Practice questions, congenital GI disorders
Practice questions
Congenital GI disorders
Updated: 03/01/2019
© Jun Wang, MD, PhD
1. Use this
image for this question. A new born boy has thick oral secretions and choke
after suckling, followed by respiratory distress. The prenatal course is
significant for polyhydramnios. Physical examination is unremarkable. The
neonatologist failed to insert a nasogastric tube to stomach. An image of his
chest X-ray with contrast is shown. What is the diagnosis?
(image credit: DrM!key/WikiCommons)
A. Diaphragmatic hernia
B. Esophageal atresia
C. Esophageal duplication
D. Tracheoesophagial fistula
E. Vacterl syndrome
2. Use this
image and this case for the next 2 questions. A 1-month-old girl presents
with coughing and choking with feed and recurrent bilateral pneumonia since
birth. The prenatal and delivery course are unremarkable. An image of chest
X-ray with contrast is shown. What is the diagnosis?
(Image credit: Kinderradiologie
Olgahospital Klinikum Stuttgart/WikiCommons)
A. Diaphragmatic hernia
B. Esophageal atresia
C. Pulmonary hypoplasia
D. Tracheoesophagial fistula
E. Vacterl syndrome
3. A 1-month-old girl presents with coughing and
choking with feed and recurrent bilateral pneumonia since birth. The prenatal
and delivery course are unremarkable. An image of chest X-ray with contrast is
shown. What is the cause of these findings?
(Image credit: Kinderradiologie Olgahospital
Klinikum Stuttgart/WikiCommons)
A. Abnormal fetal gut rotation
B. Diaphragm defect
C. Failure of vitelline duct involution
D. Rupture of amnion in second trimester
E. Tracheoesophageal septum abnormality
4. A three-day-old boy presents with recurrent choking
following suckling since birth. Prenatal and delivery course are unremarkable. Physical
examination reveals scoliosis towards right side, and absence of thumb on right
hand. Image studies reveals hemi-vertebrae, and absence of right radius and
thumb. Left kidney is absent as well. What is the likely the cause of his
recurrent choking after suckling?
A. Gastroschisis
B. Omphalocele
C. Pulmonary hypoplasia
D. Thymus hypoplasia
E. Tracheoesophageal fistula
5. Use this
image and this case for the next 2 questions. A full term new born boy was
found to have a periumbilical swelling. The swelling appear to be translucent
and normal appearing intestines can be seen through the covering. No other
abnormalities are noted. What is the diagnosis?
A. Diaphragmatic hernia
B. Gastroschisis
C. Meckel diverticulum
D. Omphalocele
E. Umbilical hernia
6. A full term new born boy was found to have a
periumbilical swelling. The swelling appear to be translucent and normal
appearing intestines can be seen through the covering. No other abnormalities
are noted. What is the cause of these findings?
A. Abnormal fetal gut rotation
B. Diaphragm defect
C. Failure of vitelline duct involution
D. Rupture of amnion in second trimester
E. Tracheoesophageal septum abnormality
7. Use this
case for the next 2 questions. A new born full term boy presents with
sudden respiratory distress. The prenatal and delivery course are unremarkable.
Chest X-ray reveal may air bubble like structures in his left chest. The
mediastinum is shifted to the right. No other abnormalities are noted. What is
the diagnosis?
A. Diaphragmatic hernia
B. Esophageal atresia
C. Hirschprung disease
D. Pneumothorax
E. Tracheoesophagus fistula
8. A new born full term boy presents with sudden respiratory
distress. The prenatal and delivery course are unremarkable. Chest X-ray reveal
may air bubble like structures in his left chest. The mediastinum is shifted to
the right. No other abnormalities are noted. What is the cause of his
respiratory distress?
A. Aspiration
B. Pneumonia
C. Pneumothorax
D. Pulmonary hypoplasia
E. Thoracic cage abnormality
9. Use this
image and this case for the next 2 questions. A 2-week-old boy presents
with non-bilious vomiting after feeding. The prenatal course and delivery
process are unremarkable. Physical examination reveals body weight at the 10th
percentile, and height at 75th percentile. A firm mass is noted at
right upper abdomen. No other abnormalities are noted. An image of the
sonographic exam is shown. What is the diagnosis?
(Image credit: Doc James, wiki
commons)
A. Diaphragmatic hernia
B. Esophageal atresia
C. Hirschprung disease
D. Pyloric stenosis
E. Tracheoesophagus fistula
10. A 2-week-old boy presents with non-bilious
vomiting after feeding. The prenatal course and delivery process are unremarkable.
Physical examination reveals body weight at the 10th percentile, and
height at 75th percentile. A firm mass is noted at right upper
abdomen. No other abnormalities are noted. An image of the sonographic exam is
shown. What is the cause of his symptoms?
(Image credit: Doc James, wiki
commons)
A. Gastrointestinal stromal tumor
B. Helicobacter gastritis
C. Menetrier’s disease
D. Pyloric smooth muscle neoplasm
E. Pyloric sphincter hypertrophy
11. Use this
image and this case for the next 2 questions. A 21-year-old man presents
with fever, vomiting and dull right lower abdominal pain for 5 hours. His past
medical history is unremarkable. His temperature is 39.2 degree Celsius. Other
vital signs are normal. Physical
examination reveals slightly rigid abdomen with tenderness and rebound
tenderness, worst at lower abdomen. Laboratory tests reveal a white cell count
of 15 x 109/L (normal 4.5-10.3 x 109/L) with left shift.
No immature cells are seen. Laparotomy reveals a necrotic appendix. In
addition, a lesion as shown in the image is seen at terminal ileum. What is the
diagnosis?
(Image credit: Milliways
Wiki Commons)
A. Carcinoid
B. Ileal fistula
C. Hirschsprung disease
D. Meckel diverticulum
D. Meckel diverticulum
E. Mesothelioma
12. A 21-year-old man presents with fever, vomiting
and dull right lower abdominal pain for 5 hours. His past medical history is unremarkable.
His temperature is 39.2 degree Celsius. Other vital signs are normal. Physical examination reveals slightly rigid
abdomen with tenderness and rebound tenderness, worst at lower abdomen.
Laboratory tests reveal a white cell count of 15 x 109/L (normal
4.5-10.3 x 109/L) with left shift. No immature cells are seen. Laparotomy
reveals a necrotic appendix. In addition, a lesion as shown in the image is
seen at terminal ileum. What is the cause of these findings?
(Image credit: Milliways
Wiki Commons)
A. Abnormal fetal gut rotation
B. Developmental failure of enteric ganglions
C. Hypergastrinemia
D. Failure of vitelline duct involution
E. Rupture of amnion in second trimester
13. Use this image and this case
for the next 3 questions. An 8-year-old boy presents with
progressive abdominal distension for a year. He has a history of constipation since
age 3. Physical examination reveals a distended abdomen with tympany to
percussion. Laboratory tests results are unremarkable. Abdominal X-ray reveals
markedly dilated colonic loops. An image of barium enema is shown. What is most
likely the diagnosis?
A. Carcinoid
B. Ileal fistula
C. Hirschsprung disease
D. Meckel diverticulum
D. Meckel diverticulum
E. Mesothelioma
14. An 8-year-old boy presents with progressive
abdominal distension for a year. He has a history of constipation since age 3.
Physical examination reveals a distended abdomen with tympany to percussion.
Laboratory tests results are unremarkable. Abdominal X-ray reveals markedly
dilated colonic loops. An image of barium enema is shown. What is most likely the
causing these changes?
A. Abnormal fetal gut rotation
B. Developmental failure of enteric ganglions
C. Hypergastrinemia
D. Failure of vitelline duct involution
E. Rupture of amnion in second trimester
15. An 8-year-old boy presents with progressive
abdominal distension for a year. He has a history of constipation since age 3.
Physical examination reveals a distended abdomen with tympany to percussion.
Laboratory tests results are unremarkable. Abdominal X-ray reveals markedly
dilated colonic loops. An image of barium enema is shown. Mutation of what gene
is associated with these changes?
A. APC
B. EGFR
C. MEN1
D. RET
E. WT1
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