Gastroenterology Practice Questions

Q: The commonest cause of intestinal obstruction in children is –

Intussusception. ***Intussusception*** - **Intussusception** is the most common cause of intestinal obstruction in children, especially in infants between 6 months and 3 years of age. - It occurs when one segment of the intestine telescopes into an adjacent segment, leading to obstruction and potentially compromising blood supply. *Adhesions* - **Adhesions** are bands of scar tissue that can form after abdominal surgery and are a common cause of intestinal obstruction in adults. - While they can occur in children, they are generally less common as a primary cause of obstruction compared to intussusception, especially in infants. *Hernia* - **Hernias**, particularly incarcerated inguinal hernias, can cause intestinal obstruction in children. - Although common, hernias are not the single most frequent cause of intestinal obstruction across all pediatric age groups compared to intussusception. *Volvulus* - **Volvulus** refers to the twisting of a loop of intestine around its mesentery, often associated with intestinal malrotation. - It is a serious cause of intestinal obstruction in children and infants, but less common than intussusception, though it carries a higher risk of intestinal ischemia.

Q: A 4-year-old boy is admitted to the hospital with pneumonia and respiratory distress. The nurses report that the child's bowel movements are greasy and have a pungent odor. A sweat-chloride test is positive. Which of the following mechanisms of disease is the most likely cause of steatorrhea in this child?

Lack of pancreatic enzyme secretion. ***Lack of pancreatic enzyme secretion*** - The clinical picture of **pneumonia**, **respiratory distress**, **greasy/pungent bowel movements (steatorrhea)**, and a **positive sweat chloride test** is classic for **cystic fibrosis (CF)**. - In CF, a defective **CFTR protein** leads to thick, viscous secretions that block pancreatic ducts, causing **pancreatic insufficiency** and leading to inadequate release of digestive enzymes necessary for fat absorption. *Abnormal dietary intake* - While dietary factors can contribute to digestive issues, abnormal intake alone would not explain the other core features like the **positive sweat chloride test** or recurrent respiratory infections characteristic of cystic fibrosis. - This mechanism doesn't account for the fundamental physiological defect seen in this patient. *Hyperbilirubinemia with kernicterus* - **Kernicterus** is a condition caused by very high levels of **bilirubin** in a newborn's blood, leading to brain damage; it is not typically associated with steatorrhea or the respiratory symptoms described. - While CF can sometimes cause liver complications, **kernicterus** is unrelated to the primary mechanism of steatorrhea in this context. *Bacterial overgrowth* - **Bacterial overgrowth** in the small intestine can cause malabsorption and diarrhea, but it does not directly lead to the specific findings of **respiratory distress**, recurrent infections, or the underlying genetic defect indicated by a **positive sweat chloride test** in cystic fibrosis. - This condition is not the primary cause of the systemic and pancreatic issues described.

Q: What is the treatment of choice for an 11-year-old child with hepatitis C infection?

Direct-Acting Antivirals (DAAs). ***Direct-Acting Antivirals (DAAs)*** - **Direct-acting antivirals** are the current **standard of care** for hepatitis C infection in children due to their high efficacy, good safety profile, and ability to achieve sustained virologic response (SVR). - Several DAAs are approved and recommended for use in children as young as 3 years, with treatment regimens tailored to the **genotype** of the hepatitis C virus (HCV). *Gamma-globulin* - **Gamma-globulin** (immunoglobulin) is primarily used for **passive immunization** against certain infections or in conditions involving antibody deficiencies; it has no direct antiviral activity against chronic hepatitis C. - It would not be effective in eradicating the hepatitis C virus from an infected individual. *Corticosteroids* - **Corticosteroids** are potent **anti-inflammatory** and immunosuppressive agents, but they do not possess direct antiviral properties against HCV. - Using corticosteroids could potentially worsen the infection by **suppressing the immune response** needed to clear the virus, and they are generally contraindicated in active viral hepatitis. *Vaccine* - While there are effective **vaccines** for hepatitis A and hepatitis B, there is currently **no vaccine available** to prevent hepatitis C infection. - Research is ongoing, but a preventive vaccine for HCV has yet to be developed.

Q: What is the commonest cause of intestinal obstruction in children between 3 months to 6 years of age?

Intussusception. ***Intussusception*** - **Intussusception** is the most frequent cause of **intestinal obstruction** in children between 3 months and 6 years, where a segment of intestine telescopes into an adjacent segment. - This condition presents with classic symptoms like **abdominal pain**, vomiting, and bloody stools (currant jelly stools). *Nonspecific cause* - While many childhood illnesses have nonspecific causes, **intestinal obstruction** is a specific and severe condition requiring prompt diagnosis. - Attributing it to a "nonspecific cause" would delay proper identification of the underlying pathology. *Intestinal polyp* - While intestinal polyps can cause **gastrointestinal bleeding** and, less commonly, obstruction in children, they are not the most common cause of obstruction in this age group. - Polyps usually present with intermittent bleeding or prolapse rather than acute, severe obstruction. *Meckel's diverticulum* - **Meckel's diverticulum** is the most common congenital anomaly of the gastrointestinal tract and can cause obstruction, bleeding, or inflammation (diverticulitis). - However, it is a less common cause of intestinal obstruction in this specific age range compared to **intussusception**.

Q: A 12 year old boy presents with hematemesis, melena and mild splenomegaly. There is no obvious jaundice or ascites. The most likely diagnosis is:

EHPVO. EHPVO - **Extrahepatic portal vein obstruction (EHPVO)** in children commonly presents with upper GI bleeding due to **esophageal varices** caused by portal hypertension, alongside **splenomegaly**. [1] - The absence of jaundice and ascites, paired with the patient's age, is highly suggestive of EHPVO since it primarily affects the portal vein before it reaches the liver, sparing hepatic function initially. NCPF - **Non-cirrhotic portal fibrosis (NCPF)** also causes portal hypertension, splenomegaly, and GI bleeding. However, it is more commonly seen in older adults and is a diagnosis of exclusion. - While it fits some symptoms, EHPVO is a more common cause of portal hypertension in children without underlying liver disease. [1] Malaria with DIC - **Malaria** can cause splenomegaly and, in severe cases, DIC leading to bleeding, but it would typically present with **fever, chills**, and other systemic signs of infection, which are not mentioned. - DIC would also likely present with more diffuse bleeding manifestations beyond hematemesis and melena, and not typically without other signs of severe malaria. Cirrhosis - **Cirrhosis** leads to portal hypertension, splenomegaly, and GI bleeding from varices. However, it is usually accompanied by overt signs of **liver dysfunction** such as **jaundice, ascites**, and encephalopathy, which are reportedly absent in this case. [1] - In a 12-year-old, childhood cirrhosis causes are typically distinct from adult causes and would still manifest with more significant liver compromise.

Q: Most common cause of acute intestinal obstruction in children is

Intussusception. ***Intussusception*** - **Intussusception** is the most common cause of **acute intestinal obstruction** in children, particularly between 3 months and 3 years of age. - It occurs when a segment of the intestine telescopes into an adjacent segment, leading to obstruction and potentially **ischemia**. *Inguinal hernia* - While an **incarcerated inguinal hernia** can cause intestinal obstruction, it is less common than intussusception as the primary cause of acute obstruction in children generally. - It is more frequent in **neonates and infants** but overall incidence of obstruction is lower than intussusception. *Volvulus* - **Volvulus** refers to a twisting of the intestine on its mesentery, often associated with **malrotation**, leading to obstruction and vascular compromise. - While a serious cause of obstruction, especially in neonates, it is less common overall than intussusception in the pediatric population. *None of the options* - This option is incorrect because **intussusception** is a recognized and frequent cause of acute intestinal obstruction in children.

Q: A 6-month-old child woke up at night, crying with severe colicky abdominal pain, and later passed red currant jelly stools. What is the most likely diagnosis?

Intussusception. ***Intussusception*** - The classic presentation of **intussusception** includes sudden onset of **severe colicky abdominal pain** (intermittent crying spells), drawing legs to the chest, and passing **red currant jelly stools** (blood and mucus). - The pain occurs in intermittent episodes with periods of relative calm in between. Red currant jelly stools typically appear later in the disease course (often after 12-24 hours). - This is a **pediatric emergency** with peak incidence at **6-18 months** of age. *Malrotation* - Malrotation typically presents with **bilious vomiting** due to midgut volvulus and duodenal obstruction, particularly in the neonatal period. - While it can cause abdominal pain, the hallmark is persistent bilious vomiting rather than the intermittent colicky pain with red currant jelly stools seen in intussusception. *Meckel's diverticulum* - Meckel's diverticulum typically causes **painless rectal bleeding** (due to **heterotopic gastric mucosa** causing ulceration). - When it causes pain, it's usually due to **diverticulitis** or obstruction from an inverted diverticulum, but these do not produce the classic red currant jelly stools of intussusception. *Intestinal obstruction* - While intussusception is a specific type of intestinal obstruction, this option is too general. Other forms of intestinal obstruction (e.g., from adhesions, hernias) in an infant would typically present with **bilious vomiting**, abdominal distension, and may not produce red currant jelly stools. - The combination of intermittent colicky pain and red currant jelly stools is pathognomonic for intussusception.

Q: All are true about Hirschsprung disease Except

The rectum is never affected. ***The rectum is never affected*** - Hirschsprung disease always involves the **rectum** and extends proximally for a variable distance. - The aganglionic segment uniformly includes the **distal rectum**. *Absence of ganglion cells within the affected segment* - The primary defect in Hirschsprung disease is the **absence of ganglion cells** (Meissner and Auerbach plexuses) in the affected intestinal segment. - This **aganglionosis** leads to a functional obstruction. *Dilation proximal to the affected segment* - Due to the functional obstruction from the aganglionic segment, the normal bowel **proximal** to it becomes dilated and hypertrophied. - This dilation occurs as the bowel tries to overcome the obstruction. *Hirschsprung disease typically presents with a failure to pass meconium in the immediate postnatal period* - A classic presentation of Hirschsprung disease is the failure to pass **meconium** within the first 24-48 hours of life. - This symptom is due to the lack of peristalsis in the aganglionic segment.

Q: Which of the following supplementation has been shown to reduce the duration and severity of acute diarrhea in children?

Zinc. ***Zinc*** - **Zinc supplementation** has been shown to reduce the **duration** and **severity** of acute diarrhea in children, particularly in low-income settings. - It aids in the **recovery of the intestinal mucosa** and improves immune function. *Potassium* - While critical for **fluid and electrolyte balance** and often lost in diarrhea, potassium is primarily replaced, not therapeutically useful in shortening the course of acute diarrhea itself. - **Oral rehydration solutions (ORS)** contain potassium to counteract losses. *Magnesium* - Magnesium is an essential electrolyte that can be lost during diarrhea, but its primary role is in replacement, not in the direct treatment or reduction of diarrhea duration. - **High doses of magnesium** can paradoxically cause diarrhea. *Calcium* - Calcium is vital for many bodily functions but plays no direct role in the treatment or shortening the course of acute diarrhea. - Its primary absorption site, the **small intestine**, can be affected by diarrhea, but supplementation would not address the acute diarrheal episode itself.

Question 1

The commonest cause of intestinal obstruction in children is –

Accepted Answer

Intussusception

Answer

Adhesions

Answer

Hernia

Answer

Volvulus

Question 2

A 4-year-old boy is admitted to the hospital with pneumonia and respiratory distress. The nurses report that the child's bowel movements are greasy and have a pungent odor. A sweat-chloride test is positive. Which of the following mechanisms of disease is the most likely cause of steatorrhea in this child?

Accepted Answer

Lack of pancreatic enzyme secretion

Answer

Abnormal dietary intake

Answer

Hyperbilirubinemia with kernicterus

Answer

Bacterial overgrowth

Question 3

What is the treatment of choice for an 11-year-old child with hepatitis C infection?

Accepted Answer

Direct-Acting Antivirals (DAAs)

Answer

Gamma-globulin

Answer

Corticosteroids

Answer

Vaccine

Question 4

What is the commonest cause of intestinal obstruction in children between 3 months to 6 years of age?

Accepted Answer

Intussusception

Answer

Nonspecific cause

Answer

Intestinal polyp

Answer

Meckel's diverticulum

Question 5

A 12 year old boy presents with hematemesis, melena and mild splenomegaly. There is no obvious jaundice or ascites. The most likely diagnosis is:

Accepted Answer

EHPVO

Answer

NCPF

Answer

Malaria with DIC

Answer

Cirrhosis

Question 6

Most common cause of acute intestinal obstruction in children is

Accepted Answer

Intussusception

Answer

Inguinal hernia

Answer

Volvulus

Answer

None of the options

Question 7

A 6-month-old child woke up at night, crying with severe colicky abdominal pain, and later passed red currant jelly stools. What is the most likely diagnosis?

Accepted Answer

Intussusception

Answer

Malrotation

Answer

Meckel's diverticulum

Answer

Intestinal obstruction

Question 8

A child suffering from acute diarrhoea is brought to the casualty and is diagnosed as having severe dehydration with pH of 7.23. Serum Na-125, Serum K-3, HCO3 16. The best I.V. fluid of choice is -

Accepted Answer

N/3 saline + 5% dextrose

Answer

Normal saline

Answer

N/3 Saline + 10% dextrose

Answer

3% Saline

Question 9

All are true about Hirschsprung disease Except

Accepted Answer

The rectum is never affected

Answer

Absence of ganglion cells within the affected segment

Answer

Dilation proximal to the affected segment.

Answer

Hirschsprung disease typically presents with a failure to pass meconium in the immediate postnatal period.

Question 10

Which of the following supplementation has been shown to reduce the duration and severity of acute diarrhea in children?

Accepted Answer

Zinc

Answer

Potassium

Answer

Magnesium

Answer

Calcium

Gastroenterology — MCQs

Gastroenterology — MCQs

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