GI practice questions

Question 1

A 10-year-old boy is brought to your clinic by his parents. They are concerned because he has been experiencing abdominal pain for the past six months. The pain is not constant, occurring several times a week. It seems to improve when he goes to the bathroom and is sometimes accompanied by changes in stool frequency and consistency. The boy does not have a fever, weight loss, or blood in his stool.

Questions:
1. What diagnostic criteria are likely being met in this scenario?

Answer 1

The Rome III criteria are likely being met. The child experiences abdominal pain that improves with defecation and changes in stool consistency or frequency

Question 2

A 10-year-old boy is brought to your clinic by his parents. They are concerned because he has been experiencing abdominal pain for the past six months. The pain is not constant, occurring several times a week. It seems to improve when he goes to the bathroom and is sometimes accompanied by changes in stool frequency and consistency. The boy does not have a fever, weight loss, or blood in his stool.

. What further evaluation, if any, is needed?

Answer 2

Since there are no alarm features (e.g., weight loss, fever, rectal bleeding), invasive diagnostics are not immediately necessary. Routine screening for Celiac disease might be considered.

Question 3

A 10-year-old boy is brought to your clinic by his parents. They are concerned because he has been experiencing abdominal pain for the past six months. The pain is not constant, occurring several times a week. It seems to improve when he goes to the bathroom and is sometimes accompanied by changes in stool frequency and consistency. The boy does not have a fever, weight loss, or blood in his stool

3. What initial management approach would you recommend?

Answer 3

Management could begin with dietary modifications, such as increasing fiber or trialing a low FODMAP diet, as well as addressing psychosocial factors.

Question 4

A 16-year-old female presents with bloating, abdominal distention, and alternating diarrhea and constipation. She reports that stress and certain foods, such as greasy or spicy meals, exacerbate her symptoms. She denies weight loss or blood in her stools.

What lifestyle changes might benefit this patient?

Answer 4

Encourage regular meals, increase dietary fiber gradually, reduce triggers like spicy and greasy foods, and implement stress management techniques.

Question 5

. A 16-year-old female presents with bloating, abdominal distention, and alternating diarrhea and constipation. She reports that stress and certain foods, such as greasy or spicy meals, exacerbate her symptoms. She denies weight loss or blood in her stools.

What are some suitable treatment options for her symptoms?

Answer 5

Probiotics for gut health, antispasmodic medications to relieve cramping, and, potentially, a trial of a low-FODMAP diet might help manage symptoms.

Question 6

What is the primary dietary restriction for individuals diagnosed with celiac disease?
- A) Soy
- B) Gluten
- C) Lactose
- D) Fructose

Answer 6

Answer:** B) Gluten
Explanation: Celiac disease is an immune-mediated disorder where exposure to gluten, found in wheat, barley, and rye, triggers symptoms. A strict gluten-free diet is required for management.

Question 7

Which of the following symptoms is most commonly associated with lactose intolerance?
- A) Rash
- B) Diarrhea
- C) Fever
- D) Cough

Answer 7

Answer:** B) Diarrhea
Explanation: Lactose intolerance typically presents with gastrointestinal symptoms such as abdominal pain, bloating, and diarrhea after consumption of lactose-containing foods.

Question 8

Cow’s Milk Protein Intolerance (CMPI)

3. What is an appropriate formula to use for infants with cow’s milk protein intolerance?
   
   • A) Cow’s milk formula
   • B) Soy-based formula
   • C) Extensively hydrolyzed formula
   • D) Goat’s milk formula

Answer 8

Answer:** C) Extensively hydrolyzed formula
Explanation: Extensively hydrolyzed formulas are recommended for infants with cow’s milk protein intolerance or allergy, as they break down proteins into smaller sizes, reducing the likelihood of an allergic response.

Question 9

In Crohn’s disease, which area of the GI tract is most commonly affected?
- A) Stomach
- B) Terminal ileum and colon
- C) Esophagus
- D) Rectum

Answer 9

Answer:** B) Terminal ileum and colon
Explanation: Crohn’s disease can affect any part of the GI tract but most commonly involves the terminal ileum and colon, often presenting with “skip” lesions.

Question 10

Which diagnostic test may be helpful in differentiating inflammatory bowel disease from other causes of diarrhea?
- A) Fasting blood glucose
- B) Esophagoscopy
- C) Fecal calprotectin assay
- D) Chest X-ray

Answer 10

C) Fecal calprotectin assay
Explanation: Fecal calprotectin serves to evaluate intestinal inflammation, making it useful in differentiating IBD from irritable bowel syndrome (IBS) and other non-inflammatory causes of diarrhea.

Question 11

Which symptom is NOT typical of Crohn’s disease?
- A) Clubbing of digits
- B) Abdominal distension and pain
- C) Anaphylaxis
- D) Arthralgias/arthritis

Answer 11

*Answer:** C) Anaphylaxis
Explanation: Anaphylaxis is not typical of Crohn’s disease. Crohn’s symptoms often include abdominal pain, diarrhea, clubbing, and joint pain, due to systemic inflammation.

Question 12

ymptoms:** Chronic diarrhea, abdominal distension, fatigue, pallor

History:
Sarah presents with a history of chronic diarrhea, abdominal discomfort, and a bloated feeling. Her past medical history includes iron-deficiency anemia, and her growth has been suboptimal.

Physical Examination:
- Delayed growth and puberty
- Abdominal distension

Diagnostic Testing:
- Positive serologic markers for celiac disease
Question:**

Based on the case presentation, what is the most appropriate management strategy for Sarah?

Answer 12

The most appropriate management for Sarah, who has celiac disease, is to implement a strict gluten-free diet for life. This involves avoiding all foods containing gluten, such as those made with wheat, barley, and rye.

Discussion:
Celiac disease is an immune-mediated disorder triggered by gluten in genetically susceptible individuals. A gluten-free diet is necessary to prevent symptom recurrence and complications, such as further nutritional deficiencies and bone density issues.

Question 13

atient Profile:**
- Name: Alex, 10 years old
- Symptoms: Abdominal pain, bloating, diarrhea after consuming dairy

History:
Alex complains of gastrointestinal symptoms including abdominal pain, bloating, and diarrhea shortly after consuming milk or dairy products for the past year.

Physical Examination:
- Abdominal distension
- Mild tenderness on palpation

Diagnostic Testing:
- Lactose hydrogen breath test positive

Question:
What dietary modifications should be made for Alex to alleviate his symptoms?

Answer 13

Alex should reduce his lactose intake by avoiding or limiting dairy products. Incorporating lactose-free alternatives or using lactase enzyme supplements before consuming dairy can help manage symptoms.

Discussion:
Lactose intolerance is due to reduced or absent lactase enzyme activity, leading to symptoms when lactose is ingested. Managing the condition involves dietary modification to reduce lactose load and symptom relief through available enzyme supplements.

Question 14

Patient Profile:**
- Name: Emma, 8 months old
- Symptoms: Blood in stool, vomiting, eczema

History:
Emma, an exclusively formula-fed infant, has been experiencing blood-tinged stools, vomiting, and eczema since her introduction to cow’s milk formula.

Physical Examination:
- Moderate eczema on arms and legs
- Slightly anemic appearance

Diagnostic Testing:
- Elimination of cow’s milk from diet leads to symptom resolution

Question:
What is the best feeding strategy for Emma going forward?

Answer 14

*Answer:**
Emma should be switched to an extensively hydrolyzed or an amino acid-based formula, which is less likely to provoke an allergic response.

Discussion:
Cow’s milk protein intolerance or allergy necessitates removal of cow’s milk proteins from the diet. Hydrolyzed and amino acid formulas are designed to provide nutrition without eliciting an allergic response.

Question 15

Patient Profile:**
- Name: Jason, 16 years old
- Symptoms: Weight loss, persistent RLQ pain, diarrhea

History:
Jason comes in with unintentional weight loss, recurrent episodes of diarrhea, and pain localized to the right lower quadrant (RLQ). He also experiences joint pain.

Physical Examination:
- RLQ tenderness
- Visible anemia
- Clubbing of fingers

Diagnostic Testing:
- Elevated inflammatory markers
- Colonoscopy reveals patchy areas of inflammation in the terminal ileum

Question:
What combination of treatment options might be considered for managing Jason’s symptoms and condition?

Answer 15

Answer:**
Jason’s management might include anti-inflammatory medication (such as corticosteroids), immunosuppressive therapy (such as azathioprine), and nutritional support. Biologics may also be considered for severe cases, in consultation with a gastroenterologist.

Discussion:
Crohn’s disease is a chronic inflammatory condition of the gastrointestinal tract characterized by transmural inflammation. A comprehensive approach involving medication, lifestyle and dietary management, and sometimes surgery is employed to manage symptoms and prevent complications.

Question 16

1. What is the first-line dietary treatment for a confirmed diagnosis of celiac disease?
   A) Low carbohydrate diet
   B) Gluten-free diet
   C) Lactose-free diet
   D) Low-fat diet

Answer 16

Answer: B) Gluten-free diet**
Explanation: Celiac disease is managed by eliminating gluten, which is found in wheat, barley, and rye, from the diet to alleviate symptoms and prevent complications.

Question 17

Which of the following tests is most commonly used to diagnose lactose intolerance?
A) Urea breath test
B) Hydrogen breath test
C) Colonoscopy
D) CT scan

Answer 17

B) Hydrogen breath test**
Explanation: The hydrogen breath test measures the amount of hydrogen in the breath after lactose consumption to diagnose lactose intolerance.

Question 18

. Which symptom is not typically associated with Crohn’s disease?
A) Bloody diarrhea
B) Constipation
C) Abdominal pain
D) Unintentional weight loss

Answer 18

Constipation**
Explanation: Crohn’s disease more commonly presents with diarrhea, abdominal pain, and weight loss. Constipation is not a typical symptom of Crohn’s.

Question 19

What is the primary mechanism of anemia in patients with celiac disease?
A) Gastrointestinal bleeding
B) Autoimmune hemolysis
C) Iron malabsorption
D) Hemorrhagic strokes

Answer 19

C) Iron malabsorption**
Explanation: Celiac disease can cause malabsorption of nutrients, including iron, which leads to anemia.

Question 20

Which formula is recommended for infants with cow’s milk protein intolerance?
A) Standard cow’s milk formula
B) Soy-based formula
C) Extensively hydrolyzed formula
D) Goat milk formula

Answer 20

C) Extensively hydrolyzed formula**
Explanation: Extensively hydrolyzed formulas are usually tolerated by infants with cow’s milk protein allergy or intolerance.

Question 21

Which statement is true regarding Crohn’s disease?
A) It only affects the colon and rectum.
B) It presents with continuous lesions in the GI tract.
C) It can affect any part of the GI tract from mouth to anus.
D) It is always responsive to antibiotics.

Answer 21

C) It can affect any part of the GI tract from mouth to anus.**
Explanation: Crohn’s disease can affect any part of the gastrointestinal tract and tends to have patchy areas of inflammation.

Question 22

Which of the following is a common extra-intestinal manifestation of inflammatory bowel disease (IBD)?
A) Osteoporosis
B) Eczema
C) Vitamin B12 deficiency
D) Erythema nodosum

Answer 22

D) Erythema nodosum**
Explanation: Erythema nodosum is a common extra-intestinal manifestation of IBD.

Question 23

What food component should be urgently eliminated from the diet of a child diagnosed with cow’s milk allergy?
A) Soy protein
B) Gluten
C) Lactose
D) Cow’s milk proteins

Answer 23

Answer: D) Cow’s milk proteins**
Explanation: In children with cow’s milk allergy, all foods containing cow’s milk proteins should be avoided.

Question 24

Which diagnostic marker is important in diagnosing celiac disease?
A) Anti-nuclear antibodies (ANA)
B) Anti-tissue transglutaminase (tTG) antibodies
C) Anti-cyclic citrullinated peptide (CCP) antibodies
D) C-reactive protein (CRP)

Answer 24

B) Anti-tissue transglutaminase (tTG) antibodies**
Explanation: tTG antibodies are highly sensitive and specific for celiac disease.

Question 25

What type of diet may help alleviate symptoms in a lactose intolerant person?
A) High fiber diet
B) Gluten-free diet
C) Lactose-free diet
D) Ketogenic diet

Answer 25

C) Lactose-free diet**
Explanation: By avoiding lactose-containing foods, individuals with lactose intolerance can alleviate their symptoms.

Question 26

Which of the following is not a common symptom of celiac disease in adolescents?
A) Diarrhea
B) Fatigue
C) Weight gain
D) Abdominal distension

Answer 26

C) Weight gain**
Explanation: Weight loss, not gain, is more commonly associated with celiac disease due to malabsorption.

Question 27

What is typically the first-line medication for managing acute exacerbations of Crohn’s disease?
A) Methotrexate
B) Corticosteroids
C) Sulfasalazine
D) Ketoprofen

Answer 27

B) Corticosteroids**
Explanation: Corticosteroids are often used for their potent anti-inflammatory effects during acute exacerbations of Crohn’s disease.

Question 28

Which nutrient deficiency is common in untreated celiac disease due to damaged intestinal villi?
A) Vitamin D
B) Vitamin C
C) Vitamin B12
D) Iron

Answer 28

D) Iron**
Explanation: Iron deficiency is common in celiac disease due to malabsorption caused by damaged intestinal villi.

Question 29

A child known to have Cow’s Milk Protein Intolerance (CMPI) presents with repeated episodes of rectal bleeding. The most likely source of bleeding is:
A) Intestinal polyps
B) Hemorrhoids
C) Colitis
D) Constipation tears

Answer 29

C) Colitis**
Explanation: CMPI can lead to proctocolitis, inflammation of the colon’s lining, causing rectal bleeding.

Question 30

Which is not a characteristic of Crohn’s disease?
A) Transmural inflammation
B) Continuous lesions
C) Fistula formation
D) Skip lesions

Answer 30

B) Continuous lesions**
*Explanation: Crohn’s disease is characterized by skip lesions, not continuous ones

Question 31

Management of lactose intolerance does not include which of the following?
A) Consuming lactose-free dairy alternatives
B) Use of lactase enzyme supplements
C) Avoiding all types of cheese
D) Gradually increasing lactose intake to tolerance level

Answer 31

C) Avoiding all types of cheese**
Explanation: Some cheeses, especially hard and aged ones, contain very little lactose and may be tolerated.

Question 32

What condition should be considered in a child with eczema, recurrent diarrhea, and bloody stools?
A) Appendicitis
B) Cystic fibrosis
C) Cow’s milk protein allergy
D) Type 1 diabetes

Answer 32

C) Cow’s milk protein allergy**
Explanation: These symptoms in combination often suggest cow’s milk protein allergy.

Question 33

In evaluating FTT, which of the following is a key diagnostic tool to assess the dietary habits of a child?
A) Renal ultrasound
B) Complete blood count (CBC)
C) Detailed dietary history
D) Chest radiograph

Answer 33

*Answer: C) Detailed dietary history**
Explanation: A thorough dietary history helps identify potential inadequacies in caloric intake contributing to FTT.

Question 34

Which congenital abnormality commonly presents with FTT due to poor nutrient absorption?
A) Down syndrome
B) Cystic fibrosis
C) Sickle cell disease
D) Autism

Answer 34

B) Cystic fibrosis**
Explanation: Cystic fibrosis can lead to malabsorption of nutrients because of pancreatic insufficiency, presenting as FTT.

Question 35

Which type of assessment is crucial for differentiating between organic and non-organic causes of FTT?
A) Feeding assessment
B) Radiographic assessment
C) Hepatic function testing
D) Genetic screening

Answer 35

A) Feeding assessment**
Explanation: A feeding assessment helps determine whether feeding practices contribute to FTT, indicating non-organic causes.

Question 36

Among the following, which psychosocial factor is most likely to lead to FTT?
A) Living in an urban environment
B) Sibling rivalry
C) Maternal depression
D) Access to public healthcare

Answer 36

C) Maternal depression**
Explanation: Maternal depression can negatively affect a child’s nutritional and emotional needs, leading to FTT.

Question 37

Which of the following findings would be concerning for a child with FTT on physical examination?
A) Normal skin turgor
B) Decreased head circumference growth rate
C) Regular respiratory rate
D) Absence of dysmorphic features

Answer 37

B) Decreased head circumference growth rate**
Explanation: A decreased growth rate in head circumference may indicate poor brain development, a critical concern in FTT cases.

Question 38

A 6-month-old infant has persistent FTT. Which laboratory test might be considered initially to screen for a metabolic disorder?
A) Karyotype analysis
B) Newborn metabolic screening review
C) Bone marrow biopsy
D) Liver function tests

Answer 38

B) Newborn metabolic screening review**
Explanation: Reviewing newborn metabolic screening tests can reveal inherited metabolic disorders impacting growth.

Question 39

In managing FTT, hospitalizing a child might be necessary. Which is NOT a typical reason for hospitalization?
A) Treat severe malnutrition
B) Provide comprehensive interdisciplinary care
C) Allow for outpatient follow-up
D) Monitor response to treatment adjustments

Answer 39

C) Allow for outpatient follow-up**
Explanation: Outpatient follow-up would generally not require hospitalization, which is reserved for more critical needs.

Question 40

Which of the following is NOT a common organism responsible for causing acute diarrhea in children?
A) Rotavirus
B) Campylobacter
C) Influenza virus
D) Giardia

Answer 40

C) Influenza virus**
Explanation: Influenza virus typically causes respiratory symptoms, not gastrointestinal ones like diarrhea.

Question 41

Dysentery is commonly caused by specific strains of which organisms?
A) Escherichia coli and Cryptosporidium
B) Salmonella and Shigella
C) Giardia and Listeria
D) Norovirus and Enteric adenovirus

Answer 41

B) Salmonella and Shigella**
Explanation: Dysentery involves strains like certain Salmonella and Shigella species.

Question 42

Which of the following symptoms would NOT necessitate reporting to the CDC when a child shows signs of acute diarrhea?
A) Diarrhea due to Cryptosporidium
B) E. coli O157:H7 infection
C) Foods recently introduced
D) Vibrio cholerae infection

Answer 42

C) Foods recently introduced**
*Explanation: Newly introduced foods are part of the dietary history, not a cause for CDC reporting.

Question 43

An effective component in the prevention of acute diarrhea for children is:
A) Use antibacterial soap regularly
B) Exclusive breastfeeding for the first 6 months
C) Limit outdoor activities
D) Use probiotics every day

Answer 43

B) Exclusive breastfeeding for the first 6 months**
Explanation: Exclusive breastfeeding for the first 6 months of life is recommended to help prevent diarrhea.

Question 44

In managing diarrhea, which treatment measure is generally NOT recommended?
A) Oral rehydration therapy
B) Antibiotic therapy for every case
C) Probiotics for antibiotic-associated diarrhea
D) Antidiarrheals

Answer 44

D) Antidiarrheals**
Explanation: Antidiarrheals are generally not recommended, especially in children with acute diarrhea.

Question 45

Which is a significant complication of acute diarrhea if left untreated?
A) Hypertension
B) Heart failure
C) Dehydration and electrolyte imbalance
D) Metabolic alkalosis

Answer 45

C) Dehydration and electrolyte imbalance**
Explanation: Dehydration and imbalance of electrolytes are common complications due to fluid loss in diarrhea.

Question 46

What is a critical component of acute diarrhea history taking?
A) Blood type of the child
B) Onset, volume, frequency of diarrhea
C) Liters of water consumed per week
D) The time spent playing outdoors

Answer 46

B) Onset, volume, frequency of diarrhea**
Explanation: Key historical components in diarrhea assessment include onset, volume, and frequency.

Question 47

Which of the following defines chronic diarrhea in older children?
A) Loose stools >30 mL/kg/day
B) Loose stools >3 times a day for >5 days
C) Stool output >200 g/day
D) Stool output <200 g/day

Answer 47

Answer: C) Stool output >200 g/day**
Explanation: Chronic diarrhea in older children is characterized by a stool output of more than 200 grams per day.

Question 48

Toddler’s diarrhea” is characterized by which of the following?
A) Weight loss accompanying diarrhea
B) Bloody diarrhea with fever
C) Diarrhea 10 times daily without other serious symptoms
D) Diarrhea with dehydration

Answer 48

Answer: C) Diarrhea 10 times daily without other serious symptoms**
Explanation: “Toddler’s diarrhea” often involves frequent watery stools but without severe dehydration or other systemic symptoms.

Question 49

Which of the following is a “red flag” symptom for chronic diarrhea that warrants further investigation?
A) Fatty stools
B) Hematochezia/melena
C) Mild fever for a few hours
D) Intermittent cough

Answer 49

Answer: B) Hematochezia/melena**
*Explanation: The presence of blood in the stool, especially hematochezia or melena, is a red flag that requires further evaluation

Question 50

What test is used to diagnose lactose intolerance?
A) Stool occult blood test
B) Fecal elastase measurement
C) Breath hydrogen test
D) Serum lactate levels

Answer 50

C) Breath hydrogen test**
Explanation: The breath hydrogen test is commonly used to diagnose lactose intolerance.

Question 51

Which of the following statements about intestinal parasites is true?
A) Helminths are typically spread through respiratory droplets.
B) Protozoa and helminths are transmitted mainly through the fecal-oral route.
C) Helminths do not require management as they resolve on their own.
D) All intestinal parasites are easily detected through a complete blood count (CBC).

Answer 51

B) Protozoa and helminths are transmitted mainly through the fecal-oral route.**
*Explanation: Most intestinal parasites spread through the fecal-oral route, particularly via contaminated food or water

Question 52

Management of chronic diarrhea in toddlers involves which of the following approaches?
A) Strict fasting for a week
B) Increasing intake of sorbitol and fructose
C) Normalizing diet and reducing fluid intake
D) Limiting all solid foods and fluids

Answer 52

C) Normalizing diet and reducing fluid intake**
Explanation: Management includes normalizing the diet, removing offending foods, and reducing fluid intake to help manage “toddler’s diarrhea.”

Question 53

In assessing a child with chronic diarrhea, which diagnostic test would you consider if you suspect cystic fibrosis?
A) Breath hydrogen test
B) Sweat chloride test
C) ESR and CRP only
D) Urinalysis

Answer 53

B) Sweat chloride test**
Explanation: The sweat chloride test is used to diagnose cystic fibrosis, which can present with chronic diarrhea.