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: Persistent diarrhoea is defined as diarrhoea lasting more than?

14 days. ***14 days*** - **Persistent diarrhea** is clinically defined as an episode of diarrhea that lasts for **14 days or longer**. - This definition helps differentiate it from **acute diarrhea** (less than 14 days) and aids in guiding appropriate diagnostic and management strategies. *28 days* - Diarrhea lasting **longer than 28 days** is typically classified as **chronic diarrhea**, which is a distinct category from persistent diarrhea. - Chronic diarrhea often requires a more extensive workup to identify underlying causes, which can include malabsorption syndromes, inflammatory bowel disease, or irritable bowel syndrome. *21 days* - While 21 days is a prolonged period, it falls within the spectrum of **persistent diarrhea**, but the standard definition starts at **14 days**. - There is no specific clinical classification for diarrhea lasting exactly 21 days as distinct from persistent or chronic. *7 days* - Diarrhea lasting less than 14 days, including **7 days**, is generally considered **acute diarrhea**. - Acute diarrhea is very common and often self-limiting, frequently caused by infections and typically resolves without specific intervention.

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: Which of the following metabolic derangements is associated with congenital pyloric stenosis?

Hypochloremic alkalosis. ***Hypochloremic alkalosis*** - The forceful vomiting in **pyloric stenosis** leads to a significant loss of **gastric acid (HCl)**, resulting in **hypochloremia** and the metabolic picture of **alkalosis**. - The body attempts to compensate by retaining bicarbonate and excreting hydrogen ions, further contributing to the alkalosis. *Hypochloremic acidosis* - This condition is characterized by a low chloride level accompanied by **acidosis**, which contradicts the loss of acidic gastric contents seen in pyloric stenosis. - While chloride is lost, the predominant acid-base disturbance is alkalosis due to hydrogen ion loss. *Hyperchloremic acidosis* - This condition involves an elevated chloride level and acidosis, often seen in cases like **renal tubular acidosis** or severe diarrhea where bicarbonate is lost. - It is the opposite of the metabolic disturbance caused by the loss of gastric acid through vomiting. *Hyperchloremic alkalosis* - This imbalance would involve increased chloride and alkalosis, which does not align with the pathophysiology of pyloric stenosis where chloride is lost. - The body's compensatory mechanisms do not involve increasing chloride to an elevated level in this context.

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: The commonest cause of intestinal obstruction in children is –

Intussusception. ***Intussusception*** - **Intussusception** is the most common cause of intestinal obstruction in children, especially in infants between 6 months and 3 years of age. - It occurs when one segment of the intestine telescopes into an adjacent segment, leading to obstruction and potentially compromising blood supply. *Adhesions* - **Adhesions** are bands of scar tissue that can form after abdominal surgery and are a common cause of intestinal obstruction in adults. - While they can occur in children, they are generally less common as a primary cause of obstruction compared to intussusception, especially in infants. *Hernia* - **Hernias**, particularly incarcerated inguinal hernias, can cause intestinal obstruction in children. - Although common, hernias are not the single most frequent cause of intestinal obstruction across all pediatric age groups compared to intussusception. *Volvulus* - **Volvulus** refers to the twisting of a loop of intestine around its mesentery, often associated with intestinal malrotation. - It is a serious cause of intestinal obstruction in children and infants, but less common than intussusception, though it carries a higher risk of intestinal ischemia.

Q: A 4-year-old boy is admitted to the hospital with pneumonia and respiratory distress. The nurses report that the child's bowel movements are greasy and have a pungent odor. A sweat-chloride test is positive. Which of the following mechanisms of disease is the most likely cause of steatorrhea in this child?

Lack of pancreatic enzyme secretion. ***Lack of pancreatic enzyme secretion*** - The clinical picture of **pneumonia**, **respiratory distress**, **greasy/pungent bowel movements (steatorrhea)**, and a **positive sweat chloride test** is classic for **cystic fibrosis (CF)**. - In CF, a defective **CFTR protein** leads to thick, viscous secretions that block pancreatic ducts, causing **pancreatic insufficiency** and leading to inadequate release of digestive enzymes necessary for fat absorption. *Abnormal dietary intake* - While dietary factors can contribute to digestive issues, abnormal intake alone would not explain the other core features like the **positive sweat chloride test** or recurrent respiratory infections characteristic of cystic fibrosis. - This mechanism doesn't account for the fundamental physiological defect seen in this patient. *Hyperbilirubinemia with kernicterus* - **Kernicterus** is a condition caused by very high levels of **bilirubin** in a newborn's blood, leading to brain damage; it is not typically associated with steatorrhea or the respiratory symptoms described. - While CF can sometimes cause liver complications, **kernicterus** is unrelated to the primary mechanism of steatorrhea in this context. *Bacterial overgrowth* - **Bacterial overgrowth** in the small intestine can cause malabsorption and diarrhea, but it does not directly lead to the specific findings of **respiratory distress**, recurrent infections, or the underlying genetic defect indicated by a **positive sweat chloride test** in cystic fibrosis. - This condition is not the primary cause of the systemic and pancreatic issues described.

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

Persistent diarrhoea is defined as diarrhoea lasting more than?

Accepted Answer

14 days

Answer

28 days

Answer

21 days

Answer

7 days

Question 4

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 5

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 6

Which of the following metabolic derangements is associated with congenital pyloric stenosis?

Accepted Answer

Hypochloremic alkalosis

Answer

Hypochloremic acidosis

Answer

Hyperchloremic acidosis

Answer

Hyperchloremic alkalosis

Question 7

A 4-year-old boy presents with a history of constipation since the age of 6 months. His stools, produced every 3 to 4 days, are described as large and hard. His growth velocity is normal. Physical examination is normal; rectal examination reveals a large ampulla, poor sphincter tone but present anal wink, and stool in the rectal vault. The plain film of his abdomen is shown. Which of the following is the most appropriate next step in the management of this child?

Accepted Answer

Parental reassurance and dietary counseling

Answer

Lower gastrointestinal (GI) barium study

Answer

Upper GI barium study

Answer

Serum electrolyte measurement

Question 8

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 9

The commonest cause of intestinal obstruction in children is –

Accepted Answer

Intussusception

Answer

Adhesions

Answer

Hernia

Answer

Volvulus

Question 10

A 4-year-old boy is admitted to the hospital with pneumonia and respiratory distress. The nurses report that the child's bowel movements are greasy and have a pungent odor. A sweat-chloride test is positive. Which of the following mechanisms of disease is the most likely cause of steatorrhea in this child?

Accepted Answer

Lack of pancreatic enzyme secretion

Answer

Abnormal dietary intake

Answer

Hyperbilirubinemia with kernicterus

Answer

Bacterial overgrowth

Gastroenterology — MCQs

Gastroenterology — MCQs

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