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WorksheetsGEM1 Module 5 Questions
Total questions: 51
Worksheet time: 51mins
Name
Class
Date
1.
A 62-year-old man presents with epigastric pain that worsens after eating. He also reports nausea and occasional bloating. He is a smoker and regularly takes ibuprofen for osteoarthritis. An upper GI endoscopy reveals a 1.5 cm gastric ulcer on the lesser curvature of the stomach. Which of the following is the most appropriate next step in the management of this patient?
a)
Start omeprazole and refer for repeat endoscopy in 6–8 weeks
b)
Prescribe sucralfate and reassure
c)
Begin triple therapy for H. pylori without further investigation
d)
Refer immediately for surgical resection
e)
Discharge with advice to avoid spicy food
2.
A 44-year-old woman presents with a 3-month history of dyspepsia. She denies weight loss, vomiting, or GI bleeding. She has no significant medical history. A urea breath test is positive for Helicobacter pylori. Which of the following is the most appropriate first-line treatment?
a)
Omeprazole alone
b)
Amoxicillin and metronidazole
c)
Omeprazole, amoxicillin, and clarithromycin
d)
Ranitidine and sucralfate
e)
Esomeprazole and ciprofloxacin
3.
A 27-year-old woman presents with tiredness, intermittent diarrhoea, and a pruritic rash on her elbows and knees. Blood tests reveal microcytic anaemia. Anti-tTG IgA antibodies are positive. She has not started any dietary changes yet. Which of the following is the most appropriate next step?
a)
Begin a strict gluten-free diet immediately
b)
Refer for upper GI endoscopy with duodenal biopsy
c)
Start iron and folate supplementation
d)
Order colonoscopy to rule out IBD
e)
Prescribe topical steroids for the rash
4.
A 59-year-old man with a history of alcohol-related cirrhosis presents with increasing abdominal girth and ankle swelling. Examination reveals shifting dullness and mild jaundice. Bloods show elevated bilirubin and INR. An ultrasound confirms ascites and splenomegaly. Which of the following best explains his peripheral oedema and ascites?
a)
Increased aldosterone levels
b)
Obstructed lymphatic drainage
c)
Hypocalcaemia
d)
Elevated hepatic artery pressure
e)
Renal artery stenosis
5.
A 72-year-old man had a positive faecal immunochemical test (FIT). He underwent colonoscopy, where several large polyps were removed. Twelve hours later, he develops severe abdominal pain and a distended abdomen. His temperature is 38.5°C, and blood pressure is 90/60 mmHg. On examination, he has guarding and rebound tenderness. What is the most likely diagnosis?
a)
Small bowel obstruction
b)
Diverticulitis
c)
Bowel perforation
d)
Acute pancreatitis
e)
Perforated peptic ulcer
6.
A 68-year-old man undergoes a midline laparotomy to relieve a small bowel obstruction. After surgery, he reports numbness and tingling over the skin just below the umbilicus on the right side. Which nerve is most likely injured during the surgical incision?
a)
Ilioinguinal nerve
b)
Subcostal nerve (T12)
c)
Iliohypogastric nerve
d)
Genitofemoral nerve
e)
Lateral cutaneous nerve of the thigh
7.
A 56-year-old woman presents with acute upper abdominal pain radiating to her back. Serum lipase is significantly raised. CT confirms inflammation of the pancreas with some peripancreatic fluid. Which of the following best describes the anatomical positioning of the pancreas?
a)
Entirely intraperitoneal
b)
Primary retroperitoneal
c)
Secondarily retroperitoneal, except for the tail
d)
Suspended entirely by dorsal mesentery
e)
Contained within the lesser sac
8.
A 61-year-old man with alcoholic liver cirrhosis presents with haematemesis. Upper GI endoscopy reveals oesophageal varices. He is diagnosed with portal hypertension. Which of the following best explains the formation of oesophageal varices in this condition?
a)
Backflow from the hepatic artery
b)
Obstruction of inferior vena cava
c)
Anastomosis between left gastric vein and azygos system
d)
High pressure in the pulmonary veins
e)
Portal artery fistula into the oesophageal plexus
9.
A 3-day-old male neonate presents with bilious vomiting and abdominal distension. He is otherwise stable. An abdominal X-ray shows a gasless abdomen. An upper GI contrast study shows the duodenojejunal junction to the right of the midline. Which of the following embryological events most likely failed to occur?
a)
Rotation of the stomach along its longitudinal axis
b)
Fusion of dorsal and ventral pancreatic buds
c)
Obliteration of the vitelline duct
d)
270° counterclockwise rotation of the midgut
e)
Descent of the caecum into the right iliac fossa
10.
A 70-year-old man presents with difficulty swallowing, especially with liquids, and frequent coughing during meals. He has a history of stroke. Examination shows a hoarse voice and reduced gag reflex. Which of the following structures is most likely dysfunctional in this patient?
a)
Cricopharyngeus muscle
b)
Lower oesophageal sphincter
c)
Submandibular gland
d)
Cardia of the stomach
e)
Pharyngeal constrictor muscles
11.
A 60-year-old woman presents with epigastric pain worse after eating and occasional melena. She has osteoarthritis and regularly takes ibuprofen. Endoscopy reveals a gastric ulcer on the lesser curvature. Which of the following best explains how NSAIDs contribute to ulcer formation?
a)
Increased histamine secretion from enterochromaffin-like cells
b)
Inhibition of gastric acid production by parietal cells
c)
Direct erosion of the mucosa by NSAID crystals
d)
Impaired prostaglandin-mediated mucosal protection
e)
Overactivation of the vagus nerve leading to acid hypersecretion
12.
A 25-year-old woman presents with chronic diarrhoea, bloating, and weight loss. Blood tests show iron-deficiency anaemia. Anti-tTG antibodies are positive. Which of the following histological changes is most likely seen in this patient’s small intestine?
a)
Hyperplastic Peyer's patches
b)
Thickened muscularis propria
c)
Blunted villi with crypt hyperplasia
d)
Glandular metaplasia of mucosa
e)
Increased goblet cells and Paneth cells
13.
A 19-year-old man presents with jaundice, dark urine, and pale stools. He recently returned from a backpacking trip to Asia and reports malaise and nausea. Examination reveals hepatomegaly and scleral icterus. His ALT and AST are markedly raised; ALP is mildly elevated. Hepatitis A IgM is positive. What type of jaundice is this patient most likely experiencing?
a)
Pre-hepatic jaundice
b)
Hepatic jaundice
c)
Post-hepatic jaundice
d)
Haemolytic jaundice
e)
Physiological jaundice
14.
A 48-year-old woman undergoes a secretin stimulation test as part of evaluation for chronic pancreatitis. After IV secretin, there is increased bicarbonate-rich pancreatic fluid in the duodenum. Which of the following best describes the role of secretin in digestion?
a)
Stimulates pancreatic acinar cells to release digestive enzymes
b)
Inhibits gastric acid secretion and gastric motility
c)
Stimulates bile release from the gallbladder
d)
Stimulates ductal cells to secrete bicarbonate-rich fluid
e)
Enhances insulin secretion from pancreatic islets
15.
A 67-year-old woman presents with right upper quadrant pain, jaundice, and fever. She is febrile and hypotensive. Bloods show raised ALP and GGT, conjugated hyperbilirubinaemia, and leukocytosis. Ultrasound shows gallstones in the common bile duct. Which of the following best explains her jaundice?
a)
Impaired hepatic conjugation of bilirubin
b)
Overproduction of unconjugated bilirubin
c)
Obstruction of bile outflow into the intestine
d)
Hepatocyte necrosis
e)
Reabsorption of bilirubin from bowel contents
16.
A 24-year-old man presents with abdominal pain, weight loss, and chronic diarrhoea. He reports episodes of perianal pain and has a history of iron-deficiency anaemia. Colonoscopy reveals skip lesions, transmural inflammation, and a terminal ileal stricture. Which of the following features most supports a diagnosis of Crohn’s disease over ulcerative colitis?
a)
Continuous inflammation from the rectum
b)
Mucosal and submucosal involvement only
c)
Crypt abscesses on histology
d)
Presence of granulomas and transmural inflammation
e)
Increased risk of primary sclerosing cholangitis
17.
A 62-year-old man presents for colorectal cancer screening. He is asymptomatic. His FIT test was positive, and he undergoes a colonoscopy which reveals multiple adenomatous polyps, two of which show high-grade dysplasia. Which of the following factors most increases his risk of developing colorectal cancer?
a)
Having had a cholecystectomy
b)
Presence of adenomatous polyps with dysplasia
c)
History of irritable bowel syndrome
d)
Vegetarian diet
e)
Helicobacter pylori infection
18.
A 30-year-old woman presents with malaise, nausea, and mild jaundice. She returned from India 3 weeks ago. Her LFTs show elevated ALT and AST. Hepatitis A IgM is positive. Which of the following is the most appropriate next step in her management?
a)
Start pegylated interferon therapy
b)
Initiate oral antivirals immediately
c)
Reassure and provide supportive care
d)
Refer for liver transplantation
e)
Begin lifelong monitoring for hepatocellular carcinoma
19.
A 68-year-old woman presents with sudden onset left lower quadrant pain, fever, and nausea. She has a history of chronic constipation. Examination reveals tenderness with mild guarding in the left iliac fossa. CT scan shows thickened sigmoid colon with fat stranding and an adjacent abscess. Which of the following is the most likely diagnosis?
a)
Colonic polyp
b)
Diverticulosis
c)
Diverticulitis
d)
Sigmoid volvulus
e)
Ulcerative colitis
20.
A 55-year-old woman is undergoing chemotherapy for breast cancer. She reports severe nausea and vomiting after her last session. Her oncologist prescribes ondansetron. Ondansetron primarily acts by antagonizing which receptor to reduce chemotherapy-induced nausea?
a)
Dopamine D2 receptor
b)
Muscarinic M1 receptor
c)
Histamine H1 receptor
d)
Serotonin 5-HT3 receptor
e)
Neurokinin-1 receptor
21.
A 60-year-old man with cirrhosis secondary to alcohol use is admitted with worsening ascites. His medications include simvastatin for hyperlipidaemia and codeine for chronic back pain. Which of the following is the most appropriate advice regarding his medication use?
a)
Continue both simvastatin and codeine at usual doses
b)
Increase simvastatin dose to improve efficacy
c)
Avoid codeine due to increased risk of toxicity
d)
Add rifampicin to improve drug metabolism
e)
Stop simvastatin but continue codeine
22.
A 3-year-old child presents with acute diarrhoea and mild dehydration. The child is alert but has dry mucous membranes and reduced skin turgor. What is the most appropriate initial management for this child?
a)
Intravenous saline infusion
b)
Oral rehydration therapy (ORT) with glucose-electrolyte solution
c)
Immediate anti-diarrhoeal medication
d)
Fasting to rest the gut
e)
Administration of broad-spectrum antibiotics
23.
A 45-year-old woman with migraine headaches experiences nausea and vomiting. She is prescribed metoclopramide to relieve symptoms. What is the main mechanism of action of metoclopramide in controlling nausea?
a)
Blockade of serotonin 5-HT3 receptors
b)
Stimulation of muscarinic receptors
c)
Dopamine D2 receptor antagonism in the chemoreceptor trigger zone
d)
Activation of histamine H1 receptors
e)
Peripheral anticholinergic effects
24.
A 38-year-old man undergoes a vagotomy as part of treatment for a refractory gastric ulcer. Postoperatively, he experiences delayed gastric emptying and reduced acid secretion. Which of the following best explains these symptoms?
a)
Loss of sympathetic stimulation causing increased motility
b)
Disruption of parasympathetic vagus nerve supply reducing gastric motility and acid secretion
c)
Increased secretion of pancreatic enzymes due to vagal stimulation
d)
Enhanced peristalsis due to increased parasympathetic activity
e)
Damage to enteric nervous system causing diarrhoea
25.
A 52-year-old woman presents with right upper quadrant abdominal pain radiating to her right shoulder tip, worsened after fatty meals. Ultrasound confirms gallstones. What is the anatomical explanation for the pain referral to the right shoulder?
a)
Referred somatic pain via phrenic nerve due to diaphragmatic irritation
b)
Direct spread of inflammation to shoulder muscles
c)
Referred pain via vagus nerve to the left shoulder
d)
Compression of the brachial plexus causing shoulder pain
e)
Radiation of pain through lumbar spinal nerves
26.
A 45-year-old woman presents with fatigue and pallor. She reports heavy menstrual bleeding over the past 6 months. Blood tests show Hb 90 g/L, MCV 70 fL, and low serum ferritin. Which of the following is the most likely cause of her anemia?
a)
Vitamin B12 deficiency
b)
Chronic blood loss leading to iron deficiency
c)
Folate deficiency
d)
Sickle cell anemia
e)
Lead poisoning
27.
A 60-year-old man presents with numbness and tingling in his feet and difficulty walking. He has a history of chronic gastritis. Blood tests show macrocytic anemia (MCV 110 fL) and low serum B12. Which of the following is the most likely cause of his vitamin B12 deficiency?
a)
Dietary deficiency due to vegan diet
b)
Impaired absorption due to lack of intrinsic factor
c)
Excessive iron loss from bleeding
d)
Lead toxicity inhibiting heme synthesis
e)
Folate deficiency from poor diet
28.
A 35-year-old man working in a battery factory presents with abdominal pain, constipation, and anemia. Blood tests show basophilic stippling of red cells and elevated blood lead levels. Which step in heme synthesis is most directly inhibited by lead poisoning?
a)
Conversion of porphobilinogen to hydroxymethylbilane
b)
Ferrochelatase activity inserting iron into protoporphyrin
c)
ALA dehydratase activity converting ALA to porphobilinogen
d)
Uroporphyrinogen decarboxylase activity
e)
Synthesis of delta-aminolevulinic acid (ALA)
29.
A 9-month-old infant is brought to clinic due to poor weight gain and lethargy. The infant is exclusively breastfed but shows signs of muscle wasting and delayed developmental milestones. Which of the following is the most likely cause of faltering growth in this infant?
a)
Congenital heart disease causing increased metabolic demand
b)
Inadequate nutritional intake due to insufficient breastfeeding
c)
Cystic fibrosis causing malabsorption
d)
Lead poisoning affecting appetite
e)
Excessive caloric intake causing obesity
30.
A 2-year-old child with cystic fibrosis presents with foul-smelling, bulky, oily stools and poor weight gain despite good appetite. What is the most likely cause of the steatorrhea in this child?
a)
Decreased bile salt production by the liver
b)
Reduced pancreatic enzyme secretion leading to fat malabsorption
c)
Increased intestinal motility reducing absorption time
d)
Excessive dietary fat intake overwhelming digestion
e)
Lactose intolerance causing osmotic diarrhea
31.
A 4-year-old child with a history of chronic kidney disease is failing to thrive despite adequate nutrition. The child also has frequent infections and delayed motor milestones. Which of the following mechanisms most likely contributes to faltering growth in this child?
a)
Increased caloric intake from renal diet
b)
Malabsorption due to pancreatic insufficiency
c)
Increased metabolic demands and inflammation due to chronic illness
d)
Excessive vitamin A supplementation
e)
Decreased thyroid hormone production
32.
A 50-year-old man presents with jaundice and right upper quadrant pain. His blood results show: ALT: 450 U/L (normal <40), ALP: 120 U/L (normal 40–130), Bilirubin: Elevated. What is the most likely cause of his liver injury?
a)
Biliary obstruction
b)
Hepatocellular injury (hepatitis)
c)
Bone disease causing raised ALP
d)
Cholestasis without hepatocyte damage
e)
Hemolysis causing elevated bilirubin
33.
A 42-year-old woman presents with episodic right upper quadrant pain after fatty meals. An abdominal ultrasound reveals multiple echogenic foci with posterior acoustic shadowing within the gallbladder. What is the most likely diagnosis?
a)
Gallbladder polyp
b)
Gallstones
c)
Gallbladder carcinoma
d)
Pancreatic pseudocyst
e)
Biliary sludge
34.
A 65-year-old man with unexplained weight loss and abdominal pain undergoes a CT scan of the abdomen, which reveals a mass in the head of the pancreas. Which of the following is the most common malignancy arising in this location?
a)
Pancreatic adenocarcinoma
b)
Neuroendocrine tumor
c)
Cystadenoma
d)
Lymphoma
e)
Metastatic colorectal carcinoma
35.
A 28-year-old woman presents with recurrent abdominal pain and altered bowel habits (diarrhea alternating with constipation) for 6 months. She reports increased symptoms during stressful work periods. Blood tests and colonoscopy are normal. Which of the following best explains her symptoms?
a)
Inflammatory bowel disease
b)
Irritable bowel syndrome influenced by psychological stress
c)
Colorectal cancer
d)
Celiac disease
e)
Infectious colitis
36.
A 45-year-old man with newly diagnosed Crohn’s disease expresses anxiety about lifelong treatment. He actively seeks information, joins support groups, and practices relaxation techniques. Which aspect of resilience is this patient demonstrating?
a)
Denial of illness
b)
Avoidance of treatment
c)
Adaptive coping strategies
d)
Poor psychological adjustment
e)
Social withdrawal
37.
A 35-year-old woman with ulcerative colitis reports increased frequency of bloody diarrhea and abdominal cramps during periods of high work stress despite adherence to medication. Which statement best describes the role of stress in her condition?
a)
Stress causes new ulcerative colitis lesions
b)
Stress exacerbates symptoms by altering gut motility and immune response
c)
Stress prevents medication absorption
d)
Stress has no effect on inflammatory bowel disease
e)
Stress directly causes infections leading to flare-ups
38.
A 55-year-old man with a history of alcohol-related liver cirrhosis presents with sudden onset of vomiting large amounts of bright red blood. He is hypotensive and tachycardic. What is the most likely cause of his bleeding?
a)
Peptic ulcer disease
b)
Mallory-Weiss tear
c)
Ruptured esophageal varices due to portal hypertension
d)
Gastric cancer
e)
Hemorrhoids
39.
A 62-year-old woman reports a 3-month history of unintentional weight loss, persistent rectal bleeding, and a recent change from normal bowel habits to alternating constipation and diarrhea. What is the next best step in management?
a)
Reassure and advise dietary changes
b)
Arrange urgent colonoscopy
c)
Prescribe laxatives and follow up in 3 months
d)
Test for celiac disease antibodies
e)
Start antibiotics for infectious colitis
40.
A 34-year-old woman presents with jaundice, malaise, and right upper quadrant pain. Blood tests show elevated ALT and AST (>1000 U/L). Viral serology is positive for hepatitis A IgM antibodies. What is the most likely diagnosis?
a)
Acute alcoholic hepatitis
b)
Chronic hepatitis B infection
c)
Acute hepatitis A infection
d)
Autoimmune hepatitis
e)
Drug-induced liver injury
41.
Which of the following is a major complication of portal hypertension?
a)
Ascites
b)
Peptic ulcer disease
c)
Duodenal atresia
d)
Pancreatic cancer
e)
Small bowel obstruction
42.
A 58-year-old man complains of fatigue, dark stools, and intermittent abdominal pain. On examination, he is pale with mild abdominal tenderness. Which investigation is most appropriate initially?
a)
Serum ferritin
b)
Fecal immunochemical test (FIT)
c)
Upper GI endoscopy
d)
Abdominal ultrasound
e)
Stool culture
43.
A 58-year-old man with type 2 diabetes is started on gliclazide. How does gliclazide help lower blood glucose?
a)
Increases insulin sensitivity in muscle
b)
Stimulates insulin secretion by closing ATP-sensitive potassium channels in pancreatic beta cells
c)
Delays carbohydrate absorption in the intestine
d)
Inhibits hepatic gluconeogenesis
e)
Increases renal glucose excretion
44.
A 75-year-old woman on multiple medications presents with new constipation. She takes codeine for chronic pain. Which of the following best explains her constipation?
a)
Codeine decreases gut motility by binding to opioid receptors in the GI tract
b)
Codeine increases water secretion into the intestines
c)
Codeine increases colonic muscle contractions
d)
Codeine causes bacterial overgrowth
e)
Codeine stimulates serotonin release in the gut
45.
A 48-year-old man with alcoholic cirrhosis is noted to have dilated, tortuous veins radiating from the umbilicus on the abdominal wall. What is the most likely cause of these veins (caput medusae)?
a)
Inferior vena cava obstruction
b)
Portal hypertension causing reopening of paraumbilical veins
c)
Superior vena cava syndrome
d)
Abdominal wall infection
e)
Superior mesenteric artery aneurysm
46.
A newborn is diagnosed with a midline abdominal wall defect with herniation of abdominal contents covered by a thin membrane. What is the most likely diagnosis?
a)
Gastroschisis
b)
Omphalocele
c)
Diaphragmatic hernia
d)
Umbilical hernia
e)
Inguinal hernia
47.
A 50-year-old man undergoes surgical resection of the transverse colon. Which artery primarily supplies this section of the gut?
a)
Coeliac trunk
b)
Superior mesenteric artery
c)
Inferior mesenteric artery
d)
Internal iliac artery
e)
Gastroduodenal artery
48.
During sigmoid colectomy, which artery must be carefully preserved to maintain blood flow to the descending colon?
a)
Inferior mesenteric artery
b)
Superior mesenteric artery
c)
Coeliac trunk
d)
Left gastric artery
e)
Middle colic artery
49.
A newborn presents with jaundice on day 2 of life. Blood tests show elevated unconjugated bilirubin. Which organ is primarily responsible for conjugating bilirubin?
a)
Kidney
b)
Liver
c)
Spleen
d)
Pancreas
e)
Small intestine
50.
Which of the following is the main route for excretion of conjugated bilirubin?
a)
Urine only
b)
Feces only
c)
Bile into the intestine and feces
d)
Sweat
e)
Exhaled air
51.
A patient is prescribed omeprazole for gastric ulcer. What is the mechanism of action of this drug?
a)
Blocks histamine H2 receptors
b)
Inhibits the H+/K+ ATPase pump in parietal cells
c)
Neutralizes gastric acid
d)
Increases bicarbonate secretion
e)
Stimulates mucus production
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