Gastroenterology Practice Questions

Q: A 6-week-old infant presents with a history of non-bilious, non-projectile vomiting starting at 3 weeks of age. The infant's abdominal examination is normal. Which of the following is the most likely diagnosis?

Gastroesophageal reflux disease (GERD). ***Gastroesophageal reflux disease (GERD)*** - This is the most common cause of non-bilious, **non-projectile** vomiting (regurgitation) in healthy infants, often starting early and peaking around 4-5 months of age. - The history is consistent with simple **physiologic reflux**, characterized by non-forceful spitting up and a **normal abdominal examination**. *Pyloric stenosis* - Classically involves **projectile** non-bilious vomiting that becomes progressively worse, which contradicts the non-projectile description. - A physical exam would typically reveal an **olive-like mass** (hypertrophied pylorus) or visible gastric peristalsis, which is stated to be absent. *Cow Milk Protein Allergy* - Although vomiting can occur, it is usually accompanied by other symptoms like **bloody stools**, severe irritability, or **eczema**, which are not mentioned. - Isolated, mild, non-projectile vomiting without systemic signs is less specific for a protein allergy than for GERD. *Intestinal obstruction* - Obstruction distal to the ampulla of Vater (e.g., malrotation, atresia) typically causes **bilious vomiting**, which is absent in this case. - Such conditions usually lead to an **abnormal abdominal examination** or signs of acute illness, which are not present here.

Q: A 4-week-old baby presents with non-bilious vomiting and abdominal distension. The radiological image is shown. Among the clinical features, which is the most essential finding in reaching the diagnosis of this condition?

Palpation of lump. ***Palpation of lump*** - In pyloric stenosis, the hypertrophied pylorus can often be palpated as an **olive-shaped mass** in the right upper quadrant or epigastrium. - This palpable mass upon abdominal examination is considered the most **crucial diagnostic finding** for pyloric stenosis. *Visible peristalsis* - While **visible peristaltic waves** (particularly from left to right across the epigastrium) can be a sign of pyloric stenosis, they are not specific or the most essential diagnostic feature. - Visible peristalsis indicates an attempt by the stomach to force contents past an obstruction, but its presence can vary and may not be consistently observed. *Projectile vomiting* - **Projectile non-bilious vomiting** is a classic symptom of pyloric stenosis, suggesting a significant outflow obstruction. - However, symptoms alone are not as definitive for diagnosis as the physical finding of the "olive-shaped" mass, as other conditions can also cause severe vomiting. *Loss of weight and dehydration* - **Weight loss** and **dehydration** are common consequences of persistent vomiting due to pyloric stenosis, indicating disease progression. - These are systemic effects reflecting the severity of the condition rather than a direct diagnostic feature of the underlying anatomical abnormality.

Q: A baby on day 4 of its birth presents with repeated vomiting. The vomiting is bilious in nature. What is the most possible diagnosis as per the infantogram?

Duodenal atresia. ***Duodenal atresia*** - The infantogram shows the classic "double bubble" sign, indicating a distended stomach and a dilated duodenum separated by the pylorus. This is pathognomonic for **duodenal atresia**. - **Bilious vomiting** in a neonate, especially from day 1-2 of life, is a key clinical feature of duodenal atresia due to the obstruction being distal to the ampulla of Vater. *Hypertrophic obstructive pyloric stenosis* - This condition typically presents around **3-6 weeks of age** and is characterized by **non-bilious projectile vomiting**. - Radiologically, it would show a distended stomach but not a dilated duodenum; an ultrasound showing a thickened and elongated pyloric channel is diagnostic. *Jejunal atresia* - Jejunal atresia presents with **multiple dilated loops of small bowel proximally** due to the obstruction and air-fluid levels, often leading to a "triple bubble" or multiple air-fluid levels but not the distinct double bubble sign. - While it causes bilious vomiting, the imaging pattern is different from what is seen in the provided infantogram. *Meconium ileus* - This condition is typically associated with **cystic fibrosis** and presents with abdominal distension, failure to pass meconium, and bilious vomiting. - The infantogram would show multiple dilated loops of bowel of varying caliber, often with a "ground glass" appearance due to tenacious meconium, and typically no air-fluid levels or a distinct double bubble.

Q: A 6-year-old child is brought with the following lesion. He can develop lesions in which organ in future?

Small intestine. ***Small intestine*** - The image shows **perioral melanotic macules**, specifically around the mouth, which are classic cutaneous manifestations of **Peutz-Jeghers syndrome**. - Peutz-Jeghers syndrome is an **autosomal dominant disorder** characterized by these mucocutaneous pigmentations and an increased risk of developing **hamartomatous polyps** in the gastrointestinal tract. - The **small intestine** is the **most commonly affected site** for polyps in Peutz-Jeghers syndrome, with **60-90% of patients** developing small bowel polyps, particularly in the **jejunum**. - These polyps can cause complications including **intussusception**, bleeding, and obstruction. - Patients also have an increased risk of **malignancies** in the small intestine and other organs (breast, ovary, pancreas, colon). *Colon (Large Intestine)* - While colonic polyps do occur in Peutz-Jeghers syndrome (**20-30% of cases**), they are **less frequent** than small intestinal polyps. - The colon is a secondary site of involvement compared to the small intestine. - Increased risk of colorectal cancer exists but the predominant polyp site remains the small bowel. *Stomach* - Gastric polyps occur in **approximately 25% of patients** with Peutz-Jeghers syndrome. - While gastric involvement can occur, it is **less common** than small intestinal involvement. - The stomach is a secondary site compared to the small intestine. *Esophagus* - Esophageal involvement with polyps in Peutz-Jeghers syndrome is **very rare**. - The typical distribution of hamartomatous polyps extends from stomach to rectum, with minimal esophageal involvement. - Esophagus is the least commonly affected GI organ in this syndrome.

Q: A newborn presents with bilious vomiting on the first day of life. X-ray abdomen shows:

Duodenal atresia. ***Duodenal atresia*** - The X-ray image shows a classic "double bubble" sign, which is pathognomonic for **duodenal atresia**, caused by air trapped in the stomach and the proximal dilated duodenum. - There is an absence of distal bowel gas, indicating a complete obstruction beyond the duodenum. *Jejunal atresia* - While jejunal atresia also presents with intestinal obstruction, it typically shows **multiple dilated loops of small bowel** proximal to the obstruction, not just two distinct air-filled structures. - The "double bubble" sign is not characteristic of jejunal atresia, as the obstruction occurs further down the small intestine. *Pneumatosis intestinalis* - **Pneumatosis intestinalis** is characterized by the presence of gas within the bowel wall, often appearing as linear lucencies or bubbly patterns on X-ray. - This finding is typically associated with **necrotizing enterocolitis** and is not seen in the provided image. *Hirschsprung's disease* - **Hirschsprung's disease** is characterized by the absence of ganglion cells in the distal colon, leading to a functional obstruction. - X-rays typically show a **dilated colon proximal to the aganglionic segment** and often a paucity of gas in the rectum, but not the specific "double bubble" sign seen here.

Q: Neonate is brought at 3 weeks of age, with projectile vomiting. USG was performed and is shown below. When can the abdominal mass in this condition be best palpated?

During feeding. ***During feeding*** - In **hypertrophic pyloric stenosis**, the characteristic **"olive" mass** formed by the thickened pylorus is most easily palpable **during feeding or immediately after vomiting**. - During this time, the infant’s abdominal muscles are relaxed, making palpation of the mass in the **epigastrium (right upper quadrant)** more successful. *In umbilical area* - The umbilical area is typically where **omphaloceles** or **umbilical hernias** are found, not the pyloric mass. - The pylorus is located much higher in the epigastric region, to the right of the midline. *In epigastric area* - While the pyloric mass is located in the **epigastric area**, palpation is more difficult when the infant is crying or agitated. - The question asks when it can be *best* palpated, emphasizing the conditions under which it is most detectable. *In Right upper quadrant* - The pylorus is indeed located in the **right upper quadrant/epigastrium**. - However, the optimal timing for palpation is during feeding or after vomiting, as the infant's abdomen is relaxed at that point.

Q: Which of the following statements are correct regarding the management of gastrointestinal bleeding in children? I. Somatostatin or octreotide infusion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding II. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N -butyl-2-cyanoacrylate or iso-butyl-2-cyanoacrylate III. EST has upto 90 % efficacy in controlling acute bleeding IV. Following an episode of acute variceal bleeding, all patients should receive secondary prophylaxis to prevent rebleeding Select the answer using the code given below :

III and IV. ***III and IV*** **Statement I is INCORRECT:** Somatostatin or octreotide infusions are typically administered for **3-5 days** (not 7 days) after initial bleeding has stopped to prevent rebleeding. Prolonged use beyond this period is not generally recommended due to potential side effects and lack of additional benefit. **Statement II is INCORRECT:** Endoscopic Sclerotherapy (EST) for esophageal varices involves injection of sclerosants such as **ethanolamine oleate, sodium tetradecyl sulfate**, or polidocanol. The tissue adhesives **N-butyl-2-cyanoacrylate** or **iso-butyl-2-cyanoacrylate** are used in **endoscopic variceal obturation (EVO)** for **gastric varices**, not in standard sclerotherapy for esophageal varices. **Statement III is CORRECT:** Endoscopic Sclerotherapy (EST) demonstrates **up to 90% efficacy** in controlling acute variceal bleeding, making it a highly effective intervention for managing acute hemorrhage. **Statement IV is CORRECT:** Following an episode of acute variceal bleeding, **all patients should receive secondary prophylaxis** (typically combination of non-selective beta-blockers and endoscopic band ligation) to prevent rebleeding, which is associated with significant morbidity and mortality. *I and III* - Incorrect because Statement I is wrong about the duration of vasoactive drug therapy. *II and IV* - Incorrect because Statement II confuses sclerotherapy agents with tissue adhesives used for gastric varices. *I and II* - Incorrect because both statements I and II contain inaccuracies regarding duration of therapy and sclerosing agents respectively.

Question 1

A 6-week-old infant presents with a history of non-bilious, non-projectile vomiting starting at 3 weeks of age. The infant's abdominal examination is normal. Which of the following is the most likely diagnosis?

Accepted Answer

Gastroesophageal reflux disease (GERD)

Answer

Cow Milk Protein Allergy

Answer

Intestinal obstruction

Answer

Pyloric stenosis

Question 2

A 4-week-old baby presents with non-bilious vomiting and abdominal distension. The radiological image is shown. Among the clinical features, which is the most essential finding in reaching the diagnosis of this condition?

Accepted Answer

Palpation of lump

Answer

Visible peristalsis

Answer

Projectile vomiting

Answer

Loss of weight and dehydration

Question 3

All of the following statements regarding this image are true except:

Accepted Answer

Rate of re-occurrence is $50 \%$ after non-operative reduction

Answer

Diagnosis is confirmed by USG

Answer

Seventy percent of the cases can be reduced nonoperatively

Answer

Baby may present with red currant jelly stools

Question 4

A baby presents with colicky abdominal pain. Mother gives a history of bloody stools. All the statements regarding this condition are true except:

Accepted Answer

Treatment of choice in this condition is resection and anastomosis

Answer

Most common age of presentation is between 6-9 months

Answer

Most common site is ileocolic

Answer

Most common cause of this condition is hypertrophy of Peyer's patches

Question 5

A baby on day 4 of its birth presents with repeated vomiting. The vomiting is bilious in nature. What is the most possible diagnosis as per the infantogram?

Accepted Answer

Duodenal atresia

Answer

Hypertrophic obstructive pyloric stenosis

Answer

Jejunal atresia

Answer

Meconium ileus

Question 6

A 6-year-old child is brought with the following lesion. He can develop lesions in which organ in future?

Accepted Answer

Small intestine

Answer

Esophagus

Answer

Colon (Large Intestine)

Answer

Stomach

Question 7

A 2-day-old neonate has passed stool of the color shown in the image. Which of the following best describes the clinical possibility?

Accepted Answer

Biliary atresia, perform hepatobiliary scintigraphy

Answer

It is normal meconium passed within first 24 hours

Answer

Meconium plug syndrome, perform sweat chloride test

Answer

Metabolic liver disease, perform urine for reducing substances

Question 8

A newborn presents with bilious vomiting on the first day of life. X-ray abdomen shows:

Accepted Answer

Duodenal atresia

Answer

Jejunal atresia

Answer

Pneumatosis intestinalis

Answer

Hirschsprung's disease

Question 9

Neonate is brought at 3 weeks of age, with projectile vomiting. USG was performed and is shown below. When can the abdominal mass in this condition be best palpated?

Accepted Answer

During feeding

Answer

In umbilical area

Answer

In epigastric area

Answer

In Right upper quadrant

Question 10

Which of the following statements are correct regarding the management of gastrointestinal bleeding in children?
I. Somatostatin or octreotide infusion should be given for at least 7 days after stoppage of initial bleeding to prevent rebleeding
II. Endoscopic Sclerotherapy (EST) involves endoscopic injection of N -butyl-2-cyanoacrylate or iso-butyl-2-cyanoacrylate
III. EST has upto 90 % efficacy in controlling acute bleeding
IV. Following an episode of acute variceal bleeding, all patients should receive secondary prophylaxis to prevent rebleeding

Select the answer using the code given below :

Accepted Answer

III and IV

Answer

I and III

Answer

II and IV

Answer

I and II

Gastroenterology — MCQs

Gastroenterology — MCQs

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