Gastroenterology Practice Questions

Q: What is the treatment of choice for an 11-year-old child with hepatitis C infection?

Direct-Acting Antivirals (DAAs). ***Direct-Acting Antivirals (DAAs)*** - **Direct-acting antivirals** are the current **standard of care** for hepatitis C infection in children due to their high efficacy, good safety profile, and ability to achieve sustained virologic response (SVR). - Several DAAs are approved and recommended for use in children as young as 3 years, with treatment regimens tailored to the **genotype** of the hepatitis C virus (HCV). *Gamma-globulin* - **Gamma-globulin** (immunoglobulin) is primarily used for **passive immunization** against certain infections or in conditions involving antibody deficiencies; it has no direct antiviral activity against chronic hepatitis C. - It would not be effective in eradicating the hepatitis C virus from an infected individual. *Corticosteroids* - **Corticosteroids** are potent **anti-inflammatory** and immunosuppressive agents, but they do not possess direct antiviral properties against HCV. - Using corticosteroids could potentially worsen the infection by **suppressing the immune response** needed to clear the virus, and they are generally contraindicated in active viral hepatitis. *Vaccine* - While there are effective **vaccines** for hepatitis A and hepatitis B, there is currently **no vaccine available** to prevent hepatitis C infection. - Research is ongoing, but a preventive vaccine for HCV has yet to be developed.

Q: What is the commonest cause of intestinal obstruction in children between 3 months to 6 years of age?

Intussusception. ***Intussusception*** - **Intussusception** is the most frequent cause of **intestinal obstruction** in children between 3 months and 6 years, where a segment of intestine telescopes into an adjacent segment. - This condition presents with classic symptoms like **abdominal pain**, vomiting, and bloody stools (currant jelly stools). *Nonspecific cause* - While many childhood illnesses have nonspecific causes, **intestinal obstruction** is a specific and severe condition requiring prompt diagnosis. - Attributing it to a "nonspecific cause" would delay proper identification of the underlying pathology. *Intestinal polyp* - While intestinal polyps can cause **gastrointestinal bleeding** and, less commonly, obstruction in children, they are not the most common cause of obstruction in this age group. - Polyps usually present with intermittent bleeding or prolapse rather than acute, severe obstruction. *Meckel's diverticulum* - **Meckel's diverticulum** is the most common congenital anomaly of the gastrointestinal tract and can cause obstruction, bleeding, or inflammation (diverticulitis). - However, it is a less common cause of intestinal obstruction in this specific age range compared to **intussusception**.

Q: A 12 year old boy presents with hematemesis, melena and mild splenomegaly. There is no obvious jaundice or ascites. The most likely diagnosis is:

EHPVO. EHPVO - **Extrahepatic portal vein obstruction (EHPVO)** in children commonly presents with upper GI bleeding due to **esophageal varices** caused by portal hypertension, alongside **splenomegaly**. [1] - The absence of jaundice and ascites, paired with the patient's age, is highly suggestive of EHPVO since it primarily affects the portal vein before it reaches the liver, sparing hepatic function initially. NCPF - **Non-cirrhotic portal fibrosis (NCPF)** also causes portal hypertension, splenomegaly, and GI bleeding. However, it is more commonly seen in older adults and is a diagnosis of exclusion. - While it fits some symptoms, EHPVO is a more common cause of portal hypertension in children without underlying liver disease. [1] Malaria with DIC - **Malaria** can cause splenomegaly and, in severe cases, DIC leading to bleeding, but it would typically present with **fever, chills**, and other systemic signs of infection, which are not mentioned. - DIC would also likely present with more diffuse bleeding manifestations beyond hematemesis and melena, and not typically without other signs of severe malaria. Cirrhosis - **Cirrhosis** leads to portal hypertension, splenomegaly, and GI bleeding from varices. However, it is usually accompanied by overt signs of **liver dysfunction** such as **jaundice, ascites**, and encephalopathy, which are reportedly absent in this case. [1] - In a 12-year-old, childhood cirrhosis causes are typically distinct from adult causes and would still manifest with more significant liver compromise.

Q: Most common cause of acute intestinal obstruction in children is

Intussusception. ***Intussusception*** - **Intussusception** is the most common cause of **acute intestinal obstruction** in children, particularly between 3 months and 3 years of age. - It occurs when a segment of the intestine telescopes into an adjacent segment, leading to obstruction and potentially **ischemia**. *Inguinal hernia* - While an **incarcerated inguinal hernia** can cause intestinal obstruction, it is less common than intussusception as the primary cause of acute obstruction in children generally. - It is more frequent in **neonates and infants** but overall incidence of obstruction is lower than intussusception. *Volvulus* - **Volvulus** refers to a twisting of the intestine on its mesentery, often associated with **malrotation**, leading to obstruction and vascular compromise. - While a serious cause of obstruction, especially in neonates, it is less common overall than intussusception in the pediatric population. *None of the options* - This option is incorrect because **intussusception** is a recognized and frequent cause of acute intestinal obstruction in children.

Q: A 6-month-old child woke up at night, crying with severe colicky abdominal pain, and later passed red currant jelly stools. What is the most likely diagnosis?

Intussusception. ***Intussusception*** - The classic presentation of **intussusception** includes sudden onset of **severe colicky abdominal pain** (intermittent crying spells), drawing legs to the chest, and passing **red currant jelly stools** (blood and mucus). - The pain occurs in intermittent episodes with periods of relative calm in between. Red currant jelly stools typically appear later in the disease course (often after 12-24 hours). - This is a **pediatric emergency** with peak incidence at **6-18 months** of age. *Malrotation* - Malrotation typically presents with **bilious vomiting** due to midgut volvulus and duodenal obstruction, particularly in the neonatal period. - While it can cause abdominal pain, the hallmark is persistent bilious vomiting rather than the intermittent colicky pain with red currant jelly stools seen in intussusception. *Meckel's diverticulum* - Meckel's diverticulum typically causes **painless rectal bleeding** (due to **heterotopic gastric mucosa** causing ulceration). - When it causes pain, it's usually due to **diverticulitis** or obstruction from an inverted diverticulum, but these do not produce the classic red currant jelly stools of intussusception. *Intestinal obstruction* - While intussusception is a specific type of intestinal obstruction, this option is too general. Other forms of intestinal obstruction (e.g., from adhesions, hernias) in an infant would typically present with **bilious vomiting**, abdominal distension, and may not produce red currant jelly stools. - The combination of intermittent colicky pain and red currant jelly stools is pathognomonic for intussusception.

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

What is the treatment of choice for an 11-year-old child with hepatitis C infection?

Accepted Answer

Direct-Acting Antivirals (DAAs)

Answer

Gamma-globulin

Answer

Corticosteroids

Answer

Vaccine

Question 2

What is the commonest cause of intestinal obstruction in children between 3 months to 6 years of age?

Accepted Answer

Intussusception

Answer

Nonspecific cause

Answer

Intestinal polyp

Answer

Meckel's diverticulum

Question 3

A 12 year old boy presents with hematemesis, melena and mild splenomegaly. There is no obvious jaundice or ascites. The most likely diagnosis is:

Accepted Answer

EHPVO

Answer

NCPF

Answer

Malaria with DIC

Answer

Cirrhosis

Question 4

Most common cause of acute intestinal obstruction in children is

Accepted Answer

Intussusception

Answer

Inguinal hernia

Answer

Volvulus

Answer

None of the options

Question 5

A 6-month-old child woke up at night, crying with severe colicky abdominal pain, and later passed red currant jelly stools. What is the most likely diagnosis?

Accepted Answer

Intussusception

Answer

Malrotation

Answer

Meckel's diverticulum

Answer

Intestinal obstruction

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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