Medicine
Gastroenterology & Hepatology
Which physical sign is classically associated with hepatic encephalopathy?
A. Clubbing as the defining sign
B. Fixed pinpoint pupils
C. Asterixis
D. Isolated ankle clonus only
Correct Answer: C
Asterixis is a classic though not specific finding in hepatic encephalopathy.
Medicine
Gastroenterology & Hepatology
Which complication or major adverse outcome is particularly associated with Hepatic encephalopathy?
A. Acute liver failure
B. Coma with loss of airway protection
C. Hemorrhagic shock
D. Perforated peptic ulcer
Correct Answer: B
Severe encephalopathy can progress to coma and aspiration risk.
Medicine
Gastroenterology & Hepatology
A patient is diagnosed with Hepatic encephalopathy. Which is the most appropriate management principle?
A. Treat the precipitant and use lactulose, adding other ammonia-lowering therapy when indicated
B. Use sodium restriction and appropriate diuretic therapy; perform therapeutic paracentesis for tense ascites
C. Provide supportive care for uncomplicated disease and urgently evaluate any evidence of acute liver failure
D. Stabilize airway and circulation, establish IV access, resuscitate appropriately and arrange urgent endoscopic therapy
Correct Answer: A
Lactulose reduces intestinal ammonia absorption and is standard initial therapy.
Medicine
Gastroenterology & Hepatology
In a patient with suspected Hepatic encephalopathy, which investigation or diagnostic approach is most appropriate at this stage?
A. Colonoscopy with biopsies when safe and appropriate
B. Diagnostic paracentesis for new or clinically significant ascites
C. Liver profile, coagulation status and targeted viral serology
D. Clinical assessment plus a search for precipitating factors such as infection, bleeding, electrolyte disturbance or constipation
Correct Answer: D
Hepatic encephalopathy is primarily clinical; finding and correcting the precipitating factor is essential.
Medicine
Gastroenterology & Hepatology
A patient has cirrhosis with confusion, sleep-pattern reversal and asterixis after a gastrointestinal bleed. What is the most likely diagnosis?
A. Acute ascending cholangitis
B. Ulcerative colitis
C. Hepatic encephalopathy
D. Decompensated cirrhosis with ascites
Correct Answer: C
Altered cognition and asterixis in decompensated liver disease with a precipitant are typical of hepatic encephalopathy.
Medicine
Gastroenterology & Hepatology
A cirrhotic patient with ascites develops fever and abdominal pain. What should be performed promptly?
A. Elective colonoscopy first
B. Diagnostic paracentesis
C. Barium swallow
D. Routine exercise stress test
Correct Answer: B
Possible spontaneous bacterial peritonitis requires prompt ascitic-fluid analysis.
Medicine
Gastroenterology & Hepatology
Which complication or major adverse outcome is particularly associated with Decompensated cirrhosis with ascites?
A. Spontaneous bacterial peritonitis
B. Perforated peptic ulcer
C. Pancreatic necrosis
D. Septic shock
Correct Answer: A
Cirrhotic ascites predisposes to spontaneous bacterial infection with high morbidity and mortality.
Medicine
Gastroenterology & Hepatology
A patient is diagnosed with Decompensated cirrhosis with ascites. Which is the most appropriate management principle?
A. Stabilize airway and circulation, establish IV access, resuscitate appropriately and arrange urgent endoscopic therapy
B. Use an evidence-based H. pylori eradication regimen and confirm eradication after treatment
C. Provide early supportive care with appropriate IV fluids, analgesia and early enteral nutrition as tolerated
D. Use sodium restriction and appropriate diuretic therapy; perform therapeutic paracentesis for tense ascites
Correct Answer: D
Ascites treatment depends on severity and kidney function; large-volume paracentesis is used for tense symptomatic ascites.
Medicine
Gastroenterology & Hepatology
In a patient with suspected Decompensated cirrhosis with ascites, which investigation or diagnostic approach is most appropriate at this stage?
A. Liver profile, coagulation status and targeted viral serology
B. Urgent upper endoscopy after initial stabilization
C. Diagnostic paracentesis for new or clinically significant ascites
D. Test for active H. pylori infection using an appropriate noninvasive or biopsy-based method
Correct Answer: C
Ascitic-fluid analysis evaluates portal-hypertensive physiology and excludes spontaneous bacterial peritonitis.
Medicine
Gastroenterology & Hepatology
A patient has chronic liver disease, abdominal distension, shifting dullness and peripheral edema. What is the most likely diagnosis?
A. Hepatic encephalopathy
B. Decompensated cirrhosis with ascites
C. Acute viral hepatitis
D. Acute upper gastrointestinal bleeding
Correct Answer: B
Ascites in chronic liver disease is a major marker of hepatic decompensation.
Medicine
Gastroenterology & Hepatology
Which feature favors ulcerative colitis over Crohn disease?
A. Continuous inflammation beginning in the rectum
B. Transmural skip lesions
C. Frequent small-bowel fistulas
D. Perianal fistulizing disease as the defining feature
Correct Answer: A
Ulcerative colitis classically causes continuous superficial colonic inflammation starting in the rectum.
Medicine
Gastroenterology & Hepatology
Which complication or major adverse outcome is particularly associated with Ulcerative colitis?
A. Septic shock
B. Spontaneous bacterial peritonitis
C. Coma with loss of airway protection
D. Toxic megacolon
Correct Answer: D
Severe colonic inflammation can cause dilation, systemic toxicity and perforation risk.
Medicine
Gastroenterology & Hepatology
A patient is diagnosed with Ulcerative colitis. Which is the most appropriate management principle?
A. Provide early supportive care with appropriate IV fluids, analgesia and early enteral nutrition as tolerated
B. Give IV antibiotics and arrange urgent biliary decompression when obstruction with significant cholangitis is present
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: C
Therapy ranges from 5-ASA-based treatment to corticosteroids and advanced agents depending on extent and severity.
Medicine
Gastroenterology & Hepatology
In a patient with suspected Ulcerative colitis, which investigation or diagnostic approach is most appropriate at this stage?
A. Test for active H. pylori infection using an appropriate noninvasive or biopsy-based method
B. Colonoscopy with biopsies when safe and appropriate
C. Serum lipase plus targeted imaging when diagnosis, severity or biliary cause requires clarification
D. Liver tests and biliary imaging, usually starting with ultrasound
Correct Answer: B
Endoscopy establishes distribution and histology while excluding alternative colitis causes.
Medicine
Gastroenterology & Hepatology
A patient has recurrent bloody diarrhea, urgency and continuous colonic inflammation beginning at the rectum. What is the most likely diagnosis?
A. Ulcerative colitis
B. Acute upper gastrointestinal bleeding
C. Helicobacter pylori-associated peptic ulcer disease
D. Acute pancreatitis
Correct Answer: A
Continuous mucosal inflammation extending proximally from the rectum is characteristic of ulcerative colitis.
Medicine
Gastroenterology & Hepatology
Which additional findings complete Reynolds pentad in severe cholangitis?
A. Hematuria and flank pain
B. Bradycardia and constipation
C. Rash and wheeze
D. Hypotension and altered mental status
Correct Answer: D
Reynolds pentad is Charcot triad plus hypotension and altered mental status, indicating severe disease.
Medicine
Gastroenterology & Hepatology
Which complication or major adverse outcome is particularly associated with Acute ascending cholangitis?
A. Coma with loss of airway protection
B. Acute liver failure
C. Septic shock
D. Hemorrhagic shock
Correct Answer: C
Untreated infected biliary obstruction can rapidly progress to bacteremia and shock.
Medicine
Gastroenterology & Hepatology
A patient is diagnosed with Acute ascending cholangitis. Which is the most appropriate management principle?
A. Use sodium restriction and appropriate diuretic therapy; perform therapeutic paracentesis for tense ascites
B. Give IV antibiotics and arrange urgent biliary decompression when obstruction with significant cholangitis is present
C. Treat the precipitant and use lactulose, adding other ammonia-lowering therapy when indicated
D. Provide supportive care for uncomplicated disease and urgently evaluate any evidence of acute liver failure
Correct Answer: B
Source control by biliary drainage is crucial in moderate or severe cholangitis.
Medicine
Gastroenterology & Hepatology
In a patient with suspected Acute ascending cholangitis, which investigation or diagnostic approach is most appropriate at this stage?
A. Liver tests and biliary imaging, usually starting with ultrasound
B. Colonoscopy with biopsies when safe and appropriate
C. Diagnostic paracentesis for new or clinically significant ascites
D. Clinical assessment plus a search for precipitating factors such as infection, bleeding, electrolyte disturbance or constipation
Correct Answer: A
Imaging looks for ductal dilatation or obstruction, while laboratory tests assess cholestasis and organ dysfunction.
Medicine
Gastroenterology & Hepatology
A patient has fever, jaundice and right-upper-quadrant pain with biochemical cholestasis. What is the most likely diagnosis?
A. Acute pancreatitis
B. Ulcerative colitis
C. Decompensated cirrhosis with ascites
D. Acute ascending cholangitis
Correct Answer: D
Charcot triad of fever, jaundice and right-upper-quadrant pain suggests acute cholangitis due to infected biliary obstruction.