GI practice questions Flashcards
A 5-year-old child presents with a history of infrequent and difficult bowel movements for the past three weeks. The parent reports occasional soiling of the child’s underwear. The child complains of abdominal pain occasionally but is otherwise healthy.
Questions:
- Based on the history and clinical presentation, what is the most likely diagnosis?A) Irritable bowel syndrome (IBS)B) Functional constipation with encopresisC) AppendicitisD) Celiac disease
Answer:** B) Functional constipation with encopresis
Which initial dietary modification should be recommended for this child to help manage constipation?**
A) Reduce fluid intake to decrease bowel movements
B) Increase fiber intake with whole grains, fruits, and vegetables
C) Introduce a gluten-free diet
D) Eliminate dairy products completely
Answer:** B) Increase fiber intake with whole grains, fruits, and vegetables
What pharmacological management could be considered for this child to relieve constipation symptoms?**
A) Proton pump inhibitors
B) Antidiarrheals
C) Laxatives, such as Miralax or lactulose
D) Antibiotics
Answer:** C) Laxatives, such as Miralax or lactulose
What is a key component that should be emphasized to the parents for successful long-term management of encopresis?**
A) Short-term medication use
B) Regularly scheduled toileting and positive reinforcement
C) Taking stool softeners only as needed
D) Immediate cessation of all dairy products
Answer:** B) Regularly scheduled toileting and positive reinforcement
An 8-year-old child presents with intermittent abdominal pain localized mainly around the umbilical area. The child’s growth is normal, there is no significant weight loss, and there are no alarming symptoms such as rectal bleeding.
Questions:
- What initial diagnosis should be considered for this child based on the information provided?A) Lactose intoleranceB) AppendicitisC) Functional abdominal painD) Constipation
*Answer:** C) Functional abdominal pain
What non-pharmacological strategies would be recommended first for the management of this child’s abdominal pain?**
A) Initiate gluten-free diet
B) Perform regular physical activity and maintain a structured schedule
C) Recommend daily enemas
D) Implement a regular intake of probiotics with every meal
Answer:** B) Perform regular physical activity and maintain a structured schedule
When should further diagnostic testing be considered for abdominal pain?**
A) If the child complains only during school hours
B) If the pain persists beyond expected time and quality of life is affected, or if red flags like unexplained weight loss or GI bleeding appear
C) As the first approach to identify any possible abnormalities
D) Only if there is a family history of GI disorders
B) If the pain persists beyond expected time and quality of life is affected, or if red flags like unexplained weight loss or GI bleeding appear
A 6-year-old child presents with passing stool containing blood and mucus, along with abdominal pain and weight loss. On examination, abnormal growth charts suggest poor weight gain.
Questions:
- What condition should be highly suspected in this case given the presentation?A) Chronic constipationB) Inflammatory bowel disease, such as Crohn’s disease or Ulcerative ColitisC) Irritable bowel syndrome (IBS)D) Simple gastroenteritis
B) Inflammatory bowel disease, such as Crohn’s disease or Ulcerative Colitis
What is the most appropriate next step in the diagnostic process?**
A) Encourage dietary changes and observe for improvement
B) Advise the use of over-the-counter probiotics
C) Refer for specialist consultation and likely endoscopic evaluation
D) Prescribe a regimen of antispasmodics
C) Refer for specialist consultation and likely endoscopic evaluation
Given the potential finding of an inflammatory bowel condition, what dietary management could aid in treatment initially?**
A) High intake of raw vegetables and spices
B) A diet low in fiber and simple sugars during acute phases
C) Emphasis on a high-dairy diet for increased calcium
D) Complete fluid restriction until diagnosis is confirmed
B) A diet low in fiber and simple sugars during acute phases
A 7-year-old boy is brought to your clinic with a history of not having a bowel movement for 4 days. His parents report he often strains during defecation and has intermittent episodes of abdominal pain. He sometimes leaks stool into his underwear. His dietary history reveals limited fiber intake and he dislikes vegetables.
Questions:
-
What is the most likely diagnosis?A) Gastroenteritis
B) Functional constipation with encopresis
C) Appendicitis
D) Celiac disease
*Answer:** B) Functional constipation with encopresis
Which dietary recommendation would be most appropriate for this child?**
A 7-year-old boy is brought to your clinic with a history of not having a bowel movement for 4 days. His parents report he often strains during defecation and has intermittent episodes of abdominal pain. He sometimes leaks stool into his underwear. His dietary history reveals limited fiber intake and he dislikes vegetables.
A) Encourage intake of high-fat foods
B) Increase intake of high-fiber fruits and vegetables
C) Start a gluten-free diet
D) Reduce fluid intake
Answer:** B) Increase intake of high-fiber fruits and vegetables
Which medication is commonly used to relieve symptoms in this scenario?**
A) Proton pump inhibitors
B) Laxatives, like polyethylene glycol (Miralax)
C) Opioid analgesics
D) Antibiotics
*Answer:** B) Laxatives, like polyethylene glycol (Miralax)
What behavioral strategy should parents be encouraged to try?**
A) Discouraging all snacks between meals
B) Creating a regular toileting schedule
C) Limiting playtime until symptoms resolve
D) Administering frequent enemas
Answer: B) Creating a regular toileting schedule
A 10-year-old girl presents with recurrent episodes of abdominal pain primarily around the umbilical area. The pain does not wake her at night and is not associated with any other alarming symptoms like fever or weight loss. Physical exam and growth parameters are normal.
Questions:
-
Which diagnosis is most consistent with this presentation?A) Lactose intolerance
B) Functional abdominal pain
C) Appendicitis
D) Celiac disease
Answer:** B) Functional abdominal pain
What initial management strategy would be appropriate?**
A) Begin a lactose-free diet
B) Consider psychological support and stress-reducing techniques
C) Immediate referral for surgical consultation
D) Initiate antispasmodic therapy
Answer:** B) Consider psychological support and stress-reducing techniques
When is further diagnostic testing warranted for recurrent abdominal pain?**
A) Few episodes with no severe impact on daily activities
B) Presence of systemic symptoms like fever, weight loss, or persistent vomiting
C) Only after dietary modifications fail
D) Immediately after the first complaint
Answer:** B) Presence of systemic symptoms like fever, weight loss, or persistent vomiting
A 6-year-old child is brought in by his parents for chronic diarrhea, abdominal pain, blood in stools, and significant weight loss over a period of several months. His growth chart indicates failure to thrive.
Questions:
-
What condition should be highly suspected?A) Functional constipation
B) Inflammatory bowel disease (IBD)
C) Viral gastroenteritis
D) Irritable bowel syndrome (IBS)
Answer:** B) Inflammatory bowel disease (IBD)
What is the best next step in management?**
A) Begin a high-calorie diet
B) Immediate referral to a gastroenterologist for further evaluation
C) Prescribing antispasmodics
D) Initiating over-the-counter probiotics
B) Immediate referral to a gastroenterologist for further evaluation
Which dietary modification might be suggested during active symptom periods related to IBD?**
A) High fiber intake
B) Low-residue diet
C) High dairy consumption
D) Complete fasting
Answer:** B) Low-residue diet
An 8-week-old male infant is brought to the clinic by his parents, who are concerned because he has been experiencing “forceful” vomiting after feedings for the past week. The vomit is non-bilious, and the baby appears hungry soon after vomiting. The parents note that the baby has not had many wet diapers today, and the baby seems fussier than usual. On examination, you observe signs of dehydration and palpate an “olive-like” mass in the right upper quadrant of the abdomen. The infant is afebrile and lethargic, with noticeable weight loss compared to previous visits.
Questions:
-
What is the most likely diagnosis?A) Gastroesophageal Reflux Disease (GERD)
B) Hypertrophied Pyloric Stenosis
C) Intussusception
D) Gastroenteritis
Answer: B) Hypertrophied Pyloric Stenosis
What metabolic findings are commonly associated with hypertrophied pyloric stenosis?**
A) Metabolic acidosis with hypernatremia
B) Metabolic alkalosis with hypochloremia and hypokalemia
C) Respiratory alkalosis with hyponatremia
D) Metabolic acidosis with hypokalemia
Answer:** B) Metabolic alkalosis with hypochloremia and hypokalemia
What is the first-line diagnostic tool for confirming hypertrophied pyloric stenosis **
A) Plain abdominal X-ray
B) Upper GI barium study
C) Abdominal ultrasound
D) CT scan of the abdomen
Answer:** C) Abdominal ultrasound
What is the mainstay treatment for hypertrophied pyloric stenosis**
A) Dietary modification and antiemetics
B) Intravenous antibiotics and observation
C) Surgical intervention after fluid and electrolyte correction
D) Oral rehydration and proton pump inhibitors
Answer:** C) Surgical intervention after fluid and electrolyte correction
Which factor from the history and examination is a red flag symptom suggesting this condition?**
A) Hungry after vomiting
B) Poor feeding and dehydration signs
C) Palpable mass in the right upper quadrant
D) Afebrile status
*Answer:** C) Palpable mass in the right upper quadrant
A new mother reports her 4-week-old son has been vomiting frequently. Upon examination, an “olive-like” mass is felt in the right upper quadrant. What is the most likely diagnosis?**
A) Duodenal Atresia
B) Hypertrophied Pyloric Stenosis
C) Intussusception
D) Gastroenteritis
*Answer:** B) Hypertrophied Pyloric Stenosis
Which of the following lab findings is most commonly associated with hypertrophied pyloric stenosis?**
A) Metabolic acidosis with hyperkalemia
B) Metabolic alkalosis with hypochloremia
C) Respiratory acidosis with hypernatremia
D) Metabolic alkalosis with hypercalcemia
Answer:** B) Metabolic alkalosis with hypochloremia
What is the first step in the management of an infant with confirmed hypertrophied pyloric stenosis?**
A) Immediate surgical intervention
B) Correction of electrolyte imbalances and dehydration
C) Initiate anti-reflux medications
D) Introduction of hypoallergenic formula
B) Correction of electrolyte imbalances and dehydration
During the abdominal exam of an infant suspected of having pyloric stenosis, which physical finding is considered classic?**
A) Palpable lymph nodes in the groin
B) Abdominal distention and liver enlargement
C) Olive-shaped mass in the right upper quadrant
D) Positive rebound tenderness in the lower abdomen
Answer:** C) Olive-shaped mass in the right upper quadrant
An 18-month-old presents with vomiting for the past 2 days and exhibits signs of moderate dehydration. What is the recommended treatment for moderate dehydration in this child?**
A) Initiate intravenous rehydration
B) Oral rehydration solution
C) Electrolyte-free liquids such as water
D) Encourage clear liquids only like apple juice
Answer:** B) Oral rehydration solution
Which type of vomiting is most often associated with hypertrophied pyloric stenosis?**
A) Bilious vomiting
B) Projectile, non-bilious vomiting
C) Non-projectile, bilious vomiting
D) Bloody vomiting
Answer:** B) Projectile, non-bilious vomiting
A parent expresses concern about their child’s difficulty swallowing and frequent regurgitation but notes the child is not losing weight. Which diagnostic study would be useful to evaluate for possible dysphagia?**
A) Abdominal ultrasound
B) MRI of the brain
C) Barium swallow
D) Chest X-ray
Answer:** C) Barium swallow
Which of the following symptoms is commonly associated with abdominal migraines in school-age children?**
A) Persistent fever
B) Recurrent vomiting
C) Constipation
D) Persistent diarrhea
Answer:** B) Recurrent vomiting
What is the typical prognosis for children diagnosed with abdominal migraines?**
A) They often develop chronic diarrhea later in life.
B) They usually need surgical intervention.
C) They may develop migraine headaches later in life.
D) They generally have no further symptoms as adults.
Answer:** C) They may develop migraine headaches later in life.
Eosinophilic esophagitis is most closely related to which of the following factors?**
A) Viral infection exposure
B) Ingestion of specific foods
C) Environmental allergies
D) Bacterial infections
B) Ingestion of specific foods
Which of the following is NOT part of the 6-food elimination diet used for managing eosinophilic esophagitis?**
A) Milk
B) Peanuts/tree nuts
C) Chicken
D) Eggs
Answer:** C) Chicken
Which type of peptic ulcer is more common in adolescents and often recurs?**
A) Gastric ulcer
B) Duodenal ulcer
C) Stress ulcer
D) Idiopathic ulcer
Answer:** B) Duodenal ulcer
Which of the following tests is a non-invasive method used to detect H. pylori infection?**
A) Serum IgG antibody titer
B) Stool monoclonal antibody test
C) C-urea breath test
D) Esophagogastroduodenoscopy (EGD)
Answer:** C) C-urea breath test
What is the initial first-line therapy for managing idiopathic peptic ulcers?**
A) NSAIDs
B) H2-receptor antagonists (H2RAs)
C) Proton pump inhibitors (PPIs)
D) Antacids
Answer:** B) H2-receptor antagonists (H2RAs)
A rare syndrome characterized by gastric hypersecretion and refractory PUD is known as:**
A) Eosinophilic Esophagitis
B) Abdominal Migraine
C) Zollinger-Ellison Syndrome (ZES)
D) Gastroesophageal Reflux Disease (GERD)
C) Zollinger-Ellison Syndrome (ZES)
Sophie is a 9-year-old girl brought to the clinic by her mother because of recurrent abdominal pain. Her mother reports that Sophie has episodes of severe, midline, periumbilical pain about once a month. During these episodes, Sophie appears pale, listless, and sometimes vomits. There are no other accompanying gastrointestinal symptoms, and physical examination today is unremarkable. Sophie’s school performance has been affected slightly due to these absences. Her family history reveals that her mother and grandmother have a history of migraines.
What condition does Sophie most likely have, based on her symptoms and family history?**
Answer:** Abdominal migraine
What non-pharmacological management strategies might be beneficial for Sophie?**
Answer:** Identifying and avoiding triggers, ensuring that Sophie gets adequate sleep, which may relieve symptoms.
What is a possible long-term prognosis for Sophie?**
- Sophie may develop migraine headaches later in life.
James is a 6-year-old boy who presents with recurrent episodes of vomiting and abdominal pain. His parents note that after meals, James often complains of pain and sometimes refuses to eat. Upon further questioning, they mention that similar symptoms were present since he was a toddler. They also report that he has had issues with feeding in the past, including what seemed like choking episodes.
What condition should be considered in James’ case?**
*Answer:** Eosinophilic esophagitis
