Gastroenterology Practice Questions

Q: 6 year old drowsy child came in emergency with history of vomiting, loose motion for 3 days. On examination he had sunken eye, hypothermia, skin on pinching takes time to revert. Diagnosis

Severe dehydration. ***Severe dehydration*** - The combination of **drowsiness (altered mental status)**, **sunken eyes**, and **skin pinch going back very slowly (poor skin turgor)** are classic signs of severe dehydration according to WHO classification. - **Hypothermia** in a dehydrated child indicates profound physiological compromise, likely progressing toward hypovolemic shock. - Severe dehydration requires **2 or more signs**: lethargy/unconsciousness, sunken eyes, unable to drink or drinks poorly, skin pinch goes back very slowly (≥2 seconds). *Moderate dehydration* - This level presents with **restlessness or irritability** (not drowsiness), thirst, sunken eyes, and skin pinch going back slowly. - The child would be more alert and showing signs of irritability rather than the decreased consciousness seen here. *No dehydration* - This would present with a child who is **alert**, has normal eyes, drinks normally, and has normal skin elasticity with skin pinch going back immediately. - The symptoms described (vomiting, loose motions, drowsiness, sunken eyes) clearly indicate significant fluid deficit. *Some dehydration* - Some dehydration (mild) typically involves **restlessness**, increased thirst, slightly sunken eyes, and drinks eagerly. - It does not present with the severe signs of drowsiness, hypothermia, or markedly delayed skin turgor (≥2 seconds) as seen in this case.

Q: The most common congenital esophageal anomaly is which of the following?

Esophageal atresia. ***Esophageal atresia*** - This is the **most common congenital esophageal anomaly**, occurring in approximately 1 in 3,000-4,500 live births. - Most commonly presents as **esophageal atresia with distal tracheoesophageal fistula (TEF)** - the classic Type C variant (85-90% of cases). - Neonates present with excessive salivation, **inability to swallow**, choking with first feeding, and inability to pass a nasogastric tube beyond 10-12 cm. - Associated with **VACTERL** anomalies (Vertebral, Anorectal, Cardiac, Tracheoesophageal, Renal, Limb). *Congenital esophageal stenosis* - This is a **rare congenital narrowing** of the esophagus, far less common than esophageal atresia. - May be caused by tracheobronchial remnants, fibromuscular hypertrophy, or membranous diaphragm. - Typically presents later in infancy with **progressive dysphagia** when solid foods are introduced. *Congenital web* - A congenital web is a **thin mucosal membrane** that partially obstructs the esophageal lumen. - Much less common than esophageal atresia and usually presents with **intermittent dysphagia**. - May be asymptomatic until childhood or even adulthood depending on the degree of obstruction. *Esophageal duplication cyst* - A rare congenital anomaly consisting of a **fluid-filled cystic structure** adjacent to or within the esophageal wall. - Shares a common muscular wall with the esophagus and is lined by gastrointestinal epithelium. - May present with dysphagia, respiratory symptoms, or remain asymptomatic until discovered incidentally.

Q: A 4-week-old boy is brought to your OPD by his mother because he has had increasing amounts of vomiting over the past week. Initially it started as "spitting up" after a few meals a day, but now the baby is having projectile vomiting after every meal. She says the vomitus is non-bloody and non-bilious and the baby appears hungry after he vomits. This is her first child and she is not sure if this is normal. Physical examination is unremarkable. Laboratory studies show: Sodium: 140 mEq/L Potassium: 3.0 mEq/L Chloride: 87 mEq/L Bicarbonate: 30 mEq/L At this time the most appropriate next step is to

obtain an abdominal ultrasound. ***obtain an abdominal ultrasound*** - The presentation of **projectile, non-bilious vomiting** in a 4-week-old infant who remains hungry after vomiting, along with **hypokalemic, hypochloremic metabolic alkalosis**, is classic for **pyloric stenosis**. - An **abdominal ultrasound** is the diagnostic study of choice for pyloric stenosis, as it can directly visualize the thickened and elongated pylorus. *do nothing* - This approach is inappropriate given the strong clinical suspicion of **pyloric stenosis**, a condition that requires medical intervention. - Failing to investigate and treat could lead to severe **dehydration, electrolyte imbalances**, and failure to thrive. *order a barium enema* - A **barium enema** is typically used to diagnose conditions affecting the colon, such as **intussusception** or **Hirschsprung disease**. - It is not indicated for the diagnosis of **pyloric stenosis**, which is located in the upper gastrointestinal tract. *obtain an abdominal radiograph* - An **abdominal radiograph** (X-ray) would likely be unremarkable in pyloric stenosis, as it does not provide detailed visualization of the soft tissue structures of the pylorus. - While it might show features of gastric distension, it is not diagnostic for **pyloric stenosis** and would not be the most appropriate next step.

Q: Amount of ORS to be given in the first 4 hours to a child with some dehydration is

75 ml/kg body wt.. ***75 ml/kg body wt.*** - For a child with **some dehydration**, the World Health Organization (WHO) and UNICEF recommend administering **75 mL/kg body weight** of ORS over the first 4 hours as part of Plan B. - This volume is calculated to replenish lost fluids and electrolytes, addressing the estimated fluid deficit in **some dehydration**. *50 ml/kg body wt.* - A dose of **50 mL/kg** is generally insufficient for effective rehydration in a child presenting with **some dehydration**. - This amount might be used in milder cases or for maintenance, but not for initial rehydration in the **first 4 hours** with signs of dehydration. *100 ml/kg body wt.* - Administering **100 mL/kg** body weight is typically used for **severe dehydration** (Plan C) when given as **intravenous fluids**. - For **some dehydration** treated with ORS, the recommended dose is 75 mL/kg, not 100 mL/kg. This higher amount could lead to fluid overload if given orally in the first 4 hours. *200 ml/kg body wt.* - A dose of **200 mL/kg** body weight is excessive and potentially dangerous for a child with **some dehydration**. - Such a large volume could lead to **fluid overload**, electrolyte imbalances, and other complications, especially in young children.

Q: Persistent diarrhoea is defined as diarrhoea lasting more than?

14 days. ***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.

Q: A 10-year-old child presents with recurrent episodes of blood in stool. On examination, his lips show pigmented macules. He may be suffering from?

Peutz Jegher syndrome. ***Peutz Jegher syndrome*** - This syndrome is characterized by **hamartomatous polyps** in the gastrointestinal tract and **melanin spots** on the mucous membranes (lips, buccal mucosa) and digits. - The polyps can lead to complications such as **bleeding** (blood in stool), intussusception, and an increased risk of various cancers. *Crohn disease* - This is an **inflammatory bowel disease** causing chronic inflammation of the GI tract, which can lead to blood in stool. - However, Crohn's disease is not associated with **pigmented macules** on the lips. *Intussusception* - This condition involves the **telescoping of one part of the intestine into another**, which can cause sudden onset severe abdominal pain, vomiting, and "current jelly" stools (blood and mucus). - It is not primarily associated with **pigmented macules** on the lips as a diagnostic feature. *Meckel's diverticulum* - This is a common congenital anomaly where a remnant of the **vitelline duct** persists, often containing ectopic gastric or pancreatic tissue. - It can cause **painless rectal bleeding**, but it is not associated with **pigmented macules** on the lips.

Q: A 3-year-old child is evaluated by a pediatrician for poor growth despite excessive food intake. The mother reports that the child's stools are bulky, foul-smelling, and difficult to flush because they float. Determination of which of the following would most likely be diagnostic in this case?

Na+ in sweat. ***Na+ in sweat*** - This clinical presentation of **poor growth despite excessive food intake** (due to malabsorption) and **bulky, foul-smelling, floating stools** (steatorrhea) is highly suggestive of **cystic fibrosis (CF)**. - The **sweat test** is the diagnostic gold standard for CF. While the test measures both Na+ and Cl- in sweat, the **diagnostic criterion is based primarily on elevated chloride concentration** (Cl- ≥60 mmol/L). In CF, both sodium and chloride are elevated due to defective CFTR channel function. - This patient's symptoms of malabsorption result from **pancreatic insufficiency**, a common manifestation of CF. *Na+ in cerebrospinal fluid* - Measuring Na+ in cerebrospinal fluid is typically done to evaluate neurological conditions or electrolyte imbalances affecting the **central nervous system**, which is not indicated here. - There is no direct link between CSF Na+ levels and the malabsorption or growth failure described in this case. *Na+ in urine* - Urinary Na+ levels are used to assess **renal function** and overall **fluid and electrolyte balance**, and are relevant in conditions like **dehydration**, **kidney disease**, or **adrenal disorders**. - These tests are not primary diagnostic tools for the gastrointestinal and growth issues described, which point more towards a malabsorption syndrome. *Na+ in serum* - Serum Na+ levels reflect the body's overall **hydration status** and are crucial for diagnosing **hyponatremia** or **hypernatremia**. - While important for general medical assessment, serum Na+ levels do not specifically diagnose the underlying cause of malabsorption and steatorrhea seen in this child.

Q: Which of the following metabolic derangements is associated with congenital pyloric stenosis?

Hypochloremic alkalosis. ***Hypochloremic alkalosis*** - The forceful vomiting in **pyloric stenosis** leads to a significant loss of **gastric acid (HCl)**, resulting in **hypochloremia** and the metabolic picture of **alkalosis**. - The body attempts to compensate by retaining bicarbonate and excreting hydrogen ions, further contributing to the alkalosis. *Hypochloremic acidosis* - This condition is characterized by a low chloride level accompanied by **acidosis**, which contradicts the loss of acidic gastric contents seen in pyloric stenosis. - While chloride is lost, the predominant acid-base disturbance is alkalosis due to hydrogen ion loss. *Hyperchloremic acidosis* - This condition involves an elevated chloride level and acidosis, often seen in cases like **renal tubular acidosis** or severe diarrhea where bicarbonate is lost. - It is the opposite of the metabolic disturbance caused by the loss of gastric acid through vomiting. *Hyperchloremic alkalosis* - This imbalance would involve increased chloride and alkalosis, which does not align with the pathophysiology of pyloric stenosis where chloride is lost. - The body's compensatory mechanisms do not involve increasing chloride to an elevated level in this context.

Q: The most common cause of fresh bleeding per rectum in a 5-year-old child is:

Rectal polyp. ***Rectal polyp*** - **Juvenile polyps** are the most common cause of painless, fresh rectal bleeding in children aged 2-10 years. - These polyps are typically benign and can cause bleeding due to their friable nature as they are traumatized by stool passage. *Trauma* - Trauma, such as **anal fissures** or foreign body insertion, can cause bleeding but is often associated with pain during defecation. - While fissures are common in infants, they are less likely to be the recurrent cause of painless fresh rectal bleeding in an older child compared to polyps. *Worm infestation* - **Worm infestations** can cause gastrointestinal symptoms like abdominal pain, diarrhea, or itching, but fresh bleeding per rectum is not their primary or most common presentation. - **Hookworms** can cause iron deficiency anemia due to chronic blood loss, but this is typically occult blood, not overt fresh bleeding. *Volvulus* - **Volvulus** is a surgical emergency involving twisting of the bowel, presenting with acute abdominal pain, distension, and often bilious vomiting. - While it can lead to bloody stools due to ischemia, it is an acute, severe condition and not a common cause of isolated fresh bleeding per rectum in a 5-year-old.

Question 1

6 year old drowsy child came in emergency with history of vomiting, loose motion for 3 days. On examination he had sunken eye, hypothermia, skin on pinching takes time to revert. Diagnosis

Accepted Answer

Severe dehydration

Answer

Moderate dehydration

Answer

No dehydration

Answer

Some dehydration

Question 2

The most common congenital esophageal anomaly is which of the following?

Accepted Answer

Esophageal atresia

Answer

Congenital esophageal stenosis

Answer

Congenital web

Answer

Esophageal duplication cyst

Question 3

A 4-week-old boy is brought to your OPD by his mother because he has had increasing amounts of vomiting over the past week. Initially it started as "spitting up" after a few meals a day, but now the baby is having projectile vomiting after every meal. She says the vomitus is non-bloody and non-bilious and the baby appears hungry after he vomits. This is her first child and she is not sure if this is normal. Physical examination is unremarkable. Laboratory studies show: Sodium: 140 mEq/L Potassium: 3.0 mEq/L Chloride: 87 mEq/L Bicarbonate: 30 mEq/L At this time the most appropriate next step is to

Accepted Answer

obtain an abdominal ultrasound

Answer

do nothing

Answer

order a barium enema

Answer

obtain an abdominal radiograph

Question 4

Amount of ORS to be given in the first 4 hours to a child with some dehydration is

Accepted Answer

75 ml/kg body wt.

Answer

50 ml/kg body wt.

Answer

100 ml/kg body wt.

Answer

200 ml/kg body wt.

Question 5

Persistent diarrhoea is defined as diarrhoea lasting more than?

Accepted Answer

14 days

Answer

28 days

Answer

21 days

Answer

7 days

Question 6

A 10-year-old child presents with recurrent episodes of blood in stool. On examination, his lips show pigmented macules. He may be suffering from?

Accepted Answer

Peutz Jegher syndrome

Answer

Crohn disease

Answer

Intussusception

Answer

Meckel's diverticulum

Question 7

A 3-year-old child is evaluated by a pediatrician for poor growth despite excessive food intake. The mother reports that the child's stools are bulky, foul-smelling, and difficult to flush because they float. Determination of which of the following would most likely be diagnostic in this case?

Accepted Answer

Na+ in sweat

Answer

Na+ in cerebrospinal fluid

Answer

Na+ in urine

Answer

Na+ in serum

Question 8

Which of the following metabolic derangements is associated with congenital pyloric stenosis?

Accepted Answer

Hypochloremic alkalosis

Answer

Hypochloremic acidosis

Answer

Hyperchloremic acidosis

Answer

Hyperchloremic alkalosis

Question 9

A 4-year-old boy presents with a history of constipation since the age of 6 months. His stools, produced every 3 to 4 days, are described as large and hard. His growth velocity is normal. Physical examination is normal; rectal examination reveals a large ampulla, poor sphincter tone but present anal wink, and stool in the rectal vault. The plain film of his abdomen is shown. Which of the following is the most appropriate next step in the management of this child?

Accepted Answer

Parental reassurance and dietary counseling

Answer

Lower gastrointestinal (GI) barium study

Answer

Upper GI barium study

Answer

Serum electrolyte measurement

Question 10

The most common cause of fresh bleeding per rectum in a 5-year-old child is:

Accepted Answer

Rectal polyp

Answer

Trauma

Answer

Worm infestation

Answer

Volvulus

Gastroenterology — MCQs

Gastroenterology — MCQs

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