FCPS IMM Gastroenterology & Hepatology MCQs: High-Yield Practice & Prep

Sample FCPS IMM Medicine gastroenterology and hepatology MCQs on IBD, hepatitis serology, pancreatitis, coeliac disease and GI bleeding, with explanations.

Gastroenterology and hepatology is a high-volume area in IMM: inflammatory bowel disease, viral hepatitis serology, cholestatic disease, coeliac disease, pancreatitis, peptic ulcer disease and GI bleeding. These are sample questions with the reasoning after each answer.

Sample Gastroenterology MCQs

1. A young lady has a 3-month history of dysphagia to both solids and liquids from the start, which improves with standing. It is occasionally associated with heartburn. What is your diagnosis?

A) Pharyngeal pouch
B) Diffuse oesophageal spasm
C) Bering stricture
D) Oesophageal cancer
E) Achalasia ✅

Why: Dysphagia for both solids and liquids from the onset with regurgitation, improved by standing, is achalasia from failure of LES relaxation.

2. A 54-year-old female has fatigue and xerostomia. Blood tests show bilirubin 33 mmol/L, ALP 292 U/L, ALT 47 U/L. What is the most likely diagnosis?

A) Primary biliary cirrhosis ✅
B) Infectious mononucleosis
C) Systemic lupus erythematosus
D) Autoimmune hepatitis

Why: A middle-aged woman with fatigue, sicca symptoms and a cholestatic pattern (high ALP) is primary biliary cholangitis.

3. An alcoholic patient develops a distended abdomen with ascites and a tender liver. Which investigation should be performed next?

A) Ascitic fluid examination ✅
B) Doppler ultrasound of abdomen
C) Serum bilirubin
D) Alpha-fetoprotein measurement

Why: Diagnostic paracentesis (cell count, albumin, culture, cytology) should be done in every patient with new ascites, to exclude infection and determine the cause.

4. In a patient with coeliac disease, which is the best test to perform?

A) Endoscopy with duodenal biopsy ✅
B) Endoscopy with jejunal biopsy
C) Endoscopy with gastric biopsy
D) Endoscopy with ileal biopsy

Why: Multiple biopsies of the second part of the duodenum are the gold standard for diagnosing coeliac disease, after positive serology.

5. An elderly male has constipation, fatigue and weakness. His labs show Hb 9, TLC 5800, platelet count 320,000, MCV 60 fL. What is your diagnosis?

A) Hypothyroidism
B) CA caecum ✅
C) Decreased oral intake
D) Hypercalcaemia

Why: Microcytic iron-deficiency anaemia in an elderly man indicates occult GI blood loss, most often from a right-sided (caecal) colon cancer.

6. A patient has progressive dysphagia first for solids, then liquids. She has a history of some psychiatric disorder as well. What is the next step?

A) Barium swallow
B) H. pylori antibodies
C) Oesophagogastroduodenoscopy (EGD) ✅
D) Manometry

Why: Progressive dysphagia to solids then liquids is oesophageal cancer until proved otherwise, and urgent endoscopy with biopsy is required.

7. A 23-year-old lady in the 3rd trimester of her pregnancy has high-grade fever with chills, bilirubin 3 mg/dL and increased PT and APTT. What is the diagnosis?

A) Hepatitis E
B) Cholestatic jaundice
C) Acute fatty liver of pregnancy ✅
D) Haemolytic

Why: Jaundice with coagulopathy in the third trimester is acute fatty liver of pregnancy, and hepatitis E is also common in pregnancy in endemic areas. Coagulopathy and hypoglycaemia out of proportion to jaundice favour AFLP.

8. An old alcoholic male has a history of GERD for many weeks. He took antacids and a PPI, but symptoms persist. He also has significant weight loss. What should be your immediate management plan?

A) Upper GI endoscopy ✅
B) US abdomen
C) Urea breath test
D) Serology

Why: Dyspepsia in a patient over 55 with weight loss is an alarm feature, and urgent upper GI endoscopy is required.

How to Approach Gastroenterology for IMM

Hepatitis B serology patterns are examined repeatedly, so practise reading them until it is automatic.
Know the first investigation for each presentation, because the exam often asks for the next test rather than the diagnosis.
Separate Crohn disease from ulcerative colitis by distribution, histology and complications.

Browse every Gastroenterology question on its own: Gastroenterology MCQs.

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