Gastroenterology — MCQs
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Which of the following is not elevated in a child presenting with jaundice, icterus, pruritus and clay-colored stools?
A previously healthy infant presents with recurrent episodes of abdominal pain. The mother says that the child has been passing altered stool after episodes of pain. There is no history of projectile vomiting or significant active bleeding per rectum. Which of the following is the most likely diagnosis -
A newborn baby presented with a failure to pass meconium in the immediate postnatal period. The pediatrician also notices visible yet ineffective peristalsis, and abdominal distention. A radiological contrast enema demonstrated a narrow conical segment and a dilated proximal bowel. A diagnosis of Hirschsprung disease was made. Which of the following is a cause of the condition in the patient?
A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?
In infantile hypertrophic pyloric stenosis, which metabolic disturbance is typical?
Which of the following pathogens is most commonly associated with acute infectious diarrhea?
A 6-month-old infant presents with failure to thrive and chronic diarrhea. Examination reveals a distended abdomen. Which condition is most likely?
A 3-year-old child is brought to the clinic with a history of constipation, abdominal pain, and irritability. Physical examination reveals a palpable abdominal mass. What is the most appropriate next step in management?
A 7-year-old boy presents with recurrent episodes of abdominal pain, diarrhea, and failure to thrive. Laboratory findings show anti-tissue transglutaminase antibodies. What is the most likely diagnosis?
A 6-month-old infant presents with recurrent episodes of sudden-onset crying, drawing up of the legs, and currant jelly stools. What is the most likely diagnosis?
Gastroenterology Indian Medical PG Practice Questions and MCQs
Question 291: Which of the following is not elevated in a child presenting with jaundice, icterus, pruritus and clay-colored stools?
- A. Serum amylase
- B. Glutamate dehydrogenase
- C. Lactate dehydrogenase
- D. Creatine kinase (Correct Answer)
Explanation: ***Creatine kinase*** - **Creatine kinase (CK)** is a muscle enzyme found primarily in cardiac and skeletal muscle - CK elevation indicates **muscle injury** (rhabdomyolysis, myositis, myocardial infarction), NOT hepatobiliary disease - In **obstructive cholestasis** (jaundice, pruritus, clay stools), CK remains **normal** - **This is the correct answer** - CK is not elevated in cholestatic liver disease *Serum amylase* - May be **mildly elevated** if biliary obstruction causes **ampullary obstruction** or secondary pancreatic duct involvement - In pediatric biliary atresia or choledochal cyst, amylase is usually normal unless there is concurrent **pancreatitis** - Less specific than hepatobiliary markers but can be elevated in complicated cases *Glutamate dehydrogenase* - **GLDH** is a mitochondrial liver enzyme that reflects **hepatocellular necrosis** - In **prolonged cholestasis**, secondary hepatocellular damage occurs, leading to GLDH elevation - Elevated in biliary atresia with progressive liver damage *Lactate dehydrogenase* - **LDH** is a non-specific enzyme found in liver, RBCs, and many other tissues - Elevated in **hepatocellular injury**, hemolysis, and tissue damage - Can be elevated in cholestatic liver disease with hepatocyte damage or associated hemolysis
Question 292: A previously healthy infant presents with recurrent episodes of abdominal pain. The mother says that the child has been passing altered stool after episodes of pain. There is no history of projectile vomiting or significant active bleeding per rectum. Which of the following is the most likely diagnosis -
- A. Intussusception (Correct Answer)
- B. Rectal Polyps
- C. Necrotizing Enterocolitis
- D. Meckel's Diverticulum
Explanation: ***Intussusception*** - **Recurrent colicky abdominal pain** with the passage of **altered stools** (often described as "currant jelly" stools due to a mixture of blood and mucus) is highly characteristic of intussusception. - The classic triad includes intermittent abdominal pain, vomiting, and bloody stools, though not all features may be present initially or recognized by caregivers. - In early presentations, the blood in stools may be subtle and described as "altered" rather than frank bleeding. *Rectal Polyps* - Rectal polyps most commonly present with **painless, bright red rectal bleeding**, particularly during defecation. - They are less likely to cause recurrent, severe episodic **colicky abdominal pain** or the clinical pattern described. *Necrotizing Enterocolitis* - Predominantly affects **premature or low-birth-weight infants** in the neonatal period and is characterized by abdominal distension, feeding intolerance, and bloody stools. - The infant in the vignette is described as "previously healthy," which makes necrotizing enterocolitis highly unlikely. *Meckel's Diverticulum* - The most common presentation of Meckel's diverticulum is **painless, significant rectal bleeding** due to ectopic gastric mucosa causing ulceration. - While it can cause complications like obstruction or intussusception, the primary presentation with recurrent colicky pain and altered stools without prominent bleeding is less typical.
Question 293: A newborn baby presented with a failure to pass meconium in the immediate postnatal period. The pediatrician also notices visible yet ineffective peristalsis, and abdominal distention. A radiological contrast enema demonstrated a narrow conical segment and a dilated proximal bowel. A diagnosis of Hirschsprung disease was made. Which of the following is a cause of the condition in the patient?
- A. Persistence of embryonic structures in the bowel wall
- B. Congenital obstruction due to external factors
- C. Failure of migration of neural crest cells (Correct Answer)
- D. Abnormal peristalsis due to neural dysfunction
Explanation: ***Failure of migration of neural crest cells*** - Hirschsprung disease is characterized by the **absence of ganglion cells** (specifically **Auerbach's and Meissner's plexuses**) in the distal bowel. - This aganglionosis results from the **failure of neural crest cells to migrate** completely into the intestinal wall during embryonic development. *Persistence of embryonic structures in the bowel wall* - This mechanism is associated with conditions like **Meckel's diverticulum**, where a remnant of the **vitelline duct** persists. - It does not explain the absence of ganglion cells or the functional obstruction seen in Hirschsprung disease. *Congenital obstruction due to external factors* - This would involve conditions such as an **annular pancreas**, **bands**, or **malrotation with volvulus**, creating a physical barrier. - Hirschsprung disease is a **functional obstruction** due to neuromuscular dysfunction, not an external compression or blockage. *Abnormal peristalsis due to neural dysfunction* - While there is abnormal peristalsis, the underlying cause is not just **"neural dysfunction"** in a general sense, but specifically the **absence of entire ganglion cell plexuses** within the bowel wall. - This option is too broad and doesn't pinpoint the precise developmental defect.
Question 294: A 5-year-old child is having acute liver failure. Which one of the following criteria is not included in the King's College criteria?
- A. Age < 11 years (Correct Answer)
- B. INR > 6.5
- C. Jaundice < 7 days before development of encephalopathy
- D. Bilirubin > 300 mmol/L
Explanation: ***Age < 11 years*** - Age is **NOT included** in the original King's College criteria for acute liver failure - King's College criteria are based on **biochemical parameters** (INR, bilirubin, pH, creatinine) and **clinical factors** (encephalopathy grade, jaundice-to-encephalopathy interval), not patient age - While **younger age may be a prognostic factor** in pediatric liver failure, it is not part of the formal King's College criteria used to predict poor prognosis or need for transplantation *INR > 6.5* - An **elevated INR > 6.5** (or PT > 100 seconds) is a **key criterion** in King's College criteria for non-paracetamol acute liver failure - Indicates severe **coagulopathy** and hepatic synthetic dysfunction - One of the most important predictors of poor outcome *Jaundice < 7 days before development of encephalopathy* - The **interval from jaundice to encephalopathy** is explicitly included in King's College criteria for non-paracetamol ALF - Jaundice to encephalopathy < 7 days = hyperacute (relatively better prognosis) - Jaundice to encephalopathy > 7 days = subacute (worse prognosis, indicates need for transplant) - This temporal relationship is a **critical prognostic indicator** *Bilirubin > 300 mmol/L* - **Serum bilirubin > 300 μmol/L** (17.5 mg/dL) is explicitly included in King's College criteria for non-paracetamol ALF - Indicates severe **cholestasis** and hepatocellular dysfunction - Part of the multi-parameter assessment for transplant listing
Question 295: In infantile hypertrophic pyloric stenosis, which metabolic disturbance is typical?
- A. Hyperkalemic acidosis
- B. Hypokalemic alkalosis (Correct Answer)
- C. Hyponatremic acidosis
- D. Hyperchloremic alkalosis
Explanation: ***Hypokalemic alkalosis*** - Due to **pyloric obstruction**, infants experience persistent **vomiting of gastric contents**, leading to loss of **hydrochloric acid (HCl)** and subsequent **metabolic alkalosis**. - The classic presentation is **hypochloremic, hypokalemic metabolic alkalosis**. - The kidneys attempt to compensate by excreting **potassium** and retaining hydrogen ions, causing **hypokalemia** and paradoxical aciduria. - Dehydration and contraction alkalosis further perpetuate the metabolic derangement. *Hyperkalemic acidosis* - This is typically seen in conditions like **renal failure** or **diabetic ketoacidosis**, not infantile hypertrophic pyloric stenosis. - Would involve a gain of **acid** or loss of **bicarbonate**, along with elevated potassium levels. *Hyponatremic acidosis* - While hyponatremia can occur due to fluid loss and inappropriate antidiuretic hormone secretion, the primary acid-base disturbance is **alkalosis** due to gastric acid loss, not acidosis. - Acidosis would imply retention of acid or loss of bicarbonate, inconsistent with recurrent vomiting of gastric acid. *Hyperchloremic alkalosis* - In pyloric stenosis, there is a loss of **chloride** along with hydrogen ions, leading to **hypochloremia**, not hyperchloremia. - Therefore, the alkalosis is primarily **hypochloremic** and hypokalemic, not hyperchloremic.
Question 296: Which of the following pathogens is most commonly associated with acute infectious diarrhea?
- A. Salmonella
- B. Escherichia coli
- C. Shigella
- D. Rotavirus (Correct Answer)
Explanation: ***Rotavirus*** - **Rotavirus** is the leading cause of **severe, acute diarrheal disease** in **infants and young children worldwide**, especially in unvaccinated populations. - It causes significant **morbidity and mortality** globally, primarily through dehydration. *Salmonella* - While *Salmonella* can cause acute infectious diarrhea, particularly **foodborne outbreaks**, it is **less common overall** than rotavirus, especially in children. - It often presents with **fever, abdominal cramps**, and **bloody or non-bloody diarrhea**, and can lead to systemic infections. *Escherichia coli* - Various strains of *E. coli* can cause diarrhea (e.g., **ETEC, EPEC, EHEC**), but collectively they do not surpass rotavirus as the single most common cause of acute infectious diarrhea globally. - **Enterohemorrhagic *E. coli* (EHEC)**, particularly O157:H7, is known for causing **hemorrhagic colitis** and **hemolytic uremic syndrome**. *Shigella* - *Shigella* species cause **bacillary dysentery**, characterized by **bloody diarrhea, fever, and severe abdominal cramps**. - While it is a significant cause of diarrheal disease, its prevalence is generally **lower than rotavirus**, especially in developed countries.
Question 297: A 6-month-old infant presents with failure to thrive and chronic diarrhea. Examination reveals a distended abdomen. Which condition is most likely?
- A. Cystic fibrosis (Correct Answer)
- B. Celiac disease
- C. Lactose intolerance
- D. GERD
Explanation: ***Cystic fibrosis*** - **Failure to thrive**, **chronic diarrhea** (due to pancreatic insufficiency leading to malabsorption), and **abdominal distension** are classic symptoms in infants with cystic fibrosis. - The thick, sticky mucus produced in CF obstructs pancreatic ducts, preventing the release of digestive enzymes. - CF is one of the most common causes of malabsorption presenting in early infancy. *Celiac disease* - While celiac disease can cause **failure to thrive** and **diarrhea**, it typically manifests later when gluten is introduced into the diet (around 6-12 months of age or later). - At 6 months, many infants may not yet have been exposed to gluten-containing foods. - A distended abdomen can occur, but celiac disease does not involve pancreatic insufficiency, which is the hallmark of CF-related malabsorption. *Lactose intolerance* - **Lactose intolerance** can cause diarrhea and abdominal distension, but primary lactose intolerance is extremely rare in infants. - Secondary lactose intolerance can occur but typically does not lead to severe **failure to thrive** or the chronic, severe malabsorption seen in this case. - This presentation is more consistent with pancreatic insufficiency rather than isolated lactase deficiency. *GERD* - **Gastroesophageal reflux disease (GERD)** commonly causes spitting up, vomiting, and irritability, which can indirectly lead to poor weight gain. - However, severe **chronic diarrhea** and marked abdominal distension are not typical primary symptoms of GERD. - GERD does not cause malabsorption or the gastrointestinal symptoms described in this case.
Question 298: A 3-year-old child is brought to the clinic with a history of constipation, abdominal pain, and irritability. Physical examination reveals a palpable abdominal mass. What is the most appropriate next step in management?
- A. Abdominal ultrasound (Correct Answer)
- B. Barium enema
- C. Stool softeners
- D. CT scan of the abdomen
Explanation: ***Abdominal ultrasound*** - An **abdominal ultrasound** is the most appropriate initial imaging study for a child with an unexplained abdominal mass and symptoms of **constipation** and **abdominal pain**. It is **non-invasive**, uses no radiation, and can effectively characterize masses (solid, cystic), identify their origin, and detect potential complications like **hydronephrosis** or **intussusception**. - It can help guide further management by determining if the mass is likely **neoplastic** (e.g., **Wilms' tumor**, **neuroblastoma**) or a benign condition such as a **fecaloma** or **hydronephrotic kidney**. *Barium enema* - A **barium enema** is primarily used to diagnose conditions like **intussusception** (and can sometimes reduce it), **Hirschsprung disease**, or **colonic strictures**. While intussusception can present with an abdominal mass and pain, the primary symptoms of constipation and irritability point to a broader differential. - It involves **radiation exposure** and is generally not the first-line diagnostic for an undifferentiated abdominal mass, especially when simpler, non-ionizing options are available. *Stool softeners* - While constipation is a symptom, merely prescribing **stool softeners** without investigating the underlying cause of constipation and the palpable abdominal mass would be a **delay in diagnosis** and potentially harmful. - The presence of a palpable mass indicates a need for immediate diagnostic workup to rule out serious conditions such as a **tumor** or severe **fecal impaction** that may require more than conservative management. *CT scan of the abdomen* - A **CT scan** provides detailed anatomical information but involves significant **ionizing radiation**, which is a concern in children due to their higher **radiosensitivity**. - It is usually reserved for further characterization of a mass after initial screening (like ultrasound) or when ultrasound is inconclusive, or when specific surgical planning requires the detailed 3D imaging it offers.
Question 299: A 7-year-old boy presents with recurrent episodes of abdominal pain, diarrhea, and failure to thrive. Laboratory findings show anti-tissue transglutaminase antibodies. What is the most likely diagnosis?
- A. Celiac disease (Correct Answer)
- B. Crohn's disease
- C. Ulcerative colitis
- D. Lactose intolerance
Explanation: ***Celiac disease*** - The constellation of **abdominal pain**, **diarrhea**, **failure to thrive**, and specifically **positive anti-tissue transglutaminase (tTG) antibodies** is highly indicative of celiac disease. - **Anti-tTG antibodies** are a sensitive and specific marker for celiac disease, which is an autoimmune disorder triggered by gluten consumption. *Crohn's disease* - While it can cause abdominal pain, diarrhea, and failure to thrive, it typically involves **transmural inflammation** and can affect any part of the gastrointestinal tract. - It is not associated with **anti-tTG antibodies**; instead, it might show elevated **ESR/CRP** and sometimes **anti-Saccharomyces cerevisiae antibodies (ASCA)**. *Ulcerative colitis* - This condition primarily presents with **bloody diarrhea** and **colonic inflammation** starting in the rectum and extending proximally. - It is also not associated with **anti-tTG antibodies** and is characterized by different inflammatory markers and endoscopic findings. *Lactose intolerance* - Primarily causes **abdominal pain**, **bloating**, and **diarrhea** after consuming dairy products due to lactase deficiency. - It does not cause **failure to thrive** or involve **anti-tTG antibodies**, and its symptoms are usually relieved by avoiding lactose.
Question 300: A 6-month-old infant presents with recurrent episodes of sudden-onset crying, drawing up of the legs, and currant jelly stools. What is the most likely diagnosis?
- A. Intussusception (Correct Answer)
- B. Volvulus
- C. Necrotizing Enterocolitis
- D. Hirschsprung Disease
Explanation: ***Intussusception*** - The classic triad of **sudden-onset intermittent abdominal pain** (crying and drawing up legs), **vomiting**, and **currant jelly stools** (blood and mucus) is highly indicative of intussusception. - This condition is the most common cause of **intestinal obstruction** in infants between 6 months and 3 years of age, often presenting with a **sausage-shaped abdominal mass**. *Volvulus* - Volvulus typically presents with **bilious vomiting** and **abdominal distension**, indicating intestinal obstruction and ischemia. - While it causes acute abdominal pain, the characteristic "currant jelly stools" are not typical of volvulus, and the pain is usually constant, not intermittent. *Necrotizing Enterocolitis* - NEC primarily affects **premature infants** and presents with abdominal distension, feeding intolerance, and bloody stools (often non-currant jelly). - The infant's age (6 months) makes NEC less likely, and the sudden, intermittent pain pattern is not typical. *Hirschsprung Disease* - Hirschsprung disease typically presents with **constipation** from birth, **abdominal distention**, and failure to pass meconium, rather than acute severe intermittent pain. - While it can lead to enterocolitis with bloody stools, the specific "currant jelly stool" appearance and the acute, intermittent nature of the symptoms are not characteristic.
Practice by Chapter
Gastroesophageal Reflux
Practice Questions
Peptic Ulcer Disease
Practice Questions
Inflammatory Bowel Disease
Practice Questions
Celiac Disease
Practice Questions
Malabsorption Syndromes
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Acute and Chronic Diarrhea
Practice Questions
Constipation and Encopresis
Practice Questions
Gastrointestinal Bleeding
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Intestinal Obstruction
Practice Questions
Liver Diseases in Children
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Pancreatic Disorders
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Pediatric Nutritional Support
Practice Questions
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