Gastroenterology Practice Questions

Q: A 6-year-old child presents with joint pain and a purpuric rash over the buttocks and lower limbs. The rash is palpable and non -blanching. An image of the rash is shown. The child also complains of colicky abdominal pain. What is the most likely diagnos is?

Henoch –Schönlein purpura. ***Henoch-Schönlein purpura*** - This condition, also known as **IgA vasculitis**, classically presents with the triad of **palpable purpura** on dependent areas (lower limbs/buttocks), **arthritis/arthralgia**, and **abdominal pain** due to vasculitis of the bowel wall. - Diagnosis is supported by clinical presentation without significant thrombocytopenia, distinguishing it from platelet-related disorders. *Immune thrombocytopenic purpura* - Characterized by isolated **thrombocytopenia** resulting in **petechiae** and **ecchymoses** rather than palpable, raised lesions. - Abdominal pain and joint involvement are generally not features of this condition. *Acute rheumatic fever* - Presents with **migratory polyarthritis** and potential cardiac involvement following a **Group A Streptococcus** infection. - While it involves joints, it does not present with the characteristic palpable purpuric rash seen in vasculitis. *Kawasaki disease* - Manifests primarily as **prolonged high fever**, **conjunctivitis**, **mucosal changes** (strawberry tongue), and **polymorphous rash**. - The rash is typically not palpable purpura, and the condition is strongly associated with **coronary artery aneurysms**.

Q: A 5-year-old female is brought to OPD with a red mass protruding from the anal verge after defecation. On examination, the mass is 4 cm long and demonstrates concentric mucosal folds. What is the most appropriate initial management?

Conservative. ***Conservative management*** - Pediatric **rectal prolapse** is most commonly self-limiting and resolved by treating the underlying cause, such as **constipation**, **parasitic infection**, or **diarrhea**, and teaching the child to avoid prolonged straining. - Biofeedback or behavioral modifications, such as using a footstool while defecating to achieve a better anatomic position, are highly effective **initial management** strategies. *Injection Sclerotherapy* - This invasive procedure involves injecting an **irritant solution** into the perirectal space to create inflammation and fibrosis, which is generally reserved for patients who have failed long-term conservative treatment. - It carries significant risks, including **rectal ulceration**, **stricture formation**, and **perirectal abscess**, making it unsuitable as a primary approach. *Suture Rectopexy* - This is a surgical intervention indicated only for **refractory cases** or those unresponsive to comprehensive medical management and conservative measures. - It is overly aggressive for a typical 5-year-old presenting without red flags or complications, meaning surgery should be deferred until non-surgical avenues are exhausted. *Thiersch Stitch* - This procedure involves encircling the anal verge with a foreign material (like wire or suture) to narrow the anal opening, which is rarely indicated and primarily reserved for frail, elderly patients with **incontinence**. - It is associated with high rates of **fecal impaction** and infection, making it inappropriate and unnecessary for a pediatric patient.

Q: Sandifer syndrome due to GERD in infants is confused with which of the following conditions?

Seizures. **Explanation:** **Sandifer syndrome** is a paroxysmal movement disorder associated with **Gastroesophageal Reflux Disease (GERD)** in infants and young children. It is characterized by abnormal posturing of the head, neck, and trunk (torticollis and opisthotonus) during or immediately after feeding. **Why Seizures is the correct answer:** The classic presentation involves sudden, repetitive episodes of arching the back and tilting the head to one side. These movements are often mistaken for **infantile spasms or focal seizures**. The underlying mechanism is a physiological response where the child assumes these positions to lengthen the esophagus and increase the lower esophageal sphincter pressure, thereby reducing the pain caused by acid reflux. Because the movements are episodic and paroxysmal, they frequently lead to unnecessary neurological workups (like EEGs) before the GI cause is identified. **Why other options are incorrect:** * **Recurrent vomiting:** While vomiting is a symptom of GERD, it is the *clinical manifestation* of the reflux itself, not a condition that the specific "posturing" of Sandifer syndrome is confused with. * **Acute otitis media & Sinusitis:** While chronic GERD can lead to ENT complications (like recurrent ear infections) due to micro-aspiration or Eustachian tube dysfunction, these conditions do not present with the paroxysmal motor movements that mimic neurological disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Triad of Sandifer Syndrome:** GERD, Hiatus hernia (often present), and abnormal posturing (Torticollis/Opisthotonus). * **Diagnosis:** Primarily clinical; confirmed by pH monitoring or improvement with anti-reflux therapy (PPIs). * **Key Differentiator:** Unlike seizures, Sandifer syndrome episodes are strictly associated with feeding and are not accompanied by post-ictal confusion or abnormal EEG activity.

Q: Hypertrophic pyloric stenosis typically presents after how many months of age?

One month. **Explanation:** **Infantile Hypertrophic Pyloric Stenosis (IHPS)** is a condition characterized by hypertrophy and hyperplasia of the pyloric sphincter muscles, leading to gastric outlet obstruction. 1. **Why Option A is correct:** The classic presentation of IHPS occurs between **3 to 6 weeks of life** (averaging around 1 month). While the anatomical predisposition may exist earlier, the muscular hypertrophy progresses over time until it causes a significant clinical obstruction. Therefore, "one month" is the most accurate timeframe for the onset of symptoms. 2. **Why Options B, C, and D are incorrect:** * **Two/Three months:** While IHPS can occasionally present later, it is rare after 12 weeks. Most cases are diagnosed well before the end of the second month. * **Six months:** This is far outside the typical window. Vomiting starting at six months is more likely due to GERD, introduction of solids, or other anatomical obstructions like malrotation. **Clinical Pearls for NEET-PG:** * **Classic Presentation:** Non-bilious, projectile vomiting in a "hungry vomiter" (the infant wants to feed again immediately after vomiting). * **Physical Exam:** A palpable, olive-shaped mass in the epigastrium (best felt after a feed or vomiting) and visible gastric peristalsis. * **Metabolic Profile:** **Hypochloremic, hypokalemic metabolic alkalosis** with paradoxical aciduria (High-yield for exams). * **Diagnosis:** Ultrasound is the gold standard (Pyloric muscle thickness >4mm or length >14mm). * **Management:** Initial step is fluid resuscitation (Normal Saline); definitive treatment is **Ramstedt’s Pyloromyotomy**.

Q: A child has a history of profuse watery diarrhea, is not taking oral fluids, and has not passed urine for 2 days. Which of the following should be given?

Intravenous (IV) fluids. **Explanation:** The clinical presentation of profuse watery diarrhea, inability to take oral fluids (refusal to drink), and anuria (no urine output for 2 days) indicates **Severe Dehydration** and potential hypovolemic shock. 1. **Why IV Fluids are correct:** According to WHO and IAP guidelines, severe dehydration is a medical emergency. Since the child is unable to drink and shows signs of renal hypoperfusion (anuria), the immediate priority is rapid volume expansion to restore intravascular volume and prevent organ failure. **Intravenous (IV) fluids (specifically Ringer’s Lactate or Normal Saline)** are the treatment of choice (Plan C) to stabilize the hemodynamics. 2. **Why other options are incorrect:** * **ORS:** While ORS is the mainstay for mild-to-moderate dehydration (Plan A and B), it is contraindicated here because the child is "not taking oral fluids." Forcing oral fluids in a severely dehydrated, potentially lethargic child increases the risk of aspiration. * **Milk:** Milk does not contain the necessary electrolyte concentration to correct severe dehydration and may worsen osmotic diarrhea in some cases. * **IV Antibiotics:** Most cases of watery diarrhea are viral (e.g., Rotavirus). Antibiotics are not indicated unless there is evidence of systemic infection or specific pathogens like *Vibrio cholerae* or *Shigella* (dysentery). Regardless, fluid resuscitation always precedes antibiotic therapy. **NEET-PG High-Yield Pearls:** * **WHO Plan C (Severe Dehydration):** 100 ml/kg of IV Ringer’s Lactate. * *Infants ( 2 seconds), and inability to drink.

Q: A toddler presents with a few drops of blood coming out of the rectum. What is the probable diagnosis?

Juvenile rectal polyp. ### Explanation **1. Why Juvenile Rectal Polyp is the Correct Answer:** In the pediatric age group (especially toddlers aged 2–5 years), **Juvenile Polyps** are the most common cause of painless lower gastrointestinal bleeding. These are typically "hamartomatous" (benign) solitary lesions located in the rectosigmoid area. The classic presentation is **painless, bright red streaks of blood** on the surface of the stool or a few drops of blood at the end of defecation. Occasionally, the polyp may prolapse through the anus during straining. **2. Why the Other Options are Incorrect:** * **Adenomatous Polyposis Coli (APC):** This is a premalignant condition characterized by hundreds of polyps. It usually presents in late childhood or adolescence, not typically in a toddler, and is associated with a high risk of malignancy. * **Rectal Ulcer:** Solitary Rectal Ulcer Syndrome (SRUS) is rare in toddlers and is usually associated with chronic straining, mucus discharge, and a feeling of incomplete evacuation. * **Piles (Hemorrhoids):** These are extremely rare in the pediatric population. If present in a child, they are usually secondary to portal hypertension (e.g., cirrhosis or extrahepatic portal vein obstruction). **3. NEET-PG High-Yield Pearls:** * **Most common site:** Rectosigmoid (80-90%). * **Histology:** Hamartomatous (not neoplastic). * **Management:** Colonoscopic snare polypectomy is the treatment of choice. * **Differential Diagnosis:** If the bleeding is associated with pain, consider **Anal Fissure** (the most common cause of *painful* rectal bleeding in children). * **Juvenile Polyposis Syndrome:** Defined by >5 polyps or a family history; unlike solitary polyps, this syndrome carries an increased risk of GI malignancy.

Q: What is the molar concentration of sodium in standard oral rehydration fluid?

50 mEq/L. **Explanation:** The correct answer is **75 mEq/L**. *(Note: There appears to be a discrepancy in the prompt's provided key. According to current WHO/UNICEF guidelines, the standard "Reduced Osmolarity ORS" contains 75 mEq/L of Sodium. If the question refers to the older "Standard/High Osmolarity ORS," the value is 90 mEq/L. A value of 50 mEq/L is typically seen in ReSoMal or maintenance fluids.)* **1. Why 75 mEq/L is the Standard:** The current WHO-recommended **Reduced Osmolarity ORS** is the global standard for managing dehydration in diarrhea. It contains **75 mEq/L of Sodium** and 75 mmol/L of Glucose (Total Osmolarity: 245 mOsm/L). This concentration is optimal because it utilizes the SGLT-1 receptor for sodium-glucose co-transport while minimizing the risk of osmotic diarrhea and hypernatremia associated with older, more concentrated formulas. **2. Analysis of Incorrect Options:** * **30 mEq/L (Option A):** This is too low for rehydration in acute diarrhea; it is closer to the sodium content in some maintenance IV fluids or pediatric juices. * **45-50 mEq/L (Option B):** This is the sodium concentration found in **ReSoMal** (Rehydration Solution for Malnutrition), used specifically for children with Severe Acute Malnutrition (SAM) to avoid sodium overload. * **90 mEq/L (Option D):** This was the sodium concentration of the **Old WHO ORS** (Standard ORS). While effective for cholera, it was found to increase stool output and risk of hypernatremia in non-cholera cases. **High-Yield Clinical Pearls for NEET-PG:** * **Total Osmolarity of Reduced ORS:** 245 mOsm/L (Crucial for exams). * **Potassium concentration:** Always 20 mEq/L in both old and new formulas. * **Citrate vs. Bicarbonate:** Modern ORS uses Trisodium Citrate (2.9 g/L) because it is more stable in tropical climates than Bicarbonate. * **Zinc Supplementation:** Always give 20 mg/day (10 mg if <6 months) for 14 days alongside ORS to reduce recurrence.

Q: An apparently healthy newborn with a good appetite begins feedings with formula. After feeding, when laid down in the crib, the infant experiences projectile vomiting. Which of the following conditions is a probable cause of this vomiting?

Esophageal hiatal hernia. **Explanation:** The correct answer is **Esophageal hiatal hernia (Option B)**. In this condition, a portion of the stomach protrudes through the esophageal hiatus into the thoracic cavity. This disrupts the normal anti-reflux mechanism of the lower esophageal sphincter (LES). When the infant is laid flat after a feeding, the lack of a functional sphincter and the effect of gravity allow gastric contents to reflux forcefully, leading to **projectile vomiting**. While projectile vomiting is classically associated with Hypertrophic Pyloric Stenosis (HPS), HPS typically presents at 3–6 weeks of age, whereas hiatal hernia can manifest shortly after birth. **Analysis of Incorrect Options:** * **A. Physiological umbilical herniation:** This is a normal developmental stage between the 6th and 10th weeks of gestation where midgut loops reside in the umbilical cord. It does not cause vomiting. * **C. Tetralogy of Fallot:** This is a cyanotic heart disease characterized by "Tet spells" and cyanosis, not gastrointestinal obstruction or projectile vomiting. * **D. Congenital diaphragmatic hernia (CDH):** CDH typically presents in the immediate neonatal period with **respiratory distress** and a scaphoid abdomen. While it involves herniation of abdominal contents, the primary clinical emergency is pulmonary hypoplasia, not post-prandial projectile vomiting. **NEET-PG High-Yield Pearls:** * **Projectile Vomiting (Non-bilious):** Think HPS (3–6 weeks) or Hiatal Hernia/GERD (early infancy). * **Projectile Vomiting (Bilious):** Think Duodenal Atresia (Double-bubble sign) or Malrotation with Volvulus. * **Hiatal Hernia Association:** It is a component of **Saint’s Triad** (Hiatal hernia, Diverticulosis, and Cholelithiasis). * **Management:** Most pediatric hiatal hernias are managed conservatively with thickened feeds and upright positioning (propped up) after meals.

Question 1

A 6-year-old child presents with joint pain and a purpuric rash over the buttocks and lower limbs. The rash is palpable and non -blanching. An image of the rash is shown. The child also complains of colicky abdominal pain. What is the most likely diagnos is?

Accepted Answer

Henoch –Schönlein purpura

Answer

Immune thrombocytopenic purpura

Answer

Acute rheumatic fever

Answer

Kawasaki disease

Question 2

A 5-year-old female is brought to OPD with a red mass protruding from the anal verge after defecation. On examination, the mass is 4 cm long and demonstrates concentric mucosal folds. What is the most appropriate initial management?

Accepted Answer

Conservative

Answer

Injection Sclerotherapy

Answer

Suture Rectopexy

Answer

Thiersch Stitch

Question 3

Sandifer syndrome due to GERD in infants is confused with which of the following conditions?

Accepted Answer

Seizures

Answer

Recurrent vomiting

Answer

Acute otitis media

Answer

Sinusitis

Question 4

Hypertrophic pyloric stenosis typically presents after how many months of age?

Accepted Answer

One month

Answer

Two months

Answer

Three months

Answer

Six months

Question 5

A child has a history of profuse watery diarrhea, is not taking oral fluids, and has not passed urine for 2 days. Which of the following should be given?

Accepted Answer

Intravenous (IV) fluids

Answer

Milk

Answer

Oral rehydration solution (ORS)

Answer

Intravenous (IV) antibiotics

Question 6

A toddler presents with a few drops of blood coming out of the rectum. What is the probable diagnosis?

Accepted Answer

Juvenile rectal polyp

Answer

Adenomatous Polyposis Coli

Answer

Rectal ulcer

Answer

Piles

Question 7

What is the recommended anticopper drug for Wilson's disease in paediatric patients?

Accepted Answer

Zinc

Answer

Trientine

Answer

Tetrathiomolybdate

Answer

d-penicillamine

Question 8

What is the molar concentration of sodium in standard oral rehydration fluid?

Accepted Answer

50 mEq/L

Answer

30 mEq/L

Answer

75 mEq/L

Answer

90 mEq/L

Question 9

Which of the following statements regarding Hirschsprung disease is false?

Accepted Answer

Absence of stools after digital rectal examination is a characteristic finding.

Answer

Aganglionosis always involves the distal rectum.

Answer

Failure to pass meconium within the first 24 hours of life is a cardinal feature.

Answer

Diagnosis is established by suction rectal biopsy.

Question 10

An apparently healthy newborn with a good appetite begins feedings with formula. After feeding, when laid down in the crib, the infant experiences projectile vomiting. Which of the following conditions is a probable cause of this vomiting?

Accepted Answer

Esophageal hiatal hernia

Answer

Physiological umbilical herniation

Answer

Tetralogy of Fallot

Answer

Congenital diaphragmatic hernia

Gastroenterology — MCQs

Gastroenterology — MCQs

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