GASTROINTESTINAL SYSTEM

To study the phenomena of disease without books is to sail an uncharted sea, while to study
books without patients is not to go to sea at all

Sir William Osler (1849-1919)

GASTROINTESTINAL SYSTEM
1. Positive family history is helpful in
A. gall stones
B. carcinoma of stomach
C. inflammatory bowel disease
D. viral hepatitis
E. colon cancer
BCDE
2. The following pairings of terms and their meanings are true
A. dysphagia is pain on swallowing difficulty swallowing
B. water brush is vomiting of water excessive amount of saliva that mixes with
stomach acids that have risen to the throat
C. dyspepsia is pain or discomfort sensation in the upper abdomen
D. nausea is sensation of feeling sick
E. melaena is the passage of fatty pale stools which is difficult to flush
CD
3. Gastrointestinal alarm features are
A. dysphagia
B. jaundice
C. weight loss
D. persistent vomiting
E. anaemia

ACDE
4. Causes of painful mouth include
A. apthous mouth ulcers
B. crohn’s disease
C. adverse drug reaction
D. herpes simplex
E. lichen planus Lichen planus is a common disease that causes inflammation (swelling and
irritation) on your skin or inside your mouth.
ABCDE

5. Anorexia is a common presenting complaint in

 A. diabetes mellitus
B. viral hepatitis
C. thyrotoxicosis
D. uraemia
E. carcinoma stomach
BDE

6. Weight loss with a normal or increased appetite may occur in

A. inflammatory bowel disease
B. diabetes mellitus
C. hyperthyroidism
D. malabsorption
E. hepatoma

BCD
7. Peptic ulcer abdominal pain is characterized by
A. mainly in the right hypochondrium
B. radiation to the shoulder
C. sudden onset
D. periodicity
E. sharp and crushing in nature

D
8. Causes of dyspepsia are
A. acute gastritis
B. chronic pancreatitis
C. peptic ulcer
D. alcohol
E. renal failure

ABCDE
9. Recognized causes of dysphagia include
A. painful mouth ulcer
B. oesophagreal cancer
C. bulbar palsy
D. systemic sclerosis
E. myasthenia gravis
ABCDE
10. Cause of abdominal distension are
A. intestinal obstruction
B. faecal loaded intestines
C. melaena
D. ovarian tumor
E. ascites
ABDE

11. Vomiting is a recognized feature of

A. pancreatitis
B. cholecystitis,
C. colonrectal cancer
D. diabetes ketoacidosis
E. digoxin overdose

ABDE
12. Chronic diarrhoea may be a manifestation of
A. human immunodeficiency viral infection
 B. malabsorption
C. autonomic neuropathy
D. colorectal cancer
E. hypothyroidism

ABCD
13. Which of the followings are causes of constipation?
A. high fibre diet
B. intestinal obstruction
C. oral iron therapy
D. hyperthyroidism
E. hypocalcaemia
BC
14. Causes of upper GI bleeding are
A. duodenal ulcer
B. gastric erosion
C. rupture of oesophageal varices
D. colorectal cancer
E. esophageal cancer
ABCE
15. Rectal bleeding is caused by
A. inflammatory bowel disease
B. anal fissure
C. fistula in ano
D. colorectal cancer
E. peptic ulcer disease

ABD
16. The following statements about jaundice are correct
A. it is yellowish discoloration of the skin and sclera due to hyperbilirubinaemia
B. it will be clinicially detectable when bilirubin levels exceed 50 mmol per litre
C. acholuric jaundice means dark-colored urine
Unconjugated bilirubin is soluble in fat but insoluble in water and thus
cannot be renally excreted. Unconjugated hyperbilirubinemia is
characterized by acholuric jaundice as urine is not darkened by urinary
bilirubin as bilirubin is not detected in the urine in such cases.
D. jaundice with pale stools indicates excessive breakdown of red cells
E. in unconjugated hyperbilirubinaemia, urine and stool colors are normal

ABE
17. Haemolytic jaundice is characterized by
A. deep jaundice
B. conjugated hyperbilirubinaemia
C. increased urobilinogen
D. bilirubinuria
E. increased liver enzymes
C
18. Features of obstructive jaundice are
A. generalized pruritus
B. pale stools
C. mild jaundice
D. sinus bradycardia
E. dark urine

ABDE
19. Hepatocellular jaundice is caused by
A. viral hepatitis
B. alcohol abuse
 C. gall stones
D. haemolysis
E. antituberculous drugs
ABE

20. Cholestetic jaundice is caused by

A. common bile duct stones
B. carcinoma of head of pancreas
C. viral hepatitis
D. sclerosing cholangitis
E. pregnancy
ABDE
21. Leukonychia is caused by
A. malabsorption
B. acute pancreatitis
C. colorectal cancer
D. chronic liver disease
E. nephrotic syndrome

ADE
22. Alimentary causes of finger clubbing include
A. cirrhosis of liver
B. inflammatory bowel disease
C. carcinoma of stomach
 D. malabsorption syndromes
E. irritable bowel syndrome

ABD
23. Dupuytren’s contracture is seen in following conditions
A. alcohol-related chronic liver disease
B. carcinoma of stomach
C. HIV
D. diabetes mellitus
E. smoking
myofibroblastic disease that affects the palmar and digital fascia of the
hand and results in contracture deformities. The most commonly
affected digits are the fourth (ring) and fifth (small or pinky) digits
It is associated with diabetes, seizure disorders, smoking, alcoholism,
HIV, and vascular disease
ACDE

24. Causes of asterixis are

A. hepatic encephalopathy
B. uraemia
C. heart failure
D. hypercapnia
E. phenytoin
ABD
25. Palmar erythema is seen in
A. chronic liver disease
B. pregnancy
C. rheumatoid arthritis
D. thyrotoxicosis
E. smoking
ABCDE
26. Causes of spider naevi are
A. cirrhosis of liver
B. alcohol abuse
C. autoimmune hepatitis
D. pregnancy
E. IVDU
ABCD
27. Causes of gynaecomastia include
A. chronic liver disease
B. chronic renal failure
C. digoxin therapy
D. spironolactone therapy
E. carcinoma of bronchus

ACDE
28. The differential diagnosis of epigastric mass includes
A. carcinoma of left lobe of liver
B. gastric cancer
C. pancreatic cancer
D. aortic aneurysm
E. appendicular mass
ABCD
29. The following findings are in favor of hepatomegaly
A. mass moves with respiration
B. dullness of mass is continuous with liver dullness on percussion
C. mass enlarges downwards and medially
 D. finger can be insinuated between mass and right costal margin
E. mass is situated in right hypochondrium
ABE
30. The following findings are in favor of splenomegaly
A. band of resonance is noted across the mass on percussion
B. notch is palpable
C. mass enlarges downwards and laterally
D. mass is situated at epigastrium
E. dull percussion note to 9-11th rib mid-axillary line

BE

31. Causes of hepatomegaly include

A. left sided heart failure
B. hepatocellular carcinoma
C. alcoholic cirrhosis
D. viral hepatitis
E. hepatic steatosis
BCDE
32. Causes of enlarged tender liver are
A. amoebic hepatitis
B. carcinoma of liver
C. cirrhosis of liver
D. right sided heart failure
E. polycystic liver disease
AD

33. Hepatic bruit is audible in

A. alcoholic hepatitis
B. cirrhosis of liver
C. arteriovenous malformation in liver
D. hepatocellular carcinoma
E. viral hepatitis
ACD
34. Causes of splenomegaly include
A. portal hypertension
B. early cirrhosis
C. haemolytic anaemia
D. infective endocarditis
E. aplastic anaemia
ACD
35. Causes of massive splenomegaly are
A. chronic myeloid leukaemia
 B. lymphoma
C. Kala azar
D. thalassemia minor
E. tropical splenomegaly syndrome
ACE

36. Causes of hepatosplenomegaly are

A. alcoholic hepatitis
B. leukaemia
C. cirrhosis with portal hypertension
D. malaria
E. lymphoma
BCDE

37. The mechanisms of ascites fluid formation are

A. hypoalbuminaemia
B. lymphatic obstruction
C. stimulation of renin angiotensin aldosterone system
D. ADH production
E. secondary hyperaldosteronism
ABCE
38. Common causes of ascites include
A. cirrhosis of liver with portal hypertension
B. pancreatitis
C. hypothyroidism
D. intra-abdominal malignancy
E. hepatic vein occlusion
AD
39. Causes of transudative ascites are
A. tuberculous peritonitis
B. congestive heart failure
C. nephrotic syndrome
D. cirrhosis of liver
E. hepatocellular carcinoma
BCD

40. Risk factors for viral hepatitis are

A. alcohol
B. person with multiple sexual partners
C. thalassaemia major
D. intravenous drug user
E. foreign travel
 BCDE

41. Mode of transmission of type B viral hepatitis is by

A. blood transfusion
B. oral fecal route
C. sexual contact
D. inhalation
E. vertical transmission
ACE
42. Common causes of cirrhosis are
A. alcohol
B. hepatitis A
C. hepatitis C
D. Wilson’s disease
E. Haemochromatosis
AC
43. Rare causes of cirrhosis of liver are
A. chronic alcohol abuse
B. hepatitis B infection
C. haemochromatosis
D. primary biliary cirrhosis
E. Non-alcoholic fatty liver disease
CD
44. Complications of cirrhosis of liver are
A. hepatocellular carcinoma
B. portal hypertension
C. hepatic encephalopathy
D. malabsorption
E. coagulopathy
ABCE
45. Signs of chronic liver insufficiency are
A. jaundice
B. angular stomatitis
C. gynaecomastia
D. leukonychia
E. dilated collateral vessels around umbilicus
ACDE
46. Clinical features of portal hypertension include
A. oesophageal varices
B. caput medusae
C. hepatomegaly
D. ascites
E. spider naevi

ABD
47. Precipitating factors for hepatic encephalopathy are
A. hypokalaemia
B. diarrhoea
C. sedatives
 D. abdominal paracentesis
E. reduced protein intake

ACD
48. Glossitis may be found in
A. folate deficiency
B. iron deficiency
C. niancin deficiency
D. vitamin B1 deficiency
E. vitamin B12 deficiency
ABCE

49. The followings are features of vitamin B deficiency

 A. night blindness
B. angular stomatitis
C. neurological disorders
D. Beri Beri
E. Diarrhea
BCDE

50. Niacin deficiency causes

A. diarrhoea
B. Casal’s necklace
 C. dermatitis
D. psychosis
E. glossitis
ABCD
51. Vitamin C deficiency causes
A. keratomalacia
B. scurvy
C. perifollicular haemorrhages
D. osteomalasia
E. glossitis
BC
52. Features of chronic alcoholism are
A. bilateral parotid swelling
B. splenomegly
C. Dupuytren’s contracture
D. tremor
E. florid spider naevi
ACDE
53. Following are the conditions caused by alcohol drinking
A. gall stones
B. pancreatitis
C. hepatitis
D. colorectal cancer
E. Mallory–Weiss syndrome
BCE
54. Followings are features of acute pancreatitis
A. severe epigastric pain radiating through to the back
B. pain is relieved by supine position
C. hypertension in severe cases
D. bruising around the umbilicus or loin
E. reduced or absent bowel sounds

ADE
55. Followings are features of chronic pancreatitis
A. steatorrhoea
B. haematemesis
C. regurgitation
D. diabetes mellitus
E. chronic diarrhea

ADE
56. Causes of acute pancreatitis include
A. gallstones
B. measles
C. alcohol
D. severe hypothermia
E. hypertriglyceridaemia
ACDE
57. Causes of chronic pancreatitis are
A. hypercalcaemia
B. tobacco
C. alcoholism
D. stenosis of Ampulla of Vater
E. mumps
ABCD
58. The followings are common presenting features of small bowel disease
A. black tarry stool
B. bloating
C. dysphagia
D. steatorrhoea
E. unexplained weight loss
ABDE
59. The followings are common presenting features of large bowel disease
A. vomiting
B. melaena
C. heartburn
D. constipation
E. jaundice
AD
60. The followings are presenting symptoms of oesophagus
 A. indigestion
B. regurgitation
C. persistent vomiting
D. hoarseness of voice
E. odynophagia

ABDE
61. Non-alimentary causes of abdominal pain include
A. dissecting aortic aneurysm
B. spinal cord compression
C. pleurisy
D. herpes zoster
E. diabetic ketoacidosis

ABCDE
62. Which of the following medical conditions can be presented as acute abdomen?
A. diabetic ketoacidosis
 B. TB abdomen
C. myocardial infarction
D. renal colic
E. hepatitis

ACD
63. The followings support a diagnosis of dyspepsia rather than cardiac chest pain
A. pain at epigastric region
B. upward radiation
C. mild to moderate severity
D. association with acid reflux
E. occurrence on lying flat or bending forward
BDE
64. The followings are features of renal colic
A. unilateral loin pain
B. no radiation
C. rapid onset and severe pain
D. pain lasting only few minutes and resolving abruptly
E. pain can be precipitated by NSAID
AC
65. Following symptoms are included under the term of dyspepsia
A. heartburn
B. epigastric pain
C. nausea
 D. diarrhoea
E. bloating
ABCE

66. Which of the following associations of abdominal pain and radiation are true?
A. biliary colic and to the right infrascapular area
B. acute pancreatitis and to the loin
C. peptic ulcer and to the umbilical region
D. renal colic and to the genitalia
E. pain from the diaphragmatic irritation and to the shoulder
ADE
67. Followings are true regarding dysphagia
A. neurological dysphagia is worse for solids than for liquid
B. obstructive dysphagia is initially worse for liquids
C. oesophageal cancer can result in painful progressive dysphagia
D. mechanical dysphagia is often due to oesophageal stricture
E. painful dysphagia is an indicatior for oesophagitis
DE
68. Which of the followings are important points in the analysis of dysphagia?
A. painful or painless
B. dysphagia for solids or liquids or both
C. food sticking after swallowing
D. intermittent or progressive
E. associated choking or aspiration
ABCDE
69. The differential diagnosis of non-alimentary causes of vomiting includes
A. opioids
B. myocardial infarction
C. renal failure
D. thyroid disorders
E. increased intracranial pressure
ABCDE
70. Bloody diarrhoea may be due to
A. inflammatory bowel disease
B. malabsorption
C. hyperthyroidism
D. colonic ischaemia
E. infective gastroenteritis

ADE
71. Following statements about steatorrhoea are correct
Steatorrhoea is the result of fat malabsorption. The hallmark of steatorrhoea is the passage
of pale, bulky, and malodorous stools, which often float and are difficult to flush
A. the stools are pale bulky and offensive
B. float in the lavatory pan
C. increased air content
D. the cause may be a small intestinal disorder
E. is not associated with pancreatic disease
ABD
72. Which of the followings are true regarding diarrhoea?
A. large volume and not excessively frequent diarrhoea suggests large bowel disease
B. nocturnal diarrhoea suggests organic disease
C. if duration of diarrhoea is more than one week, it is defined as chronic diarrhoea
D. melaena results from lower gastrointestinal bleeding.
E. travelling history is an important point in the analysis of chronic diarrhea
BE
73. Which of the followings are true regarding GI bleeding?
A. haematochezia is rectal bleeding indicating lower gastrointestinal bleeding passage of
fresh blood through the anus , Hematochezia usually comes from a colonic site, although
blood rapidly transported from the upper gastrointestinal tract can be red when passed
B. melaena is the passage of tarry, shiny black stools with a characteristic odour
C. haematemesis results from lower gastrointestinal bleeding
D. Mallory–Weiss syndrome causes vomiting of fresh blood after forceful vomiting of
several times
E. age is not important to predict the risk of mortality in upper GI bleeding

BD
74. The followings support a diagnosis of haematemesis rather than haemoptysis
A. frothy bright blood
B. blood mixed with food particles
 C. coffee grounds in colour
D. history of smoking
E. previous history of liver disease

BCE
75. The followings are true about bilirubin metabolism
A. the spleen plays a central role in the metabolism
B. bilirubin in the blood is normally almost all unconjugated and water-insoluble
C. bilurubin conjugation takes place in the liver to form bilirubin diglucuronide and excreted
in bile
D. metabolism of conjugated bilirubin by bacterial flora to stercobilinogen and stercobilin
occurs in the small intestine
E. conjugated bilirubin is bound to albumin
BC
76. Hepatocellular jaundice is characterized by
A. increase in both conjugated and unconjugated bilirubin
B. no bilirubin in urine
C. increase in urobilinogen
D. acholuric jaundice
E. normal stool colour

77. Following statements about nail changes are true

A. Clubbing is spoon-shaped nails
B. Koilonychia suggests chronic iron deficency
 C. Leukonychia suggests hypoalbuminaemia
D. Yellow nail syndrome may occur in jaundice
E. Clubbing may disappear if the underlying condition is cured

BCE
78. Dupuytren’s contracture
A. results in swan neck deformity of the fingers
B. is thickening of the palmar fascia
C. may be familial
D. may be associated with conditions causing microvascular pathology
E. usually affecting the middle and little fingers
BCD
79. Spider naevi
A. are due to reduced oestrogen associated with increased hepatic breakdown of sex steroids
B. are telangiectasias
C. are found below the nipple line
D. consist of a central arteriole with radiating small vessels
E. may be normal in women

BDE
80. Causes of haemorrhagic ascites include
A. nephrotic syndrome
B. cirrhosis
 C. acute pancreatitis
D. malignancy
E. ruptured ectopic pregnancy

CDE

81. The following statements regarding the surface anatomy are correct
A. upper border of the liver lies in the fifth right intercostal space on full expiration
B. the normal spleen lies beneath the left ninth and 11th ribs in the left mid-axillary line
C. liver is located in the left hypochrondrium region
D. splenic notch may be palpable midway at its medial surface
E. the kidneys lie retroperitoneally on either side of the spine at the T12–L3 level
ABDE
82. Liver cancer is a recognized complication of
A. hepatitis A virus infection
B. hepatitis C virus infection
C. alcohol
D. steatohepatitis
E. cholelithiasis
BCD
83. Recognized features which suggest liver failure include
A. fetor hepaticus
B. jaundice
C. flapping tremor
D. reversed day and night sleep pattern
E. hepatomegaly
ACD
84. Recognized features hepatic encephalopathy include
A. fetor hepaticus
B. slurred speech
C. constructional apraxia
D. astrerixis
E. headache

BCDE
85. Which of the following signs of vitamin deficiency would be expected during
examination of the mouth ?
A. atrophic glossitis B12 deficiency
B. angular cheilitis Riboflavin (vitamin B2)
C. oral thrush
D. aphthous ulcers
E. gum bleeding vitamin C

ABE

86. Causes of hypoalbuminaemia include

A. irritable bowel syndrome
 B. cirrhosis of liver
C. chronic renal failure
D. coeliac disease
E. peptic ulcer

BD
87. Which of the following associations of vitamins and deficienciy states are true?
A. vitamin B1 Wernicke–Korsakoff syndrome
B. vitamin D osteomalacia
C. vitamin E xerophthalmia
D. folate haemolytic anaemia
E. riboflavin polyneuropathy
AB
 GASTROINTESTINAL SYSTEM

1. CDE 39. BCD 77. BCE

2. CD 40. BCDE 78. BCD
3. ACDE 41. ACE 79. BDE
4. ABCDE 42. AC 80. CDE
5. BDE 43. CD 81. ABDE
6. BCD 44. ABCE 82. BCD
7. D 45. ACDE 83. ACD
8. ABCDE 46. ABD 84. BCDE
9. ABCDE 47. ACD 85. ABE
10. ABDE 48. ABCE 86. BD
11. ABDE 49. BCDE 87. AB
12. ABCD 50. ABCD
13. BC 51. BC
14. ABCE 52. ACDE
15. ABD 53. BCE
16. ABE 54. ADE
17. C 55. ADE
18. ABD 56. ACDE
19. ABE 57. ABCD
20. ABDE 58. ABDE
21. ADE 59. AD
22. ABD 60. ABDE
23. ACDE 61. ABCDE
24. ABD 62. ACD
25. ABCDE 63. BDE
26. ABCD 64. AC
27. ACDE 65. ABCE
28. ABCD 66. ADE
29. ABE 67. DE
30. BE 68. ABCDE
31. BCDE 69. ABCDE
32. AD 70. ADE
33. ACD 71. ABD
34. ACD 72. BE
35. ACE 73. ABD
36. BCDE 74. BCE
37. ABCE 75. BC
38. AD 76. ACE