AMC MCQ Paediatrics and Child Health 2 — Questions and Answers
Question 1: A 6-week-old presents with non-bilious projectile vomiting and a palpable olive-shaped epigastric mass. What is the most likely diagnosis?
- Pyloric stenosis (Correct answer)
- Duodenal atresia
- Gastro-oesophageal reflux
- Malrotation with volvulus
Correct answer: Pyloric stenosis
Non-bilious projectile vomiting with a palpable olive in a baby around 4-8 weeks is classic for hypertrophic pyloric stenosis.
Question 2: A child with pyloric stenosis typically shows which biochemical abnormality?
- Hypochloraemic hypokalaemic metabolic alkalosis (Correct answer)
- Metabolic acidosis with high anion gap
- Hyperchloraemic acidosis
- Respiratory alkalosis
Correct answer: Hypochloraemic hypokalaemic metabolic alkalosis
Loss of gastric acid through vomiting produces a hypochloraemic, hypokalaemic metabolic alkalosis.
Question 3: What is the initial management priority before surgery in an infant with pyloric stenosis?
- Fluid and electrolyte correction (Correct answer)
- Immediate pyloromyotomy
- Start oral feeds
- Administer antibiotics
Correct answer: Fluid and electrolyte correction
Pyloromyotomy is not an emergency; fluid and electrolyte resuscitation must be completed first.
Question 4: A 2-year-old presents with intermittent severe colicky abdominal pain, drawing up the legs, and 'redcurrant jelly' stools. What is the most likely diagnosis?
- Intussusception (Correct answer)
- Appendicitis
- Mesenteric adenitis
- Constipation
Correct answer: Intussusception
Paroxysmal colic, leg-drawing and redcurrant jelly stool are hallmarks of intussusception.
Question 5: What is the first-line treatment for ileocolic intussusception in a stable child without peritonitis?
- Air or contrast enema reduction (Correct answer)
- Immediate laparotomy
- Nasogastric decompression alone
- Oral rehydration and observation
Correct answer: Air or contrast enema reduction
Non-operative reduction with an air (pneumatic) or contrast enema is first-line when there are no signs of perforation or peritonitis.
Question 6: A neonate has bilious vomiting in the first day of life. What is the most concerning diagnosis to exclude urgently?
- Malrotation with midgut volvulus (Correct answer)
- Gastro-oesophageal reflux
- Overfeeding
- Pyloric stenosis
Correct answer: Malrotation with midgut volvulus
Bilious vomiting in a neonate is malrotation with volvulus until proven otherwise as it threatens bowel viability.
Question 7: Which investigation is the gold standard to diagnose malrotation?
- Upper GI contrast study (Correct answer)
- Abdominal ultrasound
- Plain abdominal X-ray
- CT abdomen
Correct answer: Upper GI contrast study
An upper GI contrast study showing an abnormally placed duodenojejunal junction is the diagnostic standard for malrotation.
AMC MCQ Paediatrics and Child Health 2
A 6-week-old presents with non-bilious projectile vomiting and a palpable olive-shaped epigastric mass.
What is the most likely diagnosis?