Medicine
Gastroenterology & Hepatology
Which finding in a patient with acute upper GI bleeding most strongly indicates the need for urgent resuscitation before endoscopy?
A. Hemodynamic instability
B. Mild isolated dyspepsia
C. Normal hemoglobin on one early sample
D. History of constipation
Correct Answer: A
Airway, breathing and circulation stabilization take priority over diagnostic endoscopy in an unstable bleeding patient.
Medicine
Gastroenterology & Hepatology
A patient with painless jaundice, weight loss and a palpable nontender gallbladder most likely has obstruction from which condition?
A. Pancreatic head malignancy
B. Acute viral hepatitis
C. Peptic ulcer disease
D. Irritable bowel syndrome
Correct Answer: A
Courvoisier sign with painless obstructive jaundice suggests malignant distal biliary obstruction, classically from pancreatic head cancer.
Medicine
Gastroenterology & Hepatology
A cirrhotic patient develops rising creatinine without shock, nephrotoxic drugs or structural kidney disease. Which syndrome should be considered?
A. Hepatorenal syndrome
B. Acute glomerulonephritis
C. Diabetic ketoacidosis
D. Renal artery stenosis only
Correct Answer: A
Hepatorenal syndrome is functional kidney failure in advanced liver disease after other causes of acute kidney injury are excluded.
Medicine
Gastroenterology & Hepatology
A patient with suspected celiac disease is eating gluten. What is the preferred initial serologic test in most adults?
A. IgA tissue transglutaminase with total IgA
B. ANA only
C. p-ANCA only
D. Serum gastrin
Correct Answer: A
IgA tissue transglutaminase is the usual first serologic test, accompanied by total IgA to identify IgA deficiency.
Medicine
Gastroenterology & Hepatology
A 45-year-old man has iron overload, diabetes, bronze skin and cardiomyopathy. Which genetic disorder is most likely?
A. Hereditary hemochromatosis
B. Wilson disease
C. Alpha-1 antitrypsin deficiency
D. Gilbert syndrome
Correct Answer: A
Hereditary hemochromatosis causes systemic iron deposition affecting liver, pancreas, skin, heart and joints.
Medicine
Gastroenterology & Hepatology
A patient with chronic hepatitis B has cirrhosis. Which complication requires regular surveillance with liver ultrasound, with or without AFP according to local guidance?
A. Hepatocellular carcinoma
B. Acute appendicitis
C. Pancreatic pseudocyst
D. Achalasia
Correct Answer: A
Chronic hepatitis B with cirrhosis confers high HCC risk and warrants regular surveillance.
Medicine
Gastroenterology & Hepatology
A patient has progressive dysphagia initially to solids and later liquids with weight loss. What is the most appropriate next investigation?
A. Upper GI endoscopy
B. Stool occult blood only
C. Abdominal ultrasound only
D. HIDA scan
Correct Answer: A
Progressive mechanical dysphagia with weight loss is an alarm presentation requiring prompt upper endoscopy to evaluate for malignancy or stricture.
Medicine
Gastroenterology & Hepatology
A patient with cirrhosis becomes confused and has asterixis after a GI bleed. What is the first-line drug to reduce intestinal ammonia absorption?
A. Lactulose
B. Mesalamine
C. Omeprazole
D. Pancrelipase
Correct Answer: A
Lactulose is first-line therapy for overt hepatic encephalopathy and is titrated to produce regular soft stools.
Medicine
Gastroenterology & Hepatology
Which feature favors Crohn disease over ulcerative colitis?
A. Continuous rectal involvement
B. Transmural inflammation with fistula formation
C. Disease limited to colon mucosa
D. Toxic megacolon never occurs
Correct Answer: B
Crohn disease is transmural and can cause fistulas, strictures and skip lesions anywhere in the gastrointestinal tract.
Medicine
Gastroenterology & Hepatology
A young adult has recurrent abdominal pain, bloody diarrhea and continuous inflammation beginning in the rectum. Which condition is most likely?
A. Ulcerative colitis
B. Crohn disease
C. Irritable bowel syndrome
D. Celiac disease
Correct Answer: A
Ulcerative colitis characteristically causes continuous mucosal inflammation extending proximally from the rectum.
Medicine
Gastroenterology & Hepatology
A 36-year-old woman has pruritus, fatigue and cholestatic liver tests. Antimitochondrial antibody is positive. What is the diagnosis?
A. Primary biliary cholangitis
B. Primary sclerosing cholangitis
C. Autoimmune pancreatitis
D. Wilson disease
Correct Answer: A
Primary biliary cholangitis typically affects women and is associated with cholestatic enzymes and antimitochondrial antibodies.
Medicine
Gastroenterology & Hepatology
A patient with severe epigastric pain radiating to the back has lipase five times normal. What is the most appropriate initial management of uncomplicated acute pancreatitis?
A. Early IV fluids, analgesia and early oral feeding as tolerated
B. Immediate prophylactic antibiotics for all patients
C. Emergency ERCP in every case
D. Total parenteral nutrition routinely
Correct Answer: A
Initial pancreatitis care focuses on fluid resuscitation, analgesia and early enteral/oral nutrition; antibiotics are not routine without infection.
Medicine
Gastroenterology & Hepatology
Which laboratory pattern is most consistent with cholestatic liver injury?
A. Marked ALT elevation only
B. Disproportionate alkaline phosphatase elevation
C. Isolated low albumin after one day
D. Low creatinine only
Correct Answer: B
Cholestatic injury is characterized by a disproportionate rise in alkaline phosphatase compared with aminotransferases.
Medicine
Gastroenterology & Hepatology
A patient with cirrhosis and ascites develops fever and abdominal pain. Ascitic neutrophil count is 420 cells/mm3. What is the diagnosis?
A. Spontaneous bacterial peritonitis
B. Hepatorenal syndrome
C. Portal vein thrombosis
D. Budd-Chiari syndrome
Correct Answer: A
An ascitic polymorphonuclear leukocyte count of at least 250 cells/mm3 establishes spontaneous bacterial peritonitis in the appropriate clinical setting.
Medicine
Gastroenterology & Hepatology
A cirrhotic patient presents with hematemesis and hypotension. After initial resuscitation, which drug should be started promptly when variceal bleeding is suspected?
A. Octreotide or another vasoactive agent
B. Loperamide
C. Metoclopramide only
D. Ursodeoxycholic acid
Correct Answer: A
Suspected acute variceal hemorrhage is treated early with a vasoactive agent along with antibiotics and urgent endoscopic therapy after stabilization.
Medicine
Gastroenterology & Hepatology
Which combination is most concerning for acute liver failure?
A. Isolated mild ALT elevation with normal INR
B. Chronic stable splenomegaly only
C. Uncomplicated dyspepsia
D. Coagulopathy with hepatic encephalopathy in a patient without pre-existing cirrhosis
Correct Answer: D
Acute liver failure is characterized by rapid severe hepatic dysfunction with coagulopathy and encephalopathy in the absence of established cirrhosis.
Medicine
Gastroenterology & Hepatology
Which complication or major adverse outcome is particularly associated with Acute viral hepatitis?
A. Toxic megacolon
B. Spontaneous bacterial peritonitis
C. Acute liver failure
D. Coma with loss of airway protection
Correct Answer: C
Severe acute hepatitis can cause coagulopathy and encephalopathy from rapid loss of hepatic function.
Medicine
Gastroenterology & Hepatology
A patient is diagnosed with Acute viral hepatitis. Which is the most appropriate management principle?
A. Give IV antibiotics and arrange urgent biliary decompression when obstruction with significant cholangitis is present
B. Provide supportive care for uncomplicated disease and urgently evaluate any evidence of acute liver failure
C. Use severity-appropriate anti-inflammatory therapy; severe acute colitis requires hospital-based management
D. Use sodium restriction and appropriate diuretic therapy; perform therapeutic paracentesis for tense ascites
Correct Answer: B
Management depends on the virus and severity; acute liver failure requires specialist and critical-care management.
Medicine
Gastroenterology & Hepatology
In a patient with suspected Acute viral hepatitis, which investigation or diagnostic approach is most appropriate at this stage?
A. Liver profile, coagulation status and targeted viral serology
B. Serum lipase plus targeted imaging when diagnosis, severity or biliary cause requires clarification
C. Liver tests and biliary imaging, usually starting with ultrasound
D. Colonoscopy with biopsies when safe and appropriate
Correct Answer: A
Serology identifies the viral cause while INR and other measures assess hepatic synthetic function and severity.
Medicine
Gastroenterology & Hepatology
A patient develops malaise, anorexia, jaundice and markedly elevated aminotransferases after a compatible exposure. What is the most likely diagnosis?
A. Helicobacter pylori-associated peptic ulcer disease
B. Acute pancreatitis
C. Acute ascending cholangitis
D. Acute viral hepatitis
Correct Answer: D
Acute hepatitis often presents with constitutional symptoms, jaundice and a hepatocellular enzyme pattern.