Gastroenterology Practice Questions

Q: A coin is lodged in the esophagus of an asymptomatic 3-year-old female child. What is the recommended treatment?

Endoscopic removal after 24 hours. **Explanation:** The management of esophageal foreign bodies depends on the **nature of the object**, the **location**, and the **symptomatology** of the patient. **1. Why Option A is correct:** For a **blunt object** (like a coin) lodged in the esophagus of an **asymptomatic** child, a period of observation for up to **24 hours** is recommended. Many coins pass spontaneously into the stomach during this window. If the coin remains in the esophagus after 24 hours, endoscopic removal is indicated to prevent mucosal ulceration or stricture formation. **2. Why other options are incorrect:** * **Option B:** Immediate removal is reserved for **symptomatic** patients (drooling, respiratory distress), **sharp objects**, **button batteries** (due to risk of corrosive injury), or if the airway is compromised. * **Option C:** Waiting for 48 hours increases the risk of pressure necrosis and esophageal perforation. The standard observation limit for esophageal foreign bodies is 24 hours. * **Option D:** Blindly pushing the object with a Ryle’s tube is contraindicated as it can cause esophageal trauma or lead to accidental aspiration into the airway. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of lodgment:** Cricopharyngeus muscle (Upper Esophageal Sphincter). * **Radiology:** On X-ray (AP view), a coin in the **esophagus** appears as a full circle ("face-on"), whereas a coin in the **trachea** appears as a thin line (on edge). * **Button Battery:** This is a **surgical emergency** if lodged in the esophagus; it can cause liquefactive necrosis and perforation within 2 hours. * **Post-Stomach:** Once a coin passes the pylorus into the stomach, it usually passes through the entire GI tract spontaneously. Intervention is only needed if it remains in the stomach for >3-4 weeks.

Q: A child is brought with bleeding nostrils. There is a history of viral infection 3 months back and treatment with aspirin. What is the most likely diagnosis?

Reye's Syndrome. **Explanation:** The clinical scenario describes a classic presentation of **Reye’s Syndrome**. The key diagnostic triggers are a **preceding viral illness** (typically Influenza or Varicella) followed by the administration of **Aspirin (salicylates)**. Reye’s Syndrome is characterized by acute non-inflammatory encephalopathy and fatty degeneration of the liver. The underlying pathophysiology involves **mitochondrial dysfunction**, leading to impaired fatty acid oxidation. This results in severe hepatic dysfunction, causing a decrease in the synthesis of clotting factors and subsequent bleeding manifestations, such as epistaxis (bleeding nostrils), hematemesis, or ecchymosis. **Analysis of Incorrect Options:** * **ITP (A):** While ITP presents with mucosal bleeding and often follows a viral infection, it is not specifically associated with aspirin use. The hallmark is isolated thrombocytopenia, whereas Reye’s involves multi-organ (liver/brain) dysfunction. * **Epistaxis (C):** This is a clinical sign (symptom), not a systemic diagnosis. Given the specific history of aspirin and viral illness, a systemic cause must be prioritized. * **DIC (D):** DIC involves widespread activation of coagulation and is usually seen in sepsis or shock. While it causes bleeding, the specific "Aspirin + Viral illness" triad is pathognomonic for Reye’s. **NEET-PG High-Yield Pearls:** * **Liver Biopsy Finding:** Microvesicular steatosis (fatty change) without significant inflammation. * **Biochemical Markers:** Elevated serum ammonia, prolonged Prothrombin Time (PT), and elevated AST/ALT (3x normal). Bilirubin is usually normal or only slightly elevated. * **Electron Microscopy:** Shows "swollen, amoeboid" mitochondria. * **Contraindication:** Aspirin is contraindicated in children with fever/viral illness; **Acetaminophen** is the preferred antipyretic.

Q: What is the characteristic liver finding in a child with Reye's syndrome?

Microvesicular steatosis. **Explanation:** **Reye’s Syndrome** is an acute, non-inflammatory encephalopathy associated with fatty degeneration of the liver. It typically occurs in children following a viral prodrome (like Influenza or Varicella) who have been treated with **aspirin (salicylates)**. **Why Microvesicular Steatosis is Correct:** The pathophysiology involves **mitochondrial dysfunction**, leading to the inhibition of fatty acid beta-oxidation. This results in the accumulation of small fat droplets within the cytoplasm of hepatocytes that do not displace the nucleus. This specific histological pattern is known as **microvesicular steatosis**. Unlike many other liver pathologies, there is a characteristic **absence of inflammation** or significant necrosis. **Analysis of Incorrect Options:** * **A. Macrovesicular steatosis:** This is characterized by large fat globules that displace the nucleus to the periphery. It is typically seen in **Alcoholic Liver Disease**, Non-Alcoholic Fatty Liver Disease (NAFLD), and Obesity. * **C. Hepatocellular necrosis:** While severe Reye’s can show some cell death, the hallmark is fatty change without significant necrosis. Massive necrosis is more characteristic of **Paracetamol (Acetaminophen) poisoning** or viral hepatitis. * **D. Noncaseating epithelioid granulomas:** These are characteristic of **Sarcoidosis**, Tuberculosis (though usually caseating), or certain drug reactions, but are not seen in Reye’s syndrome. **NEET-PG High-Yield Pearls:** * **Clinical Triad:** Viral illness + Aspirin use + Persistent vomiting/altered sensorium. * **Biochemical findings:** Elevated serum ammonia (hyperammonemia), prolonged PT/INR, and elevated AST/ALT, but **normal bilirubin** (a key diagnostic clue). * **Electron Microscopy:** Shows "swollen, pleomorphic mitochondria" (Ames' bodies). * **Treatment:** Supportive; focus on managing cerebral edema (Mannitol) and hypoglycemia.

Q: Which of the following is true about Extrahepatic biliary atresia?

All of these. **Explanation:** Extrahepatic Biliary Atresia (EHBA) is a progressive, idiopathic fibro-obliterative disease of the extrahepatic biliary tree, leading to bile flow obstruction. It is the most common cause of neonatal cholestasis and the leading indication for pediatric liver transplantation. **Analysis of Options:** * **Acholic Stools (Option A):** Due to the complete anatomical obstruction or obliteration of the bile ducts, bile (bilirubin) cannot reach the small intestine. This results in the characteristic pale, clay-colored, or "acholic" stools. * **Conjugated Hyperbilirubinemia (Option B):** In EHBA, the liver can conjugate bilirubin, but the obstructive pathology prevents its excretion into the gut. This leads to a backup of conjugated bilirubin into the bloodstream (defined as a direct bilirubin >1.0 mg/dL if total bilirubin is 20% of the total). * **Absence of nuclide in duodenum in HIDA scan (Option C):** The Hepatobiliary Iminodiacetic Acid (HIDA) scan is a functional imaging study. In EHBA, the radiotracer is taken up by the hepatocytes but fails to be excreted into the duodenum even after 24 hours, confirming biliary obstruction. **Conclusion:** Since all three clinical and diagnostic features are hallmarks of the disease, **Option D (All of these)** is correct. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Intraoperative Cholangiogram (IOCG). * **Best Initial Screening:** Fractionated bilirubin and Ultrasound (look for the **"Triangular Cord Sign"**). * **Management:** The **Kasai Procedure** (Hepatoportoenterostomy) is the surgery of choice. * **Prognostic Factor:** The Kasai procedure is most successful if performed early, ideally **before 60 days of life**. * **Differential:** Always rule out Choledochal cyst via ultrasound.

Q: Pseudopancreatic cyst in a child is commonly due to which of the following?

Traumatic pancreatitis. **Explanation:** **1. Why Traumatic Pancreatitis is Correct:** In the pediatric population, **blunt abdominal trauma** (e.g., bicycle handlebar injuries, motor vehicle accidents, or child abuse) is the most common cause of acute pancreatitis and subsequent pseudocyst formation. A pseudocyst is a collection of pancreatic juice enclosed by a wall of inflammatory/fibrous tissue (lacking an epithelial lining, hence "pseudo"). In children, the pancreas is relatively fixed against the vertebral column, making it susceptible to compression and ductal injury during blunt impact. **2. Analysis of Incorrect Options:** * **Annular Pancreas (A):** This is a congenital anomaly where pancreatic tissue encircles the duodenum. While it can cause duodenal obstruction or chronic pancreatitis, it is a rare cause of pseudocysts compared to trauma. * **Drug-induced Pancreatitis (B):** While certain drugs (e.g., Valproic acid, L-asparaginase, Steroids) cause pancreatitis in children, they rarely lead to the localized ductal disruption required to form a large pseudocyst. * **Choledochal Cyst (D):** This is a congenital dilation of the biliary tree. While it may present with a palpable mass and jaundice, it is anatomically distinct from a pancreatic pseudocyst. **3. NEET-PG High-Yield Pearls:** * **Most common cause of Acute Pancreatitis in children:** Trauma (specifically "Handlebar injury"). * **Definition:** A pseudocyst takes approximately **4–6 weeks** to form following the initial insult. * **Diagnosis:** Ultrasound is the initial screening tool; **CECT** is the gold standard for characterizing the cyst and its relationship to surrounding structures. * **Management:** Many pediatric pseudocysts resolve spontaneously. Intervention (Internal drainage like Cystogastrostomy) is indicated if the cyst is symptomatic, enlarging, or infected.

Q: Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhoea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggest a fluid volume deficit?

A sunken fontanel. ### **Explanation** The clinical presentation of vomiting, diarrhea, dry mucous membranes, and lethargy in an infant points toward **Dehydration (Isotonic or Hypotonic)**. In infants, the anterior fontanel is a key clinical window for assessing hydration status. **1. Why "A sunken fontanel" is correct:** In infants, the anterior fontanel normally feels flat and firm. When there is a significant fluid volume deficit (Dehydration), the intracranial pressure decreases due to reduced intravascular and interstitial fluid. This causes the fontanel to dip below the level of the skull bones, appearing "sunken." This is a hallmark sign of **moderate to severe dehydration** (typically >5-10% fluid loss). **2. Why the other options are incorrect:** * **B. Decreased pulse rate:** Dehydration typically causes **Tachycardia** (increased heart rate) as a compensatory mechanism to maintain cardiac output despite low stroke volume. Bradycardia is a late, pre-terminal sign of circulatory collapse. * **C. Increased blood pressure:** Fluid volume deficit leads to **Hypotension** (low blood pressure). However, in infants, BP is often maintained until the late stages of shock due to strong compensatory vasoconstriction. * **D. Low urine specific gravity:** In dehydration, the kidneys conserve water, leading to oliguria and **High urine specific gravity** (>1.025) as the urine becomes highly concentrated. **3. NEET-PG High-Yield Pearls:** * **Best indicator of dehydration severity:** Percentage of body weight loss. * **Earliest clinical sign:** Tachycardia and dry mouth. * **WHO Classification:** Focuses on "Some Dehydration" (irritable, sunken eyes, thirsty, skin pinch goes back slowly) vs. "Severe Dehydration" (lethargic/unconscious, unable to drink, skin pinch goes back very slowly >2 seconds). * **Management:** "Some dehydration" is treated with ORS (Plan B); "Severe dehydration" requires IV Ringer’s Lactate (Plan C).

Q: The diagnosis of congenital megacolon is confirmed by:

Rectal biopsy. **Explanation:** **Congenital Megacolon (Hirschsprung Disease)** is characterized by the absence of ganglion cells in the submucosal (Meissner's) and myenteric (Auerbach's) plexuses, typically starting at the internal anal sphincter and extending proximally. **Why Rectal Biopsy is the Correct Answer:** A **rectal biopsy** is the **gold standard** for diagnosis. It provides definitive histological evidence of the disease. The diagnosis is confirmed by two key findings: 1. **Absence of ganglion cells** in the intestinal wall. 2. **Hypertrophy of nerve fibers** (demonstrated via Acetylcholinesterase staining). A "suction biopsy" is usually preferred in neonates as it is painless and does not require anesthesia. **Analysis of Incorrect Options:** * **A. Clinical features:** While symptoms like delayed passage of meconium (>48 hours), abdominal distension, and "blast sign" on digital rectal exam are highly suggestive, they are not confirmatory. * **B. Barium enema:** This is the initial imaging modality of choice. It shows a **"transition zone"** (the narrow aganglionic segment distal to the dilated normal segment). However, it can be false-negative in neonates (total colonic aganglionosis). * **D. Recto-sigmoidoscopy:** This is generally not used for diagnosis as it cannot visualize the microscopic absence of ganglion cells and carries a risk of perforation in a distended bowel. **NEET-PG High-Yield Pearls:** * **Most common site:** Rectosigmoid region (Short-segment disease). * **Associated Condition:** Down Syndrome (Trisomy 21) is seen in ~10% of cases. * **Anorectal Manometry:** Shows **failure of the Rectoanal Inhibitory Reflex (RAIR)**; it is a sensitive screening tool but not the gold standard. * **Definitive Treatment:** Surgical pull-through procedures (e.g., Duhamel, Soave, or Swenson).

Question 1

Meconium ileus is a manifestation of -

Accepted Answer

Fibrocystic disease of the pancreas

Answer

Hirschsprung's disease

Answer

Achalasia cardia

Answer

Celiac disease

Question 2

A coin is lodged in the esophagus of an asymptomatic 3-year-old female child. What is the recommended treatment?

Accepted Answer

Endoscopic removal after 24 hours

Answer

Immediate endoscopic removal

Answer

Wait for 48 hours

Answer

Dislodge the coin into the stomach by inserting a Ryles tube

Question 3

The double bubble sign in children is typically seen in which of the following conditions?

Accepted Answer

Diaphragmatic hernia

Answer

Ladds band

Answer

Annular pancreas

Answer

Pancreatic pseudocyst

Question 4

A patient presents with acute abdominal pain, blood and mucus in the stool, and a palpable abdominal mass. What is the most likely diagnosis?

Accepted Answer

Intussusception

Answer

Meckel's diverticulum

Answer

Volvulus

Answer

Hypertrophic pyloric stenosis

Question 5

A child is brought with bleeding nostrils. There is a history of viral infection 3 months back and treatment with aspirin. What is the most likely diagnosis?

Accepted Answer

Reye's Syndrome

Answer

Idiopathic Thrombocytopenic Purpura (ITP)

Answer

Epistaxis

Answer

Disseminated Intravascular Coagulation (DIC)

Question 6

What is the characteristic liver finding in a child with Reye's syndrome?

Accepted Answer

Microvesicular steatosis

Answer

Macrovesicular steatosis

Answer

Hepatocellular necrosis

Answer

Noncaseating epithelioid granulomas

Question 7

Which of the following is true about Extrahepatic biliary atresia?

Accepted Answer

All of these

Answer

Acholic stool

Answer

Conjugated hyperbilirubinemia

Answer

Absence of nucleide in duodenum in HIDA scan

Question 8

Pseudopancreatic cyst in a child is commonly due to which of the following?

Accepted Answer

Traumatic pancreatitis

Answer

Annular pancreatitis

Answer

Drug-induced pancreatitis

Answer

Choledochal cyst

Question 9

Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhoea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggest a fluid volume deficit?

Accepted Answer

A sunken fontanel

Answer

Decreased pulse rate

Answer

Increased blood pressure

Answer

Low urine specific gravity

Question 10

The diagnosis of congenital megacolon is confirmed by:

Accepted Answer

Rectal biopsy

Answer

Clinical features

Answer

Barium enema

Answer

Recto-sigmoidoscopy

Gastroenterology — MCQs

Gastroenterology — MCQs

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