Postgrad MedJ 1998;74:379-380 © The Fellowship of Postgraduate Medicine, 1998

Multiple-choice questions
Multiple-choice questions in gastro-enterology
and hepatology
M C Bateson, R Holden
Are the statements listed beneath each question true or false? Answers are given overleaf.

QUESTION 1 D Co-codamol
Which cranial nerves are involved in nor- E Co-amilofruse
mal functioning of the gastrointestinal
tract: QUESTION 6
A II
B IV Drug overdosage in parkinsonian patients
C VI may cause pronounced gastrointestinal
D VIII side-effects related to::
E X A Bromocriptine
B Co-beneldopa
QUESTION 2 C Benzhexol
Liver abnormalities definitely associated D Selegeline
with Crohn's disease include: E Amantadine
A Steatosis
B Pericholangitis QUESTION 7
C Amyloid
D Primary sclerosing cholangitis What cranial nerves are involved in normal
E Cirrhosis functioning of the gastrointestinal tract:
AI
QUESTION 3 B III
In childhood gastro-oesophageal reflux D V
C
disease: VII
A Respiratory symptoms are common E IX
B Barium swallow is the best test
C Columnar lined epithelium is rare QUESTION 8
D Thickening infant feed and avoiding over-
feeding are important The following hormones are important to
E Metoclopramide is useful treatment the normal function of the gut:
A Gastrin
QUESTION 4 B Secretin
C Hydrogen potassium ATPase
False-negative direct urease tests for Heli- D Cholecystokinin-pancreozymin (CCK-PZ)
cobacter pylori are: E Vaso-active intestinal peptide (VIP)
A Rare
B Caused by gastrointestinal haemorrhage
C Related to recent treatment with antibiotics, QUESTION 9
Bishop Auckland bismuth and proton pump inhibitors In carcinoma of the colon:
General Hospital, D Caused by ranitidine A Most cancers arise in adenomatous polyps
Bishop Aukland, E Identifiable by ELISA serology
County Durham B Familial polyposis coli is inherited by a
DL14 6AD, UK recessive gene on chromosome 5
M C Bateson QUESTION 5 C Progression from polyp to cancer takes on
Monklands Hospital,
Drugs with prominent hepatic and gastro- average four years
Airdrie, UK intestinal effects in overdose are: D High animal fat and high vegetable intake
R Holden A Co-phenotrope are risk factors
B Co-trimoxazole E All patients with ulcerative colitis have an
Accepted 16 December 1997 C Co-proxamol increased risk of carcinoma of the colon
380 Multiple-choice questions

Answers ant anticholinergic side-effects, including dry

mouth, are designed to discourage over-use.
QUESTION 1
A False QUESTION 6
B False A True
C False B False
D False C True
E True D False
The vagus nerve is extensively important for E False
swallowing, gastric acid secretion and motility. Bromocriptine's usefulness is severely limited
QUESTION 2 by nausea and vomiting, and this is a problem
even in therapeutic doses. Benzhexol and other
A True atropinics may cause dry mouth, gastro-
B True oesophageal reflux and constipation. However,
C True the most serious adverse effects for these drugs
D True are neuropsychiatric.
E False
Any link between cirrhosis and Crohn's disease QUESTION 7
is dubious, though there may be an increase A True
because of transfusion-related viral hepatitis or B False
end-stage primary sclerosing cholangitis. It is C True
important to look for other aetiologies such as D True
alcohol if cirrhosis does occur in these patients. E True
QUESTION 3 Taste sensation is largely derived from smell, so
the first nerve is involved as well as the seventh
A True and ninth nerves which innervate the tongue.
B False The fifth nerve serves the muscles of mastica-
C True tion. The ninth nerve is also important in swal-
D True lowing.
E False
Up to 10% of childhood gastro-oesophageal QUESTION 8
reflux disease patients have associated respira- A True
tory symptoms, possibly linked to aspiration. B True
The best objective test is 24-h oesophageal pH C False
monitoring. Metoclopramide is contra- D True
indicated for those under 20 years because of E False
severe dystonic reactions. Cisapride is probably
the best prokinetic drug for children. Gastrin stimulates gastric acid secretion and
secretin stimulates bicarbonate-rich pancreatic
QUESTION 4 secretion. CCK-PZ both stimulates gallblad-
der contraction and pancreatic enzyme secre-
A False tion. Hydrogen potassium ATPase is an
B True
C True enzyme which determines the activity of the
D False gastric proton pump. Though VIP excess is
known to cause Verner-Morrison syndrome
E True
(watery diarrhoea, hypokalaemia, and achlo-
After proton pump inhibitor and antibiotic rhydria) its role in health is doubtful.
therapy it is best to wait a month before repeat
endoscopy for gastric biopsy and urease QUESTION 9
testing. The same is true of the urea breath test A True
which is a convenient noninvasive alternative. B True
A urease test at the time of haematemesis will C False
usually be negative. Even after definite eradica- D False
tion of Helicobacter pylori, serology will remain E False
positive for months. ELISA testing would con- The adenoma-dysplasia-carcinoma sequence
firm a true positive urease test.
probably occurs in all colon cancers; however,
QUESTION 5 stalked polyps are less common in the right side
of the colon and cancers can arise in flat, often
A True small, adenomas. The interval for transition
B False from adenoma to carcinoma is on average 10
C True years. High fat and low fibre intake is positively
D True associated with increased risk of colon cancer.
E False Increased intake of fruit and vegetable is
Both co-codamol and co-proxamol contain probably protective. Only patients who have
paracetamol which may be hepatotoxic. Co- ulcerative colitis involving most of the colon
phenotrope has the constipating opioid diphe- have significantly increased risk, which begins to
noxylate, but includes atropine whose unpleas- rise 8 years after diagnosis.