Q.1 Which of the following is the most common cause of acute upper gastrointestinal bleeding in adults?
Peptic ulcer disease
Esophageal varices
Gastric carcinoma
Mallory-Weiss tear
Explanation - Peptic ulcer disease is the leading cause of acute upper GI bleeding, followed by varices and Mallory-Weiss tears.
Correct answer is: Peptic ulcer disease
Q.2 A 60-year-old patient presents with hematemesis. Which initial step is most appropriate?
Insert nasogastric tube
Endoscopy immediately
Secure airway and IV access
Start antibiotics
Explanation - In GI emergencies, airway, breathing, and circulation are prioritized before definitive diagnostics like endoscopy.
Correct answer is: Secure airway and IV access
Q.3 Which condition most commonly causes lower gastrointestinal bleeding in adults over 50?
Diverticulosis
Hemorrhoids
Crohn’s disease
Ulcerative colitis
Explanation - Diverticulosis is the leading cause of painless lower GI bleeding in older adults.
Correct answer is: Diverticulosis
Q.4 Massive hematemesis in a patient with cirrhosis is most likely due to:
Esophageal varices
Gastric carcinoma
Peptic ulcer disease
Gastritis
Explanation - Portal hypertension in cirrhosis commonly leads to variceal bleeding, which can cause massive hematemesis.
Correct answer is: Esophageal varices
Q.5 Which diagnostic test is first-line for suspected upper GI bleeding after stabilization?
CT scan
Upper endoscopy
Abdominal ultrasound
Colonoscopy
Explanation - Upper endoscopy is the gold standard for diagnosing and treating upper GI bleeding once the patient is stable.
Correct answer is: Upper endoscopy
Q.6 A patient with severe abdominal pain out of proportion to exam findings may have:
Mesenteric ischemia
Appendicitis
Pancreatitis
Cholecystitis
Explanation - Acute mesenteric ischemia classically presents with severe pain that is disproportionate to the physical findings.
Correct answer is: Mesenteric ischemia
Q.7 Which electrolyte disturbance is commonly seen in prolonged vomiting?
Hypokalemia and metabolic alkalosis
Hyperkalemia and acidosis
Hyponatremia and acidosis
Hypercalcemia and alkalosis
Explanation - Prolonged vomiting leads to loss of hydrogen and potassium ions, resulting in metabolic alkalosis and hypokalemia.
Correct answer is: Hypokalemia and metabolic alkalosis
Q.8 Coffee-ground vomitus indicates:
Fresh arterial bleeding
Bleeding that has slowed or stopped
Non-GI bleeding
Hemoptysis
Explanation - Coffee-ground vomitus suggests partially digested blood, often indicating that bleeding has decreased in intensity.
Correct answer is: Bleeding that has slowed or stopped
Q.9 Boerhaave’s syndrome refers to:
Esophageal perforation due to forceful vomiting
Mallory-Weiss tear
Achalasia
GERD
Explanation - Boerhaave’s syndrome is spontaneous transmural rupture of the esophagus after severe retching or vomiting.
Correct answer is: Esophageal perforation due to forceful vomiting
Q.10 Which imaging is best for suspected perforated viscus?
Plain upright abdominal X-ray
CT scan of abdomen
Ultrasound
MRI
Explanation - An upright abdominal or chest X-ray can reveal free air under the diaphragm, a classic sign of perforation.
Correct answer is: Plain upright abdominal X-ray
Q.11 The most common cause of acute pancreatitis is:
Gallstones
Alcohol
Trauma
Hypertriglyceridemia
Explanation - Gallstones are the leading cause of acute pancreatitis, followed by chronic alcohol use.
Correct answer is: Gallstones
Q.12 Grey Turner’s sign in acute pancreatitis indicates:
Superficial infection
Retroperitoneal hemorrhage
Portal hypertension
Cholangitis
Explanation - Grey Turner’s sign is ecchymosis of the flanks, indicating retroperitoneal bleeding in severe pancreatitis.
Correct answer is: Retroperitoneal hemorrhage
Q.13 Which of the following is the initial management of a patient with suspected acute mesenteric ischemia?
Broad-spectrum antibiotics and fluid resuscitation
Immediate laparotomy
Oral anticoagulants
Colonoscopy
Explanation - Initial management includes resuscitation and antibiotics to prevent sepsis before definitive intervention.
Correct answer is: Broad-spectrum antibiotics and fluid resuscitation
Q.14 Which condition presents with sudden, severe epigastric pain radiating to the back?
Acute pancreatitis
Peptic ulcer perforation
Cholecystitis
Appendicitis
Explanation - Pancreatitis typically presents with severe epigastric pain radiating to the back, worsened by lying down.
Correct answer is: Acute pancreatitis
Q.15 Melena is most often caused by bleeding from:
Upper gastrointestinal tract
Small intestine
Colon
Rectum
Explanation - Melena (black tarry stool) is usually due to digestion of blood from an upper GI source.
Correct answer is: Upper gastrointestinal tract
Q.16 The most feared complication of esophageal variceal bleeding is:
Hypovolemic shock
Esophageal stricture
Infection
Reflux disease
Explanation - Uncontrolled variceal bleeding can cause rapid blood loss and hypovolemic shock, leading to high mortality.
Correct answer is: Hypovolemic shock
Q.17 Octreotide is used in GI emergencies to treat:
Variceal bleeding
Peptic ulcer
Perforation
Diverticulitis
Explanation - Octreotide reduces portal venous pressure and is effective in controlling variceal bleeding.
Correct answer is: Variceal bleeding
Q.18 Rebound tenderness in the abdomen most strongly suggests:
Peritonitis
Cholelithiasis
Irritable bowel syndrome
Gastroenteritis
Explanation - Rebound tenderness is a clinical sign of peritoneal irritation, most often seen in peritonitis.
Correct answer is: Peritonitis
Q.19 Which sign is highly suggestive of appendiceal rupture?
Sudden relief of pain followed by worsening
Right lower quadrant tenderness
Low-grade fever
Constipation
Explanation - A brief relief in pain followed by severe generalized pain suggests rupture of appendix with peritonitis.
Correct answer is: Sudden relief of pain followed by worsening
Q.20 In suspected GI perforation, which laboratory test is least useful?
Serum amylase
Complete blood count
Serum electrolytes
Arterial blood gas
Explanation - Serum amylase is not specific for perforation; it is more relevant in pancreatitis.
Correct answer is: Serum amylase
Q.21 Which condition is classically associated with currant jelly stools?
Intussusception
Volvulus
Mesenteric ischemia
Ulcerative colitis
Explanation - Intussusception in children presents with colicky pain and currant jelly stools due to mucosal sloughing.
Correct answer is: Intussusception
Q.22 Which test is diagnostic for acute appendicitis in uncertain cases?
Ultrasound abdomen
Colonoscopy
Barium enema
Liver scan
Explanation - Ultrasound is a useful, noninvasive diagnostic tool in suspected appendicitis, especially in children and pregnancy.
Correct answer is: Ultrasound abdomen
Q.23 The classic triad of Charcot in acute cholangitis includes:
Fever, jaundice, right upper quadrant pain
Nausea, vomiting, diarrhea
Fever, hypotension, confusion
Jaundice, pruritus, dark urine
Explanation - Charcot's triad is fever, jaundice, and right upper quadrant pain, suggestive of acute cholangitis.
Correct answer is: Fever, jaundice, right upper quadrant pain
Q.24 What is the most appropriate next step for a patient with suspected massive lower GI bleed and hemodynamic instability?
IV fluid resuscitation and blood transfusion
Immediate colonoscopy
Endoscopic banding
Elective surgery
Explanation - Stabilization of circulation with fluids and blood transfusion precedes definitive interventions in massive lower GI bleeds.
Correct answer is: IV fluid resuscitation and blood transfusion
Q.25 Which imaging study is most sensitive for diagnosing acute mesenteric ischemia?
CT angiography
Plain X-ray
Ultrasound
MRI
Explanation - CT angiography is the most sensitive imaging tool for acute mesenteric ischemia and can help guide management.
Correct answer is: CT angiography
Q.26 Which complication is most feared in untreated perforated peptic ulcer?
Peritonitis and sepsis
GERD
Intussusception
Pancreatitis
Explanation - Perforated peptic ulcer can rapidly lead to peritonitis and sepsis, which are life-threatening without intervention.
Correct answer is: Peritonitis and sepsis