AMC MCQ Gastroenterology and Surgery 2 — Questions and Answers
Question 1: A 55-year-old man presents with painless progressive obstructive jaundice, weight loss, and a palpable non-tender gallbladder. What is the most likely diagnosis?
- Carcinoma of the head of the pancreas (Correct answer)
- Acute cholecystitis
- Gallstone in the cystic duct
- Hepatitis A
Correct answer: Carcinoma of the head of the pancreas
Courvoisier's law states a palpable non-tender gallbladder with painless jaundice suggests pancreatic head malignancy rather than gallstones.
Question 2: Which serum marker is most useful for monitoring pancreatic adenocarcinoma?
- CA 19-9 (Correct answer)
- AFP
- CEA
- CA-125
Correct answer: CA 19-9
CA 19-9 is the principal tumour marker used to monitor pancreatic adenocarcinoma response and recurrence.
Question 3: A patient with severe acute pancreatitis develops a fall in serum calcium. What is the mechanism?
- Saponification of calcium by released fatty acids (Correct answer)
- Increased parathyroid hormone
- Renal calcium wasting
- Vitamin D toxicity
Correct answer: Saponification of calcium by released fatty acids
Lipase-mediated fat necrosis binds calcium to free fatty acids (saponification), lowering serum calcium.
Question 4: Which scoring system uses CRP and is commonly applied to assess acute pancreatitis severity at 48 hours?
- Glasgow (Imrie) criteria (Correct answer)
- Child-Pugh score
- Alvarado score
- Rockall score
Correct answer: Glasgow (Imrie) criteria
The Glasgow/Imrie criteria stratify pancreatitis severity, and CRP >150 supports severe disease.
Question 5: A 70-year-old presents with sudden severe abdominal pain out of proportion to examination findings and atrial fibrillation. What is the most likely diagnosis?
- Acute mesenteric ischaemia (Correct answer)
- Acute appendicitis
- Diverticulitis
- Peptic ulcer
Correct answer: Acute mesenteric ischaemia
Pain out of proportion to signs with AF (embolic source) is classic for acute mesenteric ischaemia.
Question 6: Which is the most appropriate initial imaging for suspected acute cholecystitis?
- Abdominal ultrasound (Correct answer)
- Plain abdominal X-ray
- MRI abdomen
- Barium swallow
Correct answer: Abdominal ultrasound
Ultrasound is first-line, showing gallstones, wall thickening, and a sonographic Murphy's sign.
Question 7: A patient with cirrhosis develops confusion, asterixis, and elevated ammonia. What is the first-line treatment?
- Lactulose (Correct answer)
- Neomycin alone
- Intravenous albumin
- Spironolactone
Correct answer: Lactulose
Lactulose reduces ammonia absorption and is first-line therapy for hepatic encephalopathy.
AMC MCQ Gastroenterology and Surgery 2
A 55-year-old man presents with painless progressive obstructive jaundice, weight loss, and a palpable non-tender gallbladder.
What is the most likely diagnosis?