Acute and Chronic Diarrhea — MCQs
A child with fever with abdominal cramps & pus in stools, causative organism is ?
Persistent diarrhoea is defined as diarrhoea lasting more than?
Which organism is most likely to cause food poisoning with diarrhea within 6 hours of ingestion?
A 7-year-old girl passed 15 stools in the last 24 hours and vomited thrice in the last 4 hours. She is irritable but drinking fluids. What is the optimal therapy?
What is the definition of persistent diarrhea in infants based on duration?
In pediatrics, differential diagnoses for acute appendicitis include all EXCEPT:
Treatment in a 6-month-old child with acute watery diarrhea without signs of dehydration is:
A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?
A 4 year old child presents with acute watery diarrhea and abdominal cramps. Stool microscopy reveals trophozoites with falling leaf motility. What is the etiological agent?
Acute graft rejection occurs within?
Acute and Chronic Diarrhea Indian Medical PG Practice Questions and MCQs
Question 1: A child with fever with abdominal cramps & pus in stools, causative organism is ?
- A. EHEC
- B. ETEC
- C. EAEC (Correct Answer)
- D. EPEC
Explanation: ***EAEC (Enteroaggregative E. coli)*** - Among the E. coli strains listed, EAEC is the answer for this question, though **this is an atypical presentation**. - EAEC classically causes **persistent watery diarrhea** (>14 days) in children, often with **low-grade fever** and **abdominal pain**. - While EAEC primarily causes non-bloody diarrhea, it can occasionally produce **mucoid stools** with inflammatory cells due to mucosal inflammation from biofilm formation. - **Note:** The classic organism for fever + cramps + pus in stools would be **Shigella**, **Campylobacter**, or **EIEC (Enteroinvasive E. coli)** - not listed here. *EHEC (Enterohemorrhagic E. coli)* - EHEC (O157:H7) causes **hemorrhagic colitis** with bloody diarrhea due to **Shiga toxins**. - Can lead to **hemolytic uremic syndrome (HUS)** in children. - Characterized by **blood** rather than pus in stools, distinguishing it from typical dysentery. *ETEC (Enterotoxigenic E. coli)* - Most common cause of **traveler's diarrhea** and watery diarrhea in developing countries. - Produces **heat-labile (LT)** and **heat-stable (ST)** enterotoxins causing secretory diarrhea. - Results in profuse **watery stools without inflammation, blood, or pus**. *EPEC (Enteropathogenic E. coli)* - Leading cause of infantile diarrhea in developing countries. - Causes **attaching and effacing** lesions on intestinal mucosa. - Results in **watery diarrhea without significant inflammatory cells or pus** in stools.
Question 2: Persistent diarrhoea is defined as diarrhoea lasting more than?
- A. 28 days
- B. 21 days
- C. 14 days (Correct Answer)
- D. 7 days
Explanation: ***14 days*** - **Persistent diarrhea** is clinically defined as an episode of diarrhea that lasts for **14 days or longer**. - This definition helps differentiate it from **acute diarrhea** (less than 14 days) and aids in guiding appropriate diagnostic and management strategies. *28 days* - Diarrhea lasting **longer than 28 days** is typically classified as **chronic diarrhea**, which is a distinct category from persistent diarrhea. - Chronic diarrhea often requires a more extensive workup to identify underlying causes, which can include malabsorption syndromes, inflammatory bowel disease, or irritable bowel syndrome. *21 days* - While 21 days is a prolonged period, it falls within the spectrum of **persistent diarrhea**, but the standard definition starts at **14 days**. - There is no specific clinical classification for diarrhea lasting exactly 21 days as distinct from persistent or chronic. *7 days* - Diarrhea lasting less than 14 days, including **7 days**, is generally considered **acute diarrhea**. - Acute diarrhea is very common and often self-limiting, frequently caused by infections and typically resolves without specific intervention.
Question 3: Which organism is most likely to cause food poisoning with diarrhea within 6 hours of ingestion?
- A. Cl. perfringens
- B. Cl. botulinum
- C. V. cholerae
- D. Staph aureus (Correct Answer)
Explanation: ***Staph aureus*** - **Staphylococcus aureus** produces **heat-stable enterotoxins** that cause rapid onset of symptoms, typically within 1-6 hours of ingestion. - The symptoms are primarily **nausea, vomiting**, and **diarrhea**, due to the preformed toxin in the food. *Cl. perfringens* - **Clostridium perfringens** causes food poisoning with a longer incubation period, typically 8-16 hours, due to toxin production within the gut. - While it causes **diarrhea** and abdominal cramps, its onset is usually later than 6 hours. *Cl. botulinum* - **Clostridium botulinum** causes **botulism**, a severe neuroparalytic disease, not primarily diarrheal illness. - The incubation period for botulism is typically 12-36 hours, and symptoms include **flaccid paralysis** and **cranial nerve palsies**, not acute diarrhea within 6 hours. *V. cholerae* - **Vibrio cholerae** causes **cholera**, characterized by severe **watery diarrhea** with a much longer incubation period, usually 1-3 days. - The mechanism involves toxin production in the intestine, which would not result in symptoms within 6 hours.
Question 4: A 7-year-old girl passed 15 stools in the last 24 hours and vomited thrice in the last 4 hours. She is irritable but drinking fluids. What is the optimal therapy?
- A. IV fluids
- B. IV fluids followed by ORS
- C. ORS (Correct Answer)
- D. Home fluids
Explanation: ***Correct: ORS (Oral Rehydration Solution)*** - The child has **some dehydration** (15 stools/24h, irritable, recent vomiting) - **Key feature: She is able to drink fluids** - this is the critical determinant for ORS therapy - According to **WHO Plan B** and **IAP guidelines**, children with some dehydration who can drink should receive ORS - ORS should be given at **75 mL/kg over 4 hours** for some dehydration - This is the **optimal first-line therapy** for this dehydration level *Incorrect: IV fluids* - Too aggressive for a child who can drink fluids - Reserved for **severe dehydration** or inability to tolerate oral intake - Unnecessary invasive intervention with associated risks *Incorrect: IV fluids followed by ORS* - IV therapy is not indicated as first-line when child can drink - This approach is used when IV rehydration is needed initially but child improves - Overtreatment for this clinical scenario *Incorrect: Home fluids* - Insufficient for documented dehydration with high stool frequency - Does not provide the **balanced electrolyte composition** of ORS - Home fluids (water, juices) may worsen electrolyte imbalance
Question 5: What is the definition of persistent diarrhea in infants based on duration?
- A. 14 days
- B. More than 14 days (Correct Answer)
- C. Less than 14 days (Acute diarrhea)
- D. 7 days
Explanation: ***Correct: More than 14 days*** - Persistent diarrhea is defined as diarrhea lasting **more than 14 days** according to WHO and standard pediatric guidelines - This classification is crucial for differentiating it from acute diarrhea and guiding management strategies - Persistent diarrhea carries increased risk of **malnutrition, dehydration, and micronutrient deficiencies** - Requires different management approach including nutritional rehabilitation and evaluation for underlying causes *Incorrect: 14 days* - Diarrhea lasting **exactly 14 days** is at the boundary but does not meet the criterion for persistent diarrhea - The definition requires duration to **exceed** 14 days, not just reach it *Incorrect: Less than 14 days (Acute diarrhea)* - Diarrhea lasting **less than 14 days** is classified as **acute diarrhea** - Acute diarrhea typically has different etiology (mostly viral) and is generally self-limiting - Management focuses on rehydration and rarely leads to the severe nutritional complications seen in persistent cases *Incorrect: 7 days* - 7 days is well within the acute diarrhea range - Has no special significance in the classification of diarrhea duration - Most acute diarrheal episodes resolve within 5-7 days
Question 6: In pediatrics, differential diagnoses for acute appendicitis include all EXCEPT:
- A. Gastroenteritis
- B. Volvulus
- C. Trauma (Correct Answer)
- D. Torsion
Explanation: ***Trauma*** - While trauma can cause abdominal pain, it is **not typically a differential diagnosis for acute appendicitis** as the mechanism of injury and clinical presentation are distinct. - Appendicitis involves inflammation of the appendix, whereas trauma involves direct injury to abdominal organs or tissues. *Gastroenteritis* - **Gastroenteritis** can present with diffuse abdominal pain, nausea, vomiting, and fever, mimicking early symptoms of appendicitis. - However, appendicitis pain often localizes to the right lower quadrant, unlike the more generalized pain of gastroenteritis. *Volvulus* - **Volvulus**, especially in infants and young children, presents with severe, colicky abdominal pain, bilious vomiting, and signs of intestinal obstruction, which can overlap with appendicitis symptoms. - Unlike appendicitis, volvulus involves the twisting of a bowel loop, leading to vascular compromise and often requiring urgent surgical intervention. *Torsion* - **Ovarian torsion** or **testicular torsion** can cause acute, severe unilateral lower abdominal or pelvic pain, mimicking appendicitis due to proximity and similar pain presentation in children. - These conditions are distinct from appendicitis as they involve the twisting of adnexal structures or testes, leading to ischemia.
Question 7: Treatment in a 6-month-old child with acute watery diarrhea without signs of dehydration is:
- A. Mothers milk and household fluids (Correct Answer)
- B. ORS and antibiotics
- C. Mothers milk and antibiotics
- D. All of the options
Explanation: ***Mothers milk and household fluids*** - For a 6-month-old with **acute watery diarrhea** and **no signs of dehydration**, WHO Plan A management includes continued **breastfeeding (mother's milk)** for nutrition and hydration, along with **extra household fluids** like clean water. - **Note:** Ideally, **ORS should also be given** to prevent dehydration as per WHO guidelines, but among the given options, this is the most appropriate choice as it avoids unnecessary antibiotics. - This focuses on maintaining hydration and supporting recovery through adequate fluid and nutrient intake. *ORS and antibiotics* - While **ORS is actually recommended** in Plan A management (even without dehydration) to prevent progression, this option is incorrect because **antibiotics** are not indicated for acute watery diarrhea. - Most acute watery diarrhea cases are **viral** (rotavirus, norovirus) and self-limiting; antibiotics are reserved for specific bacterial infections with systemic features or bloody diarrhea. - The inclusion of antibiotics makes this option inappropriate. *Mothers milk and antibiotics* - While **mother's milk** is essential, **antibiotics** are unnecessary for uncomplicated acute watery diarrhea without dehydration. - Routine antibiotic use can lead to **antimicrobial resistance** and disrupt the intestinal microbiome, potentially prolonging diarrhea. *All of the options* - This is incorrect because **antibiotics** are not appropriate for routine acute watery diarrhea without signs of bacterial infection or systemic illness. - The correct management avoids unnecessary antibiotic use.
Question 8: A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?
- A. Age < 11 years (Correct Answer)
- B. INR > 6.5
- C. Jaundice < 7 days before development of encephalopathy
- D. Bilirubin > 300 mmol/L
Explanation: ***Age < 11 years*** - Age is **NOT included** in the original King's College criteria for acute liver failure - King's College criteria are based on **biochemical parameters** (INR, bilirubin, pH, creatinine) and **clinical factors** (encephalopathy grade, jaundice-to-encephalopathy interval), not patient age - While **younger age may be a prognostic factor** in pediatric liver failure, it is not part of the formal King's College criteria used to predict poor prognosis or need for transplantation *INR > 6.5* - An **elevated INR > 6.5** (or PT > 100 seconds) is a **key criterion** in King's College criteria for non-paracetamol acute liver failure - Indicates severe **coagulopathy** and hepatic synthetic dysfunction - One of the most important predictors of poor outcome *Jaundice < 7 days before development of encephalopathy* - The **interval from jaundice to encephalopathy** is explicitly included in King's College criteria for non-paracetamol ALF - Jaundice to encephalopathy < 7 days = hyperacute (relatively better prognosis) - Jaundice to encephalopathy > 7 days = subacute (worse prognosis, indicates need for transplant) - This temporal relationship is a **critical prognostic indicator** *Bilirubin > 300 mmol/L* - **Serum bilirubin > 300 μmol/L** (17.5 mg/dL) is explicitly included in King's College criteria for non-paracetamol ALF - Indicates severe **cholestasis** and hepatocellular dysfunction - Part of the multi-parameter assessment for transplant listing
Question 9: A 4 year old child presents with acute watery diarrhea and abdominal cramps. Stool microscopy reveals trophozoites with falling leaf motility. What is the etiological agent?
- A. Giardia lamblia (Correct Answer)
- B. Trichomonas tenax
- C. Balantidium coli
- D. Entamoeba histolytica
Explanation: **Giardia lamblia** - The presence of **trophozoites** with characteristic **falling leaf motility** in stool microscopy is pathognomonic for **Giardia lamblia** infection. - **Giardiasis** commonly causes **acute watery diarrhea** and **abdominal cramps** in children, often acquired through contaminated water or food. *Entamoeba histolytica* - **Entamoeba histolytica** causes **amoebic dysentery**, characterized by bloody diarrhea, unlike the watery diarrhea described. - Its trophozoites exhibit **directional motility** with pseudopods and may contain ingested red blood cells, not falling leaf motility. *Trichomonas tenax* - **Trichomonas tenax** is found in the **oral cavity** and is not associated with intestinal infections or diarrhea. - Its typical habitat and clinical presentation are entirely different from the symptoms described. *Balantidium coli* - **Balantidium coli** is a large, ciliated protozoan whose trophozoites have a **distinctive kidney-shaped macronucleus** and rotary motility with cilia. - It causes **balantidiasis**, which can range from asymptomatic to dysentery, but its trophozoite morphology and motility are distinct from falling leaf.
Question 10: Acute graft rejection occurs within?
- A. Few minutes
- B. 6-12 months
- C. Few hours
- D. < 6 months (Correct Answer)
Explanation: ***< 6 months*** - **Acute graft rejection** typically occurs within the first few **weeks to months** after transplantation due to a T-cell mediated immune response against the donor organ [1]. - While it can manifest at any time, the majority of cases occur within the **first 6 months** post-transplant, making this the most appropriate time frame [1]. *Few minutes* - Rejection presenting within minutes of transplantation is characteristic of **hyperacute rejection**, which is caused by pre-existing **donor-specific antibodies** [1]. - This rapid form of rejection is mediated by **complement activation** and leads to immediate graft failure [1]. *6-12 months* - Rejection occurring in this timeframe might still be acute, but the peak incidence is generally earlier. - Rejection presenting after 6 months is often categorized as **late acute rejection** or may start to transition towards signs of chronic rejection, which occurs over a longer period. *Few hours* - Rejection within a few hours could be a very early form of **acute rejection** or a delayed presentation of **hyperacute rejection** [1]. - However, the classic presentation of acute rejection is more prolonged than a few hours, usually developing over days to weeks. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 241-242.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free