GI GI Pediatric & Geriatric Considerations 2 — Questions and Answers
Question 1: Which diagnostic test is used to confirm celiac disease in a child with suspected gluten intolerance?
- Colonoscopy with biopsy
- Small bowel biopsy showing villous atrophy plus positive tissue transglutaminase IgA antibody (Correct answer)
- Stool culture
- Hydrogen breath test
Correct answer: Small bowel biopsy showing villous atrophy plus positive tissue transglutaminase IgA antibody
The gold standard for celiac diagnosis is small intestinal biopsy showing villous atrophy with positive serological testing for anti-tissue transglutaminase IgA antibodies.
Question 2: In geriatric patients, which GI cancer screening guideline applies to average-risk individuals who are 75 years or older?
- Continue colonoscopy every 10 years indefinitely
- Individualize based on health status and life expectancy; may stop screening (Correct answer)
- Screen every 5 years with flexible sigmoidoscopy
- Annual fecal occult blood test is mandatory
Correct answer: Individualize based on health status and life expectancy; may stop screening
US guidelines (USPSTF) recommend individualizing colorectal cancer screening decisions for adults 76–85, considering overall health and life expectancy, and generally stopping after age 85.
Question 3: What is the most common GI malignancy in children under 15 years of age?
- Colorectal adenocarcinoma
- Hepatoblastoma (Correct answer)
- Gastric carcinoma
- Pancreatic cancer
Correct answer: Hepatoblastoma
Hepatoblastoma is the most common malignant liver tumor in children, typically presenting before age 3 with an abdominal mass and elevated alpha-fetoprotein (AFP).
Question 4: Which condition causes fatty infiltration of the liver in obese children and is increasingly recognized in pediatric populations?
- Biliary atresia
- Non-alcoholic fatty liver disease (NAFLD) (Correct answer)
- Wilson's disease
- Alpha-1 antitrypsin deficiency
Correct answer: Non-alcoholic fatty liver disease (NAFLD)
NAFLD, including non-alcoholic steatohepatitis (NASH), is the most common chronic liver disease in children, strongly associated with obesity, insulin resistance, and metabolic syndrome.
Question 5: In the elderly, decreased lower esophageal sphincter (LES) tone and impaired esophageal motility contribute to an increased prevalence of which condition?
- Achalasia
- GERD and Barrett's esophagus (Correct answer)
- Zenker's diverticulum only
- Eosinophilic esophagitis
Correct answer: GERD and Barrett's esophagus
Age-related reduction in LES pressure and esophageal clearance mechanisms increase reflux frequency in older adults, raising the risk of GERD and its complication, Barrett's esophagus.
Question 6: Meconium ileus in a newborn is strongly associated with which underlying genetic condition?
- Down syndrome
- Cystic fibrosis (Correct answer)
- Trisomy 18
- Turner syndrome
Correct answer: Cystic fibrosis
Meconium ileus, caused by thick inspissated meconium obstructing the terminal ileum, occurs in about 10–20% of cystic fibrosis patients and is often the first presentation of the disease.
GI GI Pediatric & Geriatric Considerations 2
Which diagnostic test is used to confirm celiac disease in a child with suspected gluten intolerance?