Gastroenterology Practice Questions

Q: What is the total amount of Oral Rehydration Solution (ORS) required during the first 4 hours for a 20 kg child?

1200-2000 ml. ***1200-2000 ml*** - According to **WHO ORS Guidelines (Plan B)**, for a child with **some dehydration**, the recommended ORS amount during the first 4 hours is **75 ml/kg**. - For a 20 kg child: 20 kg × 75 ml/kg = **1500 ml**. - This falls within the range of **1200-2000 ml**, making this the correct answer. - This guideline applies to children with **some dehydration** who are alert and able to drink. *2000-2200 ml* - This range is **excessive** for a 20 kg child and could lead to **fluid overload**. - This amount would be appropriate for a child weighing approximately **27-29 kg** using the 75 ml/kg guideline. - Administering this volume could result in **hypernatremia** or fluid overload complications. *400-600 ml* - This amount is **grossly insufficient** for rehydrating a 20 kg child with some dehydration over 4 hours. - This range represents only **20-30 ml/kg**, which is far below the WHO-recommended **75 ml/kg**. - This volume might be suitable for a **5-8 kg infant** or for maintenance therapy only. *600-800 ml* - This range is also **insufficient** for adequate rehydration of a 20 kg child. - This represents only **30-40 ml/kg**, which is about **half** the recommended amount. - This volume would be appropriate for a child weighing approximately **8-11 kg** using the 75 ml/kg guideline.

Q: A 24-day-old neonate presents with projectile vomiting and failure to gain weight. What is the most likely diagnosis?

Congenital Hypertrophic Pyloric Stenosis. ***Congenital Hypertrophic Pyloric Stenosis*** - The classic presentation includes **projectile, non-bilious vomiting** in a neonate around 2-8 weeks old, leading to **failure to thrive**. - An **olive-shaped mass** (hypertrophied pylorus) may be palpable in the epigastrium. *NEC* - **Necrotizing enterocolitis (NEC)** is an inflammatory disease of the intestine, primarily affecting premature infants. - Symptoms typically include **abdominal distension**, bloody stools, and lethargy, rather than projectile vomiting. *Duodenal atresia* - Presents with **bilious vomiting** within the first 24-48 hours of life due to an obstruction below the ampulla of Vater. - An X-ray would show a **"double bubble" sign**, which is not implied by the provided symptoms. *Hirschsprung's disease* - Characterized by **failure to pass meconium** within the first 24-48 hours and chronic constipation. - Vomiting, if present, is usually **bilious** and associated with abdominal distension, not projectile in nature.

Q: A 3-month-old infant presents with an abdominal palpable mass and non-bilious vomiting. What is the most likely diagnosis?

Hypertrophic pyloric stenosis. ***Hypertrophic pyloric stenosis*** - The classic presentation includes **projectile non-bilious vomiting** and a palpable **olive-shaped mass** in the epigastrium of an infant typically between 3 weeks and 6 months of age. - The vomiting is non-bilious because the obstruction is proximal to the ampulla of Vater. *Intussusception* - While it can present with an **abdominal mass** and vomiting, the vomiting is often **bilious** and the classic stool is **'currant jelly'**, which is not mentioned here. - It usually presents with sudden onset of severe, **colicky abdominal pain** and occurs more commonly in slightly older infants (6-12 months). *Tracheoesophageal fistula* - This condition presents at birth with symptoms such as **choking, coughing**, and **cyanosis** during feeding. - It usually causes respiratory distress and feeding difficulties from the first days of life, not a palpable abdominal mass and non-bilious vomiting at 3 months. *Duodenal atresia* - This is a congenital obstruction that typically presents with **bilious vomiting** (as the obstruction is distal to the ampulla of Vater) within the first 24-48 hours of life. - Imaging usually shows a **“double bubble” sign** on abdominal X-ray, and an abdominal mass is not typically palpable.

Q: What is the most common cause of conjugated hyperbilirubinemia in infants?

Biliary atresia. ***Rotor syndrome*** - Characterized by **conjugated hyperbilirubinemia** due to a defect in hepatic uptake and storage of bilirubin [1]. - This condition can lead to elevated levels of **direct (conjugated) bilirubin** without significant liver damage. *Crigler Najjar* - This condition primarily causes **unconjugated hyperbilirubinemia** due to a deficiency of the enzyme **uridine diphosphate glucuronyl transferase** [1]. - It typically presents with **kernicterus** in newborns rather than conjugated bilirubin elevation. *Breast milk jaundice* - Mainly leads to **unconjugated hyperbilirubinemia** due to substances in breast milk that inhibit bilirubin conjugation. - Generally occurs in **breastfed infants** after the first week of life, not presenting with increased conjugated bilirubin. *Gilbert syndrome* - This syndrome is associated with **unconjugated hyperbilirubinemia** due to a genetic defect in bilirubin conjugation [1]. - Typically benign, it does not cause **increased conjugated bilirubin** levels as seen in Rotor syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Liver and Gallbladder, p. 860.

Q: Diarrhoea in a child of 12 months, dose of Zinc is?

20 mg / 10 - 14 day. **20 mg / 10 - 14 day** - For children aged **12 months and older**, the recommended dose of zinc for acute diarrhea is **20 mg** once daily for **10 to 14 days**. - This dosage helps reduce the severity and duration of diarrheal episodes and prevents future occurrences. *1 mg / 10 - 14 day* - This dosage is **too low** and would be ineffective in treating or preventing the future incidence of diarrhea in a 12-month-old child. - Subtherapeutic doses will not provide the necessary micronutrient support during diarrheal illness. *10 mg / 10 - 14 day* - This is the recommended dose for children **under 6 months of age**, not for a 12-month-old child. - While it's a correct dosage for a different age group, it is an insufficient dose for a 12-month-old. *15 mg / 10 - 14 day* - This dose is **not the standard recommendation** by major health organizations like WHO or UNICEF for any age group for treating diarrhea. - It falls between the standard dosages and may not provide optimal benefit.

Q: A child presents with massive hematemesis and systemic hypotension, with no fever or other significant history. Examination reveals massive splenomegaly but no hepatomegaly. What is the likely diagnosis?

Non-cirrhotic portal fibrosis. ***Non-cirrhotic portal fibrosis*** - This condition is characterized by **portal hypertension** [1] without cirrhosis, often leading to **splenomegaly** and **esophageal varices** due to increased portal vein pressure. - The massive hematemesis and hypotension, coupled with massive splenomegaly and normal liver size, are highly suggestive of **variceal bleeding** secondary to portal hypertension from non-cirrhotic portal fibrosis [1]. *Hepatocellular carcinoma* - While it can cause gastrointestinal bleeding and systemic symptoms, it typically presents with **hepatomegaly** and signs of liver dysfunction, which are absent here. - **Splenomegaly without hepatomegaly** would be unusual for primary hepatocellular carcinoma unless advanced portal vein thrombosis is also present. *Bleeding duodenal ulcer* - A bleeding duodenal ulcer would cause **hematemesis** and **hypotension** [2], but it does not typically cause **massive splenomegaly**. - Its presentation is usually associated with epigastric pain or dyspepsia, which is not mentioned. *Oesophageal varices* - While esophageal varices are the **direct cause of the hematemesis**, they are a **manifestation** of an underlying condition like non-cirrhotic portal fibrosis, not the primary diagnosis. - The question asks for the "likely diagnosis," implying the root cause of the varices and splenomegaly, not just the bleeding source.

Q: What is true regarding congenital hypertrophic pyloric stenosis?

Hypochloremic alkalosis. ***Hypochloremic alkalosis*** - The forceful vomiting in pyloric stenosis leads to a significant loss of **hydrochloric acid** from the stomach, resulting in **metabolic alkalosis**. - Additionally, the loss of gastric fluid containing chloride contributes to **hypochloremia**. *More common in girls* - **Congenital hypertrophic pyloric stenosis** is significantly more common in **boys**, with a male-to-female ratio of about 4:1. - This gender predilection is a key epidemiological feature of the condition. *Heller's myotomy is the procedure of choice* - **Ramstedt pyloromyotomy** is the standard surgical procedure for pyloric stenosis, involving the incision of the hypertrophied pyloric muscle. - **Heller's myotomy** is a procedure typically performed for **achalasia**, a disorder of the esophagus, not pyloric stenosis. *Most often manifests at birth* - Symptoms of pyloric stenosis usually manifest between **2 and 8 weeks of age**, not immediately at birth. - The hypertrophy of the pyloric muscle takes time to progress sufficiently to cause significant obstruction.

Q: A 4-year-old girl weighing 12 kg, with diarrhea, skin pinch that goes back very slowly, and who is unable to drink, is most likely to:

Start IV fluids per Plan C. ***Start IV fluids per Plan C*** - The child presents with **severe dehydration** based on WHO criteria: **skin pinch goes back very slowly** (>2 seconds) and **unable to drink**. - These two signs mandate immediate **Plan C management** which involves rapid IV fluid resuscitation using **Ringer's Lactate or Normal Saline**. - WHO Plan C protocol: Give **100 ml/kg** IV fluids divided as 30 ml/kg in first hour (if <12 months) or first 30 minutes (if ≥12 months), then 70 ml/kg over next 2.5-5 hours. - Plan C is specifically designed for **severe dehydration** requiring immediate intravenous rehydration, not Plan B which is for moderate dehydration with oral rehydration. *Discharge home with oral fluids* - Discharging a child with **severe dehydration** is inappropriate and potentially life-threatening. - The child **cannot drink** effectively, making home management with oral fluids impossible and dangerous. - This would lead to worsening dehydration, shock, and potentially fatal complications. *Monitor for worsening dehydration* - While monitoring is important, this child requires **immediate active intervention**, not observation alone. - Delaying IV rehydration in a child with **severe dehydration** (unable to drink, very slow skin pinch) could lead to hypovolemic shock, acute kidney injury, and death. *Attempt oral rehydration with ORS* - This child is **unable to drink**, making ORS ineffective and contraindicated. - Oral rehydration (Plan B) is appropriate only for **moderate dehydration** in children who are conscious, alert, and able to drink. - Attempting ORS in a child unable to drink delays appropriate IV therapy and worsens outcomes.

Q: A 12 kg child with diarrhoea and some dehydration: based on WHO guidelines, how much fluid should be replaced in the first 4 hours?

800-1200 ml. ***800-1200 ml*** - For a child weighing **12 kg** with **some dehydration** due to diarrhea, WHO Plan B recommends **75 mL/kg** over 4 hours. - Therefore, 12 kg × 75 mL/kg = **900 mL**, which falls within this range. - This range allows for slight variations in clinical practice while staying close to the WHO standard guideline. *0-400 ml* - This range is significantly **too low** for a 12 kg child with some dehydration, as it would not adequately address the fluid deficit. - Inadequate fluid replacement can lead to worsening dehydration and its associated complications, such as **persistent signs of dehydration or progression to severe dehydration**. *400-800 ml* - While higher than the lowest option, **400-800 mL** is still generally insufficient for a 12 kg child needing rehydration over 4 hours per WHO Plan B. - This amount would only partially correct the fluid deficit, potentially delaying recovery and necessitating further interventions. *1200-1600 ml* - This range is **excessive** for WHO Plan B rehydration in a 12 kg child over 4 hours, potentially leading to **fluid overload**. - While adequate rehydration is crucial, administering significantly more than 75 mL/kg can increase the risk of complications, especially in children with underlying cardiac or renal conditions.

Q: Most common genetic mutation associated with Hirschsprung's disease is:

RET gene. ***RET gene*** - Mutations in the **RET proto-oncogene** are the most common genetic cause of Hirschsprung's disease, accounting for up to 50% of familial cases and 15-20% of sporadic cases. - The RET gene codes for a **receptor tyrosine kinase** involved in the development of the enteric nervous system. *EDN3 gene* - The **EDN3 gene** (endothelin 3) plays a role in Hirschsprung's disease; however, mutations in this gene are much less common than those in the RET gene. - EDN3 mutations are typically associated with a smaller subset of Hirschsprung's cases. *ATP 7A* - The **ATP7A gene** is associated with **Menkes disease**, a disorder of copper transport, not Hirschsprung's disease. - This gene codes for a copper-transporting ATPase. *EDNRB gene* - The **EDNRB gene** (endothelin receptor type B) is involved in some cases of Hirschsprung's disease, but mutations in this gene are less frequent than RET mutations. - It works in conjunction with EDN3 in neural crest cell development.

Question 1

What is the total amount of Oral Rehydration Solution (ORS) required during the first 4 hours for a 20 kg child?

Accepted Answer

1200-2000 ml

Answer

2000-2200 ml

Answer

400-600 ml

Answer

600-800 ml

Question 2

A 24-day-old neonate presents with projectile vomiting and failure to gain weight. What is the most likely diagnosis?

Accepted Answer

Congenital Hypertrophic Pyloric Stenosis

Answer

NEC

Answer

Duodenal atresia

Answer

Hirschsprung's disease

Question 3

A 3-month-old infant presents with an abdominal palpable mass and non-bilious vomiting. What is the most likely diagnosis?

Accepted Answer

Hypertrophic pyloric stenosis

Answer

Tracheoesophageal fistula

Answer

Duodenal atresia

Answer

Intussusception

Question 4

What is the most common cause of conjugated hyperbilirubinemia in infants?

Accepted Answer

Biliary atresia

Answer

Rotor syndrome

Answer

Crigler Najjar syndrome

Answer

Dubin-Johnson syndrome

Question 5

Diarrhoea in a child of 12 months, dose of Zinc is?

Accepted Answer

20 mg / 10 - 14 day

Answer

1 mg / 10 - 14 day

Answer

10 mg / 10 - 14 day

Answer

15 mg / 10 - 14 day

Question 6

A child presents with massive hematemesis and systemic hypotension, with no fever or other significant history. Examination reveals massive splenomegaly but no hepatomegaly. What is the likely diagnosis?

Accepted Answer

Non-cirrhotic portal fibrosis

Answer

Hepatocellular carcinoma

Answer

Bleeding duodenal ulcer

Answer

Oesophageal varices

Question 7

What is true regarding congenital hypertrophic pyloric stenosis?

Accepted Answer

Hypochloremic alkalosis

Answer

Heller's myotomy is the procedure of choice

Answer

More common in girls

Answer

Most often manifests at birth

Question 8

A 4-year-old girl weighing 12 kg, with diarrhea, skin pinch that goes back very slowly, and who is unable to drink, is most likely to:

Accepted Answer

Start IV fluids per Plan C

Answer

Discharge home with oral fluids

Answer

Monitor for worsening dehydration

Answer

Attempt oral rehydration with ORS

Question 9

A 12 kg child with diarrhoea and some dehydration: based on WHO guidelines, how much fluid should be replaced in the first 4 hours?

Accepted Answer

800-1200 ml

Answer

0-400 ml

Answer

400-800 ml

Answer

1200-1600 ml

Question 10

Most common genetic mutation associated with Hirschsprung's disease is:

Accepted Answer

RET gene

Answer

ATP 7A

Answer

EDNRB gene

Answer

EDN3 gene

Gastroenterology — MCQs

Gastroenterology — MCQs

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