This document contains 47 multiple choice questions related to gastroenterology and the liver. The questions cover topics such as the classification of different types of jaundice, hepatitis viruses, investigations for liver diseases, complications of cirrhosis such as portal hypertension and ascites, and treatment of conditions like hepatic encephalopathy and spontaneous bacterial peritonitis.

1. The MCQ OF
Gastroenterology&liver
By
Prof.Rashed Hasan

2. 1-Jaundice in Sickle Cell Anaemia can be classified under:
Congenital Hyperbilirubinaemia
Haemolytic
Hepatocellular
Obstructive
Answer: Haemolytic
2-Jaundice in Viral Hepatitis can be classified under:
• Congenital Hyperbilirubinaemia
• Haemolytic
• Hepatocellular
• Obstructive
Answer: Hepatocellular
3-Jaundice in Acute Cholecystitis can be classified under:
• Congenital Hyperbilirubinaemia
• Haemolytic
• Hepatocellular
• Obstructive
Answer: Obstructive
4-Stercobilinogen is absent in the stools in the following type of
jaundice:
• Hemolytic
• Hepatocellular
• Obstructive
Answer: Obstructive
5-Urobilinogen is absent in the urine in the following type of jaundice:
• Hemolytic
• Hepatocellular
• Obstructive

3. Answer: Obstructive
6-Immunological evidence of immunity to hepatitis B is the
presence of
A. hepatitis B core antibodies
B. hepatitis B core antigen
C. hepatitis B surface antibodies
D. hepatitis B surface antigen
E. any of the above.
ANSWER C
7-A 20 year old man presented with fever ,anorexia and upper
abdominal pain followed by jaundice. On examination liver was
palpable and tender. The most likely investigation is:
a) Alfa feto protein
b) CT abdomen
c) HBsAg
d) Alkaline phosphatase
e) LFT
Answer: b
8- A 45 years old man presented with jaundice and ascites. He gave
history of jaundice for several episodes in last 5 years. The most likely
investigation is not needed:
a) Alfa feto protein
b) CT abdomen
c) HBsAg
d) Alkaline phosphatase
e) LFT
Answer: d
9- A known case of cirrhosis suddenly developed severe jaundice and
rapid deterioration of health. On examination liver was enlarged and
tender. The most likely investigation is:
a) Alfa feto protein
b) CT abdomen
c) HBsAg
d) Alkaline phosphatase
e) LFT
Answer: b

4. 10. A 40 year old man suddenly developed painless jaundice. He also
complains of abdominal pain with mucous diarrhea. The most likely
investigation is:
a) Alfa feto protein
b) CT abdomen
c) HBsAg
d) Alkaline phosphatase
e) LFT.
Answer: b
11- A 55 year old women developed progressive jaundice with abdominal
pain which radiates towards back and weight loss. The most likely
investigation is:
a) Alfa feto protein
b) CT abdomen
c) HBsAg
d) Alkaline phosphatase
e) LFT
Answer: B .
12. Which of the following hepatitis viruses is not RNA virus?
A. Hepatitis A virus
B. Hepatitis B virus
C. Hepatitis E virus
D. Hepatitis G virus
Answer: Option B
13-Which of the following nucleic acid is present in hepatitis B virus?
A. dsDNA B. ssRNA
C. ssDNA D. dsRNA
Answer & Explanation
Answer: Option A
14-The most serious infection is
A. superinfection of an HBsAg carrier by HDV
B. infection with HBV alone

5. C. coinfection of HBVand HDV
D. none of the above
Answer: Option A
15- Which of the following specimens contain/s hepatitis B virus in an infected
person?
A. Blood
B. Semen
C. Saliva
D. All of these
A
Answer: Option D
. 16-Vertical transmission may be seen in
A. Hepatitis B virus
B. Hepatitis C virus
C. Hepatitis D virus
D. All of these
Answer: Option D
. 17-Which of the following viral infections can result in chronic carrier state?
A. HBV
B. HCV
C. HDV
D. All of these
Answer: Option D
18-Most reliable test for detection of hepatitis E infection is
A. ELISA test for IgM anti-HEV
B. Western blot assay for IgM anti-HEV

6. C. Polymerase chain reaction for detection of HEV RNA
D. ELISA test for IgG anti-HEV
Answer: Option C
19. Hepatocellular carcinoma (Hepatoma) may be caused by
A. Hepatitis A virus
B. Hepatitis C virus
C. Both (a) and (b)
D. None of these
Answer: Option C
20. The diagnosis of hepatitis A virus infection is carried out from the method
based on
A. aminotransferase levels
B. detection of faecal HAV by immunoelectron microscopy
C. both (a) and (b)
D. detection of IgM anti-HAV by ELISA
Answer: Option D.
. 21.
---
Which of the following is not correct for hepatitis A virus?
A. It can be grown in cell cultures of primate and human cells
B. It is one of the most stable viruses infecting humans
C. It may cause hepatocellular carcinoma
D. None of the above
Answer: Option C
.22. Which of the following viruses can be transmitted by the parenteral route?
A. HBV
B. HCV
C. HDV

7. D. All of these
Answer: Option D
23.The viruses, which is/are transmitted by parenteral and sexual routes is/are
A. Hepatitis B virus
B. Hepatitis C virus
C. Hepatitis G virus
D. All of these
Answer: Option D
24-Which of the following are true of hepatitis
C infection ?:
A Hepatitis C virus is a DNA virus
B Infection is a risk factor for hepatocellular
carcinoma
C Infection is commoner in women
D Commonly transmitted by sexual contact
E Alpha-interferon is an effective treatment to
cure the infection.
Answer:B True
.
25-Gallstones are proved to be associated
With except:
A Female sex
B Pregnancy
C Oral contraceptives
D Ageing
E Insulin therapy.
Answer:E
26. In a patient with liver cirrhosis, the recommended diet is?
A. Low protein
B. High protein
C. High fat
D. Low fiber
Answer B

8. 27.A portal venous pressure of 30 mm. Hg (elevated)
and a hepatic venous wedge pressure of 5 mm. Hg
(normal) may be associated with which of the
following causes of portal hypertension?
A. Portal vein thrombosis.
B. Alcoholic cirrhosis.
C. Schistosomiasis.
D. Alcoholic hepatitis.
Answer: AC
28-Which of the following complications of portal
hypertension often require surgical intervention (for
more than 25% of patients?(
A. Hypersplenism.
B. Variceal hemorrhage.
C. Ascites.
D. Encephalopathy.
Answer: B.
29-A male client with a history of cirrhosis and alcoholism is
admitted with severe dyspnea resulted to ascites. The nurse
should be aware that the ascites is most likely the result of
increased…
A. Pressure in the portal
vein
B. Production of serum
albumin
C. Secretion of bile
salts
D. Interstitial osmotic
pressure
.Answer:A
30-The nurse is caring for a client with cirrhosis of the liver who
has developed esophageal varices. The nurse understands that
the best explanation for development of esophageal varices is
which of the following?
A. Chronic low serum protein levels result in inadequate tissue
repair, allowing the esophageal wall to weaken.

9. B. The enlarged liver presses on the diaphragm, which in turn
presses on the esophageal wall, causing collapse of blood
vessels into the esophageal lumen.
C. Increased portal pressure causes some of the blood that
normally circulates through the liver to be shunted to the
esophageal vessels, increasing their pressure and causing
varicosities.
D. The enlarged liver displaces the esophagus toward the left,
tearing the muscle layer of the esophageal blood vessels,
which allows small aneurysms to form along the lower
esophageal vessels.
Answer:c
31.In hepatitis C is false:
a. cirrhosis develops in most untreated cases
b. blood transfusion is the commonest mode of transmission in the
UK.
c. children born to hepatitis C infected mothers will not have the
infection
d. High serum alanine transaminase level indicate active liver
disease
Answer :C
32-Neuropsychiatric symptoms of hepatic insufficiency include:
A) a reverse sleep pattern
B) Argyll-Robertson pupils
C) myelopathy with paraplegia
D) diagnostic EEG abnormalities.
Answer :A&D.
33- Which is not true regarding physiology of portal hypertension?
a) Both the portal blood flow as well as portal resistance increases
b) There is extensive hyperdynamic circulation
c) Blood flow towards the portal vein increases because the systemic venous pressure
increases.
d) Splanchnic vasodilatation is caused by relaxation of splanchnic arterioles and
splanchnic hyperemia.
Answers.1. c
34.False about site of porto systemic collaterals in portal hypertension is
a) Rectal Varices- Where Inferior mesenteric vein meets pudendal vein
b) Retroperitoneal veins- Comunication between the iliac and renal veins
c) Umbilicus- Obliterated umbilical vein and Left portal vein
d) Varices in lower esophagus and stomach.

10. Answer: b
35 Treatment of Choice for gastric varices is
a) Sclerotherapy
b) Band Ligation
c) Transjugular Intrahepatic Portosystemic Shunt
d) Application of cyanoacrylate glue
e) Shunt Surgery.
Answer:. d
36. Measurement of Portal vein pressure can be done by all of these except
a) Hepatic venous pressure gradient (HVPG)
b) Direct measurement of portal pressure
c) Splenic pulp pressure
d) IVC pressur.
Answer:. d
37 . False statement regarding endoscopic management of varices is:
a) All patients with cirrhosis should undergo screening endoscopy.
b) If no varices are found endocscopy should be done every 2-3 years
c) Endoscopic management is useless.
Answer:c
3 8-which is the most common cause of portal hypertension?
a. Iatrogenic causes
b. Trauma
c. Chronic renal failure
d. Liver cirrhosis
e. Tumour.
Answer:d
.3 9- What are the tests that should be done on the ascitic fluid?
a.wbcs.
b.lymphocytes.
c.total protein.
d.culture.
E.all of these.
Answer:E
40-Ascites is fluid collection in the :
a-pleura.
b-pericardium.
c-peritoneum,
Answer:c

11. 41-The most common cause of Ascites is:
a-myocardial infarction.
b-cerebral haemorrhage.
c-liver cirrhosis.
Answer:c
42-low-salt diet anddiuretics in treatment of ascites has:
a- very important role.
b- Less important role.
c- No role.
Answer:A
43-Standard treatment of spontaneous bacterial peritonitis (SBP) includes which of the
following?
aAmpicillin and gentamicin.
bCeftriaxone 1 g intravenously daily for 5 days.
cCefotaxime 2 g intravenously every 8 hours for 5 days.
dCefotaxime and metronidazole.
The correct answer is c
44-.In hepatic encephalopathyA significant proportion of portal vein
ammonia is generated by intestinal ammonia.
a-True
b-False
.
: The correct answer is – true.
45-Hepatic encephalopathy (HE) primarily arises because of large portosystemic shunts.
a-True
b-False
The correct answer is b – false.
46-Correction of precipitating factors for HE is effective therapy.
a-True
b-False
The correct answer is a - true..
47- Blood ammonia level are useful for the diagnosis of HE.
a-True
b-False
: The correct answer is b – false.
48-Neomycin inhibits intestinal bacterial activity.

12. a-True
b-False .
The correct answer is a – true.
49- Asterixis is highly specific for the diagnosis of HE:
a-True
b-False
: The correct answer is b – false.
50- The most common cause of death in the setting of acute liver failure is which of the
following?
a-Fungal infection.
b-Cerebral edema and brainstem herniation.
c-Electrolyte imbalance.
d-Renal failure.
The correct answer is b.
51-The most common cause of ALF worldwide is which of the following?
a-Drug-induced liver injury
b-Viral hepatitis
c-Autoimmune hepatitis
d-Ischemic hepatitis
.
The correct answer is b..
52- Which of the following statements describes functional renal failure in cirrhosis?
A-Renal failure where there is no structural damage in the kidneys.
b-Diagnosed when the serum creatinine is Les than 1 mg/dL.
c--The same as hepatorenal syndrome
Answer.A&C
53-Which of the following statements applies in assessing a patient for a diagnosis of acute or
type 1 hepatorenal syndrome?
a-One should always look for a precipitating event as hepatorenal syndrome never occurs
spontaneously.
b-The patient usually has signs to suggest a hyperdynamic circulation.
c-The rise in serum creatinine occurs within 48 hours.
. Answer.A,b&C

13. 54- Which of the following is not an ultrasonic finding in acute
cholecystitis
a) Absence of gall stomes
b) Gall bladder wall thickness more than 6 mm
c) Pericholecystic fluid
d) Murphy's sign
Answer.d
55-- Signs and symptoms of acute cholecystitis usually include the following except:
a- Jaundice
b- RUQ pain
c- Fever
d- Elevated WBC count
e- Nausea and vomiting.
Answer A
56- In obstructive jaundice, LFTs usually shows
a- Elevated indirect bilirubin and alkaline phosphatase
b- Elevated indirect bilirubin and GGT
c- Elevated direct bilirubin and alkaline phosphatase
d- Elevated direct bilirubin and ALT
e- Elevated direct bilirubin and AST.
Answer. C
57- Prolonged PT (INR) in obstructive jaundice is due to decrease absorption of
a- Vitamin A
b- Vitamin D
c- Vitamin E
d- Vitamin K
e- Calcium.
Answer. D
58- In acute cholecystitis,the sonar shows
a- Distended gallbladder
b- Contracted gallbladder
c- Non-filling of gallbladder
d- Dilated common bile duct
e- Bile leak..
Answer. C
59-Risk factors for gallstones include all the following except
a- Obesity
b- Contraceptive pills

14. c- Sickle cell anemia
d- High protien diet
e- Rapid weight loss.
Answer. D.
60-The following are indications for cholecystectomy in asymptomatic gall bladder stone
patients except
a- Diabetes
b- During surgery
c- Stone 4 cm in size
d- Ischemic heart diseas
e- Hemolytic anemia.
Answer. D.
61-The clinical picture of gallstone includes which of
the following?
A. Air in the biliary tree.
B. Small bowel obstruction.
C. A stone at the site of obstruction.
D. Acholic stools.
E. Associated bouts of cholangitis.
Answer: C&E.
62-. Standard supportive measures for patients with
acute pancreatitis include the following:
A. Intravenous fluid and electrolyte therapy.
B. analgesics as pethedin.
C. Somatostatin therapy.
D. Nasogastric decompression.
E. Prophylactic antibiotics.
Answer: A ,B&C.
63-. Which of the following statements about chronic
pancreatitis is/are correct?
A. Chronic pancreatitis is the inevitable result after
repeated episodes of acute pancreatitis.
B. Patients with chronic pancreatitis commonly
present with jaundice, pruritus, and fever.

15. C. Mesenteric angiography is useful in the evaluation
of many patients with chronic pancreatitis.
D. Total pancreatectomy usually offers the best
outcome in patients with chronic pancreatitis.
E. Pancreatic enzymes replacement& symptomatic
therapy are useful.
Answer:A& E.
64-Which of the following statements about
pancreatic ascites is/are correct?
A. Patients typically present with painful ascites.
B. The peritoneal fluid contains high concentrations
of both amylase and protein.
C. Pancreatic ascites can follow an episode of acute
pancreatitis.
D. Patients with pancreatic ascites may fail to
improve with nonoperative therapy and require
surgical procedures. At abdominal exploration an
acceptable approach to the pancreatic duct disruption
involves suture ligation with omental patching.
Answer: B&C.
65-Which of the following statements about cancer of
the pancreas is/are correct?
A. It is the most common cause of cancer death in the
U.S.
B. Most cases occur in the body and tail of the
pancreas
C. prognosis appears to be independent of the
presence of metastasis, margin status, or tumor
diameter.
D. The most accurate screening test involves
surveillance of alfa fetoprotein
Answer: A.

16. 66-In the performance of a pancreaticoduodenectomy
(Whipple procedure) .
a. The superior mesenteric vein is resected
b .The head of pancrease &duodenum are resected
c. performed in absence of tumour metastasis
d. The superior mesenteric vein courses anterior to
the neck of the pancreas
Answer: b, c.
67-A 50-year-old man develops acute pancreatitis due
to alcohol abuse, the patient is noted to have
recurrent fever (38.5°C), progressive leukocytosis
(18,500 WBC/mm3), and tachypnea. The most
appropriate management includes:
a. Laparotomy with pancreatic debridement
b .Abdominal CT &serum lipase are useful.
c. ERCP with sphincterotomy and placement of
biliary stent
d. Intravenous amphotericin B
Answer: b.
68- Which of the following medical procedures
has/have been associated with an increased risk of
post-procedure acute pancreatitis?
a. Uper endoscopy
b. Endoscopic retrograde cholangiopancreatography
c. paracentesis
d. Colonoscopy
Answer: b.

17. 69-The pathogenesis of cholesterol gallstones is :
a. Cholesterol deposition
b. Gallbladder stasis
c. Low bilirubin concentration
d. High bilirubin concentration
Answer: a, b, c.
70- Risk factors associated with development of
gallstones include:
a. Increasing age
b. Obesity
c. Rapid weight loss
d. Cirrhosis
e. Diabetes mellitus
Answer: a, b, c, d, e.
71- In which of the following clinical situations is
pigment gallstones a more common problem?
a. Amoebic abscess
b. Morbid obesity
c. Diabetes mellitus
d. Haemoletic anemia
e. Biliary tract stricture
Answer: d,
72-:GERD is the back up of stomach acid into the esophagus.
A.True.
B.False.
73-Which is not a predisposing factor for GORD?
f. High fatty food intake

18. g. Cholinergic drugs
h. Caffeine
i. Nicotine
j. Gastric outlet obstruction
Answer:B
74-Babies and children do not develop GERD.
A.True.
B.False.
Answer:B
75-Reflux is an alternative term for
AVomiting
BAcid erosion
CRegurgitation
DSalivating..
Answer:CRegurgitation
76- GERD is diagnosed by blood tests.
A.True.
B.False.
Answer:B
77-Barrett's esophagus is a potentially serious complication of GERD
A.True.
B.False.
Answer:A.
78-Who is most likely to suffer from GERD?
A-A pregnant woman
BAn obese person
CA cigarette/cigar smoker
DAny of the above
Answer: DAny of the above.
79-GERD is closely linked to which type of cancer?
A.hepatoma.
B.Cancer pancreas.
c.oesophageal adenocarcinoma.
Answer:C.

19. 80- Factors associated with the development of complications of
gastroesophageal reflux disease include:
a. The presence of a defective lower esophageal sphincter
b. Inadequate esophageal clearance
c. The presence of a hiatal hernia
d. The presence of an alkaline component of the reflux material
Answer: a, b, c, d.
81-Which is the most common cause of peptic ulcer disease of the following?
A-Smoking
B-NSAID’s
C-Zollinger-Ellison syndrome
D-Ethanol excess
E-Family hx of PUD
Answer:B.
82-Which is not correct regarding treatment of peptic ulcer disease/
A-Antacids are as effective as H2 antagonists in healing ulcers
B-Proton pump inhibitors show more rapid healing and pain relief
over 2-4 weeks compared to H2 antagonists.
C-Colloidal bismuth subcitrate will suppress H.pylori and chelate with
the base of the ulcer to aid healing.
D-H.pylori eradication with omeprazole, Amoxil and metronidazole
requires only one week of treatment.
E-Misoprostal is indicated for prevention of NSAID induced ulcers,
when treatment necessary with NSAID’s.
Answer:D.
83-Which is the most common complication of Peptic ulcer disease?
A-Perforation
B-Gastric outlet obstruction
C-Penetration
D-Haemorrhage
E-All are uncommon occurring in less than 5% of patients.
Answer:D.
84-The best duration of treatment to ensure 90% duodenal ulcer healing with H2
receptor antagonist is:
A. 1 week
B. 2 weeks
C. 4 weeks
D. 8 weeks
E. 1 year.
Answer:D. 8 weeks.

20. 85-Effective ulcer treatment which works without any action on gastric acid secretion
is:
Lactulose
B. Aluminium hydroxide
C. Sucralfate
D. Lactitol
E. Magnesium trisilicate.
Answer C. Sucralfate.
86-Antacid therapy relieves symptoms:
A. Rapidly
B. By complete neutralisation of gastric acid
C. By eradicating Helicobacter pylori
D. Indefinitely
E. By protecting the mucosa from acid
Answer A. Rapidly
87-Helicobacter pylori bacteria:
A. Live in gastric acid
B. Adhere to the gastric mucosa in an alkaline layer
C. Are never seen in healthy people
D. Can be simply identified in the endoscopy room by their urease activity
E. Are associated with peptic ulcer relapse.
Answer.B,D,E
88-Helicoabacter pylori has been investigated as a possible etiologic
agent in duodenal ulceration. Which of the following statement(s)
regarding H pylori infection in humans is/are correct?
H pylori may be isolated from antral gastric mucosa in nearly 100%
b. H pylori possess anticoagulant activity
c. Therapeutic regimens for duodenal ulcer that eliminate the

21. organism are associated with lower ulcer recurrence rates than those
in which the organism persists
d. The incidence of the organism in the normal population increases
with age
e. Antral gastritis is associated with development of duodenal ulcer
Answer: c, d, e.
89-Which is not true of H.pylori infection?
A- patients with chronic infection will not develop ulcers
B-the most common cause of peptic ulcer disease
C-it is a risk factor for adenocarcinoma of the stomach
D-IgG antibody test will remain positive for up to 2 years post
eradication limiting its usefulness
EThe CLO test is approx 90% sensitive and 100% specific for
H.pylori.
Answer: A
90-Which of the following statements about achalasia is/are correct?
A. In most cases in the cause is a parasitic infestation .
B. Chest pain and regurgitation are the usual symptoms.
C. Distal-third esophageal adenocarcinomas is the main cause.
D. Manometry demonstrates failure of LES relaxation on
swallowing and absent or weak simultaneous contractions in the
esophageal body after swallowing.
E. PPI provide highly effective curative therapy for achalasia
Answer:D
91-Which of the following statements about diffuse esophageal
spasm is/are true?
A. Chest pain due to esophageal spasm is readily differentiated from
angina pectoris of cardiac origin.
B. Bouts of esophageal obstruction and regurgitation of food are
characteristic.
C. Associated psychiatric disorders are common.
D. During manometric assessment, unless the patient is having pain
there may be no detectable multiphasic, high-amplitude,
simultaneous esophageal contractions.
E. The treatment of choice is surgery .
Answer: CD .

22. 92-. First-line therapy for routine peptic duodenal ulcer disease
includes:
A. Vagotomy and antrectomy.
B. Upper endoscopy and biopsy to rule out tumor.
C. Evaluation for Helicobacter pylori.
D. Serum gastrin determination.
E. Cream or milk-based “Sippy” diet.
Answer: C
93-Appropriate management of severe vomiting associated with
gastric outlet obstruction from peptic ulcer disease includes all of the
following except:
A. Nasogastric suction.
B. Intravenous hydration.
C. Nutritional assessment; upper endoscopy to rule out malignancy.
D. Intravenous H 2 antagonist.
E. Oral antacid therapy.
Answer: E
94- All of the following are complications of peptic ulcer surgery
except:
A. Post operative sepsis.
B. Short stomach.
C. Diarrhea.
D. Delayed gastric emptying.
E. Steatorrhea.
Answer: E
95- In patients with bleeding duodenal ulcers, the endoscopic
examination is essential:
A.True.
B.False.
Answer:A.
96-All of the following contribute to peptic ulcer disease except:
A. Cigarette smoking.
B. Nonsteroidal anti-inflammatory drugs.
C. Helicobacter pylori.
D. Gastrinoma.
E. Diet protein.
Answer:E

23. . 97-Which of the following risk factors have been shown to increase
significantly the incidence of gastrointestinal bleeding from
gastritis:
A. Glucocorticoid administration.
B. Respiratory failure.
C. Coagulopathy.
D. Organ transplantation.
E. Jaundice.
Answer: AC
98-Which of the following measures are effective in preventing
stress gastritis bleeding in critically ill patients?
A. Improving systemic circulation by correcting any shocklike state
resulting from blood loss or sepsis.
B. Correcting systemic acid-base abnormality.
C. Maintaining adequate nutrition.
D. Reducing intragastric acidity by either antacid or H 2
antagonists.
Answer: ABCD.
99-A 24-year-old woman develops epigastric pain and has a
diagnosis of duodenal ulcer confirmed by
esophagogastroduodenoscopy. The patient is in the third month of a
pregnancy. The most appropriate treatment would be:
a. Proximal gastric vagotomy
b. Misoprostol 400 mg b.i.d.
c. Sucralfate 1 gm q.i.d.
d. Cimetidine 400 mg b.i.d.
Answer: c.
100- Development of duodenal ulceration is dependent upon gastric
acid secretion. Which of the following statements correctly
characterizes acid secretion in duodenal ulcer patients?
a. Groups of duodenal ulcer patients demonstrate decreased basal
acid secretion
b. High acid output
c. Intake of alkali
d. Somatostatin is ineffective in suppressing acid secretion in

24. patients with active ulceration
Answer: b.
101-With regard to benign gastric ulceration, the most common
location of disease is which of the following?
a. Along the greater curvature
b. Immediately distal to the esophagogastric junction along the lesser
curvature
c. In the area of the incisura angularis along the lesser curvature
d. Within the gastric antrum
Answer: c
102-Which of the following parasitic infestation can lead to
malabsorption syndrome?
A. Amoebiasis
B. Ascariasis
C. Hookworm infestation
D. Giardiasis
Correct answer : D. Giardiasis.
103-Simple screening tests for malabsorption include:
A. Microscopic examination.
B. D-xylose absorption.
C. A 72-hour stool collection for fats.
D. Small bowel x-ray series.
Answer: ABD.
104- The enterohepatic circulation refers to the circular flow of bile
through the small intestine and liver. Which of the following
statement(s) concerning the absorption of bile salts is/are correct?
a. The enterohepatic circulation is highly efficient with 80% to 90%
of secreted bile salts reabsorbed and returned to the liver through the
portal circulation
b. The reabsorption of bile is not important
c. The small amount of bile escaping in the colon is deconjugated by
bacteria, promoting lipid solubility and passive colonic absorption
Answer: a, c.

25. 105- common manifestation of Crohn’s disease is perianal disease,
including anal fistulas , fissures, and perirectal abscesses. Which of
the following statement(s) is/are true concerning perianal disease
with Crohn’s disease?
a. Perianal disease is the initial mode of presentation in the majority
of patients
b. The prevalence of perianal disease is increased in patients with
either ileocolitis or isolated colonic involvement
c. Metronidazole has been shown to be effective in the treatment of
perianal disease secondary to Crohn’s
d. An aggressive surgical approach is appropriate in most cases due
to the frequent rapid progression of perianal disease
Answer: b, c.
106-Nongastrointestinal complications of Crohn’s disease include:
a. Renal calculi
b. Cholelithiasis
c. Arthritis
d. Anemia
Answer: a, b, c, d.
107-Which of the following points is/are true concerning the
diagnosis of Crohn’s disease?
a. CBC is specific for diagnosis
b. In 10% of cases, Crohn’s disease cannot be distinguished from
chronic ulcerative colitis based on clinical, radiologic, and
pathologic criteria
c. Although no specific laboratory tests exist for Crohn’s disease, the
erythrocyte sedimentation rate has evolved as a useful measure of
disease activity
d. Specific endoscopic features encountered in Crohn’s disease
which allow differentiation from ulcerative colitis include aphthous
ulcers, cobblestoning, and skip areas
Answer: b, c, d.

26. 108-. The following statement(s) is/are true concerning the surgical
management of Crohn’s disease.
a Not needed at all
b. Essential to prevent recurrence of the disease
c. Resecting only grossly involved segments of bowel
d. Patients with Crohn’s disease confined to the colon may be treated
with total proctocolectomy with construction of an ileal-anal pouch
anastomosis
Answer: c
109-The etiology of Crohn’s disease is unknown, although two
major hypotheses have evolved: an infectious and an immunologic
theory. The following statement(s) is/are true concerning the
possible etiology of Crohn’s disease.
a. The leading infectious agent thus far suggested is infection with a
Mycobacterium species
b. Strong evidence linking viral pathogens to Crohn’s disease has
been developed
c.No primary defect in the immune system has yet been identified
d. Crohn’s disease is an autoimmune process
Answer: a,
.110- Crohn’s disease is an incurable disease, therefore recurrence
after surgical resection is likely. Which of the following statement(s)
regarding the recurrence of Crohn’s disease is/are accurate?
a. Endoscopic evidence of recurrence is present in less than 50% of
patients at five years
b. Radiographic or endoscopic evidence of recurrence is frequently
not accompanied by symptoms
c. Clinical recurrence of Crohn’s disease is seen in 20% of patients
at two years, and 40–50% at four years after surgery
d. Reoperation for Crohn’s disease is necessary in the majority of
patients by five years
e. No solid evidence demonstrating prolongation of remission can be
seen with corticosteroids, sulfasalazine, or antibiotics
Answer: b, c, e.
111- Features of Crohn disease:

27. a. Transmural inflammation
b. Diffuse distribution
c. No granulomas
d. Associated with toxic megacolon.
Answer:A
112-Morphological features of Crohn disease include:
a. Skip lesions
b. Left-sided disease
c. Broad-based ulcers
d. Pseudopolyps.
Answer:A
113-The two inflammtory bowel diseases are:
a- Crohn’s disease and ulcerative colitis.
b- Irritable bowel syndrome& ischemic colitis.
c- Amoebic colitis &bilharzial colitis.
ANSWER: Crohn’s disease and ulcerative colitis.
114- Inflammatory bowel disease:
a. Is an acute autoimmune condition
b. Includes ulcerative colitis and Crohn’s disease
c. Is more common in men
d. Frequently presents in the 5th
decade.
Answers :b
115-the cause of IBD is:
A.No one knows,
B- probably an autoimmune process
C- environmental factors may contributing,
D- All of the above.
ANSWER:D.
116-Extraintestinal manifestations seen in both types of IBD are:

28. -ankylosing spondylitis
– aphthous (oral) ulcers
– iritis
- sclerosing cholangitis
– arthritis,
– All of the above.
Answer: All of the above,
117- In contrast to ulcerative colitis, Crohn’s disease of the colon which
is false.
a. Is not associated with increased risk of colon cancer
b. Frequently presents as daily vomiting
c. Is usually segmental rather than continuous
d. Has a lower incidence of perianal fistulas
e. Never develops toxic megacolon.
Answer:a ,b&d.
118-Which is incorrect regarding management of Crohn’s Disease?
A-Mesalamine (pentasa) has fewer side effects than sulphasalazine.
B-Azathioprine has been used in severe cases.
C-Metronidazole has a role in treatment .
D-Corticosteroids hase no role in its treatment .
E-Loperamide can be used to control diarrhoea.
Answer:d
119-Features of ulcerative colitis:
a. Transmural inflammation
b. Skip lesions
c. Marked pseudo polyps
d. Mouth to anus distribution.
Answer:C

29. 120-The following is NOT thought to be involved in the pathogenesis of IBD:
a. Genetics
b. Mucosal immune responses
c. Epithelia defects
d. Abnormal GI motility
Answer:D
121-The extra-intestinal symptoms of both ulcerative colitis and Crohn’s
disease may include all EXCEPT:
a. Migratory polyarthritis
b. Ankylosing spondylitis
c. Uveitis
d. Erythema multiforme
Answer:D.
122-Morphological features of ulcerative colitis include:
a. Skip lesions
b. Cobblestone appearance of mucosa
c. No granulomas
d. Noncaseating granulomas
Answer:C
123-. Complications of ulcerative colitis include all EXCEPT:
a. Fistulae
b. Neoplasia
c. Primary sclerosing cholangitis
d. Toxic megacolon.
Answer:A..
124-Which is INCORRECT regarding Ulcerative Colitis?
a-Affects men more than woman
b-Mild disease affects 60% of patients and consists of less than 4
bowel motions per day, with the disease limited to rectum in 80%.
c-In severe disease there is usually hypoalbuminemia and mildly
deranged LFT’s.
d-Loperamide and other antidiarrhoeal agents should be avoided as
they increase the risk of toxic megacolon.
e-Toxic megacolon is not complication of the disease.
Answer:E
125-Which is incorrect regarding inflammatory bowel disease?
A-The risk of developing ulcerative colitis is higher in non-smokers
than smokers.

30. B-Patients with Crohn’s disease are more at risk of colorectal cancer
than UC patients.
C-Effectiveness of colonoscopic surveillance in detecting colorectal
cancer is controversial in IBD.
D-Toxic megacolon occurs in Crohn’s and ulcerative colitis.
E-Cobblestone appearance on bowel wall is more characteristic of
Crohn disease.
Answer:B..
126-The most frequent cause of UGI(upper gastrointestinal bleeding)
bleeding is:
A. Esophageal varices
B. Peptic ulcer disease
C. Angiomata
D. Mallory Weiss tear
E. Gastritis
Answer: B.
127-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.
Answer: E.
128-Endotracheal intubation for airway protection in the management of
UGI bleeding should be considered:
A. in all cirrhotic patients
B. in all patients with UGI bleeding
C. in patients with altered mental status and ongoing hematemesis
D. in patients with stable COPD
E. unless it delays urgent endoscopy
Answer C.
129-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
E. Ethanol consumption

31. Answer: D.
130-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.
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
Answer: A
.131- 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
Answer: D.
132-The two most common causes of severe hematochezia requiring
hospitalization are:
A. Small angioma and small internal hemorrhoids
B. Diverticulitis and internal hemorrhoids
C. Colon polyp and colitis
D. Bilharzial and aembic colitis
Answer is B.
133-A 65-year-old woman has a prior history of hospitalization for UGI
bleeding from a duodenal ulcer. Which one of the following therapies is not
useful for preventing recurrent ulcer hemorrhage?
A. long-term maintenance therapy with full dose H2RA or daily PPI
B. H. pylori eradication
C. discontinuation of NSAID intake
D. ulcer surgery
E. bland diet
Answer is E.
NB: Dietary modifications have not been shown to decrease ulcer recurrence
or hemorrhage.
134-Which one of the following patients should be considered for outpatient
management of acute UGI bleed?
A. young cirrhotic patient

32. B. hemodynamically stable, 3 cm ulcer with clean ulcer base
C. no comorbid illness, 1 cm clean ulcer base
D. melena with nonbleeding visible vessel and 0.5 cm ulcer
E. coffee ground hematemesis with ulcer, with overlying active ulcer
bleeding at endoscopy.
Answer is C.
135-A 65-year-old presents with iron-deficiency anemia, refractory to iron
treatment. No history of overt gastrointestinal bleeding, but fecal occult
blood tests were positive on 4 of 5 occasions. A previous EGD showed a large
hiatal hernia. Two colonoscopies and a small bowel radiographic series were
unremarkable. . Which of the following is the most appropriate management
of this condition?
A. Endoscopic ligation
B. Endoscopic sclerotherapy
C. Laparoscopic Nissen fundoplication
D. Distal esophagectomy
E. Oral administration of a proton pump inhibitor twice daily and iron
replacement therapy.
Answer is E.
136-Regarding patients with upper GI bleeds which is incorrect?
k. Use of NSAIDs doubles the risk for an upper GI bleed
l. Urea will increase relative to creatinine in acute bleed
m. Presence of fresh blood on aspiration of NG tube increases
mortality as opposed to a clear aspirate.
n. Active bleeding seen at endoscopy has a 100% risk of rebleeding
after treatment.
o. Most deaths occur from decompensation of other organ systems
rather than exsanguination.
Answer is .D
137- Which is not true of bleeding oesophageal varices?
A-Mortality approaches 25-40%
B-Use of octreotide IV is as effective as sclerotherapy controlling
bleeding in 74-92% of cases.
C-Sclerotherapy has a high rate of complications (40%) including
perforation, aspiration, pyrexia, chest pain, ulcers and strictures.
D-Endoscopic variceal ligation is as effective as sclerotherapy with
fewer side effects.
E-Use of the sengstaken-blackmore tube is effective in controlling
severe bleeding, is easy to insert and has almost no complications.
Answer is .E.

33. 138-Which is the most common cause of lower GI bleed under 50 years of
age?
p. Anal fissures
q. Benign polyps
r. Haemorrhoids
s. Inflammatory bowel disease
t. Diverticulosis.
Answer is .C.
‫الطلب‬ ‫لبنائى‬ ‫بالتوفيق‬