years old women presented complaining of dyspnea when she is in upright position , but this resolves
when lying down . Her lips were cyanosed . She was a heavy drinker of Alcohol for 10 years , a known case of chronic
liver disease since 1 year . What is the most specicfic test to confirm the diagnosis in this patient ?
A- Macroaggregated albumin lung perfusion scanning .

B- Contrast echocardiography for any intrapulmonary shunts .
C- High resolution CT scan .
D- Liver biopsy .
46 -32 year old women with abdominal pain , jaundice and worsening ascites . She drinks 15 units of al-cohol each
week , and takes the oral contraceptive pill .
Which of the following would make a Dx of Budd Chiari syndrome likely ?
A-Encephalopathy
B-Tender hepatomegaly
C-Ankle edema
D-ALT of 150
E-Ascitic fluid protein of 42 g/L
47 A 40 years old patient with known case of chronic hepatitis C presented with general deterioration . On
examination , he has a temperature of 37.8 c , BP 100/70 and is juandiced .
His investigations reveal :
serum sodium : 129 mmol/L
serum Potassium : 4.2mmol/L
serum Urea : 20 mmol / L
serum creatinine : 350 micromol/L
Billirubin : 6 mg/dl
AST : 92
Alkaline Phosphatase : 250
Albumin : 30g/L
Urine sodium : 15 mmol/L
What explain these findings ?

A-Hepatitis B infection
B-SBP
C-Hepatorenal syndrome
D-HCC.
48 55 years-old man is known to have chronic liver disease-cirrhosis , secondary to hepatitis B infection . He
has recently felt unwell , and his hemoglobin level has increased from 13 mg/dl , 1 year ago , to 19 mg /dl .
Which of the following is the most appropriate initial diagnostic test ?
A) Alkaline phosphatase .
B) Alpha-fetoprotein (AFP)
C) Aspartate transaminase
D) Alanine transaminase
E) Unconjugated billirubin
49 A 60-year-old man with a long history Alcohol abuse present with ascites . He is experiencing mild
abdominal discomfort and nausea . Examination reveals tense asites and generalised tenderness but no
rigidity . A diagnostic paracentesis of the fluid is performed . Which of the following ascitic fluid results is
most likely to suggest an uncomplicated ascites due to portal hypertension from cirrhosis ?
A) Hemorrhage
B) Protein > 25 gm/L
C) Billirubin level twice that of the serum
D) Serum to ascites albumin gradient >1.1 gm/dl
More than 1000 WBC/mm3
50 . Which of the following statements about the lower esophageal sphincter (LES) mechanism, or high -
pressure zone (HPZ), is true?
A. The LES is a circular smooth muscle ring that is 3 to 5 cm. long.
B. In assessing esophageal manometric data, mean HPZ pressure less than 6 mm. Hg or overall length less than 2
cm. is more likely to be associated with incompetence of the LES and gastroesophageal reflux.
C. Esophageal manometry and the acid perfusion (Bernstein) test reliably identify the patient with an
incompetent LES mechanism.
D. Distal HPZ relaxation occurs within 5 to 8 seconds of initiating a swallow.
E. Twenty-four–hour distal esophageal pH monitoring is achieved with an intraesophageal p H electrode
positioned at the esophagogastric junction.
51. Which of the following is an extra-esophageal symptom associated with GERD?
A. Chest pain.
B. Asthma.
C. Chronic cough.
D. Sore throat.
E. All of the above.
52. When assessing gastroesophageal reflux disease by manometry each of the following statements is
correct except one. Identify the incorrect one.
A. Absent or extremely low LES pressures have predictive value in identifying more severe reflux.
B. Peristaltic dysfunction increases with increasing severity of esophagitis.
C. With established reflux disease the UES is hypertensive.
D. Esophageal functional changes are worst in patients with a circumferential columnar-lined esophagus.
E. Absence of peristalsis may be associated with more severe forms of reflux disease.
54. The presence of a nonmalignant mid- or upper esophageal stricture always indicates the presence of:
A. Alkaline reflux esophagitis.
B. Barrett's esophagus.
C. Idiopathic reflux disease.
D. Mediastinal fibrosis.
E. Scleroderma.
55. Which drug can aggravate GERD symptoms
A) Ranitidine.
B) Domperid one
C) Omeprazole
D)Nifedipine
56. In the assessment of gastro-esophageal reflux disease (GERD), which of following is a role of
endoscopy?
A. Assessing esophageal mucosa for erosions and ulcerations
. B. Excluding other upper gastro-intestinal pathology.
C. Obtaining biopsies at suspicious areas
. D. Treating esophageal strictures
. E. All of the above.
57. When a stricture is present in association with gastroesophageal reflux, each of the following is an
acceptable repair for reflux control except one. Identify the poorest repair.
A. Intrathoracic total fundoplication.
B. Lengthening gastroplasty with total fundoplication.
C. Total fundoplication.
D. Lengthening gastroplasty with partial fundoplication.
E. Partial fundoplication.
58. In the diagnosis of gastro-esophageal reflux disease (GERD), which of the following statement is
CORRECT?
A. Heartburn and regurgitation occurring after meals are symptoms highly specific for GERD.
B. The gold standard for diagnosis of non-erosive GERD is upper GI endoscopy.
C. In a patient with epigastric pain, response to PPI treatment is diagnostic of GERD.
D. 24-hour pH monitoring is useful for screening patients for GERD.
E. Anaemia is commonly present in GERD
59. Which of the following lifestyle modifications that have been shown to improve GERD symptoms?
A. Avoidance of spicy food.
B. Weight loss.
C. Cessation of smoking.
D. Avoidance of alcohol.
E. Reducing coffee intake.
60. Which of the following regarding the treatment of gastro-esophageal reflux disease (GERD) is
CORRECT?
A. Proton-pump inhibitors are just as effective as histamine 2 receptor antagonists in relieving GERD-related
symptoms.
B. Histamine2 receptor antagonists should be consumed 30 mins after a meal to prevent postprandial
heartburn.
C. Sucralfate is more effective in healing esophageal mucosa compared to histamine2 receptor antagonists.
D. Concomitant use of a prokinetic agent with PPI therapy have been shown to improve GERD symptoms.
E. Prokinetic agents should only be used as adjuctive therapy in GERD
61) Which ONE of these statements is TRUE about genetic Hemochromatosis?
A. It is dominantly inherited
B .It is usually caused by mutation of HFE
C .It causes excess iron in the duodenal mucosa
D. It is associated with reduced saturation of transferring
62) Which ONE of the following organs is not damaged by transfusional iron overload?
A. Liver
B .Kidneys
C. Parathyroids
D .Pituitary
E. Heart
63) In which ONE of the following is iron absorption favoured?
A. Pregnancy
B. Chronic inflammation
C. Iron overload
D. Phosphates
64) Which ONE of the following is NOT TRUE about serum iron?
A. It is low in inflammatory diseases
B. It is raised in iron overload
C. It shows a diurnal rhythm
D. It is transported in plasma by ferritin
65) Which is the usual earliest manifestation of Hemochromatosis?
A. Arthritis
B. Hepatomegaly
C. Skin Pigmentation
D. Diabetes
66)………….. is the most common cause of death in treated patients of Hemochromatosis?
A. Cardiac Failure
B.DKA
C. HCC
D. None
67) ………. Are the joints characteristically affected in Hemochromatosis?
A. 1st and 2nd PIP.
B. 1st and 2nd MCP.
C. 2nd and 3rd PIP.
D. 2nd and 3rd MCP.
68) A patient suffering from Hemochromatosis classically presents with the following triad:
A) micro-nodular liver cirrhosis, iron deficiency anemia & diabetes mellitus

B) micro-nodular liver cirrhosis, diabetes mellitus & bronze pigmentation of skin
C) diabetes mellitus, sickle cell anemia, bronze pigmentation of skin
D) micro-nodular liver cirrhosis, diabetes mellitus & sickle cell anemia
E) micro-nodular liver cirrhosis, Kayser-Fleischer rings & diabetes mellitus
69) Which of the following is not true for Hereditary Hemochromatosis

A. Gonadal failure is seen
B. Desferroxamine is the treatment of choice
C. Arthropathy is seen
D. Skin pigmentation is seen
70) Which of the following tests is used to Dx Hemochromatosis?
A. Transferrin saturation
B. S. ferritin
C. Liver biopsy and hepatic iron index
D. All
71. Which of the following patients generally does not require surgical intervention as a consequence of acute
diverticulitis?
A. A 35-year-old man with no history of diverticulitis.
B. A 68-year-old man status 2 weeks post–renal transplantation.
C. A 55-year-old woman with hypertension and diabetes mellitus.
D. A 50-year-old man with pneumaturia.
E. A 46-year-old man with right-sided diverticulitis.
72. Which of the following is not true of diverticular disease:

A. It is more common in the United States and Western Europe than in Asia and Africa.
B. A low-fiber diet may predispose to development of diverticulosis.
C. It involves sigmoid colon in more than 90% of patients.
D. Sixty per cent develop diverticulitis sometime during their lifetime.
E. It is the most common cause of massive lower gastrointestinal hemorrhage.
73. The most common indication for surgery secondary to acute diverticulitis is:
A. Abscess.
B. Colonic obstruction.
C. Colovesical fistula.
D. Free perforation.
E. Hemorrhage.
74. A 65-year-old woman develops obstipation, lower abdominal pain, and fever. Physical examination reveals a
temperature of 38.5°C, left lower quadrant tenderness, and an ill-defined lower abdominal mass. White blood
count is 17,500 per mm3. Intravenous hydration, broad spectrum antibiotics, and analgesics are ordered. After 48
hours, symptoms have not improved. Appropriate management includes which of the following?
a. Barium enema
b. Computed tomography of the abdomen
c. Immediate laparotomy
d. Intravenous pyelogram
75. which of the following statements is false ?
A. In the western world 60 percent of the population over 60 have diverticular disease.
B. Low fiber diet cause the disease.
C. These diverticular consist of mucosa, muscle,and serosa.
D. Those with perforation have 10 times higher mortalitythan those with an inflammatory mass.
E. Sepsis is the most common cause of morbidity.
76. In a recently diagnosed case of sigmoid diverticulosis with intermittent pain abdomen and alternating diarrhea
with constipation the management would include
a) Oral antibiotic with broad spectrum coverage against gram negative bacteria
b) Oral Prednisolone
c)Ondansetron
d) Fibre supplement and increased fluid intake
77. Which one of the following statements is not true regarding Meckel's Diverticulum:
A. it is approximately 2 inches long.

B. It is an embryonic remnant of the vitelline duct.
C. It is usually located 2 meters from the ileocaecal junction in the terminal ileum.
D. It may contains Gastric and pancreatic epithelial tissue.
C. It is present in approximately 2% of the population.
78. The commonest cause of bleeding from lower GI tract in elderly is:
A. Colon Cancer.
B. ischemic colitis.
C. Angiodysplasia
D. IBD
E. Diverticulosis.
79. Acute diverticulitis usually does not present with:

A. Generalized peritonitis.
B. LLQ mass.
C. Pneumaturia.
D. Massive Gi bleeding.
80- A 73 year old man, a known case of ischemic heart disease, admits to your emergency department
complaining of sudden sever abdominal pain and distention. His vital signs shows tachycardia (124
beat/minutes) and his tempreture was 38. On examination, he was confused and looks ill. His abdomen was
tender, firm and has +ve shifting dullness.
His blood tests shows
• Hb is 9.1g/l
• Albumin is 3.2g/dl (normal is 3.7-4.9g/dl)
• WBC: 24.7 X 10^9 (nornal 4-11 X10^9)
• Amylase is 205 (normal ragnes 60-180)
• Bilirubin, ALT,AST and ALP are within normal range
An ascitic tap was done and showed bloody fluid with the following lab results
• Red cell count - 21,385/mm3,

• WBC -6,734/mm3 (90% neutrophils)
• Albumin- 23 g/l.
• A Gram stain reveals Gram negative bacilli and Gram positive cocci.
What is the next step in his management ??
A. Perform abdominal X-ray

B. Perfrom abdominal CT
C. Arragne for liver biopsy
D. Perfrom ascitic fluid cytology (for malignancy)
81- A 32-year-old woman attends hospital with rapidly increasing abdominal girth,
pain and nausea. She has a past medical history of type 2 diabetes requiring insulin and she also takes the oral
contraceptive pill. She drinks two to three large glasses of wine on most nights of the week. On examination of
the abdomen there is ascites and a tender liver felt 2 cm below the costal margin.
Her blood tests reveal that:

• Haemoglobin 11.7 g/l
• White cell count 12.1 x 10^9/L (normal is 4 – 11)
• Albumin 3.3g/dl
• Bilirubin 45 μmol/l (normal 1 – 22)
• ALT 76 IU/l (normal 5 – 35)
• ALP 132 IU/l normal (45 – 10)
• INR 1.6 (normal is < 1.4)
An ascitic tap reveals that the fluid albumin is 20 g/l, glucose 6.7 mmol/l and the red
and white counts 1,231/mm3 and 175/mm3 respectively. What is the most likely cause of her ascites?
A. Peritoneal TB
B. Nephrotic syndrome
C. Bud chiarri syndrome
D. Spontenous bacterial peritonitis
A 54-year-old female presents with fatigue and xerostomia. Bloods tests reveal the following:
Hb 13.9 g/dl
WBC 6.1 *109/l
Platelets 246 *109/l
Bilirubin 33 μmol/l
ALP 292 u/l
ALT 47 u/l
What is the most likely diagnosis?
A. Systemic lupus erythematous
B. Infectious mononucleosis
C. Primary biliary cirrhosis
D. Autoimmune hepatitis
E. Primary Sjogren's syndrome
Which one of the following is the most likely presentation of Staphylococcus aureus food
poisoning?
A. Tenesmus
B. Watery diarrhoea
C. Dysentery
D. Severe vomiting
E. Presentation 24-48 hours after eating affected food
Which one of the following is most suggestive of Wilson's disease?

A. Reduced hepatic copper concentration
B. Reduced 24hr urinary copper excretion
C. Increased skin pigmentation
D. Reduced serum caeruloplasmin
E. Reduced serum copper
A 54-year-old man with a long history of heartburn has an endoscopy to investigate his
symptoms. A biopsy is taken from an abnormal area of mucosa in the lower oesophagus and
reported as follows: Non-dysplastic columnar-lined oesophagus
What is the most suitable management?
A. Reassure and discharge
B. Fundoplication
C. Laser ablation
D. Ivor-Lewis oesophagectomy
E. High-dose proton pump inhibitor and follow-up
A 46-year-old man is being investigated for indigestion. Jejunal biopsy shows deposition of
macrophages containing PAS-positive granules. What is the most likely diagnosis?
A. Bacterial overgrowth
B. Coeliac disease
C. Tropical sprue
D. Whipple's disease
E. Small bowel lymphoma
A 31-year-old man with a known history of alcoholic liver disease is reviewed following a
suspected oesophageal variceal haemorrhage. He has been resuscitated and intravenous
terlipressin has been given. His blood pressure is now 104/60 mmHg and his pulse is
84/min. What is the most appropriate intervention?
A. Transjugular Intrahepatic Portosystemic Shunt
B. Surgical referral
C. Endoscopic variceal band ligation
D. Sengstaken-Blakemore tube
E. Endoscopic sclerotherapy
A 25-year-old man presents with lethargy and increased skin pigmentation. Blood test reveal
deranged liver function tests and impaired glucose tolerance. Given the likely diagnosis of
haemochromatosis, what is the most appropriate initial investigation strategy?
A. Transferrin saturation + ferritin
B. Haematocrit + ferritin
C. Liver biopsy with Perl's stain
D. Serum iron + ferritin
E. Serum
Acetaminophen poisoning usually causes hepatotoxicity within :
a- 2-3 hours
b- 6-12 hours
c- 1-3 days
d- 3-5 days
The principle toxic metabolite of acetaminophen is :
A -11-hydroxy-THC
b- Morphine-6-glucuronide
c- O-desmethyltramadol
d- N-acetyl-p-benzoquinon-imine
To cause toxicity oral acetaminophen overdose must be :
a- total> 250 mg/kg within 24 h
b- total > 150 mg/kg within 24 h
c- total > 150 mg/kg within 12h
d- total > 70 mg/kg within 12h
For single acute overdose of rapid reliese acetaminophen level are measured :
a- >= 4 hours after ingestion
b->=4 hours after ingestion , and 4 hours later
c- > 8 hours after ingestion
d->4 hours after ingestion , and 8 hours later
Poor prognostic indicator at 24-48 hours post ingestion of acetaminophen include all the following except :
a- ph > 7.3 after adequate resuscitation .
b- INR>3
c- hypoglycemia
d- thrombocytopenia
Antidote for acetaminophen toxicity :
a- Benzylpenicillin
b- oral , IV N-acetlcyctenin
c- deferoxamine
d- protamine sulfate
All true about N-acetlcyctenin except :
a- glutathion precursor
b- it reverse the damage to liver cells
c- is most effective if given within 8 hours
d- equally effective given IV or orally .
A patient with upper gastrointestinal symptoms tests positive for Helicobacter pylori following
a urea breath test.
Which one of the following conditions is most strongly associatedHelicobacter pylori
infection?
A. Gastric adenocarcinoma
B. Gastro-oesophageal reflux disease
C. Oesophageal cancer
D. Duodenal ulceration
E. Atrophic gastritis
A 24-year-old man presents with rectal bleeding and pain on defecation. This has been
present for the past two
weeks. He has a tendency towards constipation and notices that when he wipes himself
fresh blood is often on
the paper. Rectal examination is limited due to pain but no external abnormalities are seen.
What is the most
likely diagnosis?
A. Internal haemorrhoids
B. Anal carcinoma
C. Rectal polyp
D. Anogenital herpes
E. Anal fissure
A 54-year-old woman presents with jaundice shortly after being discharged from hospital.
Liver function tests are
reported as follows:
Albumin 49 g/l
Alanine transferase (ALT) 66 iu/l
Alkaline phosphatase (ALP) 245 μmol/l
Gamma glutamyl transferase (yGT) 529 u/l
Which of the following antibiotics is she most likely to have received?
A. Flucloxacillin
B. Gentamicin
C. Ciprofloxacin
D. Trimethoprim
E. Ceftazidime
A 43-year-old man presents with diarrhoea and rectal bleeding for the past ten days. On
examination he has
brown pigmented lesions on his lips and palms but abdominal and rectal examination is
unremarkable. What is
the most likely cause for this presentation?
A. Intussusception
B. Angiodysplasia
C. Meckel's Diverticulum
D. Colon cancer
E. Diverticular abscess
A 54-year-old female presents with a 3 month history of dysphagia affecting both food and
liquids from the start,
along with occasional symptoms of heartburn. What is the most likely underlying diagnosis?
A. Pharyngeal pouch
B. Gastric adenocarcinoma
C. Benign stricture
D. Oesophageal cancer
E. Achalasia
A 22-year-old male blood donor is noted to have the following blood results:
Bilirubin 41 μmol/L
ALP 84 U/L
ALT 23 U/L
Albumin 41 g/L
Dipstick urinalysis No bilirubinuria
He has recently complained of coryzal symptoms and a non-productive cough. What is the
most likely diagnosis?
A. Gilbert's syndrome
B. Dubin-Johnson syndrome
C. Rotor syndrome
D. Hepatitis C infection
E. Infectious mononucleosis
A 55-year-old man with a history of gallstone disease presents with a two day history of pain
in the right upper
quadrant. He has feels 'like I have flu' and his wife reports he has had a fever for the past
day. On examination
his temperature is 38.1ºC, blood pressure 100/60 mmHg, pulse 102/min and he is tender in
the right upper
quadrant. His sclera have a yellow-tinge. What is the most likely diagnosis?
A. Pancreatic cancer
B. Biliary colic
C. Ascending cholangitis
D. Acute cholecystitis
E. Acute viral hepatitis
Of the following, which one is the most useful prognostic marker in paracetamol overdose?
A. ALT
B. Prothrombin time
C. Paracetamol levels at presentation
D. Paracetamol levels at 12 hours
E. Paracetamol levels at 24 hours
A 49-year-old female is referred to the gastroenterology out-patient clinic with a 3 month

history of epigastric pain
and diarrhoea. Her GP initially prescribed lansoprazole 30mg od but this didn't alleviate her
symptoms. The only
past medical history of note is hyperparathyroidism.
Endoscopy revealed multiple duodenal ulcerations. What is the likely diagnosis?
A. Multiple endocrine neoplasia type II a
B. Coeliac disease
C. Multiple endocrine neoplasia type I
D. Autoimmune polyendocrinopathy syndrome
E. Crohn's disease
A 35-year-old man who is usually fit and well presents with a 2 month history of indigestion.
His weight is stable
and there is no history of dysphagia. Examination of the abdomen is unremarkable. Of the
following options,
what is the most suitable initial management?
A. Urea breath testing and non-urgent referral for endoscopy
B. H pylori eradication therapy and full-dose proton pump inhibitor for three
months
C. Full-dose Proton pump inhibitor and immediate referral for endoscopy
D. Three month course of a standard-dose proton pump inhibitor
E. One month course of a full-dose proton pump inhibitor
A 38-year-old female with a long history of alcohol excess presents with abdominal pain,
weight loss and bulky
stools. What is the most suitable investigation to confirm the diagnosis?
A. Endoscopic ultrasound
B. Endoscopic retrograde cholangiopancreatography
C. Ultrasound abdomen
D. CT abdomen
E. Endoscopy with D2 biopsy
A 54-year-old man is investigated for dyspepsia. An endoscopy shows a gastric ulcer and a
CLO test done
during the procedure demonstrates H. pylori infection. A course of H. pylorieradication
therapy is given. Six
weeks later the patients comes for review. What is the most appropriate test to confirm
eradication?
A. Culture of gastric biopsy
B. H. pylori serology
C. Hydrogen breath test
D. Urea breath test
E. Stool culture
A 34-year-old female with a history of alcoholic liver disease is admitted with frank
haematemesis. She was
discharged three months ago following treatment for bleeding oesophageal varices.
Following resuscitation, what
is the most appropriate treatment whilst awaiting endoscopy?
A. Octreotide
B. Omeprazole
C. Propranolol
D. Tranexamic acid
E. Terlipressin
Each one of the following is a risk factor for gastric cancer, except:
A. Smoking
B. Blood group O
C. Nitrates in diet
D. Pernicious anaemia
E. H. pylori infection
Crohn's disease is associated with each one of the following findings, except:
A. Inflammation confined to the mucosa and submucosa
B. Non-caseating granulomas
C. Rose-thorn ulcers
D. Cobblestone pattern
E. Fistulas
Which one of the following is most associated with the development of acute pancreatitis?
A. Hyperchylomicronaemia
B. Amyloidosis
C. Hypogammaglobulinaemia
D. Hypercholesterolaemia
E. Hypotriglyceridaemia
A 42-year-old dentist is reviewed in the medical clinic complaining of persistent lethargy.

Routine bloods show
abnormal liver function tests so a hepatitis screen is sent. The results are shown below:
Anti-HAV IgG negative
HBsAg negative
Anti-HBs positive
Anti-HBc negative
Anti-HCV positive
What do these results most likely demonstrate?
A. Hepatitis B infection
B. Hepatitis C infection
C. Previous vaccination to hepatitis B and C
D. Hepatitis C infection with previous hepatitis B vaccination
E. Hepatitis B and C infection
A 25-year-old man with a history of Crohn's disease is reviewed in clinic. Over the past week
he has developed
painful perianal ulcers. On examination numerous shallow ulcers can be seen with a small
number of skin tags.
What is the most appropriate first-line treatment?
A. Topical mesalazine
B. Oral metronidazole
C. Barrier creams + laxatives
D. Oral prednisolone
E. Oral mesalazine
Which one of the following medications is least associated with dyspepsia?

A. Isosorbide mononitrate
B. Prednisolone
C. Aminophylline
D. Atenolol
E. Amlodipine
A 23-year-old man develops watery diarrhoea 5 days after arriving in Mexico. Which one of
the following is the
most likely responsible organism?
A. Salmonella
B. Shigella
C. Campylobacter
D. Escherichia coli
E. Bacillus cereus
A 44-year-old man is diagnosed with a duodenal ulcer. CLO testing performed during the
gastroscopy is positive
for Helicobacter pylori. What is the most appropriate management to eradicate Helicobacter
pylori?
A. Lansoprazole + clindamycin + metronidazole
B. Lansoprazole + amoxicillin + clindamycin
C. Lansoprazole + amoxicillin + clarithromycin
D. Omeprazole + amoxicillin + clindamycin
E. Omeprazole + penicillin + metronidazole
A 25-year-old woman develops deranged liver function tests following the introduction of a
new drug. Alb 40,
Bilirubin 46, ALT 576, ALP 95, yGT 150. Which of the following drugs is the most likely
cause?
A. Oral contraceptive pill
B. Sodium valproate
C. Flucloxacillin
D. Chlorpromazine
E. Tetracycline
Primary sclerosing cholangitis is most associated with:

A. Primary biliary cirrhosis
B. Crohn's disease
C. Hepatitis C infection
E. Coeliac disease
Which one of the following is true regarding bacterial exotoxins?

A. They are mainly produced by Gram positive bacteria
B. Cholera toxin inhibits cAMP release in intestinal cells
C. Diphtheria toxin necrosis is limited to the pharynx, nasopharynx and tonsils
D. Staph. aureus exotoxins are not known to cause gastroenteritis
E. 'Lockjaw' seen in tetanus is secondary to blockade of the neuromuscular
junction by Botulinus toxin
A 76-year-old woman with a history of atrial fibrillation presents with abdominal pain and
bloody diarrhoea. On
examination her temperature is 37.8ºC, pulse 102 / min and respiratory rate 30 / min. Her
abdomen is tender with
generalised guarding. Blood tests reveal the following:
Hb 10.9 g/dl
MCV 76 fl
Plt 348 * 109/l
WBC 23.4 * 109/l
Na+ 141 mmol/l
K+ 5.0 mmol/l
Bicarbonate 14 mmol/l
Urea 8.0 mmol/l
Creatinine 118 μmol/l
A. Diverticulitis
B. Mesenteric ischaemia
C. Campylobacter infection
D. Ruptured abdominal aortic aneurysm
E. Ulcerative colitis
A 65-year-old man with a history of dyspepsia is found to have a gastric MALT lymphoma on
biopsy. What
treatment should be offered?
A. Gastrectomy
B. Laser ablation
C. None
D. CHOP chemotherapy
E. H. pylori eradication
A 34-year-old HIV positive man is referred to gastroenterology due to jaundiced sclera. Liver
function tests are as
follows:
Albumin 34 g/l
ALP 540 iu/l
ALT 45 iu/l
A. Hepatic abscess
B. Fungal obstruction of the bile duct
C. Duodenal adenoma
D. Primary biliary cirrhosis
E. Sclerosing cholangitis
A 23-year-old nurse is reviewed in occupational health following a needle stick injury from a
man known to be a
carrier of hepatitis B. Which one of the following would appear first during acute hepatitis B
infection?
A. HBsAg
B. HBeAg
C. anti-HBg
D. anti-HBs
E. HBcAg
A 31-year-old man with ulcerative colitis presents with a worsening of his symptoms. He is
passing around four
loose stools a day which do not contain blood. He has also experienced some urgency and
tenesmus but is
otherwise systemically well. What is the most appropriate management?
A. Rectal mesalazine
B. Oral metronidazole
C. Rectal corticoteroids
D. Observe with review in 7 days time
E. Oral loperamide
A 65-year-old man with liver cirrhosis of unknown cause is reviewed in clinic. Which one of
the following factors
is most likely to indicate a poor prognosis?
A. Alanine transaminase > 200 u/l
B. Caput medusae
C. Ascites
D. Gynecomastia
E. Splenomegaly
A 25-year-old female currently under investigation for secondary amenorrhoea presents with
jaundiced sclera.
On examination spider naevi are present along with tender hepatomegaly. Blood tests show:
Hb 11.6 g/dl
Plt 145 * 109/l
WCC 6.4 * 109/l
Albumin 33 g/l
ALT 245 iu/l
A. Haemochromatosis
B. Wilson's disease
D. Autoimmune hepatitis
E. Primary sclerosing cholangitis
Which of the following statements is true regarding the genetics of colon cancer?
A. Hereditary non-polyposis colorectal carcinoma is a autosomal recessive
condition
B. The adenomatous polyposis coli gene is located on chromosome 12
C. Around 50% of patients with familial adenomatous polyposis develop colon
cancer
D. Both hereditary and non-hereditary colon cancers typically present at 60-70 yrs
of age
E. Non-inherited colon cancer often involves mutation of the adenomatous
polyposis coli gene
You wish to screen a patient for hepatitis B infection. Which one of the following is the most
suitable test to
perform?
A. HBcAg
B. HBsAg
C. Hepatitis B viral load
D. anti-HBs
E. HBeAg
A 54-year-old female with a history of scleroderma presents with chronic diarrhoea and
bloating. Blood tests
show a mild macrocytic anaemia. A diagnosis of small bowel bacterial overgrowth is
suspected. Which one of the
following tests is most likely to confirm the diagnosis?
A. Jejunal biopsy
B. Small bowel aspiration and culture
C. 14C-xylose breath test
D. Small bowel meal
E. 14C-glycocholate breath test
A 52-year-old woman is diagnosed with non-alcoholic steatohepatitis following a liver biopsy.

What is the single
most important step to help prevent the progression of her disease?
A. Stop smoking
B. Start statin therapy
C. Eat more omega-3 fatty acids
D. Start sulfonylurea therapy
E. Weight loss
A 31-year-old female is admitted to the Emergency Department following a paracetamol

overdose. The
paracetamol level comes back as elevated but the doctor is unsure which treatment line to
use. Which one of the
following features in the medical history would classify the patient as high risk?
A. Hypothyroidism
B. Anorexia nervosa
C. Previous paracetamol overdose
D. Combined overdose with codeine
E. Long-term sodium valproate use
A 26-year-old woman who is known to have type 1 diabetes mellitus presents with a three-
month history of
diarrhoea, fatigue and weight loss. She has tried excluding gluten from her diet for the past 4
weeks and feels
much better. She requests to be tested so that a diagnosis of coeliac disease is confirmed.
What is the most
appropriate next step?
A. Check her HbA1c
B. No need for further investigation as the clinical response is diagnostic
C. Check anti-endomysial antibodies
D. Arrange a jejunal biopsy
E. Ask her to reintroduce gluten for the next 6 weeks before further testing
What is the most common cause of hepatocellular carcinoma in the United Kingdom?
A. Haemochromatosis
B. Hepatitis B
C. Alcohol excess
D. Aflatoxin
E. Hepatitis C
A patient presents with gastrointestinal symptoms. Which one of the following features in the
history would be
least consistent with making a diagnosis of irritable bowel syndrome?
A. Urgency to open bowels
B. Symptoms made worse by eating
C. 62-year-old female
D. Passage of mucous with stool
E. Bladder symptoms
27-year-old woman with a history of depression presents to the Emergency Department. She
reports taking 50
paracetamol tablets yesterday. Bloods are taken on admission. Which one of the following
would most strongly
indicate the need for a liver transplant?
A. Blood glucose 2.2 mmol/l
B. ALT 2364 iu/l
C. INR 4.1
D. Creatinine 230 μmol/l
E. Arterial pH 7.27
A 64-year-old female with a history of COPD and hypertension presents with pain on
swallowing. Current
medication includes a salbutamol and becotide inhaler, bendrofluazide and amlodipine. What
is the most likely
cause of the presentation?
A. Myasthenia gravis precipitated by bendrofluazide
B. Oesophageal web
C. Achalasia secondary to amlodipine
D. Oesophageal candidiasis
E. Oesophageal cancer
According to recent NICE guidelines, which one of the following may have a role in the
management of irritable
bowel syndrome?
A. Reflexology
B. Acupuncture
C. Aloe vera
D. Homeopathy
E. Hypnotherapy
Which one of the following investigations is considered the gold standard for the diagnosis of
gastro-oesophageal
reflux disease?
A. Endoscopy
B. 24hr oesophageal pH monitoring
C. Oesophageal manometry
D. Barium swallow
E. CT thorax
A 27-year-old man with multiple pigmented freckles on his lips and face is investigated for
iron-deficiency
anaemia. A diagnosis of Peutz-Jeghers syndrome is suspected. What is the mode of
inheritance?
A. Autosomal recessive
B. Mitochondrial inheritance
C. X-linked dominant
D. Autosomal dominant
E. X-linked recessive
The increased risk of oesophageal malignancy in patients with Barrett's oesophagus is

approximately:
A. No increased risk
B. Twice risk
C. 5 times risk
D. 50 - 100 times risk
E. 500 - 1,000 times risk
Where do the majority of VIPomas arise from?

A. Small intestine
B. Pituitary
C. Pancreas
D. Antrum of stomach
E. Pylorus of stomach
Which one of the following is not associated with oesophageal cancer?

A. Achalasia
B. Smoking
C. Gastro-oesophageal reflux disease
D. Helicobacter pylori
E. Alcohol
A 45-year-old man is noted to have non-tender, smooth hepatomegaly associated

Dupuytren's contracture and
parotid enlargement. He recently returned from a holiday in Thailand. What is the likely
diagnosis?
A. Primary hepatoma
B. Hydatid disease
C. Alcoholic liver disease
D. Viral hepatitis
E. Tricuspid regurgitation
59-year-old female presents with a two month history of indigestion. She is otherwise well,
has not had a
similar episode before and takes no regular medication. Of note there is no recent weight
loss or vomiting and
abdominal examination is unremarkable. What is the most appropriate initial management?
A. Long-term course of a H2 receptor antagonist
B. Lifestyle advice with follow-up appointment in one month
C. Urgent referral for endoscopy
D. One month course of a full-dose proton pump inhibitor
E. Urea breath testing and treat for H pylori if positive
A 19-year-old man is referred to the general medical clinic. For the past six months his family
have noted increasing behavioural and speech problems. He himself has noticed that he is
more clumsy than normal and reports excessive salivation. His older brother died of liver
disease. Given the likely underlying condition what is
the most appropriate therapy?
A. Vitamin B6 supplements
B. Venesection
C. Ribavirin + interferon alpha
D. Pulsed methylprednisolone
E. Penicillamine
Which one of the following statements is incorrect regarding Dubin-Johnson syndrome?

A. Runs a benign course
B. Due to a defect in the canillicular multispecific organic anion transporter
C. Causes defective hepatic bilirubin excretion
D. It is an autosomal recessive disorder
E. Results in an unconjugated hyperbilirubinaemia
A 30-year-old woman presents with a three month history of indigestion. There is no history
of weight less, anorexia, dysphagia, vomiting or change in bowel habit and abdominal
examination is unremarkable. Which one of the following may decrease the accuracy of a
13C-urea breath test?
A. Use of Gaviscon around 10 days ago
B. Use of ranitidine stopping 4 weeks ago
C. Course of amoxicillin stopping 3 weeks ago
D. Use of lansoprazole stopping 6 weeks ago
E. Current use of the combined oral contraceptive pill
A 26-year-old woman complains of an itchy rash, tiredness,

abdominal pain and intermittent diarrhoea with a 10-kg
weight loss over six months. She is pale and has a rash on
her elbows and knees. She has a microcytic, hypochromic
anaemia and low ferritin and folate levels, a low serum
albumin and normal free T4, but a slightly raised TSH level.
Which of the following investigations is most
appropriate?
1-Colonoscopy
2-Bone marrow examination
3-Jejunal biopsy
4-Small-bowel follow-through
5-Schilling test
A 56-year-old man complains of diarrhoea, abdominal pain,weight loss and joint pains, with 2 or 3
pale, bulky stools daily. A jejunal biopsy shows stunted villi, and electron
microscopy shows bacilli within the macrophages.
What is the best treatment?
1-Gluten-free diet
2-Anti-TB treatment
3-Amoxicillin
4-Low-fat diet
5-Metronidazole
A 40-year-old man is investigated for abnormal liver function tests. It is decided to perform a
liver biopsy. Which
one of the following is a contraindication to liver biopsy?
A. ALT of 2,212 iu/l
B. Aspirin therapy
C. Platelet count of 100 * 109/l
D. Body mass index of 33 kg/m^2
E. Bile duct dilatation
A 55-year-old man complains of a recurrent bluish-red rash on his neck, abdominal pain and watery
diarrhoea. He has facial telangiectasis, mild pedal oedema, elevated JVP, a pansystolic murmur and
moderate hepatomegaly.
1-Lymphoma
2-Carcinoid syndrome
3-Tropical sprue
4-Intestinal tuberculosis
5-Carcinoma of the pancreas with liver Metastasis
Which one of the following is least likely to cause malabsorption?

A. Systemic sclerosis
B. Cystic fibrosis
D. Whipple's disease
E. Haemochromatosis
A 42-year-old woman is investigated for lethargy and diarrhoea. Investigations reveal

positive anti-endomysial
antibodies. Each of the following food stuffs should be avoided, except:
A. Beer
B. Rye
C. Maize
D. Bread
E. Pasta
Which one of the following statements best describes the prevention and treatment of
hepatitis C?
A. No vaccine is available and treatment is only successful in around 10-15% of
patients
B. No vaccine and no treatment is available
C. A vaccine is available and treatment is successful in around 50% of patients
D. A vaccine is available but no treatment has been shown to be effective
E. No vaccine is available but treatment is successful in around 50% of patients
The most common type of inherited colorectal cancer:

A. Familial adenomatous polyposis
B. Li-Fraumeni syndrome
C. Hereditary non-polyposis colorectal carcinoma
D. Fanconi syndrome
E. Peutz-Jeghers syndrome
Which one of the following statements regarding hepatitis C is correct?
A. Cannot be transmitted vertically from mother to child
B. Interferon-alpha and ribavirin are the treatments of choice
C. It is more infectious than hepatitis B following a needle stick injury
D. Breast feeding is contraindicated in mothers with hepatitis C
E. HCV RNA is the initial investigation of choice for at-risk groups
A 36-year-old man is reviewed in clinic. He has recently been started on mesalazine 400mg
tds for ulcerative colitis. Which one of the following adverse effects is least likely to be
attributable to mesalazine?
A. Interstitial nephritis
B. Headaches
C. Acute pancreatitis
D. Agranulocytosis
E. Infertility
A 45-year-old man is admitted to the Emergency Department with severe abdominal pain.
He smokes 20 cigarettes a day and drinks approximately 50 units of alcohol per week. He
also complains of sudden deterioration in vision. Fundoscopy reveals shows multiple micro
infarcts (cotton wool spots). Which investigation would best confirm the most likely
diagnosis?
A. Gastroscopy
B. Serum glucose
C. Amylase
D. Biliary USS
E. ECG
A 27-year-old female is referred to the medical outpatient clinic due to a long history of
fatigue and joint pains. An
autoimmune screen is done which is positive for smooth muscle antibodies. What is the most
appropriate next
investigation?
A. Liver function tests
B. Thyroid function tests
C. Creatine kinase
D. Serum glucose
E. Electrocardiogram
Which one of the following conditions is least likely to develop following hepatitis B infection?
A. Glomerulonephritis
B. Hepatocellular carcinoma
C. Acute pancreatitis
D. Chronic infection
E. Polyarteritis nodosa
Which one of the following is not associated with villous atrophy on jejunal biopsy?
A. Tropical sprue
B. Coeliac disease
C. Hypogammaglobulinaemia
D. Familial Mediterranean Fever
E. Whipple's disease
A 34-year-old male is admitted with central abdominal pain radiating through to the back and
vomiting. The
following results are obtained:
Amylase 1,245 u/dl
Which one of the following medications is most likely to be responsible?
A. Phenytoin
B. Sodium valproate
C. Metoclopramide
D. Sumatriptan
E. Pizotifen
A 59-year-old woman presents with dysphagia. There is no history of heartburn, weight loss
or change in bowel
habit. During endoscopy there is some difficulty passing through the lower oesophageal
sphincter but no other
abnormality is noted. Which one of the following tests is most likely to reveal the diagnosis?
A. Oesophageal biopsy
B. Oesophageal manometry
C. Plain chest x-ray
D. Endoscopy ultrasound
E. CT thorax
Which of the following is not a recognised complication of coeliac disease?

A. Hypersplenism
B. Osteoporosis
C. Lactose intolerance
D. Oesophageal cancer
E. Subfertility
A 43-year-old man with type 2 diabetes mellitus presents with lethargy. His current
medications include
metformin and gliclazide, although the gliclazide may soon be stopped due to his obesity. A
number of blood
tests are ordered which reveal the following:
HbA1c 8.2%
Ferritin 204 ng/ml
ALP 162 u/l
ALT 120 u/l
AST 109 u/l
On discussing these results he states that he does not drink alcohol. What is the most likely
cause of these
abnormal results?
A. Metformin-induced steatohepatitis
B. Haemochromatosis
C. Acute hepatitis secondary to gliclazide
D. Cryptogenic cirrhosis
E. Non-alcoholic fatty liver disease
A 78-year-old woman is admitted with a productive cough and pyrexia to hospital. Chest x-
ray shows a
pneumonia and she is commenced on intravenous ceftriaxone. Four days following
admission a stool sample is
sent because of diarrhoea. This confirms the suspected diagnosis of Clostridium difficile
diarrhoea and a 10-day
course of oral metronidazole is started. After 10 days her diarrhoea is ongoing but she
remains clinically stable.
What is the most appropriate treatment?
A. Oral vancomycin for 14 days
B. IV vancomycin for 3 days
C. Oral rifampicin for 7 days
D. Oral clindamycin for 7 days
E. Oral metronidazole for a further 7 days
A 45-year-old man with a history of alcohol excess is diagnosed as having grade 3

oesophageal varices during
an outpatient endoscopy. Of the following options, what is the most appropriate management
to prevent variceal
bleeding?
A. Propranolol
B. Isosorbide mononitrate
C. Endoscopic sclerotherapy
D. Terlipressin
E. Lansoprazole
A 25-year-old man presents with bloody diarrhoea associated with systemic upset. Blood
tests show the
following:
Hb 13.4 g/dl
Platelets 467 * 109/l
WBC 8.2 * 109/l
CRP 89 mg/l
A diagnosis of ulcerative colitis is suspected. Which part of the bowel is most likely to be
affected?
A. Sigmoid colon
B. Rectum
C. Ascending colon
D. Descending colon
E. Terminal ileum
A 31-year-old woman presents with symptoms consistent with coeliac disease. Which one of
the following tests
should be used first-line when screening patients for coeliac disease?
A. Anti-casein antibodies
B. Tissue transglutaminase antibodies
C. Anti-gliadin antibodies
D. Xylose absorption test
E. Anti-endomyseal antibodies
Which one the following disorders is most strongly associated with primary biliary cirrhosis?
A. Systemic sclerosis
B. Thyroid disease
C. Sjogren's syndrome
D. Rheumatoid arthritis
E. Systemic lupus erythematous
A 54-year-old female is diagnosed with primary biliary cirrhosis. What is her increased risk of
developing hepatocellular cancer, compared to a standard population?
A. 50% increased risk
B. 3-fold increased risk
C. 5-fold increased risk
D. 10-fold increased risk
E. 20-fold increased risk
A 71-year-old man presents with two year history of intermittent problems with swallowing.
His wife has also
noticed he has halitosis and is coughing at night. He has a past medical history of type 2
diabetes mellitus but
states he is otherwise well. Of note his weight is stable and he has a good appetite. Clinical
examination is
unremarkable. What is the most likely diagnosis?
A. Oesophageal cancer
B. Hiatus hernia
C. Pharyngeal pouch
D. Oesophageal candidiasis
E. Benign oesophageal stricture
A 27-year-old woman with chronic left iliac fossa pain and alternating bowel habit is
diagnosed with irritable
bowel syndrome. Initial treatment is tried with a combination of antispasmodics, laxatives and
anti-motility agents.
Unfortunately after 6 months there has been no significant improvement in her symptoms.
According to recent
NICE guidelines, what is the most appropriate next step?
A. Low-dose tricyclic antidepressant
B. Cognitive behavioural therapy
C. Refer for sigmoidoscopy
D. Trial of probiotics
E. Selective serotonin reuptake inhibitor
A 29-year-old man presents with a nine day history of watery diarrhoea that developed one
week after returning
from India. He had travelled around northern India for two months. On examination he is
apyrexial and his
abdomen is soft and non-tender. What is the most likely causative organism?
A. Amoebiasis
B. Giardiasis
C. Campylobacter
D. Shigella
E. Salmonella
Which one of the following is least useful in assessing the severity of a patient with liver
cirrhosis?
A. ALT
B. Prothrombin time
C. Bilirubin
D. The presence of ascites
E. The presence of encephalopathy
A 34-year-old woman with a history of alcohol excess is admitted with abdominal swelling to
the Acute Medical
Unit. A diagnosis of ascites secondary to liver cirrhosis is made and paracentesis is
performed. The serum
creatinine on admission is 95 μmol/l. Ten days after admission urine output decreases
significantly and blood
tests reveal:
Na+ 129 mmol/l
K+ 3.7 mmol/l
Urea 14.2 mmol/l
Creatinine 221 μmol/l
Albumin is given to correct suspected hypovolaemia. What is the most appropriate further
management?
A. Octreotide
B. Propranolol
C. Terlipressin
D. Acetylcysteine
E. Dopamine
A 29-year-old Russian man who has recently arrived into the country presents with fever and
feeling generally
unwell. His temperature is 38.2ºC and pulse 96/min. On examination a grey coating is seen
surrounding the
tonsils and there is extensive cervical lymphadenopathy. What is the most likely diagnosis?
A. Dengue fever
B. Typhoid
C. Paratyphoid
D. Actinomycosis
E. Diphtheria
A 29-year-old female is noted to have an elevated bilirubin during a viral illness. Gilbert's
syndrome is suspected.Which one of the following tests may confirm the diagnosis?
A. Bromsulphthalein excretion test
B. Ammonium chloride acidification test
C. Urine analysis
D. Nicotinic acid test
E. Faecal fat excretion
What percentage of patients with Peutz-Jeghers syndrome will have died from a related
cancer by the age of 60
years?
A. 2-3%
B. 50%
C. 5-7%
D. >95%
E. 10-20%
A 45-year-old man with a history of alcoholic liver disease presents with abdominal
distension. Examination
reveals tense ascites which is drained. What is the appropriate type of diuretic to help
prevent reaccumulation of
ascites?
A. Aldosterone antagonist
B. Loop diuretic
C. Thiazide diuretic
D. Osmotic diuretic
E. Carbonic anhydrase inhibitor
Which one of the following patients is most likely to require screening for hepatocellular
carcinoma?
A. A 45-year-old man with liver cirrhosis secondary to hepatitis C
B. A 33-year-old man with HIV. He is taking antiretroviral therapy
C. A 22-year-old man with alpha-1 antitrypsin deficiency. He has no evidence of
current liver disease
D. A 52-year-old woman with alcohol-related liver cirrhosis who is still drinking
E. A 75-year-old man who drinks 100 units / week. He has no current signs of
liver diseas
A 25-year-old intravenous drug user with chronic hepatitis C becomes pregnant.

Approximately what is the
chance of the virus being transmitted to her child?
A. <10%
B. 10-20%
C. 20-30%
D. 30-40%
E. 40-50%
A 22-year-old man is investigated for weight loss and diarrhoea. A rectal biopsy is taken and
reported as follows:
Deep inflammatory infiltrate from the mucosa to the lamina propria
Numerous granulomata noted
A. Crohn's disease
B. Rectal carcinoma-in-situ
C. Tuberculosis
D. Laxative abuse
E. Ulcerative colitis
A 31-year-old woman is reviewed in clinic. She has been referred by her GP with an 8 month
history of
abdominal discomfort associated with bloating. Which one of the following tests is it least
useful to perform
before making a positive diagnosis of irritable bowel syndrome?
A. Erythrocyte sedimentation rate
B. Thyroid function tests
C. Full blood count
D. C-reactive protein
E. Tissue transglutaminase antibodies
A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome
dyspepsia for the past six
months which has not settled with proton pump inhibitor therapy. During the review of
systems he also reports
passing 6-7 watery stools per day. An OGD 3 weeks ago showed gastric erosions and
ulcers. Which one of the
following investigations is most likely to be diagnostic?
A. Serum amylase
B. Urea breath test for Helicobacter pylori
C. Fasting gastrin
D. 14C-xylose breath test
E. CT abdomen
You are asked to review a 24-year-old man who has been admitted with an exacerbation of
Crohn's disease. Despite prednisolone and mesalazine therapy for the past 3 weeks he is
still passing 6-7 watery stools per day.He has lost a considerable amount of weight during
this period. On examination he is apyrexial,
haemodynamically stable and his abdomen is soft and non-tender. What is the most
appropriate next step?
A. Metronidazole
B. Infliximab
C. Methotrexate
D. Azathioprine
E. Surgery
A 59-year-old female with a history of hypothyroidism presents with fatigue. Blood tests
reveal the following:
Hb 9.4 g/dl
MCV 121 fl
Plt 156 * 109/l
WBC 4.3 * 109/l
What is the most appropriate investigation to perform next?
A. Antral biopsy
B. Bone marrow biopsy
C. Lactate dehydrogenase
D. Intrinsic factor antibodies
E. Barium enema
Which one of the following is least associated with hepatosplenomegaly?

A. Glandular fever
B. Chronic myeloid leukaemia
C. Alcoholic liver disease
D. Amyloidosis
E. Infective endocarditis
Which one of the following is least associated with the development of colorectal cancer in
patients with
ulcerative colitis?
A. Unremitting disease
B. Disease duration > 10 years
C. Onset before 15 years old
D. Poor compliance to treatment
E. Disease confined to the rectum
A 33-year-old woman is recently diagnosed with primary biliary cirrhosis (PBC). She is inquiring about available
treatments for this condition, including if there is a cure for the disease. Which of the following treatments is
most likely to “cure” her PBC?
(A) Ursodiol.
(B) Methotrexate.
(C) Azathioprine.
(D) Liver transplantation.
(E) Glucocorticoids.
A 40-year-old white female complains of pruritus. She has an elevated alkaline phosphatase and positive anti-
mitochondrial antibody test. The most likely diagnosis is
(A) Primary biliary cirrhosis.

(B) Primary sclerosing cholangitis.
(C) Hepatitis B.
(D) Liver abscess.
(E) Hepatitis D.
Primary sclerosing cholangitis is associated with:
(A) Crohn's disease.

(B) Ulcerative colitis.
(C) Cholecystitis.
(D) Hepatitis B.
(E) Colon cancer.
60% of patients with Primary sclerosing cholangitis have:
(A) Anti-mitochondrial antibodies (AMA).

(B) Anti-neutrophilic cytoplasmic antibodies (ANCA).
(C) Elevated LDH.
(D) Prolonged bleeding time.
(E) HBsAg positive.
The best current treatment for primary biliary cirrhosis:
(A) Glucocorticoid.
(B) Antibiotics.
(C) Anti-histamines.
(D) Ursodeoxycholic acid.
(E) Pain killer.
The most common presentation of Primary sclerosing cholangitis is:
(A) Pain.
(B) Incidental finding.
(C) Pruritus.
(D) Liver failure.
(E) Jaundice.
Primary biliary cirrhosis is mostly present in :
(A) Young men.

(B) Young Women.
(C) Women in the age of 40-50 years.
(D) Men in the age of 40-50 years.
(E) It affects both sexes equally.
Primary sclerosing cholangitis is associated with
(A) Cholangiocarcinoma.
(B) Hepatoma.
(C) Hemangioma.
(D) Pancreatic cancer.
(E) Gallbladder cancer.
In Primary sclerosing cholangitis there is:
(A) Fibrosis of intrahepatic duct

(B) Fibrosis of extrahepatic duct.
(C) Fibrosis of both intra and extrahepatic duct.
(D) Hepatocellular necrosis.
(E) Occlusion of hepatic vein.
A 44-year-old obese female is noted to have gallstones during an abdominal ultrasound,

which was requested
due to repeated urinary tract infections. Apart from the repeated UTIs she is otherwise well.
What is the most
appropriate management of the gallstones?
A. Ursodeoxycholic acid
B. Extracorporeal Short Wave Lithotripsy
C. List for laparoscopic cholecystectomy when 50 years old
D. Observation
E. List now for laparoscopic cholecystectomy
Which of the following conditions is least associated with Helicobacter pylori?

A. Gastric carcinoma
B. B cell lymphoma of MALT tissue
C. Gastro-oesophageal reflux disease
D. Atrophic gastritis
E. Peptic ulcer disease
A 54-year-old man who is known to have gastric cancer is reviewed in clinic. He asks you
about a rash he has
developed. Which of the following skin disorders is most associated with gastric cancer?
A. Erythema gyratum repens
B. Necrolytic migratory erythema
C. Sweet's syndrome
D. Acquired ichthyosis
E. Acanthosis nigricans
Each one of the following is associated with pancreatic cancer, except:

A. Chronic pancreatitis
B. Smoking
C. Blood group O
D. Diabetes
E. BRCA2 gene
A 36-year-old man presents with dyspepsia. No alarm symptoms are present. This is his first
episode and he has
no significant medical history of note. A test-and-treat strategy is agreed upon. What is the
most appropriate
investigation to test for Helicobacter pylori?
A. Gastric biopsy
B. CLO test (rapid urease test)
C. Stool culture
D. Hydrogen breath test
E. 13C-urea breath test
A 39-year-old man with a history of alcohol excess presents to the Emergency Department
with a 2 day history of
severe epigastric pain. His amylase is found to be 1260. What is the best marker of severity?
A. CRP
B. Amylase (on admission)
C. Pain scores
D. Lipase (on admission)
E. Number of similar previous admissions
Which one of the following features is least associated with ulcerative colitis?
A. Inflammatory cell infiltrate in the lamina propria
B. Pseudopolyps
C. Non-caseating granulomas
D. Depletion of goblet cells
E. Inflammation confined to the mucosa and submucosa
A 64-year-old woman complains of having 'excessive wind'. She is normally fit and well but
for the past three
months she has felt bloated and has been passing wind frequently. She also complains of
vague upper
abdominal pain and chronic diarrhoea. A hydrogen breath test confirms a diagnosis of small
bowel bacterial
overgrowth syndrome. What is the treatment of choice?
A. Tetracycline
B. Rifaximin
C. Cefaclor
D. Nitrofuratoin
E. Ciprofloxacin
What percentage of patients who contract the hepatitis C virus will become chronically
infected?
A. 30-35%
B. 80-85%
C. 65-70%
D. 5-10%
E. 15-20%
Which one of the following is not associated with non-alcoholic steatohepatitis?
A. Hyperlipidaemia
B. Obesity
C. Sudden weight loss or starvation
D. Jejunoileal bypass
E. Type 1 diabetes mellitus
A patient who was an intravenous drug user in the 1990s asks for a hepatitis C test. What is
the most appropriate
action?
A. Refer him for pre-test counselling to discuss the pros and cons of testing
B. Advise him that no accurate test is currently available but that he should
undertake normal precautions
C. Arrange an anti-HCV antibody test
D. Arrange a HCV RNA test
E. Refer him to gastroenterology for a liver biopsy
A 72-year-old female is admitted with diarrhoea to the acute medical unit. A sigmoidoscopy
is performed which
shows multiple white plaques adhered to the gastrointestinal mucosa. What is the most likely
diagnosis?
A. Crohn's disease
B. Ulcerative colitis
C. Ischaemic colitis
D. Pseudomembranous colitis
Which of the following diagnostic tests is most appropriate to determine if gallstones are the
cause of the patient’s pancreatitis?
A) Endoscopic retrograde cholangiopancreatography
B) Contrast-enhanced computed tomographic
(CT) scan of the abdomen
C) Percutaneous cholangiogram
D) Plain radiographs of the abdomen
E) Ultrasonography of the right upper quadrant
A 62-year-old man with known chronic pancreatitis caused by alcoholism reports a 20-pound
weight loss over the past 3 months and frequent, greasy, and malodorous stools. A 72-hour
fecal fat collection confirms steatorrhea. The patient no longer consumes alcohol and reports no
abdominalpain. Which of the following is the most appropriate first-line treatment for this
patient?
A) Administration of enteric-coated pancreatic enzyme replacement tablets with meals and
snacks and concurrent use of calcium containing antacids
B) Administration of non–enteric-coated pancreatic enzyme replacement tablets with meals and
snacks with concurrent dosing with a histamine2 blocker
C) Endoscopic placement of a pancreatic duct stent
D) Institution of a low-fat diet (less than 20 g fat/day)
E) Subcutaneous administration of octreotide 200 µg 3 times daily.
True about duodenal obstruction in chronic pancreatitis.
a) Duodenal obstruction is caused by pancreatic pseudeocyst alone
b) Endoscopy cannot diagnose this condition
c) 25% of patients with common bile duct stenosis need surgery for duodenal obstruction also
d) Conservative treatment should be given for a month .
The most common Vein to be involved in Extrahepatic portal hypertension in chronic

pancreatitis is
a) Portal vein
b) Splenic vein
c) Superior mesenteric vein
d) Inferior mesenteric vein
a 5 year-old female presents with 4 days fever and malaise. 3 days ago she started having watery diarrhea that
became bloody. The stool has been accompanied by tenesmus (rectal pain, cramping). She is brought to the ED
because of a seizure associated with a high fever. Which toxin is the most likely cause of this child`s symptoms?
A.  C. diff toxin A
B.  Vibrio toxin
C.  Shiga toxin
D.  Heat Labile toxin
A 54-year-old male presents with 1 month of diar-rhea. He states that he has 8 to 10 loose bowel movements a
day. He has lost 8 lb during this time. Vital signs and physical examination are normal. Serum laboratory stud-ies
are normal. A 24-h stool collection reveals 500 g of stool with a measured stool osmolality of 200 mosmol/L and
a calculated stool osmolality of 210 mosmol/L. Based on these ﬁndings, what is the most likely cause of this
patient’s diarrhea?
A. Celiac sprue
B. Chronic pancreatitis
C. Lactase deﬁciency
D. Vasoactive intestinal peptide tumor
A 54-year-old woman is treated with oral amoxicillin 500mg thrice daily for five days. Her respiratory
symptoms improve, but she develops profuse diarrhea associated with fever. On examination the pulse
rate is 98 bpm, blood pressure 136/80 mmHg, with generalized abdominal tenderness. Stool culture is
strongly positive for Clostridium difficile and you suspect a diagnosis of pseudomembranous colitis.
Which one of the following treatments would be most appropriate?
A. Ciprofloxacin
B. Erythromycin
C. Trimethoprim
D. Metronidazole
Which of the following causes profuse, watery diarrhea without inflammation or tissue damage?
A. Campylobacter jejuni
B. Vibrio vulnificus
C. Salmonella typhi
D. Vibrio cholera
The following are recognized causes of diarrhea EXCEPT
A. carcinoid syndrome
B. diabetes mellitus
C. thyrotoxicosis
D. hyperparathyroidism
A 55 year old gentleman presents to his GP with intermittent abdominal pain and diarrhoea which is sometimes
difficult to flush away. He has also had a cough, fever and has noticed aches and pains in his joints. A biopsy of
the duodenum reveals periodic acid Schiff stain positive macrophages with intracellular clumps. What is the
most likely diagnosis?
A.IBD
B. Carcinoid tumor
C. Bacterial overgrowth
D. Whipple disease
A patient with type 2 diabetes mellitus has recently had his metformin dose increased due to poor control. He is
now suffering from diarrhoea. What is the likely cause of this?
A. Bacterial overgrowth
B. Chronic pancreatitis
C. Bile acid malabsorption
D. Autonomic neuropathy
A 28 year old female presents with a history of diarrhoea for numerous years. She has been off work on several
occasions due to this. On examination this is unremarkable and her bloods are normal except for a low
potassium. She is brought into hospital for assessment and is asked to keep a stool chart which shows no
evidence of diarrhoea. A colonoscopy is performed and this reveals brown discolouration of the mucosa and a
biopsy reveals pigment laden macrophages. What is the most likely diagnosis?
A.Irritable bowel syndrome
B.Celiac disease
C.Laxative abuse
D.Ulcerative colitis
What is the most common cause of ascites
a) Nephrotic syndrome
b) CHF
c) Liver cirrhosis
d) Malignancy
What is the second most common cause of ascites
b) CHF
c) Pancreatitis
d) Malignancy
All of the following about ascites is true except
a) Renin angiotensin aldestrone system is part of pathogenesis

b) It's a poor prognostic factor in liver disease
c) Ascites is classified clinically into transudate and exudates
d) Can be associated with hepatic hydrothorax
All the following can cause high serum ascites albumin gradients except
b) Cirrhosis
c) Heart failure
d) Portal vein thrombosis
All the following is true regarding spontaneous and secondary bacterial peritonitis except
a) Usually SPB is caused by mono-organism, while secondary is poly-microbial

b) LDH, glucose and total protein level in ascites are important to differentiate
between SPB and secondary one
c) In ascites fluid ,PMN is elevated (>250 cell/mm3) just in secondary bacterial
peritonitis
d) SPB usually has low grade fever,y are both treated via anti-biotic
Presence of adenosine deaminase (ADA) in ascites usually indicates
a) Liver cirrhosis
b) TB peritonitis
c) Malignancy
d) Sarcodosis
A 52 year old male a known case of alcoholic liver cirrhosis is admitted to your hospital
complaining of abdominal pain. He has a chronic ascites, managed with spirnolactone and
furesomide. He had an episode of hematoemesis last year that has not recurred since
patient was placed on Beta blocker. His vital signs are as the following: tempreture 37.8 C,
heart rate 106/ min and BP 102/72. Paracentesis is done and results as the following:
Polymorphonuclear leukocytes count 315/mm3 and albumin is 0.8mg/dl. His serum
albumin is 2mg/dl. CXR was done and it was normal. What is the most likely diagnosis
a) Chronic pancreatitis
b) Pneumonia
c) Hepatocellular carcinoma
d) Spontenous bacterial peritonitis
A 45 year old male with liver cirrhosis related to chronic hepatitis C infection presents to
emergency department with abdominal distention and SOB. He had an episode of variceal
bleeding one year ago. He takes high dose of spirnolactone , furesomide and nadolol.
Physical examination shows that right lung base was dull on percussion and no absence of
air entrance sounds. CXR shows moderate right pleural effusion. Thoracocentesis was done
and pleural effusion was transudates. Which of the following is the best option of
management for the patient
a) Chest tube placement

b) Nitrates and hydralazine
c) Pleurodesis
d) Transjuglar intra-hepatic portosystemic shunt (TIPS)
The followings predict a poor response to INF alpha treatment in chronic hepatitis B viral
infection, except:
1- Being a male.
2- Pre-core mutant strains of the virus.
3- Being an Asian.
4- Very high pretreatment serum hepatitis B viral DNA level by PCR.
5- Absence of cirrhosis.
Which of the following is the most important goal of treating chronic viral hepatitis B infection?
1-Normalize ALT and AST.
2-Improve symptoms.
3-Lose HBsAg from serum.
All of the following are true for patients of ulcerative colitis associated with primary
sclerosing cholangitis (PSC), except:
A. They may develop biliary cirrhosis
B. May have raised alkaline phosphatase
C. Increased risk of hilar Cholangiocarcinoma
D. PSC reverts after a total colectomy
Which of the following disorders is not associated with sclerosing cholangitis?

a. Multiple myeloma
b. Retroperitoneal fibrosis
c. Riedel's thyroiditis
d. Ulcerative colitis
Which of the following therapies have been consistently shown to improve outcomes in patients
with PSC?
a Ursodeoxycholic acid at 13-15 mg/kg/day
b Ursodeoxycholic acid at 20-30 mg/kg/day
c Liver transplantation
d Pentoxifylline
e Corticosteroids

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‫بسم هللا الرحمن الرحيم‬

Gastrointestinal system disorders- course

“Practical multiple choice Questions(MCQs) for final exam-2015”.

Supervisor: Dr. Raed Titi

4- In Dermatitis Herpetiformis, all of the following are true, except:

14- According to amyloidosis in FMF, all of the following is true, except:

B. Peptic ulcer disease

D. Mallory Weiss tear

A. supportive care with transfusion requirements as necessary

B. technetium RBC scan

D. endoscopic therapy of the bleeding diverticulum

E. immediate surgical therapy

A. Determine the source of bleeding

B. Stop acute bleeding

C. Treat the underlying abnormality

19. An important risk factor for peptic ulcer hemorrhage includes:

A. Gastric acid hypersecretion

D. Non-sterioidal anti-inflammatory drug use

A. UGI series with small bowel follow-through

D. Red blood cell tagged technetium scan

E. Abdominal CT scan with contrast

A. Nasogastric tube placement

A. Abdominal CT scan with contrast

B. Magnetic resonance imaging

C. Scintigraphy and angiography

A. Nasogastric tube placement and gastric lavage

C. Intravenous infusion of H2-receptor antagonists to stop the bleeding.

D. Urgent upper panendoscopy.

E. Urgent surgical consultation.

B. Stop NSAIDs, full dose H2RA or daily PPI maintenance therapy

D. Eradicate H.pylori, full dose H2RA or daily PPI maintenance therapy

F. Full dose H2-receptor antagonist or daily PPI maintenance therapy

A. Endoscopic hemostasis with multipolar or heater probe or injection treatment

B. Endoscopic hemostasis with combination therapy

E. Medical therapy alone in a monitored setting for three days

29. Which of the following is not a common site for gastrinoma?

a) 1st part of duodenum.

b) 2nd part of duodenum

c) 3rd part of duodenum

d) 4th part of duodenum

b) Portal Venous Sampling

d) Somatostatin receptor scintigraphy

31. Symptoms of diarrhea, hypokalemia and Achlorhydria are associated with

34- Most common cause of recurrent oral ulcers is:

35- Most common cause of aphthous oral ulcers disease is:

36- Oral thrush is a frequent finding in all of following except:

37- Oral ulcers are common in all of the following except:

38- All patients with Oral ulcers give them:

41- The most common cause of liver cirrhosis in our countries is :

42- All of the following are features/consequences of Portal hypertension except :

All of the following indicate poor prognosis except :

A- Serum Albumin : 2 mg/dl .

A- Macroaggregated albumin lung perfusion scanning .

Which of the following would make a Dx of Budd Chiari syndrome likely ?

E-Ascitic fluid protein of 42 g/L

What explain these findings ?

51. Which of the following is an extra-esophageal symptom associated with GERD?

E. All of the above.

A. Assessing esophageal mucosa for erosions and ulcerations

. B. Excluding other upper gastro-intestinal pathology.

C. Obtaining biopsies at suspicious areas

. D. Treating esophageal strictures

. E. All of the above.