Gastroenterology Practice Questions

Q: A 7-year-old with recurrent abdominal pain, diarrhea, weight loss, joint pain, and a non-pruritic rash presents with laboratory findings of anemia, high ESR, and positive ASCA. What is the most likely diagnosis?

Crohn's disease. ***Crohn's disease*** - The combination of **recurrent abdominal pain**, **diarrhea**, **weight loss**, **joint pain**, and a **non-pruritic rash** (erythema nodosum or pyoderma gangrenosum) is highly suggestive of **Crohn's disease** in a child [1]. - The laboratory findings of **anemia**, **elevated ESR**, and especially **positive ASCA (anti-Saccharomyces cerevisiae antibodies)** strongly support this diagnosis, as ASCA is more specific to Crohn's than ulcerative colitis [1]. *Celiac disease* - While it can cause abdominal pain, diarrhea, and weight loss, celiac disease does not typically present with **joint pain** or a **non-pruritic rash** (dermatitis herpetiformis is pruritic). - It is diagnosed by **IgA anti-tissue transglutaminase (tTG)** and **anti-endomysial antibodies (EMA)**, and does not involve positive ASCA. *Henoch-Schönlein purpura* - Characterized by palpable **purpura**, **arthritis**, **abdominal pain**, and **renal involvement**, but the rash is typically purpuric and the abdominal pain is often colicky with potential for intussusception. - It is an **IgA-mediated vasculitis** and does not present with chronic diarrhea, weight loss, or positive ASCA. *Ulcerative colitis* - Presents with diarrhea (often bloody), abdominal pain, and weight loss, but **joint pain** and **rash** tend to be less common and less severe than in Crohn's [1]. - While it can also be associated with elevated ESR and anemia, **ASCA is typically negative** or weakly positive, and **p-ANCA** is more commonly positive.

Q: A newborn with persistent jaundice and clay-colored stools who is found to have conjugated hyperbilirubinemia is most likely diagnosed with what condition?

Biliary Atresia. ***Biliary Atresia*** - **Conjugated hyperbilirubinemia** in a newborn with **persistent jaundice** and **clay-colored stools** is the classic presentation of biliary atresia. - The absence of bile flow into the intestine due to blocked bile ducts causes the stools to lose their normal color and bilirubin to accumulate in the blood. *Physiological Jaundice* - This is a **common, transient** condition in newborns, characterized by **unconjugated hyperbilirubinemia**. - It resolves spontaneously and typically presents with **normal stool color** as bile flow is unimpaired. *Breast Milk Jaundice* - This condition is also characterized by **unconjugated hyperbilirubinemia** and is generally benign. - While it can persist, it does not typically cause **clay-colored stools** or significant conjugated hyperbilirubinemia. *Hemolytic Disease of the Newborn* - This condition typically presents with **unconjugated hyperbilirubinemia** due to increased red blood cell breakdown. - Stool color would generally be normal, and there would be no direct obstruction of bile flow.

Q: Most common cause of severe hematemesis in a child is:

Portal hypertension. ***Portal hypertension*** - Portal hypertension with **esophageal or gastric varices** is the **most common cause of severe/massive hematemesis** in children. - Varices develop due to **increased portal pressure** from conditions like **biliary atresia**, **cirrhosis**, **portal vein thrombosis**, or **extrahepatic portal venous obstruction (EHPVO)**. - Variceal bleeding is characteristically **sudden, massive, and life-threatening**, distinguishing it from other causes of upper GI bleeding. - The bleeding occurs when thin-walled dilated veins rupture under pressure. *Peptic ulcer* - While peptic ulcer disease is a **common cause of hematemesis** in children, it typically presents with **chronic, intermittent, or mild-to-moderate bleeding** rather than severe massive hematemesis. - Causes include ***Helicobacter pylori* infection** and **NSAID use**. - Bleeding from ulcers tends to be less dramatic than variceal hemorrhage. *Mallory-Weiss syndrome* - This involves a **mucosal tear** at the gastroesophageal junction from forceful **vomiting or retching**. - Usually causes **mild-to-moderate hematemesis**, rarely severe bleeding. - More common in adolescents with repeated vomiting. *Gastritis* - **Acute erosive gastritis** can cause hematemesis but is usually **mild**. - Causes include stress, medications, or infections. - Does not typically cause the massive bleeding seen with varices.

Q: What is the grade of dehydration if a child demonstrates excessive thirst and decreased urine output?

Moderate dehydration. ***Moderate dehydration*** - **Excessive thirst** and **decreased urine output** are classic indicators of moderate dehydration. - In moderate dehydration, the child has lost 6-9% of their body weight, presenting with these prominent clinical features. - Other signs include **sunken eyes**, **reduced skin turgor**, **tachycardia**, and the child drinks eagerly when offered fluids. *No dehydration* - This grade implies a child is **well-hydrated** with normal thirst and urine output. - There would be no clinical signs of fluid deficit. *Mild dehydration* - Mild dehydration (3-5% weight loss) presents with **restlessness or irritability** and the child is **thirsty and drinks eagerly**. - However, the thirst is not described as "excessive" and urine output is not significantly decreased yet. - Signs like sunken eyes and reduced skin turgor may be present but are subtle. *Severe dehydration* - Severe dehydration involves **life-threatening symptoms** like **shock**, **capillary refill time >2 seconds**, **lethargy or unconsciousness**, and **absent or minimal urine output**. - The child may be **unable to drink** due to altered consciousness. - This stage represents a fluid deficit of 10% or more of body weight.

Q: A child swallowed a watch battery containing alkaline content. What is the immediate next step?

Immediate X-ray examination. ***Immediate X-ray examination*** - An **X-ray** is crucial to confirm the presence, location, and type of battery ingested, as well as to determine if it's lodged in the esophagus, which is a medical emergency. - Button batteries, especially those caught in the esophagus, can cause severe tissue damage within hours due to **electrical discharge** and **alkaline necrosis**. *Immediate surgical removal* - While ultimately necessary for batteries lodged in the esophagus, surgical removal is not the *immediate next step*. **Localization via X-ray** is required before surgical planning. - Surgery is typically reserved for cases where **endoscopic removal** fails or for complications like perforation. *CT scan of the abdomen* - A **CT scan** is not the initial modality of choice for suspected foreign body ingestion due to radiation exposure and less rapid availability compared to X-rays. - CT might be considered if complications such as **perforation** or **abscess formation** are suspected, but not as the first step for object localization. *Administer laxatives* - Administering **laxatives** is contraindicated because it can hasten the battery's transit through the gastrointestinal tract, potentially increasing the risk of impaction or prolonged contact with tissue if the battery is already caught. - If the battery is in the esophagus, laxatives are ineffective and can delay appropriate intervention, worsening potential damage.

Q: Meconium ileus is associated with:

Cystic fibrosis. ***Cystic fibrosis*** - **Meconium ileus** is a classic presenting symptom in approximately 10-20% of newborns with **cystic fibrosis** (CF). - In CF, abnormal tenacious secretions from the pancreatic glands lead to thick, inspissated meconium that obstructs the small intestine, typically at the terminal ileum. - This is often the earliest manifestation of CF and requires surgical intervention. *Infant of diabetic mother* - Infants of diabetic mothers are at increased risk for various complications, including **macrosomia**, **hypoglycemia**, and **respiratory distress syndrome**. - They are not typically associated with meconium ileus; intestinal obstruction in these infants is more commonly related to **small left colon syndrome**. *Hypothyroidism* - **Congenital hypothyroidism** can cause symptoms like feeding difficulties, lethargy, and **constipation**, but it does not cause meconium ileus. - The constipation in hypothyroidism is due to decreased gastrointestinal motility, not an inspissated meconium plug. *Hirschsprung disease* - **Hirschsprung disease** presents with intestinal obstruction due to absence of ganglion cells in the distal colon, leading to **failure to pass meconium** within 48 hours. - Unlike meconium ileus (which involves thick, inspissated meconium in CF), Hirschsprung disease is a functional obstruction due to **aganglionic segment** and is not associated with abnormal meconium consistency.

Q: What is the most common cause of acute abdominal pain in children?

Gastroenteritis. ***Gastroenteritis*** - **Gastroenteritis** is the **most common cause** of acute abdominal pain in children across all age groups. - Presents with crampy, diffuse abdominal pain accompanied by **vomiting and/or diarrhea**, which are the hallmark features. - The abdominal pain is typically colicky, related to intestinal inflammation and increased peristalsis. - Usually self-limiting and often preceded by exposure to contaminated food/water or sick contacts. *Constipation* - **Constipation** is the **second most common cause** of acute abdominal pain in children. - Presents with cramping lower abdominal pain due to retained stool causing distension and discomfort. - Can range from mild discomfort to severe pain, sometimes mimicking other acute conditions. - History typically reveals infrequent or hard stools. *Appendicitis* - **Appendicitis** is the **most common surgical cause** of acute abdominal pain but less common overall than medical causes. - Classic presentation: periumbilical pain migrating to the **right lower quadrant (McBurney's point)**. - Associated with fever, anorexia, nausea, vomiting, and localized tenderness with guarding. - Requires prompt surgical intervention to prevent perforation. *Mesenteric adenitis* - **Mesenteric adenitis** involves inflamed mesenteric lymph nodes and is less common than the above causes. - Can mimic appendicitis with right lower quadrant pain but typically less localized. - Often preceded by or concurrent with a **viral upper respiratory tract infection**. - Usually self-limiting with supportive management.

Q: Total colonic aganglionosis is a variant of?

Hirschsprung's disease. ***Hirschsprung's disease*** - Total colonic aganglionosis is a severe form of **Hirschsprung's disease**, characterized by the *absence of ganglion cells* throughout the entire colon and often into the distal small bowel. - This congenital condition results from the failure of **neural crest cells** to migrate completely during fetal development, leading to a functional obstruction. *Crohn's disease* - This is a *chronic inflammatory bowel disease* that can affect any part of the gastrointestinal tract, causing **transmural inflammation** and skip lesions. - It is not characterized by the absence of ganglion cells but rather by an abnormal immune response. *Ulcerative colitis* - This is another *inflammatory bowel disease* that primarily affects the **colon and rectum**, causing continuous inflammation of the mucosal layer. - It does not involve the absence of ganglion cells and is distinguished by different pathological features from Hirschsprung's disease. *Tropical sprue* - This is a *malabsorption syndrome* characterized by *chronic diarrhea* and nutrient deficiencies, typically affecting individuals in tropical regions. - It is caused by an environmental enteric infection and subsequent damage to the small intestinal mucosa, not by aganglionosis.

Q: A 3-year-old child presents to the ER with a history of vomiting and loose, watery stools for 3 days. On examination, the child is drowsy, has sunken eyes, hypothermia, and slow skin pinch recoil. What is the most likely diagnosis?

Severe dehydration. ***Severe dehydration*** - The child presents with classic signs of **severe dehydration** including **drowsiness**, **sunken eyes**, and **slow skin pinch recoil**, indicating significant fluid loss. - **Hypothermia** can also be a sign of severe dehydration and metabolic derangement in young children, further supporting this diagnosis. *No dehydration* - This option is incorrect because the child exhibits multiple clear signs of fluid deficit, such as **drowsiness** and **sunken eyes**. - A child with no dehydration would typically be **alert**, have **normal eyes**, and **brisk skin turgor**. *Mild dehydration* - Mild dehydration usually involves only a **slight loss of body weight** (e.g., <3-5%) and minimal clinical signs like slight thirst. - The presented symptoms like **drowsiness** and **sunken eyes** are indicative of more advanced dehydration than mild. *Some dehydration* - Some dehydration (also known as moderate dehydration) is characterized by signs such as **restlessness/irritability**, **thirst**, and **eyes that are somewhat sunken**. - The presence of **drowsiness** and **hypothermia** goes beyond the typical presentation of "some dehydration" and points to a more critical state.

Question 1

A 7-year-old with recurrent abdominal pain, diarrhea, weight loss, joint pain, and a non-pruritic rash presents with laboratory findings of anemia, high ESR, and positive ASCA. What is the most likely diagnosis?

Accepted Answer

Crohn's disease

Answer

Celiac disease

Answer

Henoch-Schönlein purpura

Answer

Ulcerative colitis

Question 2

A newborn with persistent jaundice and clay-colored stools who is found to have conjugated hyperbilirubinemia is most likely diagnosed with what condition?

Accepted Answer

Biliary Atresia

Answer

Physiological Jaundice

Answer

Breast Milk Jaundice

Answer

Hemolytic Disease of the Newborn

Question 3

A 1-year-old child weighing 6 kg is suffering from acute gastroenteritis with signs of sunken eyes and skin pinch returning to normal very rapidly. What will be your management?

Accepted Answer

RL infusion 180 ml in the first hour followed by 270 ml in the next 5 hours

Answer

RL infusion 120 ml in the first hour followed by 360 ml in the next 5 hours

Answer

RL infusion 180 ml in the first hour followed by 480 ml in the next 5 hours

Answer

RL infusion 240 ml in the first hour followed by 360 ml in the next 5 hours

Question 4

Most common cause of severe hematemesis in a child is:

Accepted Answer

Portal hypertension

Answer

Mallory-Weiss syndrome

Answer

Gastritis

Answer

Peptic ulcer

Question 5

What is the grade of dehydration if a child demonstrates excessive thirst and decreased urine output?

Accepted Answer

Moderate dehydration

Answer

No dehydration

Answer

Mild dehydration

Answer

Severe dehydration

Question 6

A child swallowed a watch battery containing alkaline content. What is the immediate next step?

Accepted Answer

Immediate X-ray examination

Answer

Immediate surgical removal

Answer

CT scan of the abdomen

Answer

Administer laxatives

Question 7

Meconium ileus is associated with:

Accepted Answer

Cystic fibrosis

Answer

Infant of diabetic mother

Answer

Hypothyroidism

Answer

Hirschsprung disease

Question 8

What is the most common cause of acute abdominal pain in children?

Accepted Answer

Gastroenteritis

Answer

Constipation

Answer

Mesenteric adenitis

Answer

Appendicitis

Question 9

Total colonic aganglionosis is a variant of?

Accepted Answer

Hirschsprung's disease

Answer

Crohn's disease

Answer

Ulcerative colitis

Answer

Tropical sprue

Question 10

A 3-year-old child presents to the ER with a history of vomiting and loose, watery stools for 3 days. On examination, the child is drowsy, has sunken eyes, hypothermia, and slow skin pinch recoil. What is the most likely diagnosis?

Accepted Answer

Severe dehydration

Answer

No dehydration

Answer

Mild dehydration

Answer

Some dehydration

Gastroenterology — MCQs

Gastroenterology — MCQs

On this page

Practice by Chapter

Want unlimited practice?