Gastroenterology Practice Questions

Q: Most common cause of significant lower GI bleeding (hematochezia) in children is

Meckel's diverticulum. ***Meckel's diverticulum*** - **Meckel's diverticulum** is the most common congenital malformation of the gastrointestinal tract and the most common cause of **painless rectal bleeding (hematochezia)** in children. - It contains **ectopic gastric or pancreatic tissue** which can cause ulceration and bleeding in adjacent healthy small bowel mucosa. *Rectal polyp* - While a cause of hematochezia in children, **rectal polyps** are typically less common than Meckel's diverticulum as the most frequent cause of significant bleeding. - They usually present with **painless, intermittent bright red blood** per rectum, often streaking the stool. *Acute gastritis* - **Acute gastritis** rarely causes significant hematochezia in children; it typically presents with **epigastric pain, nausea, and vomiting**, and if bleeding occurs, it is usually melena (black, tarry stools). - Bleeding from gastritis is often due to inflammation or ulceration in the upper GI tract, leading to digested blood in stool. *Necrotizing enterocolitis* - **Necrotizing enterocolitis** primarily affects **premature or low-birth-weight infants** and is a serious condition involving inflammation and necrosis of the bowel, often leading to bloody stools. - While it causes hematochezia, it is not the most common cause in the broader pediatric population and is typically seen in a specific demographic with other severe systemic symptoms.

Q: A 5 year old boy is detected to be HBsAg positive on two separate occasions during a screening program for hepatitis B. He is otherwise asymptomatic. Child was given three doses of recombinant hepatitis B vaccine at the age of 1 year. His mother was treated for chronic hepatitis B infection around the same time. The next relevant step for further investigating the child would be to –

Obtain HBeAg and anti-HBe levels. **Obtain HBeAg and anti–HBe levels** - Given the child is **HBsAg positive** on two separate occasions and has a mother with **chronic hepatitis B**, evaluating **HBeAg** and **anti-HBe levels** is crucial to determine if the child is in a high replicative immune tolerant phase or an immune clearance phase. - This information helps differentiate between persistent infection, risk of vertical transmission, and guides subsequent management, including the potential for antiviral therapy and monitoring requirements. *Repeat another course of Hepatitis B vaccine* - Repeating the vaccine is not indicated as the child is already **HBsAg positive**, indicating an active infection or carrier state, not a need for further immunization. - Vaccination aims to prevent infection, but in this case, the child is already confirmed to be infected. *Repeat HBsAg* - The question states the child was detected to be **HBsAg positive on two separate occasions**, making another repeat unnecessary for confirmation of infection. - The next step should aim to characterize the infection rather than re-confirm its presence. *Obtain anti HBs levels* - **Anti-HBs antibodies** indicate immunity from vaccination or resolved infection. Since the child is **HBsAg positive**, indicating active infection, anti-HBs levels would likely be negative or low and would not provide critical information about the current stage of infection. - The focus should be on characterizing the active infection, not assessing protective immunity.

Q: A child is being assessed for possible intussusception; which of the following would be LEAST likely to provide valuable information?

Family history. ***Family history*** - Intussusception is typically an **acute pediatric condition** with no strong genetic predisposition. - While certain genetic syndromes can increase risk, general family history of other conditions is **not directly relevant** to confirming or ruling out intussusception. *Pain pattern* - The classic **intermittent, colicky abdominal pain** that recurs every 15-20 minutes is a hallmark symptom of intussusception. - This pattern provides crucial diagnostic information about the **bowel telescoping and transient obstruction**. *Abdominal palpation* - Palpation can reveal a **sausage-shaped abdominal mass**, especially in the right upper quadrant, which is a classic physical finding. - Tenderness, distension, and signs of peritonitis can also be detected, indicating **bowel obstruction or perforation**. *Stool inspection* - The presence of "**currant jelly stool**" (blood and mucus) is a highly characteristic sign of intussusception, resulting from venous congestion and sloughing of the intestinal mucosa. - This finding provides clear evidence of **intestinal ischemia and bleeding**.

Q: Exocrine pancreatic insufficiency is seen in:

Shwachman-Diamond syndrome. ***Shwachman-Diamond syndrome*** - This syndrome is characterized by **exocrine pancreatic insufficiency**, neutropenia, skeletal abnormalities, and growth retardation. - The pancreatic insufficiency leads to **malabsorption** and **steatorrhea** due to insufficient production of digestive enzymes. *Rubinstein-Taybi syndrome* - This syndrome is characterized by broad thumbs and great toes, intellectual disability, and distinctive facial features, but not primarily by exocrine pancreatic insufficiency. - It is caused by mutations in the **CREBBP** or **EP300** genes, which are not directly involved in pancreatic function. *Seckel syndrome* - This is a rare genetic disorder characterized by **primordial dwarfism**, microcephaly, and intellectual disability. - While it affects growth and development, it is not typically associated with exocrine pancreatic insufficiency. *Diamond-Blackfan syndrome* - This syndrome primarily involves **pure red cell aplasia**, leading to severe anemia. - Although it can have various congenital anomalies, **exocrine pancreatic insufficiency** is not a characteristic feature of this condition.

Q: Which one of the following is the LEAST consistent with a diagnosis of intussusception?

Grossly normal appearing stool. ***Grossly normal appearing stool*** - The classic presentation of intussusception often includes **"currant jelly" stool**, which is a mixture of blood and mucus, reflecting compromised bowel viability and mucosal shedding. - Therefore, *grossly normal appearing stool* is **least consistent** with intussusception. *Intermittent colicky abdominal pain, interspersed with symptom-free periods* - This pattern of pain is highly characteristic of intussusception, where the telescoping bowel causes episodes of **severe pain** followed by periods of relative calm as the intussusception temporarily reduces or relaxes. - The pain is due to bowel obstruction and ischemia as the mesentery is dragged into the intussusception. *Normal plain films of the abdomen* - While plain films can sometimes show signs like a **"target sign"** or **dilated bowel loops**, they are often non-specific or even normal in early intussusception, especially since the diagnosis is typically made with ultrasound. - A normal plain film does not rule out intussusception and is thus not the *least* consistent finding. *Previously healthy 9-year-old child* - Intussusception usually occurs in **infants and toddlers** (3 to 36 months of age), often with no identifiable lead point. - In older children, intussusception is less common and usually has a **pathological lead point** (e.g., Meckel's diverticulum, polyp, lymphoma) that triggers the telescoping, making the case less typical but not inconsistent.

Q: In a case of hypertrophic pyloric stenosis, which of the following metabolic disturbances are found?

Metabolic alkalosis with paradoxical aciduria. ***Metabolic alkalosis with paradoxical aciduria*** - Profound **vomiting** from pyloric stenosis leads to the loss of **gastric acid** (HCl), resulting in **metabolic alkalosis**. - The kidneys attempt to conserve sodium and water in response to ongoing fluid loss, leading to increased reabsorption of bicarbonate and excretion of hydrogen ions, resulting in a **paradoxical aciduria** despite systemic alkalosis. *Metabolic acidosis* - This condition is characterized by a **low pH** and **low bicarbonate** concentration in the blood. - It is typically caused by conditions like **diabetic ketoacidosis** or **lactic acidosis**, not the loss of stomach acid from vomiting. *Respiratory alkalosis* - This occurs due to **hyperventilation**, which causes an excessive elimination of **carbon dioxide** and a subsequent increase in blood pH. - It is not directly associated with the fluid and electrolyte imbalances seen in hypertrophic pyloric stenosis. *Metabolic alkalosis with alkaline urine* - While metabolic alkalosis is correct, **alkaline urine** would imply the kidneys are appropriately compensating by excreting excess bicarbonate. - In hypertrophic pyloric stenosis, the severe volume depletion triggers a compensatory mechanism in the kidneys causing hydrogen ion excretion leading to **acidic urine**, despite systemic alkalosis.

Q: Organic causes of constipation in infants include all of the following EXCEPT:

Infantile dyschezia. ***Infantile dyschezia*** - This is a **functional condition** where infants strain and cry before passing a soft stool, due to a lack of coordination between relaxing the pelvic floor and increasing intra-abdominal pressure. It is not an organic cause of constipation. - The stool consistency in infantile dyschezia is typically **soft**, differentiating it from true constipation. *Hirschsprung's disease* - This is an **organic cause of constipation** due to the absence of **ganglion cells** in the distal colon, leading to a functional obstruction. - Infants typically present with **failure to pass meconium** within the first 24-48 hours of life, distended abdomen, and forceful expulsion of stool upon rectal examination. *Cystic fibrosis* - This is an **organic cause of constipation** in infants due to the production of thick, sticky intestinal secretions, often leading to **meconium ileus** at birth. - Constipation can also result from **pancreatic insufficiency**, which impairs fat digestion and absorption, leading to hard, dry stools later in infancy. *Hypothyroidism* - This is an **organic cause of constipation** because thyroid hormones are essential for normal gastrointestinal motility. - Infants with hypothyroidism often present with **decreased bowel movements**, lethargy, poor feeding, and prolonged jaundice.

Q: Congenital pyloric stenosis causes: 1. Bilious vomiting 2. Non-bilious vomiting 3. Projectile vomiting 4. Non-projectile vomiting 5. Forceful vomiting

2, 3 & 5. ***2, 3 & 5*** - Congenital pyloric stenosis is characterized by **non-bilious vomiting** because the obstruction is proximal to the ampulla of Vater. - The vomiting is typically **projectile** and **forceful** due to the increased pressure in the stomach as it tries to overcome the narrowed pyloric channel. *2, 3, 4 & 5* - This option incorrectly includes **non-projectile vomiting (4)**; pyloric stenosis classically presents with projectile vomiting. - While non-bilious, projectile, and forceful vomiting are correct, the inclusion of non-projectile makes this option incorrect. *1, 3 & 4* - This option incorrectly includes **bilious vomiting (1)**; pyloric stenosis causes non-bilious vomiting as the obstruction is above the bile duct entry. - It also includes **non-projectile vomiting (4)** which is not typical for pyloric stenosis. *All are seen* - This is incorrect because **bilious vomiting** and **non-projectile vomiting** are not characteristic features of congenital pyloric stenosis. - The classic presentation is consistently non-bilious, forceful, and projectile.

Q: A 5-year-old boy presented with abdominal distension, fever, bilious vomiting and constipation. He also has a history of recurrent episodes of severe pain abdomen, tenesmus and blood in stools. Exploratory laparotomy was done and a poion of intestine had to be resected, which is seen below. What is the probable diagnosis?

Crohn disease. ***Crohn disease*** - The history of **recurrent abdominal pain**, **tenesmus**, and **blood in stools** suggests Crohn disease, especially in a child with surgical resection for complications like **strictures** or **obstruction**. - **Abdominal distension**, **fever**, **bilious vomiting**, and **constipation** are indicative of an **intestinal obstruction**, a common complication of Crohn disease due to **stricture formation** and **inflammation**. *Ulcerative colitis* - While it causes **bloody diarrhea** and **tenesmus**, **abdominal distension** and **bilious vomiting** due to obstruction are less typical. - **Ulcerative colitis** primarily affects the **colon** and **rectum**, and surgical resection is usually confined to these areas, unlike the more widespread involvement seen in Crohn disease. *Celiac disease* - Characterized by **malabsorption** and symptoms like **diarrhea**, **abdominal pain**, and **failure to thrive** due to **gluten sensitivity**. - It does not typically cause **bilious vomiting**, **fever**, or acute **intestinal obstruction** requiring surgical resection in this manner. *Intestinal lymphangiectasia* - A rare disorder causing **protein-losing enteropathy**, **lymphedema**, and **malabsorption** due to dilated lymphatic vessels in the small intestine. - While it can cause **abdominal distension** and **diarrhea**, it does not typically present with **fever**, **bilious vomiting**, **tenesmus**, or surgical complications like **strictures** leading to obstruction.

Q: A 7-year-old girl from Bihar presented with three episodes of massive hematemesis and melena. There is no history of jaundice. On examination, she had a large spleen, non-palpable liver, and mild ascites. Portal vein was not visualized on ultrasonography. Liver function tests were normal and endoscopy revealed esophageal varices. The most likely diagnosis is –

Portal hypertension due to extrahepatic obstruction. ***Portal hypertension due to extrahepatic obstruction*** - The patient presents with **massive hematemesis and melena** due to **esophageal varices**, indicating **portal hypertension** [1]. - The **non-palpable liver**, **normal liver function tests**, and **non-visualization of the portal vein** on ultrasound strongly suggest an **extrahepatic cause** like **portal vein thrombosis**, rather than intrinsic liver disease [1]. *Portal hypertension of unknown etiology* - While portal hypertension is present, the specific findings, such as the non-visualization of the portal vein and normal LFTs, provide crucial clues that allow for a more precise diagnosis than simply "unknown etiology." - This option is too broad and does not account for the specific diagnostic indicators provided. *Chronic liver disease with portal hypertension* - **Normal liver function tests (LFTs)** and a **non-palpable liver** make chronic liver disease highly unlikely. - Patients with chronic liver disease (e.g., cirrhosis) typically present with **abnormal LFTs** and often a **palpable, nodular liver**. *Kala azar with portal hypertension* - While Kala-azar (visceral leishmaniasis) is endemic in Bihar and can cause **splenomegaly** and **portal hypertension**, it is usually associated with **fever**, **weight loss**, and **pancytopenia**, which are not mentioned. - Furthermore, the specific finding of a **non-visualized portal vein** on ultrasound points more directly to a mechanical obstruction of the portal vein itself rather than diffuse liver involvement as seen in Kala-azar.

Question 1

Most common cause of significant lower GI bleeding (hematochezia) in children is

Accepted Answer

Meckel's diverticulum

Answer

Rectal polyp

Answer

Acute gastritis

Answer

Necrotizing enterocolitis

Question 2

A 5 year old boy is detected to be HBsAg positive on two separate occasions during a screening program for hepatitis B. He is otherwise asymptomatic. Child was given three doses of recombinant hepatitis B vaccine at the age of 1 year. His mother was treated for chronic hepatitis B infection around the same time. The next relevant step for further investigating the child would be to –

Accepted Answer

Obtain HBeAg and anti-HBe levels

Answer

Repeat another course of Hepatitis B vaccine

Answer

Repeat HBsAg

Answer

Obtain anti HBs levels

Question 3

A child is being assessed for possible intussusception; which of the following would be LEAST likely to provide valuable information?

Accepted Answer

Family history

Answer

Pain pattern

Answer

Abdominal palpation

Answer

Stool inspection

Question 4

Exocrine pancreatic insufficiency is seen in:

Accepted Answer

Shwachman-Diamond syndrome

Answer

Rubinstein-Taybi syndrome

Answer

Seckel syndrome

Answer

Diamond-Blackfan syndrome

Question 5

Which one of the following is the LEAST consistent with a diagnosis of intussusception?

Accepted Answer

Grossly normal appearing stool

Answer

Intermittent colicky abdominal pain, interspersed with symptom-free periods

Answer

Normal plain films of the abdomen

Answer

Previously healthy 9-year-old child

Question 6

In a case of hypertrophic pyloric stenosis, which of the following metabolic disturbances are found?

Accepted Answer

Metabolic alkalosis with paradoxical aciduria

Answer

Metabolic acidosis

Answer

Respiratory alkalosis

Answer

Metabolic alkalosis with alkaline urine

Question 7

Organic causes of constipation in infants include all of the following EXCEPT:

Accepted Answer

Infantile dyschezia

Answer

Hirschsprung's disease

Answer

Cystic fibrosis

Answer

Hypothyroidism

Question 8

Congenital pyloric stenosis causes: 1. Bilious vomiting 2. Non-bilious vomiting 3. Projectile vomiting 4. Non-projectile vomiting 5. Forceful vomiting

Accepted Answer

2, 3 & 5

Answer

2, 3, 4 & 5

Answer

1, 3 & 4

Answer

All are seen

Question 9

A 5-year-old boy presented with abdominal distension, fever, bilious vomiting and constipation. He also has a history of recurrent episodes of severe pain abdomen, tenesmus and blood in stools. Exploratory laparotomy was done and a poion of intestine had to be resected, which is seen below. What is the probable diagnosis?

Accepted Answer

Crohn disease

Answer

Ulcerative colitis

Answer

Celiac disease

Answer

Intestinal lymphangiectasia

Question 10

A 7-year-old girl from Bihar presented with three episodes of massive hematemesis and melena. There is no history of jaundice. On examination, she had a large spleen, non-palpable liver, and mild ascites. Portal vein was not visualized on ultrasonography. Liver function tests were normal and endoscopy revealed esophageal varices. The most likely diagnosis is –

Accepted Answer

Portal hypertension due to extrahepatic obstruction

Answer

Chronic liver disease with portal hypertension

Answer

Portal hypertension of unknown etiology

Answer

Kala azar with portal hypertension

Gastroenterology — MCQs

Gastroenterology — MCQs

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