A 34-year-old schoolteacher has had dysphagia to both solids and liquids for 2 years, with regurgitation of undigested food at night and mild weight loss. Barium swallow shows a dilated oesophagus tapering smoothly to a narrow 'bird beak' at the gastro-oesophageal junction. Which investigation confirms the diagnosis?

High-resolution oesophageal manometry

A 36-year-old man is taken to the OT 5 hours after the sudden onset of generalised peritonitis. At laparotomy there is a 6 mm perforation on the anterior wall of the first part of the duodenum, with bile-stained fluid in the peritoneal cavity. What is the operation of choice?

Closure with an omental patch and peritoneal lavage

Highly selective vagotomy with simple closure

Partial gastrectomy with Billroth II reconstruction

Truncal vagotomy and gastrojejunostomy

A 60-year-old man under Barrett surveillance has a 4 cm segment of Barrett mucosa with no nodule or ulcer on careful high-definition endoscopy. Random biopsies show high-grade dysplasia, confirmed by a second expert gastrointestinal pathologist. What is the preferred management?

Endoscopic radiofrequency ablation

Laparoscopic Nissen fundoplication

Oesophagectomy with lymphadenectomy

High-dose PPI and endoscopy in 3 years

Peptic ulcer, upper GI bleeding and oesophageal disease

28 NEET-PG practice questions on Peptic ulcer, upper GI bleeding and oesophageal disease, part of General Surgery. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 34-year-old schoolteacher has had dysphagia to both solids and liquids for 2 years, with regurgitation of undigested food at night and mild weight loss. Barium swallow shows a dilated oesophagus tapering smoothly to a narrow 'bird beak' at the gastro-oesophageal junction. Which investigation confirms the diagnosis?
1. AHigh-resolution oesophageal manometry
2. BContrast CT of the chest
3. C24-hour oesophageal pH study
4. DUpper GI endoscopy with biopsy
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Answer: A · High-resolution oesophageal manometry
Dysphagia to solids and liquids from the start, nocturnal regurgitation and a bird-beak barium picture suggest achalasia, caused by loss of inhibitory neurons in the myenteric plexus. High-resolution manometry is the gold standard: it shows incomplete relaxation of the lower oesophageal sphincter (raised integrated relaxation pressure) and absent normal peristalsis, and its Chicago subtypes guide treatment (pneumatic dilatation, Heller myotomy or POEM). Endoscopy is still mandatory, but to exclude a carcinoma of the cardia causing pseudoachalasia.
- B: CT may show a dilated oesophagus or a tumour but does not test motility.
- C: pH monitoring measures acid reflux, not sphincter relaxation.
- D: Endoscopy excludes malignancy but cannot show the motility disorder.
Question 2 · Medium
A 36-year-old man is taken to the OT 5 hours after the sudden onset of generalised peritonitis. At laparotomy there is a 6 mm perforation on the anterior wall of the first part of the duodenum, with bile-stained fluid in the peritoneal cavity. What is the operation of choice?
1. AClosure with an omental patch and peritoneal lavage
2. BHighly selective vagotomy with simple closure
3. CPartial gastrectomy with Billroth II reconstruction
4. DTruncal vagotomy and gastrojejunostomy
Show answerHide answer
Answer: A · Closure with an omental patch and peritoneal lavage
A small perforated duodenal ulcer is treated by closing it with an omental patch (open or laparoscopic) and thorough peritoneal lavage. Because most such ulcers are caused by H. pylori or NSAIDs, a PPI, H. pylori eradication and stopping NSAIDs prevent recurrence, so acid-reducing operations are no longer needed. Gastrectomy is kept for giant perforations that cannot be patched.
- B: Definitive acid-reducing surgery is obsolete in the PPI and eradication era.
- C: Gastrectomy is too extensive for a small perforation that a patch can close.
- D: Vagotomy adds time and morbidity in an emergency and is unnecessary when eradication cures the ulcer.
Question 3 · Hard
A 32-year-old woman asks about long-term nutrition at her 1-year review after a Roux-en-Y gastric bypass. Consider these statements: 1. Iron deficiency is common because the duodenum is bypassed. 2. Vitamin B12 deficiency can occur because less acid and intrinsic factor reach the food. 3. Poor calcium and vitamin D absorption can cause secondary hyperparathyroidism. 4. Supplements can be stopped once her weight is stable. Which are correct?
1. A3 and 4 only
2. B1, 2 and 3 only
3. C2, 3 and 4 only
4. D1 and 3 only
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Answer: B · 1, 2 and 3 only
Iron and calcium are absorbed mainly in the duodenum and proximal jejunum, which the bypass excludes, so iron deficiency and calcium and vitamin D malabsorption with secondary hyperparathyroidism and bone loss are common. Vitamin B12 needs acid and pepsin to be freed from food and intrinsic factor from the stomach, both reduced in the small pouch. Deficiencies continue lifelong, so multivitamins, iron, calcium with vitamin D and B12 are continued with yearly blood tests; statement 4 is wrong.
- A: Includes statement 4 and leaves out statements 1 and 2.
- C: Includes statement 4 and leaves out statement 1.
- D: Leaves out statement 2: B12 deficiency is a known risk after a bypass.
Question 4 · Medium
For a teaching session on Helicobacter pylori, consider these statements: 1. It is a curved Gram-negative bacillus with strong urease activity. 2. It is linked to gastric adenocarcinoma and gastric MALT lymphoma. 3. A PPI should be stopped 2 weeks before a urea breath test. 4. A positive IgG serology is the preferred test to confirm eradication. Which are correct?
1. A1 and 2 only
2. B1, 2 and 3 only
3. C2 and 4 only
4. D1, 3 and 4 only
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Answer: B · 1, 2 and 3 only
H. pylori is a curved, flagellated Gram-negative bacillus whose urease makes ammonia that protects it from acid; the WHO classes it as a group 1 carcinogen for gastric adenocarcinoma, and it drives gastric MALT lymphoma. PPIs suppress the organism and cause false-negative breath, stool antigen and urease tests, so they are stopped 2 weeks before testing. Serology stays positive long after cure, so statement 4 is wrong.
- A: Leaves out statement 3, which is correct.
- C: Includes statement 4 and leaves out statements 1 and 3.
- D: Includes statement 4 (serology cannot confirm cure) and leaves out statement 2.
Question 5 · Medium
A 60-year-old man under Barrett surveillance has a 4 cm segment of Barrett mucosa with no nodule or ulcer on careful high-definition endoscopy. Random biopsies show high-grade dysplasia, confirmed by a second expert gastrointestinal pathologist. What is the preferred management?
1. AEndoscopic radiofrequency ablation
2. BLaparoscopic Nissen fundoplication
3. COesophagectomy with lymphadenectomy
4. DHigh-dose PPI and endoscopy in 3 years
Show answerHide answer
Answer: A · Endoscopic radiofrequency ablation
Confirmed high-grade dysplasia in flat Barrett mucosa carries a substantial risk of progressing to adenocarcinoma, so it is treated, but endoscopically. Endoscopic eradication therapy (radiofrequency ablation for flat mucosa, with endoscopic resection of any visible lesion) is preferred to oesophagectomy, which carries much higher morbidity and mortality. He stays on a PPI and under surveillance after ablation.
- B: Anti-reflux surgery does not reliably make dysplasia regress.
- C: Oesophagectomy is reserved for invasive cancer or failure of endoscopic therapy.
- D: Surveillance alone is not enough for confirmed high-grade dysplasia.
Question 6 · Medium
A 44-year-old man is admitted with one episode of melaena. Pulse is 88/min, BP 124/80 mmHg and haemoglobin 12.2 g/dL. Endoscopy within 24 hours shows a 1 cm duodenal ulcer with a clean white base and no stigmata of bleeding, and the biopsy urease test is positive. What is the most appropriate management?
1. AAdrenaline injection and clipping of the ulcer
2. BOral PPI, early feeding and H. pylori eradication
3. CHigh-dose IV PPI infusion for 72 hours in an ICU
4. DRepeat endoscopy after 24 hours
Answer and explanation in LearnFree account
Question 7 · Medium
A 42-year-old man has had recurrent duodenal ulcers despite H. pylori eradication and PPIs, and now has a jejunal ulcer and chronic watery diarrhoea. Off PPIs, fasting serum gastrin is 520 pg/mL (normal below 100) and gastric pH is 1.5. Which test confirms the diagnosis?
1. ASecretin stimulation test
2. BSerum calcium and PTH
3. CRepeat urea breath test
4. DCT of the abdomen
Answer and explanation in LearnFree account
Question 8 · Easy
Consider these as risk factors for squamous cell carcinoma of the oesophagus: 1. Tobacco and alcohol use. 2. Habitual drinking of very hot beverages. 3. Long-standing achalasia cardia. 4. Barrett oesophagus. Which are correct?
1. A1, 3 and 4 only
2. B1 and 4 only
3. C2, 3 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 9 · Easy
A 38-year-old bank clerk from Chennai with a duodenal ulcer finished 14 days of H. pylori eradication therapy 6 weeks ago and stopped his proton pump inhibitor 2 weeks ago. He is now free of symptoms. Which test best confirms that the infection has been eradicated?
1. AGram stain of gastric aspirate
2. BSerum IgG antibody to H. pylori
3. CUrea breath test
4. DStool culture for H. pylori
Answer and explanation in LearnFree account
Question 10 · Medium
Six weeks after a sleeve gastrectomy, a 30-year-old woman who has been vomiting repeatedly is brought to the ward confused and unsteady, with horizontal nystagmus and weakness of both lateral rectus muscles. Blood glucose is 92 mg/dL. What should be given first?
1. AIV vitamin B12
2. BIV pantoprazole
3. CIV thiamine
4. DIV 25% dextrose
Answer and explanation in LearnFree account
Question 11 · Hard
A 66-year-old man had a spurting duodenal ulcer treated yesterday with adrenaline injection and clips and is on an IV PPI infusion. Today he passes fresh melaena; pulse rises to 118/min and BP falls to 92/60 mmHg. After 1 litre of crystalloid and 2 units of packed red cells, pulse is 100/min and BP 108/70 mmHg. What is the next best step?
1. AEmergency laparotomy and under-running
2. BRepeat endoscopy and endoscopic haemostasis
3. CDouble the PPI dose and observe
4. DStart a tranexamic acid infusion
Answer and explanation in LearnFree account
Question 12 · Medium
On day 5 after a transthoracic oesophagectomy, a 59-year-old man's right chest drain output rises to 1.2 litres a day and turns milky white soon after enteral feeds are started. Drain fluid triglyceride is 420 mg/dL. Which structure was most likely injured?
1. AAzygos vein
2. BThoracic duct
3. CRight recurrent laryngeal nerve
4. DOesophagogastric anastomosis
Answer and explanation in LearnFree account
Question 13 · Medium
A 58-year-old man with a known posterior duodenal ulcer has a massive haematemesis. Endoscopic haemostasis fails and embolisation is not available, so he is taken for surgery. When the first part of the duodenum is opened, a spurting vessel is seen in the ulcer base. Which artery is it most likely to be?
1. ALeft gastric artery
2. BSplenic artery
3. CGastroduodenal artery
4. DSuperior mesenteric artery
Answer and explanation in LearnFree account
Question 14 · Medium
Three months after a Roux-en-Y gastric bypass, a 41-year-old woman from Pune has palpitations, sweating, abdominal cramps and diarrhoea 15-30 minutes after meals, especially after sweets. What is the first-line management?
1. ASmall, low-sugar meals, fluids apart
2. BOctreotide before each meal
3. CSurgical reversal of the bypass
4. DExtra glucose with each meal
Answer and explanation in LearnFree account
Question 15 · Easy
A 62-year-old bidi smoker from a village in Assam has progressive dysphagia, first to solids and now to semisolids, with 8 kg weight loss over 3 months. He has no heartburn. What is the first investigation?
1. A24-hour pH monitoring
2. BContrast CT of the chest
3. COesophageal manometry
4. DUpper GI endoscopy with biopsy
Answer and explanation in LearnFree account
Question 16 · Medium
On the second day after a laparoscopic sleeve gastrectomy, a 36-year-old man has a pulse of 128/min, temperature 38.4 °C and pain at the tip of the left shoulder, although the drain is dry. Where is a staple-line leak most likely to be?
1. AMidway along the staple line
2. BAt the incisura angularis
3. CProximal end near the angle of His
4. DDistal end near the pylorus
Answer and explanation in LearnFree account
Question 17 · Hard
After a wedding feast with heavy drinking, a 45-year-old man vomits forcefully several times and then develops severe lower chest and upper abdominal pain with breathlessness. Crepitus is felt in the neck. Pulse is 120/min and BP 100/64 mmHg. Chest X-ray shows pneumomediastinum and a left pleural effusion. Which investigation confirms the diagnosis?
1. ACT with water-soluble oral contrast
2. BECG and serum troponin
3. CBarium swallow
4. DUpper GI endoscopy
Answer and explanation in LearnFree account
Question 18 · Medium
During endoscopy for haematemesis, a 63-year-old woman is found to have a lesser-curve gastric ulcer with a non-bleeding visible vessel. Which endoscopic treatment is recommended for this ulcer?
1. ANo endoscopic therapy, IV PPI only
2. BAdrenaline injection combined with clips or thermocoagulation
3. CAdrenaline injection alone
4. DArgon plasma coagulation of the ulcer rim
Answer and explanation in LearnFree account
Question 19 · Hard
A 52-year-old man with years of epigastric pain has had projectile vomiting of foul, undigested food eaten the day before for 2 weeks. A succussion splash is present. Serum Na is 132 mmol/L, K 2.8 mmol/L, Cl 82 mmol/L and HCO3 38 mmol/L; ABG pH 7.53, PaCO2 48 mmHg. His urine is acidic. What is the first step in management?
1. AIV 0.9% saline with potassium chloride
2. BImmediate gastrojejunostomy
3. CIV Ringer lactate alone
4. DIV sodium bicarbonate
Answer and explanation in LearnFree account
Question 20 · Hard
Two years after a laparoscopic Roux-en-Y gastric bypass and a 38 kg weight loss, a 34-year-old woman has had bouts of colicky periumbilical pain after meals; the latest episode has lasted 6 hours. She is tender but not peritonitic, and lactate is 1.4 mmol/L. CT shows a swirled mesentery and clustered small-bowel loops in the left upper abdomen. What is the next best step?
1. ANasogastric decompression and observation
2. BUrgent diagnostic laparoscopy
3. CWater-soluble contrast follow-through
4. DUpper GI endoscopy
Answer and explanation in LearnFree account
Question 21 · Easy
A 34-year-old woman with a BMI of 41 kg/m² attends the bariatric OPD. She asks for an operation that involves no stapling, no division of the stomach and no bypass of the intestine, and that can be fully reversed. Which procedure fits her wish?
1. ARoux-en-Y gastric bypass
2. BOne-anastomosis gastric bypass
3. CSleeve gastrectomy
4. DAdjustable gastric banding
Answer and explanation in LearnFree account
Question 22 · Medium
A 52-year-old woman from Imphal has had dyspepsia for a year. Biopsies from an antral ulcer show a low-grade extranodal marginal zone (MALT) lymphoma limited to the stomach, and H. pylori organisms are seen on histology. Staging CT shows no enlarged nodes. What is the first line of treatment?
1. AH. pylori eradication therapy
2. BTotal gastrectomy
3. CInvolved-field radiotherapy
4. DR-CHOP chemotherapy
Answer and explanation in LearnFree account
Question 23 · Medium
A 64-year-old man has squamous cell carcinoma of the mid oesophagus on endoscopic biopsy. Contrast CT of the chest and abdomen shows no distant metastasis. Which investigation best assesses the depth of tumour invasion and the regional lymph nodes?
1. ABarium swallow
2. BMRI of the chest
3. CEndoscopic ultrasound
4. DNarrow-band imaging endoscopy
Answer and explanation in LearnFree account
Question 24 · Hard
A 70-year-old man with unresectable squamous cell carcinoma of the mid oesophagus, already treated with chemoradiotherapy, now coughs and chokes every time he drinks and has right lower lobe pneumonia. A contrast study shows a fistula between the oesophagus and the left main bronchus. His performance status is poor. What is the best palliative option?
1. AFurther radiotherapy to the tumour
2. BCovered self-expanding oesophageal stent
3. COesophagectomy with fistula repair
4. DFeeding gastrostomy, nil by mouth
Answer and explanation in LearnFree account
Question 25 · Medium
A fit 57-year-old man has adenocarcinoma of the lower oesophagus staged as cT3 N1 M0 on CT, PET-CT and endoscopic ultrasound. What is the standard treatment?
1. ANeoadjuvant chemoradiotherapy, then oesophagectomy
2. BOesophagectomy alone
3. CPalliative self-expanding metal stent
4. DEndoscopic mucosal resection
Answer and explanation in LearnFree account

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Study General Surgery

Peptic ulcer, upper GI bleeding and oesophageal disease

A 36-year-old man is taken to the OT 5 hours after the sudden onset of generalised peritonitis. At laparotomy there is a 6 mm perforation on the anterior wall of the first part of the duodenum, with bile-stained fluid in the peritoneal cavity. What is the operation of choice?

A 60-year-old man under Barrett surveillance has a 4 cm segment of Barrett mucosa with no nodule or ulcer on careful high-definition endoscopy. Random biopsies show high-grade dysplasia, confirmed by a second expert gastrointestinal pathologist. What is the preferred management?

A 42-year-old man has had recurrent duodenal ulcers despite H. pylori eradication and PPIs, and now has a jejunal ulcer and chronic watery diarrhoea. Off PPIs, fasting serum gastrin is 520 pg/mL (normal below 100) and gastric pH is 1.5. Which test confirms the diagnosis?

Consider these as risk factors for squamous cell carcinoma of the oesophagus: 1. Tobacco and alcohol use. 2. Habitual drinking of very hot beverages. 3. Long-standing achalasia cardia. 4. Barrett oesophagus. Which are correct?

A 38-year-old bank clerk from Chennai with a duodenal ulcer finished 14 days of H. pylori eradication therapy 6 weeks ago and stopped his proton pump inhibitor 2 weeks ago. He is now free of symptoms. Which test best confirms that the infection has been eradicated?

Six weeks after a sleeve gastrectomy, a 30-year-old woman who has been vomiting repeatedly is brought to the ward confused and unsteady, with horizontal nystagmus and weakness of both lateral rectus muscles. Blood glucose is 92 mg/dL. What should be given first?

On day 5 after a transthoracic oesophagectomy, a 59-year-old man's right chest drain output rises to 1.2 litres a day and turns milky white soon after enteral feeds are started. Drain fluid triglyceride is 420 mg/dL. Which structure was most likely injured?

Three months after a Roux-en-Y gastric bypass, a 41-year-old woman from Pune has palpitations, sweating, abdominal cramps and diarrhoea 15-30 minutes after meals, especially after sweets. What is the first-line management?

A 62-year-old bidi smoker from a village in Assam has progressive dysphagia, first to solids and now to semisolids, with 8 kg weight loss over 3 months. He has no heartburn. What is the first investigation?

On the second day after a laparoscopic sleeve gastrectomy, a 36-year-old man has a pulse of 128/min, temperature 38.4 °C and pain at the tip of the left shoulder, although the drain is dry. Where is a staple-line leak most likely to be?

During endoscopy for haematemesis, a 63-year-old woman is found to have a lesser-curve gastric ulcer with a non-bleeding visible vessel. Which endoscopic treatment is recommended for this ulcer?

A 34-year-old woman with a BMI of 41 kg/m² attends the bariatric OPD. She asks for an operation that involves no stapling, no division of the stomach and no bypass of the intestine, and that can be fully reversed. Which procedure fits her wish?

A 52-year-old woman from Imphal has had dyspepsia for a year. Biopsies from an antral ulcer show a low-grade extranodal marginal zone (MALT) lymphoma limited to the stomach, and H. pylori organisms are seen on histology. Staging CT shows no enlarged nodes. What is the first line of treatment?

A 64-year-old man has squamous cell carcinoma of the mid oesophagus on endoscopic biopsy. Contrast CT of the chest and abdomen shows no distant metastasis. Which investigation best assesses the depth of tumour invasion and the regional lymph nodes?

A fit 57-year-old man has adenocarcinoma of the lower oesophagus staged as cT3 N1 M0 on CT, PET-CT and endoscopic ultrasound. What is the standard treatment?