Gastroenterology Practice Questions

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: 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: 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.

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.

Q: Baby with diarrhea presents with restlessness, irritability, sunken eyes and baby is thirsty and drinks eagerly. What is the diagnosis of this child?

Some dehydration. ***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.

Q: Treatment in a 6-month-old child with acute watery diarrhea without signs of dehydration is:

Mothers milk and household fluids. ***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.

Question 1

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 2

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 3

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 4

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 5

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

Question 6

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 7

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 8

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

Question 9

Baby with diarrhea presents with restlessness, irritability, sunken eyes and baby is thirsty and drinks eagerly. What is the diagnosis of this child?

Accepted Answer

Some dehydration

Answer

Severe dehydration

Answer

Very Severe dehydration

Answer

No dehydration

Question 10

Treatment in a 6-month-old child with acute watery diarrhea without signs of dehydration is:

Accepted Answer

Mothers milk and household fluids

Answer

ORS and antibiotics

Answer

Mothers milk and antibiotics

Answer

All of the options

Gastroenterology — MCQs

Gastroenterology — MCQs

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