Gastroenterology — MCQs
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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
Amount of ORS to be given in the first 4 hours to a child with some dehydration is
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?
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?
The most common cause of fresh bleeding per rectum in a 5-year-old child is:
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 -
All are true about Hirschsprung disease Except
Which of the following supplementation has been shown to reduce the duration and severity of acute diarrhea in children?
Baby with diarrhea presents with restlessness, irritability, sunken eyes and baby is thirsty and drinks eagerly. What is the diagnosis of this child?
Treatment in a 6-month-old child with acute watery diarrhea without signs of dehydration is:
Gastroenterology Indian Medical PG Practice Questions and MCQs
Question 271: 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
- A. obtain an abdominal ultrasound (Correct Answer)
- B. do nothing
- C. order a barium enema
- D. obtain an abdominal radiograph
Explanation: ***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.
Question 272: Amount of ORS to be given in the first 4 hours to a child with some dehydration is
- A. 75 ml/kg body wt. (Correct Answer)
- B. 50 ml/kg body wt.
- C. 100 ml/kg body wt.
- D. 200 ml/kg body wt.
Explanation: ***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.
Question 273: 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?
- A. Crohn disease
- B. Intussusception
- C. Peutz Jegher syndrome (Correct Answer)
- D. Meckel's diverticulum
Explanation: ***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.
Question 274: 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?
- A. Na+ in cerebrospinal fluid
- B. Na+ in urine
- C. Na+ in sweat (Correct Answer)
- D. Na+ in serum
Explanation: ***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.
Question 275: The most common cause of fresh bleeding per rectum in a 5-year-old child is:
- A. Rectal polyp (Correct Answer)
- B. Trauma
- C. Worm infestation
- D. Volvulus
Explanation: ***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 276: 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 -
- A. Normal saline
- B. N/3 saline + 5% dextrose (Correct Answer)
- C. N/3 Saline + 10% dextrose
- D. 3% Saline
Explanation: ***Correct: N/3 saline + 5% dextrose*** - According to **WHO and IAP guidelines** for pediatric acute diarrhea with severe dehydration, after initial rapid bolus resuscitation (Ringer's Lactate or Normal Saline at 30 mL/kg over 1-2 hours), **hypotonic solutions** are preferred for ongoing rehydration. - **N/3 saline (0.33% NaCl) + 5% dextrose** provides appropriate sodium content for gradual correction of **dilutional hyponatremia** (Na 125 mEq/L), which occurs due to water retention and fluid loss in diarrhea. - The **5% dextrose** prevents hypoglycemia and provides energy substrate, which is crucial in children with poor oral intake. - This formulation addresses the **metabolic acidosis** (pH 7.23, HCO3 16) by improving perfusion and allowing kidneys to regenerate bicarbonate, while avoiding hyperchloremic acidosis that can occur with excessive normal saline. *Incorrect: Normal saline* - While **normal saline (0.9% NaCl)** is appropriate for **initial rapid bolus** in severe dehydration, it is **not ideal for complete rehydration** in pediatric diarrhea. - Prolonged use can lead to **hypernatremia** and **hyperchloremic metabolic acidosis** due to high chloride content (154 mEq/L). - Does not provide glucose, risking **hypoglycemia** in children with inadequate oral intake. - Current pediatric guidelines recommend switching to hypotonic solutions after initial resuscitation. *Incorrect: N/3 Saline + 10% dextrose* - While N/3 saline is appropriate, **10% dextrose** is unnecessarily high and can cause: - **Osmotic diuresis** leading to worsened dehydration - **Hyperglycemia** which may worsen acidosis through osmotic shifts - Standard concentration is **5% dextrose** for maintenance fluids in children. *Incorrect: 3% Saline* - **3% saline** is a **hypertonic solution** reserved for **severe symptomatic hyponatremia** (typically Na < 120 mEq/L with seizures or altered consciousness). - The hyponatremia here (Na 125) is **mild and asymptomatic dilutional hyponatremia** from dehydration, not requiring hypertonic correction. - Rapid correction with 3% saline risks **osmotic demyelination syndrome** (central pontine myelinolysis). - Not indicated for routine rehydration in pediatric diarrhea.
Question 277: All are true about Hirschsprung disease Except
- A. Absence of ganglion cells within the affected segment
- B. The rectum is never affected (Correct Answer)
- C. Dilation proximal to the affected segment.
- D. Hirschsprung disease typically presents with a failure to pass meconium in the immediate postnatal period.
Explanation: ***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.
Question 278: Which of the following supplementation has been shown to reduce the duration and severity of acute diarrhea in children?
- A. Potassium
- B. Zinc (Correct Answer)
- C. Magnesium
- D. Calcium
Explanation: ***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 279: Baby with diarrhea presents with restlessness, irritability, sunken eyes and baby is thirsty and drinks eagerly. What is the diagnosis of this child?
- A. Severe dehydration
- B. Very Severe dehydration
- C. Some dehydration (Correct Answer)
- D. No dehydration
Explanation: ***Some dehydration*** - The combination of **restlessness and irritability**, **sunken eyes**, and **drinking eagerly/thirsty** are classic signs indicating **some dehydration** according to WHO guidelines for assessing dehydration in children with diarrhea. - While significant, these signs do not meet the criteria for severe or very severe dehydration, which typically involve more profound signs like lethargy, inability to drink, or severe skin turgor loss. *Severe dehydration* - This typically presents with **two or more** of the following: **lethargy**, **unconsciousness**, **not able to drink**, or **skin pinch goes back very slowly** (more than 2 seconds). - The child in the scenario is restless and drinking eagerly, which contradicts the signs of severe dehydration. *Very Severe dehydration* - This is not a distinct classification in the primary WHO dehydration assessment for children with diarrhea; it usually falls under "severe dehydration" or implies shock. - The given symptoms, while indicative of dehydration, do not suggest the immediate life-threatening state implied by "very severe." *No dehydration* - A child with no dehydration would typically present as **alert**, with **normal eyes**, **not thirsty**, and a **normal skin pinch**. - The presence of restlessness, sunken eyes, and thirst clearly indicates that the child is experiencing some degree of fluid deficit.
Question 280: Treatment in a 6-month-old child with acute watery diarrhea without signs of dehydration is:
- A. Mothers milk and household fluids (Correct Answer)
- B. ORS and antibiotics
- C. Mothers milk and antibiotics
- D. All of the options
Explanation: ***Mothers milk and household fluids*** - For a 6-month-old with **acute watery diarrhea** and **no signs of dehydration**, WHO Plan A management includes continued **breastfeeding (mother's milk)** for nutrition and hydration, along with **extra household fluids** like clean water. - **Note:** Ideally, **ORS should also be given** to prevent dehydration as per WHO guidelines, but among the given options, this is the most appropriate choice as it avoids unnecessary antibiotics. - This focuses on maintaining hydration and supporting recovery through adequate fluid and nutrient intake. *ORS and antibiotics* - While **ORS is actually recommended** in Plan A management (even without dehydration) to prevent progression, this option is incorrect because **antibiotics** are not indicated for acute watery diarrhea. - Most acute watery diarrhea cases are **viral** (rotavirus, norovirus) and self-limiting; antibiotics are reserved for specific bacterial infections with systemic features or bloody diarrhea. - The inclusion of antibiotics makes this option inappropriate. *Mothers milk and antibiotics* - While **mother's milk** is essential, **antibiotics** are unnecessary for uncomplicated acute watery diarrhea without dehydration. - Routine antibiotic use can lead to **antimicrobial resistance** and disrupt the intestinal microbiome, potentially prolonging diarrhea. *All of the options* - This is incorrect because **antibiotics** are not appropriate for routine acute watery diarrhea without signs of bacterial infection or systemic illness. - The correct management avoids unnecessary antibiotic use.
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Gastroesophageal Reflux
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Peptic Ulcer Disease
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Inflammatory Bowel Disease
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Celiac Disease
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Malabsorption Syndromes
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Acute and Chronic Diarrhea
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Constipation and Encopresis
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Gastrointestinal Bleeding
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Intestinal Obstruction
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Liver Diseases in Children
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Pancreatic Disorders
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Pediatric Nutritional Support
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