Gastroenterology — MCQs

Gastroenterology Indian Medical PG Practice Questions and MCQs

Question 311: A 1-year-old child weighing 6 kg is suffering from Acute Gastroenteritis with signs of sunken eyes and skin pinch returning to normal slowly. What is the appropriate management?

A. Administer Ringer's Lactate (RL) infusion with slightly higher fluid volume than recommended.
B. Administer Ringer's Lactate (RL) infusion with overestimated initial volume and underestimated subsequent volume.
C. Administer Ringer's Lactate (RL) infusion as per WHO guidelines for some dehydration. (Correct Answer)
D. Administer Ringer's Lactate (RL) infusion with underestimated fluid volumes.

Explanation: ***Administer Ringer's Lactate (RL) infusion as per WHO guidelines for some dehydration.*** - The signs of **sunken eyes** and **skin pinch returning rapidly** indicate **some dehydration** (not severe) in a 1-year-old child with acute gastroenteritis. - The **WHO guidelines for some dehydration** recommend a specific amount of Oral Rehydration Solution (ORS) or intravenous fluids like Ringer's Lactate if oral intake is not feasible, aiming to restore fluid balance without over- or under-hydration. *Administer Ringer's Lactate (RL) infusion with slightly higher fluid volume than recommended.* - Administering a **slightly higher fluid volume** than recommended can lead to **fluid overload**, which is particularly dangerous in young children and can cause complications such as pulmonary edema or cardiac strain. - While addressing dehydration is crucial, **excessive fluid administration** beyond established guidelines can result in iatrogenic harm. *Administer Ringer's Lactate (RL) infusion with overestimated initial volume and underestimated subsequent volume.* - An **overestimated initial volume** carries the risk of **fluid overload** during the initial resuscitation phase. - An **underestimated subsequent volume** could lead to **incomplete rehydration** and ongoing fluid deficit, prolonging the dehydration and potentially worsening the child's condition. *Administer Ringer's Lactate (RL) infusion with underestimated fluid volumes.* - **Underestimating fluid volumes** would result in **incomplete rehydration**, failing to correct the child's dehydration effectively. - This could lead to a **worsening of dehydration**, potentially causing progression to severe dehydration, metabolic acidosis, and other complications if not adequately addressed.

Question 312: Child with 10 episodes of diarrhea in last 24 hours with sunken dry eyes, very slow skin pinch, and absent tears. Management is

A. Administer 10% dextrose solution
B. Administer intravenous Ringer's lactate (Correct Answer)
C. Encourage breastfeeding
D. Provide oral rehydration solution (ORS)

Explanation: ***Administer intravenous Ringer's lactate*** - The child presents with signs of **severe dehydration** (sunken dry eyes, very slow skin pinch, absent tears, 10 episodes of diarrhea), which necessitates **rapid intravenous fluid resuscitation**. - **Ringer's lactate** is an isotonic crystalloid solution that effectively replenishes intravascular volume and corrects electrolyte imbalances, making it the most appropriate initial management for severe dehydration. *Encourage breastfeeding* - While **breastfeeding** is crucial for hydration and nutrition in children with diarrhea, it is insufficient to correct **severe dehydration** rapidly. - This intervention is more suitable for managing **mild to moderate dehydration** or for rehydration after initial stabilization. *Administer 10% dextrose solution* - **10% dextrose solution** is used primarily to correct **hypoglycemia** or provide a source of calories, not for rapid volume expansion in severe dehydration. - Administering hypertonic solutions like 10% dextrose without adequate volume can worsen dehydration or cause electrolyte disturbances. *Provide oral rehydration solution (ORS)* - **Oral rehydration solution (ORS)** is the gold standard for treating **mild to moderate dehydration** and preventing dehydration due to diarrhea. - However, in cases of **severe dehydration**, where the child may be lethargic, vomiting frequently, or have impaired absorption, ORS alone is often insufficient and intravenous fluids are required for initial stabilization.

Question 313: A 1-year-old child with multiple episodes of diarrhea presents with sunken dry eyes, depressed fontanelles, and very slow skin pinch. According to WHO guidelines, what is the recommended amount of fluid to be given in the first 6 hours?

A. 600 ml
B. 900 ml (Correct Answer)
C. 1200 ml
D. 1500 ml

Explanation: ***900 ml*** - This child exhibits signs of **severe dehydration** including sunken eyes, dry mucous membranes, depressed fontanelles, and very slow skin pinch. - According to **WHO guidelines for severe dehydration**, the recommended fluid replacement is **100 ml/kg over 6 hours**. - For a typical 1-year-old child weighing approximately **10 kg**, the calculated fluid requirement is 100 ml/kg × 10 kg = **1000 ml over 6 hours**. - Among the given options, **900 ml is the closest** to the WHO-recommended 1000 ml and represents appropriate fluid management for severe dehydration. - The fluid is given as **30 ml/kg in the first hour** (300 ml) and **70 ml/kg over the next 5 hours** (700 ml) for infants under 12 months. *600 ml* - This amount (60 ml/kg for a 10 kg child) is **insufficient for severe dehydration**. - This volume is more appropriate for **moderate dehydration** managed with ORS over 3-4 hours (75 ml/kg). - Inadequate fluid replacement in severe dehydration can lead to **hypovolemic shock**, persistent acidosis, and organ failure. *1200 ml* - This amount (120 ml/kg) **exceeds WHO recommendations** by 20% and risks **fluid overload**. - Over-rapid or excessive fluid administration can cause complications including **pulmonary edema**, **cerebral edema**, and **heart failure**, especially in malnourished children. - WHO guidelines are evidence-based and already account for adequate resuscitation; exceeding these volumes is not recommended. *1500 ml* - This is an **excessive amount** (150 ml/kg) that significantly exceeds WHO guidelines and carries high risk of **fluid overload**. - Such volumes can lead to **acute pulmonary edema**, **congestive heart failure**, and **dilutional hyponatremia**. - There is no indication for such aggressive fluid administration in standard severe dehydration management.

Question 314: All of the following is true about congenital hypertrophic pyloric stenosis except which of the following?

A. Metabolic alkalosis occurs
B. More common in males
C. Metabolic acidosis occurs (Correct Answer)
D. Ramstedt Pyloromyotomy is the treatment of choice

Explanation: ***Metabolic acidosis occurs*** - This statement is **incorrect** because the persistent vomiting seen in pyloric stenosis typically leads to **metabolic alkalosis**, not acidosis. - The loss of gastric acid (HCl) from vomiting causes a net loss of hydrogen ions, resulting in an elevation of blood pH and bicarbonate levels. *Metabolic alkalosis occurs* - This is a **true** statement about congenital hypertrophic pyloric stenosis. - The characteristic **projectile vomiting** of gastric contents leads to a significant loss of **hydrochloric acid (HCl)** and subsequent **metabolic alkalosis**, often with hypochloremia and hypokalemia. *More common in males* - This is a **true** statement; congenital hypertrophic pyloric stenosis shows a distinct **male predominance**, with a male-to-female ratio of about 4:1. - This difference suggests possible genetic or hormonal influences on its development. *Ramstedt Pyloromyotomy is the treatment of choice* - This is a **true** statement; **Ramstedt Pyloromyotomy** is the definitive surgical treatment for congenital hypertrophic pyloric stenosis. - The procedure involves incising the hypertrophied pyloric muscle, which relieves the obstruction and allows for normal gastric emptying.

Question 315: The most common cause of per rectal bleeding in infants is:

A. Anal fissure (Correct Answer)
B. Rectal polyp
C. Intussusception
D. Meckel's diverticulum

Explanation: ***Anal fissure*** - **Anal fissures** are tiny tears in the **anus** lining, causing bright red blood on the stool surface or diaper. - They are very common in infants due to **constipation** or passing **hard stools**, leading to trauma. *Rectal polyp* - Rectal polyps can cause **painless rectal bleeding**, but they are **less common** than anal fissures in infants. - Bleeding from polyps is usually **intermittent** and can be darker or mixed with stool. *Intussusception* - Intussusception presents with sudden onset of **crampy abdominal pain**, **vomiting**, and **currant jelly stools** (blood mixed with mucus). - This condition is an **emergency** and typically affects infants between 3 months and 3 years old. *Meckel's diverticulum* - **Meckel's diverticulum** can cause painless, recurrent **dark red or maroon bleeding**, often described as "brick-red" due to ectopic gastric mucosa. - While a significant cause of bleeding, it is **less common** than anal fissures as the primary etiology in infants.

Question 316: What is the most common differential diagnosis for appendicitis in children?

A. Intussusception
B. Meckel's diverticulitis
C. Mesenteric lymphadenitis (Correct Answer)
D. Gastroenteritis

Explanation: ***Mesenteric lymphadenitis*** - **Mesenteric lymphadenitis** commonly mimics appendicitis in children due to similar symptoms like **abdominal pain**, **fever**, and **vomiting**. - It often follows a **viral infection** and causes enlarged lymph nodes in the mesentery, leading to pain in the **right lower quadrant**. *Gastroenteritis* - While gastroenteritis also causes **abdominal pain**, **vomiting**, and often **diarrhea**, the pain is usually more generalized or diffuse, unlike the localized **right lower quadrant pain** of appendicitis. - Furthermore, patients with gastroenteritis typically do not present with the progressive, worsening pain characteristic of appendicitis. *Intussusception* - Intussusception usually presents with sudden onset of **crampy, intermittent abdominal pain** and **currant jelly stools** in younger children (typically 3 months to 3 years), which is distinct from appendicitis pain. - A palpable **sausage-shaped mass** in the abdomen can also be a key diagnostic feature, rarely seen in appendicitis. *Meckel's diverticulitis* - **Meckel's diverticulitis** can mimic appendicitis very closely in its presentation of **right lower quadrant pain** and inflammation. - However, it is a less common condition than mesenteric lymphadenitis and appendicitis itself, making it a differential rather than the **most common differential diagnosis**.

Question 317: What is the total amount of Oral Rehydration Solution (ORS) required during the first 4 hours for a 20 kg child?

A. 2000-2200 ml
B. 400-600 ml
C. 600-800 ml
D. 1200-2000 ml (Correct Answer)

Explanation: ***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.

Question 318: Diarrhoea in a child of 12 months, dose of Zinc is?

A. 1 mg / 10 - 14 day
B. 10 mg / 10 - 14 day
C. 20 mg / 10 - 14 day (Correct Answer)
D. 15 mg / 10 - 14 day

Explanation: **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.

Question 319: Rehydration therapy in a 2 year old severely dehydrated child is -

A. 75 ml/kg in 4 hours
B. 30 ml/kg in 1 hour, 70 ml/kg in 5 hours
C. 20 ml/kg in 30 min, 80 ml/kg in 2.5 hours
D. 30 ml/kg in 30 min, 70 ml/kg in 2.5 hours (Correct Answer)

Explanation: ***30 ml/kg in 30 min, 70 ml/kg in 2.5 hours*** - This option reflects the recommended rehydration protocol for a severely dehydrated child aged **12 months to 5 years**, where the first 30 ml/kg are given rapidly over 30 minutes, followed by 70 ml/kg over the next 2.5 hours. - This rapid initial infusion helps to quickly restore **circulating volume** and improve perfusion during severe dehydration. *30 ml/kg in 1 hour, 70 ml/kg in 5 hours* - This protocol is typically used for children with **some dehydration**, not severe dehydration, and is usually administered orally when possible. - The slower rate of rehydration would be insufficient for a severely dehydrated child requiring more urgent fluid replacement. *20 ml/kg in 30 min, 80 ml/kg in 2.5 hours* - While reflecting a rapid initial phase, the total volume and distribution of fluids differ from the WHO guidelines for **severe dehydration** in this age group. - The **initial 20 ml/kg over 30 minutes** is generally a slightly lower first bolus than recommended for very severe cases, and the subsequent phase is also adjusted. *75 ml/kg in 4 hours* - This represents a **lower total volume** (75 ml/kg compared to 100 ml/kg) and a different time distribution for severely dehydrated children in the 12 month to 5 year age group. - This protocol is more aligned with the management of **some dehydration** rather than the urgent requirements of severe dehydration.

Question 320: Conjugated hyperbilirubinemia is seen in which of the following conditions?

A. Gilbert syndrome
B. Crigler-Najjar syndrome
C. Dubin-Johnson syndrome (Correct Answer)
D. None of the options

Explanation: ***Dubin-Johnson syndrome*** - This is an **autosomal recessive disorder** characterized by a defect in the excretion of **conjugated bilirubin** from hepatocytes into the bile canaliculi due to mutation in the **MRP2 (ABCC2) gene**. - It leads to a **direct (conjugated) hyperbilirubinemia** causing recurrent episodes of **jaundice**, and often a characteristic **black liver** due to melanin-like pigment accumulation. - Typically presents in **adolescence or early adulthood** with mild, fluctuating jaundice. *Gilbert syndrome* - This is a common, benign, **hereditary condition** characterized by intermittently elevated levels of **unconjugated (indirect) bilirubin**. - It results from a partial deficiency of the enzyme **uridine diphosphate glucuronosyltransferase (UGT1A1)**, responsible for bilirubin conjugation. - Presents with mild jaundice during fasting, stress, or illness. *Crigler-Najjar syndrome* - This is a rare, severe, **hereditary disorder** involving a complete (Type I) or near-complete (Type II) deficiency of **UGT1A1 enzyme** activity. - It leads to very high levels of **unconjugated hyperbilirubinemia**, with Type I causing severe **kernicterus** and often death in infancy if untreated. *None of the options* - Since **Dubin-Johnson syndrome** is a well-established cause of conjugated hyperbilirubinemia, this option is incorrect.

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