Mock Exam 3 Gastroenterology Part One MRCPCH Educational Materials from MRCPCH2009 for Part 1 Number of questions: 20 Score: 100 marks Time: 30 Minutes
MRCPCH2009 SITE
ELBABA M.A.
Mock Exam Series # 3 Gastroenterology Test 1
MRCPCH2009 Site ELBABA M.A.
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EXTENDED MATCHING QUESTIONS Q. 1 (20 Marks) This is a list of certain diagnosis: A. Gluten entropathy B. Tuft entropathy C. Congenital Microvillus Atrophy D. Primary lactose intolerance E. Secondary lactose intolerance F. Cow milk protein intolerance G. Glucose-Galactose malabsorption H. Sucrose-Isomaltase deficiency I. Alpha one antitrypsin deficiency J. E-Coli gastroentritis K. Toddler diarrhea L. Acrodermatitis enteropathica M. Abetalipoproteinaemia N. Chloride loosing diarrhea Choose the most likely diagnosis for each of the following scenarios: SELECT ONE ANSWER ONLY FOR EACH QUESTION Note: Each answer may be used more than once 1. Baby with watery diarrhea shortly after birth. Mother had polyhydramnios. The baby is on exclusive breast feeding since birth. PH showed metabolic alkalosis. No change in bowel motion after trial of Lactose free formula or kept NPO for few days. Clinitest was negative 2. Baby with watery diarrhea shortly after birth. Mother had polyhydramnios. The baby was on exclusive breast feeding few days after birth.TPN started later because of severe malnutrition. No change in bowel motion after trial of Lactose free formula or kept NPO for few days. Clinitest was negative 3. Baby with watery diarrhea shortly after birth. Mother had no polyhydramnios. The baby is on exclusive breast feeding since birth. PH showed metabolic acidosis. Marked improvement occurs when fructose based formula has been introduced. Clinitest was positive. 4. Baby with watery diarrhea only last week. Bowel motion was normal for the initial 5 months. Mother had no polyhydramnios. The baby was on exclusive breast feeding until last week. Mother started weaning with simple juice only. Marked improvement occurs when regular infant formula has been introduced with additional sugar free food. Clinitest was negative. __________________________________________________________________________ http://sites.google.com/site/mrcpch2009/
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Mock Exam Series # 3 Gastroenterology Test 1
MRCPCH2009 Site ELBABA M.A.
____________________________________________________________________________
Q. 2 (15 Marks) This is a list of certain diagnosis: A. Intussusception B. Henoch- Schonlein pupura C. Hemolytic uremic syndrome D. Peutz-Jeghers syndrome E. Gardener syndrome F. Meckel’s diverticulitis G. Anal fissure H. Ulcerative colitis I. Proctetitis secondary to child abuse J. Functional constipation K. Campylobacter jejuni infection L. Pseudo-membranous colitis M. Ascasiasis N. Schistosomiasis O. Shigellosis P. Amoebic dysentery Choose the most likely diagnosis for each of the following scenarios: SELECT ONE ANSWER ONLY FOR EACH QUESTION Note: Each answer may be used more than once 1. 5 year old boy presented with painless haematochezia and intermittent left abdominal pain. Technetium scan shows ectopic gastric tissue. 2. 5 year old boy presented with painless haematochezia and intermittent vague diffuse abdominal pain. There was perioral and buccal hyperpigmentation. Father died with bowel malignancy. 3. 5 year old boy presented with painful haematochezia and intermittent vague diffuse abdominal and both ankles pain. Child has microscopic hematuria and few urticarial rash over the lower half of the body. Q. 3 (15 Marks) This is a list of Medications may be used in Gastrointestinal conditions: A. Proton pump inhibitor B. H2 receptor blockers C. Prokinetic agent D. Serotonin receptor antagonist E. Anti-tumor necrosis factor Alpha F. 5 Aminosalicylic acid __________________________________________________________________________ http://sites.google.com/site/mrcpch2009/
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Mock Exam Series # 3 Gastroenterology Test 1
MRCPCH2009 Site ELBABA M.A.
____________________________________________________________________________
G. H. I. J. K. L. M.
Corticosteroids Calcineurin inhibitors Narcotic analgesic NSAID Intestinal antispasmodics Salaz Food thickeners
Choose the drug of choice for each of the following scenarios: SELECT ONE ANSWER ONLY FOR EACH QUESTION Note: Each answer may be used more than once 1. 11 year old girl with intractable Crohn’s disease. Initial lines of medical treatment were unsatisfactory. Child is still suffering and refuses surgery. 2. 3 years old boy with non-organic recurrent sever abdominal pain. Child is well grown and achieving well in school. There is family history of migraine. 3. 7 month old baby with recurrent regurgitation and normal growth. 24 hours PH monitoring showed high reflux index.
BEST OF FIVE QUESTIONS (5 Marks each) 1. Considering Pyloric stenosis, all of the following are true EXCEPT: A. It is more common in boys and in first baby with positive family history B. Usually present between two and seven weeks of life. C. Hypochloremic metabolic alkalosis is well recognized complication. D. Fluid resuscitation is the most important initial step of management. E. Pyloromyotomy is resection of the stenotic segment and anastomosis 2. A healthy 18 month old boy is well grown and well hydrated. Mother claims, her baby has 4-7 times loose motion with occasional food content but, no vomiting. What is the likely diagnosis : SELECT ONE A. Normal bowl habit for age B. Overfeeding C. Short bowel disease D. Toddler’s diarrhea E. Atypical Coeliac disease
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Mock Exam Series # 3 Gastroenterology Test 1
MRCPCH2009 Site ELBABA M.A.
____________________________________________________________________________
3. After a blunt trauma, 5 year old girl presented with sever epigastric pain with mild rigidity. All of the following should be included in the management. EXCEPT: A. Urgent pediatric surgery consultation for exploratory laparotomy B. Abdominal Ultrasound / C-T Scan C. Serum pancreatic enzymes assay D. Close monitoring of blood pressure E. Consider short period of Nil per oral. 4. Well recognized extra-intestinal manifestations of Crohn’s disease include all of the following EXCEPT: A. Poor vision of one or both eyes B. Absent red reflex on fundus examination C. Tender red nodules over the chin of the Tibia D. Gangrenous skin lesion E. Tender swollen ankle 5. Girl of 7 presented with vomiting of fresh blood twice today. She has been treated for the last week with Erythromycin after diagnosis of sinusitis. Fever has improved but vomiting is not. What is the most likely cause of that haematemsis. : SELECT ONE A. Stress gastric ulcer B. Erythromycin adverse effect C. Sandifer’s syndrome D. Zollinger – Ellison syndrome E. Mallory – Weiss syndrome
MULTIPLE TRUE/FALSE QUESTIONS (5 Marks each) 1. Neurological complications of dehydration and its treatment includes: A. Cortical leukodystropy B. Central pontine myelinolysis C. Brain edema D. Severe combined degeneration E. Cerebral venous thrombosis
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Mock Exam Series # 3 Gastroenterology Test 1
MRCPCH2009 Site ELBABA M.A.
____________________________________________________________________________
2. 7 year healthy girl complaining of mild recurrent periumbilical pain. This pain is more in the early morning before school time and resolved completely after that. Father has peptic ulcer disease. Clinical examination is normal. What is your advice(s) to parents? : A. Inform them that the child has no pain and no action has required B. Upper GIT endoscopy usually required around the adolescence C. Functional pain is the diagnosis of exclusion after investigations. D. It is advisable to take short school leave to improve the pain. E. Irritable bowl disease may be the other image in adulthood 3. Recognized risk factors of Intussusception may includes : A. Meckle’s diverticulum B. Lymphoma C. Viral infection D. Henoch - Schonlein pupura E. Intestinal Polyp. 4. You have been assessed a 5 month old baby, 6kg in A&E dept. with gastroenteritis had frequent diarrhea & once vomiting. You determined the degree of dehydration was moderate. S. sodium was 130 mmol/L : A. Thirsty may be the only manifestation of this dehydration B. Hypotension is the early alarm of severe dehydration C. Oliguria, mild azotemia and mild acidosis are usually present D. Intravenous Saline should start very soon E. Estimated fluid deficit is around 400-500 ml. is 5. In 9 month old baby with Coeliac disease : A. Initial jejunal biopsy is confirmatory B. The hallmark of biopsy is subtotal villous atrophy & crypts hyperplasia. C. Anti tissue transglutaminase Ab. has high specificity and sensitivity. D. If confirmed, Gluten free diet should be prescribed for life. E. Dermatitis herpetiformis is a well recognized association.
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