Gastroenterology MCQ Flashcards by Chidera Nwaroh

A 2-year old girl presents after ingesting a new watch battery 2 hours ago. She is asymptomatic. Radiographs reveal the battery in the duodenum. What is the most appropriate next step in management?
A) Administer 10mL of honey
B) Admit and follow up with serial X Rays
C) Outpatient observation
D) Urgent endoscopy

Urgent endoscopy (if battery is > 20 mm)

Outpatient observation (if battery is < 20 mm)

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15-year-old boy 6 days post spinal fusion surgery presents with 24 hours of early satiety, non-bilious emesis, nausea. He denies diarrhea or anorexia. He is hungry in between. Of note, he has grown 8 cm in the last year and lost weight from 50 kg to 42 kg. Abdo exam reveals mild epigastric fullness and tenderness. What test will reveal the most likely diagnosis?

A. Barium swallow with follow through
B. Upper endoscopy
C. AUS
D. Supine and upright AXR

Barium swallow with follow through

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15-year-old female presents with a 3-week (or 3 month) history of abdominal pain. She has been missing multiple days of school. She has seen 3 other physicians with no diagnosis yet. She has a history of headaches last year which have now resolved. Her and her parents are worried. Investigations thus far are all negative including a scope. What is the most likely diagnosis?

A. Somatic symptom disorder
B. Functional neuro disorder
C. Factitious disorder
D. Generalized anxiety disorder

Somatic symptom disorder

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14 month old presents with acute onset multiple non bloody non bilious emesis. This occurred 2 to 4 hours after first trying rice cereal. You suspect FPIES (told you this). What is the best test for diagnosis:

A. Oral food challenge
B. Skin prick testing
C. Ige testing
D. Eosinophil level

Oral food challenge

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7-month-old boy with poor weight gain, photophobia and decreased visual acuity. Excessive urine output and polydipsia. Urine test shows aminoaciduria.
What is the most likely diagnosis?

A. Bartter
B. Gitelman
C. Cystinosis
D. Homocystinuria

Cystinosis

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15yo male with a 3yo history of ileal Crohn’s disease presenting with severe acute right flank pain. He is stooling twice a day and they are semi-formed. On exam, his abdomen is soft and there is right flank pain. He has been on azathioprine for 2y. What is the most likely etiology of his presentation?
A. Pancreatitis
B. Exacerbation of Crohn’s disease
C. Cholecystitis
D. Renal colic

Pancreatitis

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A 17 year old M with Crohn Disease was to be started on total parenteral nutrition. What is the most common complications associated with TPN?

A. Hepatic fibrosis
B. Insulin resistance
C. Micronutrient deficiency
D. Lipodystrophy

Hepatic fibrosis

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10-year-old boy had progressive dysphagia with solid foods. Mild abdominal pain. History of chronic GERD. Has a history of 2kg weight loss in the context of decreased appetite. CBC, albumin, ESR, and CRP are normal. Blood cultures are negative. What is the most likely diagnosis?

A. Celiac
B. EOE
C. ARFID
D. Crohn’s

EOE

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2 year old with 2 episodes of red currant jelly stool. Well otherwise, no abdo pain, no vomiting and no diarrhea. What is the best investigation to determine diagnosis

A. Meckels Scan
B. Air Enema
C. Abdo US
D. Colonoscopy

Meckels Scan

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10 year old boy with acute pancreatitis admitted, has abdo pain managed by opioids and has lipase 9x ULN. What do you advise regarding management of nutritional status?

A. Start PO feeding once lipase improved to 2xULN
B. Post pyloric feeding once abdo pain improved
C. TPN x 5-7 days
D. PO feeding once abdo pain improved and appetite

PO feeding once abdo pain and appetite improving

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16 year old girl presents with 1 week jaundice and fatigue. She has scleral icterus only.
Her AST, ALT INR are elevated. ALP is low. She has a conjugated hyperbilirubinemia and normocytic anemia with reticulocytosis. What will support/confirm the diagnosis?

A. Low ceruloplasmin
B. Positive DAT
C. Alpha 1 AT deficiency
D. Positive DsDNA

Low ceruloplasmin

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12 yo male with 12h history of abdominal pain, anorexia and nausea. Hasn’t taken any analgesia. He has a fever of 38.1 with otherwise normal vitals. He has a tender RLQ with rebound tenderness. What is the most appropriate analgesic?

A. Oral acetaminophen
B. Intranasal fentanyl
C. Oral morphine
D. IV ketorolac

Oral acetaminophen

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2-year-old boy with a history of Hirschsprung pull-through presents with acute onset fever, vomiting and abdominal distension. What is the most likely diagnosis?

A. Enterocolitis
B. Intussusception
C. Pseudo obstruction
D. Meckel Diverticulum

Enterocolitis

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10 month old baby with intermittent crying episodes, vomiting and lethargy. No fever. No nuchal rigidity or neuro abnormalities. Vitals normal. Pale and listless but normal abdominal exam. What investigation will be most helpful?
A. abdo US
B. abdo xray
C. CT head
D. Mecklels scan

abdo US

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A 3-year-old girl is seen in follow-up for iron-deficiency anemia. She has completed 3 months of therapeutic oral iron supplementation, with good compliance. Her weight plots below the 3rd percentile for her age, and her height is at the 25th percentile. Her abdomen is distended. Your follow-up laboratory investigations reveal (all normal ranges were provided): hemoglobin 82, mean corpuscular volume 64, platelets 400, and white blood cell count 5.2, with 2% reticulocytes and a ferritin of 5. (RBC count not provided). What investigation will you order next?

A. Serum tissue transglutaminase IgA (it did not specify to also do a total IgA level)
B. Hemoglobin electrophoresis
C. Abdominal ultrasound
D. Occult blood stool test

Serum tissue transglutaminase IgA

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8 year old girl who has hyperpigmented macules in her mouth and a history of GI bleeds. Her dad and brother have something similar. What type of cancer is she at risk for?
A. Colon
B. Hepatoblastoma

Colon Cancer

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8 m old exclusively breastfed and in solids, not on supplements. Vegan family. Which Deficiency is he likely to have

A. Rickets
B. Pellagra
C. Scurvy
D. Beri beri

Rickets

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4 year old boy with 1-2 episodes of watery diarrhea per day, some encopresis. No abdo pain or distention. Normal physical exam except hard palpable stool in rectum and stool around anus. What workup do you need to do?
A) TSH
B) AXR
C) No investigations needed
D) Barium enema

No investigations needed

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Preterm baby a couple weeks old comes into clinic. Mom wants to change from cow’s milk formula to soy formula for cultural reasons. What should you counsel the mother about?

A) osteopenia
b) macrocytic anemia
C) acrodermatitis enteropathica
D) Something else

osteopenia

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A 10 yo male has gained 25 kg in the past 2 years and his BMI is now at the 97th percentile. He is otherwise well. His AST and ALT are mildly elevated (60s/70s). He has a significant family history of obesity. What is the most likely diagnosis?

A. Alpha 1 antitrypsin deficiency
B. Hypothyroidism
C. Metabolic associated fatty liver disease
D. Autoimmune hepatitis

Metabolic associated fatty liver disease

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2 year old previously healthy boy, developmentally normal, has a (6 month?) history of not eating well. At home, his parents offer him a varied diet at regular meal times however he only eats very small amounts even with parental “coaxing” - (this was the word used). In daycare, he is eating well. His height and weight are tracking along his curve on the 25th (height) and 3rd (weight) centiles. What is the next step in management?

A. Start Iron supplementation
B. Cyproheptadine
C. Start a new formula (toddler’s formula)
D. Behavioural modification at home (for parents)

Behavioural modification at home (for parents)

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Female patient with CP with NJ tube. She comes in peritonitic with HR 120, vitals otherwise normal. Bilious emesis. Most likely cause of the vomiting?

A. Intussusception
B. Dislodged NJ tube
C. Peritonitis
D. Duodenal ulcer

Intussusception

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~12 year old boy diagnosed with EoE on biopsy who is awaiting referral to allergy for skin testing. What is the most appropriate additional management?

A. Ranitidine
B. Fluticasone
C. Prednisone
D. Surgery

Fluticasone

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12 year old female presenting with jaundice. Labs show ALT 300, AST 250, Bili 160, and Direct Bili 100. What is the most important next investigations

A. INR
B. Albumin
C. Stool alpha 1 antitrypsin
D. PTT

INR

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5 month male was exclusively fed with goat milk until he was 4 months, then cereal were introduced. He came in pale, and blood work showed macrocytic anemia (MCV 100). What is the cause? A. Iron deficiency B. B12 deficiency C. Niacin deficiency D. Folic acid deficiency

Folic acid deficiency

Boy who recently had the flu (few weeks ago) now regurgitates the contents of his stomach into mouth and re-swallows them numerous times per day, clenches his stomach muscles first. Some nausea, normal stooling, no abdo pain. No symptoms at night. What do you do for his management? A) Domperidone B) Diaphragmatic breathing techniques C) Fundoplication D) PPI

Diaphragmatic breathing techniques

4 week old baby, previously well presents with 2 days of increased vomiting. Normal stooling and feeding eagerly. Otherwise well. Exam- looks well apart from mild jaundice. Normal Creatinine, urea, glucose. pH 7.45 CO2 38 HCO3 28. Na 145 K 3.5 (No Cl was provided) Total bili 150 direct 5. Most likely diagnosis? A. CMPA B. Hypertrophic pyloric stenosis C. Urea cycle disorder

Hypertrophic pyloric stenosis

10-year-old boy with history of cystic fibrosis. Presents with 2 week history of decreased appetite, RLQ cramping and pain, and diarrhea. Mass palpable on abdominal examination in RLQ. What is the most likely etiology? A. Chronic intussusception B. Distal intestinal obstruction syndrome C. Chronic recurrent appendicitis

Distal intestinal obstruction syndrome

15-year-old female with ulcerative colitis still symptomatic on mercaptopurine and ASA and planning on starting biologic. Has had a 1 month history of cough and dyspnea. What is the most important test to complete before starting biologic treatment? A. Chest CT B. Sputum culture C. Purified Protein Derivative (PPD)

Chest CT ***

34. A 4 week old term infant is having difficulty passing bowel movements. There is no vomiting, diarrhea or hematochezia. His parents have to lift his legs up to assist his bowel movements. The bowel movements are otherwise normal. His physical examination and growth is normal. What is the most appropriate next step? A. Reassure B. Barium enema C. Abdo ultrasound D. Abdo x-ray

Reassure

Child with regurgitation post viral gastro. Brings up undigested food. No abdo pain or nausea. Swallows regurg and holds stomach before. What do you do? A. Domperidone B. PPI C. Diphenhydramine D. Chewing gum

Chewing gum

A 2 month old female infant is brought to your office with poor weight gain. She weighs 4kg. She is being formula fed and receives 60mL of standard cow’s milk formula every 3 hours. How many kcal/kg/day is the child receiving? A. 60 kcal/kg/day B. 80 kcal/kg/day C. 100 kcal/kg/day D. 120 kcal/kg/day

80 kcal/kg/day

A 10 year old male has gained 25kg in the last year and his BMI is now about the 97th percentile. He is otherwise well. He has a significant family history of obesity. His alt and ast are mildly elevated and you are concerned about NAFLD. What is the most appropriate next step in management A. Low fat diet B. Liver ultrasound C. AST, ALT and hepatic function yearly D. Weight loss management program

Low fat diet

7 term baby presents with jaundice. Total bili 230, indirect 100, direct 130. The baby has also vomited, has poor feeding, and has a temp of 35 degrees. What’s the most likely diagnosis? A. Septicemia B. Neonatal hepatitis C. Galactosemia D. Biliary atresia

Septicemia

41. ~6 week old infant with bright red blood and mucous per rectum. Otherwise clinically well, afebrile. What is management? A. Restrict soy and dairy in maternal diet B. Stool culture C. GI consult and scope

Restrict soy and dairy in maternal diet

A 4 yo girl with a 6 month hx of paroxysmal vomiting and abdominal pain. She has had 8 episodes where she vomits 12 times most commonly occurring first thing in the AM. In between episodes she is well and growing well. How do you best treat her? A. CBT B. Cyproheptadine C. Omeprazole D. Topiramate

Cyproheptadine

4 year old boy with ASD. He is taking megavitamins (yes, it said megavitamins). He presents after a 1 week history of headaches. On exam, he has papilledema. What is the toxicity? A. Vitamin A B. Vitamin B6 C. Vitamin C D. Vitamin D

Vitamin A

Previously healthy 8yo with a full diet. Now only able to tolerate bananas, chocolate pudding, and crackers. He is falling off the growth curve, 50th percentile to 10th. He has had some nausea and vomiting with other food types. Parents said he did not express concerns about his weight. What is the most likely diagnosis? A. ARFID B. EOE C. Anorexia Nervosa

ARFID

13 month old with poorly controlled epilepsy, hypotonia, dysphagia admitted with 2nd aspiration pneumonia. Usually eats a normal diet and receives thickened clear fluids. He also drools. What is the NEXT BEST step in management? A. Stop oral feeds and insert NG B. Restrict textures and change feeding position C. Anticholinergic D. Give prophylactic antibiotics

Stop oral feeds and insert NG

6 month old. Conjugated hyperbili, palpable RUQ mass a. Choledochal cyst b. Hepatoblastoma c. Biliary atresia

Choledochal cyst

What is the diagnostic role of fecal calprotectin a. Distinguishing functional GI illness from IBD b. Determining severity of IBD c. Distinguishing between different functional GI illnesses d. Diagnosing post infectious IBS

Distinguishing functional GI illness from IBD

Trichobezoar (picture of upper GI study) - how do you get it out? a. Laparotomy b. Laproscopy c. endoscopy

Laproscopy

7 year old boy with intermittent abdo pain, non bilious vomiting. Has some red mucousy stool and RUQ mass. What is the best test? a. Abdo US b. Stool C+S

Abdominal US

Kid with pancreatitis with 3xULN lipase - when to feed? a. Until resolution of lipase b. Until resolution of symptoms c. Feed now and watch closely for symptoms d. Start TPN and do not feed for another 48 hours

Feed now and watch closely for symptoms

7 year old male with chronic GERD. He develops progressive dysphagia to solids. He has lost 2.3 kg as a result of his restrictive eating. Labs are normal. Best test for diagnosis: A. Hydrogen breath test B. H. Pyloriserology C. Upper endoscopy and biopsy D. Upper GI series

Upper endoscopy and biopsy

Conj bili in a 6 month old - 1 week of symptom onset? RUQ mass. Acholic stools A. choloductal cyst B. hepatoblastoma C. Alagille D. biliary atresia

Alagille

8 month old with quad CP. Can’t feed orally. Has been on bolus NG feeds for past few months. Improved interactions since starting. Has GERD, well controlled on ranitidine. What next? A. G tube B. J tube C. pH probe D. G tube with fundo

G tube with fundo ****

You see a teenager in your clinic with progressive dysphagia to solids and epigastric pain. He has been diagnosed with eosinophilic esophagitis, and a referral has been sent for allergy testing. In the meantime, what should you do? a) Elimination diet b) Oral fluticasone by MDI c) Proton-pump inhibitor d) Oral Prednisone

Proton-pump inhibitor

An 18 month old girl has periorbital swelling. Her albumin is 26. Her urine is negative for protein. What do you do for diagnosis? a) Serum tripsin b) Stool alpha anti-trypsin c) Urine creatnine excretion d) ECHO

Stool alpha anti-trypsin

Child with 5 vomiting episodes over the last 12 months, associated with pallor, lasting 2-3 hours. Between episodes she is other well, growing and thriving, with a normal examination. What do you want to do: A. Reassure B. Refer to gastroenterology C. Neuroimaging D. Start PPI

Refer to gastroenterology

A 7yo boy has been complaining intermittently over the last 2 days of abdominal pain and has had non-bilious emesis. He has had several dark red mucousy stools. He is tender on palpation over the RUQ. Which imaging test would reveal the diagnosis? 1. UGI 2. Technetium 99 scan 3. Abdo U/S 4. Colonoscopy

Abdo U/S

Child referred to you with suspicion of celiac disease. Had anti-TTG done, which was negative. What is your next step. A. Refer to GI B. Endoscopy with biopsy C. Anti-gliadin antibodies D. Measure IgA

Measure IgA

8 year old girl with epigastric discomfort for many months, progressively getting worse and now waking her up at night time. Her father has peptic ulcer disease, and she has in fact tried his antacids with some relief. What should you do? A. Reassure, she can use the antacid as needed B. Treat empirically with PPI, amoxicillin, clarithromycin C. Urea breath test D. Esophagoduodenoscopy with biopsy

Esophagoduodenoscopy with biopsy

You are treating a 5 year old boy for constipation. In addition to disimpaction, his mother asks you how long he will need to be treated with PEG for? a. 3 months b. 6 months c. Until he’s toilet trained d. 3 weeks

6 months

A 3 week old baby presents with poor feeding and poor weight gain. He is jaundiced and has hepatosplenomegaly. His bilirubin is 170 with conjugated 115. Which imaging would you do next? a. Abdominal ultrasound with dopplers b. HIDA scan c. CT abdomen d. MRI abdomen

HIDA scan

8yo male. Duodenal ulcer. What is treatment? (Note: none of them listed a PPI) A. amox + clarithro B. clinda + clarithrO C. metronidazole + clinda D. bismuth subsalicylate + metronidazole

amox + clarithro

5 month old with vomiting for 6 hours intermittently, has had 3 or 4 episodes of flexion and extension of arms and legs, drowsy after, abdomen is distended, which test would reveal diagnosis? A. EEG B. CT abdomen C. Ultrasound abdomen D. Abdominal x-ray

Ultrasound abdomen

In a patient with liver failure, which of the following is most concerning regarding need for transplantation? a. Acute onset lethargy b. Acute liver volume loss c. Increase in liver enzymes

A 4 year old boy has had pain and non-bilious vomiting today. An ultrasound shows an intussusception (ileo-colic). As the emergency physician, you recommend an air enema reduction. Before going ahead with the procedure, the parents want to know more about the risks of air enema reduction: a. What are the chances of successful reduction with air enema? b. What are the chances of a perforation with air enema? c. What are the chances of a recurrence after air enema? d. What are 2 contraindications to using air enema?

a. Chances of successful reduction with air enema are generally high, 70-85% b. There is a chance of perforation 0.1 - 2.5%, the changes are higher with barium or saline reduction than with an air reduction (0.1 - 0.2%) c. Chances of recurrence after reduction is ! 10%, most reductions occur within 72 hours d. Peritonitis, persistent hypotension and pneumoperitoeneum

1 month old baby has total bilirubin of 180, conjugated bilirubin of 85. What are 5 conditions that could cause this and name the 1 diagnostic test for each condition.

Sepsis - blood, urine, CSF culture Biliary Atresia - ultrasound Hypothyroid - TSH Cystic Fibrosis - stool elastase TPN

Gastroenterology MCQ Flashcards

(60 cards)