A 42-year-old man presents with fever, right upper quadrant abdominal pain, and weight loss for 3 weeks. He gives a history of intermittent loose stools with blood and mucus over the past few months. Examination reveals tender hepatomegaly. Ultrasonography of the abdomen shows a solitary hypoechoic lesion in the right lobe of the liver. Stool microscopy demonstrates trophozoites with ingested red blood cells. Colonoscopy reveals deep ulcers with undermined edges, described as flask-shaped ulcers on histopathology.Which of the following is the drug of choice for this patient?

29-year-old man presents with weakness in both lower limbs for 3 days, which is now progressing to affect the upper limbs. He had an episode of diarrhea 4 weeks ago that resolved spontaneously. Examination reveals flaccid weakness in the limbs and areflexia. What is the most likely organism?

Regarding secretory diarrhea, consider the following statements:1.Stool volume is typically large and diarrhea persists despite fasting. 2.Stool osmotic gap is usually less than 50 mOsm/kg.3.It commonly results from osmotic agents such as lactose or polyethylene glycol. 4.Hormone-secreting tumors such as VIPoma and carcinoid syndrome are recognized causes. How many statements are correct

54-year-old male presents with 1 month of non-bloody, non-oily diarrhea. Stool osmolarity is 260 mmol/L. Based on these findings, what is the most likely cause of this patient’s diarrhea?

Which of the following drugs used in IBS with diarrhea (IBS-D) acts by antagonism of 5-HT3 receptors, thereby reducing visceral hypersensitivity and gut motility?

Which of the following laboratory or clinical findings is least consistent with irritable bowel syndrome?

Which of the following small intestinal biopsy findings is most characteristic of untreated celiac disease?

34-year-old woman presents with chronic non-bloody diarrhea, progressive weight loss, and iron-deficiency anemia. She reports worsening of symptoms after consumption of wheat-based foods. Examination reveals pallor and mild glossitis. Laboratory evaluation shows low serum folate with normal vitamin B₁₂ levels. Serology reveals markedly elevated IgA anti–tissue transglutaminase (anti-tTG) antibodies. Upper gastrointestinal endoscopy with duodenal biopsy demonstrates flattened villi with crypt hyperplasia and increased intraepithelial lymphocytes. Despite intermittent dietary modification, she has had poor long-term adherence to treatment.Which of the following is the most common cause of death associated with this condition?

36-year-old man presents with chronic non-bloody diarrhea, progressive weight loss, and fatigue for 6 months. He recently returned after living for 2 years in a tropical region. Examination reveals pallor and mild glossitis. Laboratory evaluation shows macrocytic anemia, low serum folate, and vitamin B₁₂ deficiency. Upper gastrointestinal endoscopy with jejunal biopsy demonstrates villous blunting with inflammatory infiltrate, similar to that seen in gluten-sensitive enteropathy, without improvement after a gluten-free diet.Which of the following is the most appropriate treatment for this patient?

52-year-old man presents with chronic steatorrhea and weight loss. As part of the evaluation for malabsorption, a D-xylose test is normal. A subsequent Schilling test is also normal.Based on these findings, what is the most likely underlying cause of this patient’s malabsorption?

patient complains of sticky stools. Urinary excretion of D-xylose is 2.5 g in 5 hours, and urinary radiolabelled cobalamin is 4% after 24 hours following performance of Schilling’s test.Which of the following is a possible cause of the patient’s diarrhea?

17-year-old male presents with recurrent episodes of fatigue and paresthesias since early adolescence. He has been treated multiple times for megaloblastic anemia. There is no history of chronic diarrhea, gastric surgery, autoimmune disease, or strict vegetarian diet.Laboratory investigations reveal macrocytosis, low serum vitamin B₁₂, and normal intrinsic factor levels. A Schilling test fails to show improvement with intrinsic factor administration. Urinalysis demonstrates persistent low-molecular-weight proteinuria with preserved renal function. Genetic analysis reveals a mutation affecting the ileal receptor responsible for uptake of the intrinsic factor–vitamin B₁₂ complex.Which of the following syndromes best explains this patient’s condition?

patient with chronic fat malabsorption develops spinocerebellar ataxia, skeletal muscle weakness, and retinopathy. Deficiency of which vitamin best explains these findings?

A 22-year-old woman presents with a 5 months history of diarrhea. She was taking the oral contraceptive pill and smoked 10 cigarettes per day. Endomysial antibody negative. Biopsies from the terminal ileum showed chronic inflammation with ulceration and non-caseating granulomas. The most likely diagnosis is:

A 30-year-old woman presents with diarrhea associated with passing rectal mucus and blood. A diagnosis of mild rectosigmoiditis is made on flexible sigmoidoscopy. Biopsy histology shows chronic inflammatory cell infiltrate, crypt abscesses and mild architectural distortion of the crypts. What is the most appropriate initial treatment?

Regarding Crohn’s disease, consider the following statements:1.Smoking increases the risk and severity of disease. 2.Disease involvement is continuous, starting from the rectum. 3.Transmural inflammation predisposes to fistula formation. 4.Non-caseating granulomas may be seen on histopathology. 5.Toxic megacolon is a common complication. 6.Malabsorption can occur due to small intestinal involvement. 7.ASCA positivity supports the diagnosis. 8.Tenesmus is a prominent and early symptom. How many of the above statements are correct

Which of the following decreases the risk of Crohn's disease

36-year-old woman presents with abdominal pain, weight loss, diarrhoea, and mouth ulcers. Full blood count reveals normocytic normochromic anaemia, inflammatory markers are raised, and biochemical investigation reveals a raised alkaline phosphatase. Barium follow-through shows terminal ileal inflammatory disease. Long-term remission may be maintained by the use of which of the following drugs?

44-year-old man has a 5-year history of bloody diarrhoea mixed with mucus. He had lost 2 stones in weight over this time. Flexible sigmoidoscopy showed loss of vascular appearance, erythema, and superficial ulceration consistent with ulcerative colitis.Which one of the following features is associated with the condition?

A 75-year-old woman presents with a progressive history of regurgitation of undigested, foul-smelling food, associated with significant weight loss, chronic cough, and persistent halitosis, refractory to dental treatment. Her partner reports gradual worsening of symptoms over the past year.On clinical examination, a gurgling cervical mass becomes apparent during swallowing. Vital parameters and routine laboratory investigations are within normal limits.Which of the following is the most likely diagnosis

66-year-old woman presents with dysphagia and intermittent vomiting. Endoscopy shows a tight lower oesophageal sphincter suggestive of achalasia.Which of the following medical therapies is most effective?

51-year-old male laborer presents with haematemesis. Which of the following features confers the greatest risk of a poor outcome?

58-year-old man presents with acute haematemesis and melena. Upper gastrointestinal endoscopy reveals a large gastric ulcer on the lesser curvature with an actively bleeding visible vessel at the ulcer base.Which of the following is the most likely source of bleeding in this patient?

Which of the following drugs is a recognised cause of pancreatitis?

Regarding Whipple’s disease, which of the following statements are correct?

67-year-old ex-publican presented to his GP complaining of difficulty swallowing for the past few months. The difficulty started several weeks ago with food sticking, and he also complained more recently of pain on swallowing. An OGD and biopsy confirms squamous cell carcinoma of the oesophagus.Risk factors are

cirrhotic patient with ascites presents with fever and mild abdominal discomfort. Ascitic fluid analysis shows neutrophil count of 320 cells/mm³, protein 0.8 g/dL, and culture grows E. coli. Which of the following is the most likely diagnosis?

Which of the following statements regarding hepatopulmonary syndrome is incorrect?

47-year-old male presents with loss of appetite with abdominal pain and increasing abdominal girth over 3–4 weeks. On examination he has ascites.Serum Albumin 3.7 g/dL, Ascitic fluid albumin 2.2 g/dL with ascites total protein 2.8 g/dL.What is the most likely cause of his presentation?

A 47-year-old male presents with loss of appetite with abdominal pain and increasing abdominal girth over 3–4 weeks. On examination he has ascites.Serum Albumin 3.7 g/dL, Ascitic fluid albumin 2.9 g/dL. From the given data, which of the following cause of ascites is not possible

A 52-year-old woman presents with progressive jaundice and generalized pruritus for the past 6 months. She also complains of fatigue and dryness of eyes. There is no history of alcohol intake, abdominal pain, fever, or weight loss. On examination, she has mild hepatomegaly without splenomegaly or signs of chronic liver disease. Laboratory investigations reveal conjugated hyperbilirubinemia with dark-colored urine, markedly elevated alkaline phosphatase, and mildly raised transaminases. Ultrasonography of the abdomen shows no dilatation of intrahepatic or extrahepatic bile ducts. Serological testing is positive for anti-mitochondrial antibodies (AMA).What is the most likely diagnosis

60 year old male presented with jaundice. On lab tests –Serum bilirubin: 6 mg/dl, unconjugated bilirubin: 2 mg/dl, SGPT: 50 IU/L, ALP: 500 IU/L.What is the next step in investigation

Gene for alpha 1 anti trypsin is present on which chromosome

A patient with hepatitis B infection has the following serological markers: HBsAg is negative, anti-HBs is negative, IgM anti-HBc is positive, and HBeAg is negative. This serological pattern is most consistent with which phase of hepatitis B infection?

newborn is delivered to a mother who is HBsAg positive and HBeAg positive. The baby is otherwise healthy and has no contraindications to vaccination. What is the most appropriate post-exposure prophylaxis for the newborn?

28-year-old healthcare worker sustains a needle-stick injury from a patient with unknown hepatitis B status. The healthcare worker was previously vaccinated. His anti-HBs level is 15 mIU/mL. What is the next best step in management?

40-year-old patient comes for a routine check-up. HBsAg is found to be positive. On further investigations, the following serological results are seen: Anti-HBc: IgG positive; Anti-HBc IgM: negative; HBeAg: negative; HBV DNA: <2000 IU/mL; Anti-HBs: negative. What is the cause of these serological findings?

10-year-old boy was presented to OPD by his parents as his eyes are becoming yellow. Otherwise there are no symptoms. He gives history of attending outdoor school picnic last month. On examination icterus is present. LFT shows elevated SGPT and SGOT with conjugated hyperbilirubinemia present.

30-year-old male presents with yellow eyes, high grade fever, joint pains, skin rashes and vomiting for last 1–2 weeks. He received blood transfusion 2 months back due to blood loss in road traffic accident. On examination icterus present with tender hepatomegaly. You made a clinical diagnosis of acute viral hepatitis.What will be likely serology positive in this case

A 25-year-old male presents with nausea, vomiting and loss of appetite for 1 week. He also mentions pale stools with itching over the skin. He gives history of eaten sea food one month back. No one in the family is having similar symptoms. On examination icterus present with tender hepatomegaly.What is cause of this presentation?

Which of the following is true regarding laboratory findings of Zieve’s Syndrome?

Which of the following investigations is not useful in the assessment of acute liver injury?

An 11-year-old girl with persistently elevated serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) has been diagnosed with autoimmune hepatitis.Which of the following pathological features would you not expect in this patient?

Primary biliary cholangitis is most commonly associated with which of the following conditions?

35-year-old man with tremors and chronic hepatitis is found to have the following ophthalmic finding of KF sing and Sunflower cataract. This patient is also likely to have which of the following?

Which of the following organs does not show hemosiderin deposits in hemochromatosis?

34-year-old man evaluated for chronic abdominal pain is found to have hepatomegaly and a serum ferritin level of 1800 µg/L. Which of the following complications is he at the greatest risk of developing?

Which of the following antibodies would you not expect to see in a patient with autoimmune hepatitis?

30-year-old male patient presented with personality changes and jaundice. Slit-lamp examination confirmed Wilson’s disease. Which of the following statements is true?

40-year-old man presents with an 8-month history of lethargy, joint pains, and jaundice. Over the next 4 years, he develops diabetes mellitus and is noted to have skin hyperpigmentation. Liver biopsy shows typical pre-cirrhotic changes.Laboratory evaluation reveals:Iron saturation: 93.4%,Serum ferritin: 1050 µg/L. What is the 1st line management

37-year-old man presents with 2 bowls full of haematemesis. He drinks 10 pints of beer a day and has done so for 10 years. Upper GI endoscopy reveals oesophageal varices.Which of the following is effective in reducing the rates of rebleeding in the future?

Which of the following statements regarding liver disease severity scores are correct?

45-year-old man with a history of heavy alcohol abuse presents to the emergency department with jaundice, abdominal pain, and fatigue. Laboratory tests reveal elevated liver enzymes, hyperlipidemia, and evidence of hemolysis. The physician suspects Zieve syndrome, a rare but potentially serious complication of alcohol abuse. Which of the following are characteristic feature of Zieve's syndrome

45-year-old female presents with malaise and body ache for 5 days. Routine investigation shows unconjugated bilirubinemia, normal liver enzymes and his urine contains urobilinogen. Which of the following are causes for this