Pre-test Gastro

Age 10 months with abrupt onset of watery stools 8–10×/day and two non‑bilious vomits in the last 12 hours. Temperature 37.5°C, heart rate 128/min, respiratory rate 32/min. Eyes mildly sunken, skin turgor returns within 2 seconds, capillary refill 2 seconds, urine output decreased. Weight 9 kg; alert and drinks eagerly. No blood or mucus in stool. Most appropriate initial management is:

• Oral rehydration solution ~75 mL/kg over 4 hours, then reassess

• Immediate IV Ringer’s lactate 20 mL/kg bolus repeated as needed

• Empiric azithromycin course

• Loperamide syrup for 24 hours

• Nil per os for 12–18 hours

Age 2 years with 1 day of watery diarrhea and lethargy. No vomiting. Temperature 36.8°C, HR 160/min, RR 42/min. Markedly sunken eyes, very dry oral mucosa, weak thready pulses, capillary refill 4–5 seconds, skin tenting, minimal urine for 10 hours, weight 11 kg. Which immediate step is most appropriate?

• IV ringer laktat 30 mL/kg in 30 minutes

• V ringer asetat 30 ml/kg in 1 hour

• Oral rehydration solution 75 ml/kg in 4 hours

• Empiric metronidazole

• Start lactose‑free formula and observe

Age 18 months with 3 days of watery stools; afebrile, active. HR 110/min, RR 28/min, moist mucosa, normal skin turgor, capillary refill <3 seconds, normal urine output. Stool is greenish without blood. Which adjunct is recommended to shorten illness and reduce recurrence?

• Zinc supplementation for 10–14 days

• Empiric oral ciprofloxacin

• Prolonged clear‑liquid diet

• Probiotics only

• Single dose ondansetron daily for 5 days

Age 4 years with high fever, abdominal cramps, and frequent small‑volume stools containing visible blood and mucus for 24 hours. Temperature 39.2°C, HR 132/min, signs of moderate dehydration. Stool microscopy: leukocytes (+6), mucus(+), blood (+2). Most appropriate empiric antibiotic is:

• Azithromycin

• Amoxicillin

• Metronidazole monotherapy

• Nitrofurantoin

• Nitrofurantoin

Age 7 years with 3 days of abdominal pain and bloody diarrhea after consuming street food; afebrile now. Stool microscopy shows trophozoites with ingested RBCs on fresh wet mount; no leukocytes. Liver and spleen normal. Best next step is:

• Vancomycin

• Ciprofloxacin

• Metronidazole

• Oseltamivir

• Albendazole single dose

A 7 month-girl was referred as she suffered from watery stool for more than 2 weeks. She has no fever nor cough. The baby looked active, BW 4.5 kg, HR 110 bpm, RR 30, temperature 37 C, normal peristaltic, good skin turgor, and no erythematous around anal area. What was your diagnosis for the case?

• Intractable diarrhea with dehydration

• Persistent diarrhea with dehydration

• Prolonged diarrhea without dehydration

• Chronic diarrhea without dehydration

• Post infectious diarrhea without dehydration

Age 6 weeks with progressive jaundice since week 3. Stools pale/acholic on several days, urine dark. Total bilirubin 10 mg/dL with conjugated 6.8 mg/dL; ALT/AST mildly elevated; GGT high. Abdomen soft, no splenomegaly. Most appropriate initial imaging to evaluate the cause is:

• Right upper quadrant abdominal ultrasound

• HIDA scan without pretreatment

• CT abdomen with contrast

• Plain abdominal radiograph

• ERCP

Age 8 weeks with persistent conjugated hyperbilirubinemia and repeated acholic stools. Ultrasound: absent/atrophic gallbladder, no choledochal cyst. Weight gain adequate; INR normal. Next best step in management is:

• Start ursodeoxycholic acid and observe for 3 months

• Early referral for evaluation and consideration of Kasai portoenterostomy

• Phototherapy 24–48 hours

• Oral antibiotics for presumed ascending cholangitis

• Exclusive formula change to extensively hydrolyzed protein

Newborn with delayed passage of meconium (>48 hours), progressive abdominal distension, and bilious vomiting at day 3. Plain abdominal radiograph shows dilated bowel loops without air in distal rectum. Digital rectal exam results in explosive stool. Most definitive diagnostic test is:

• Upper GI series

• Contrast enema only

• Anorectal manometry as sole test

• Abdominal ultrasound

• Rectal suction biopsy

Age 2 years with chronic constipation since infancy, abdominal distension, intermittent vomiting, and failure to thrive. Recurrent episodes of fever and foul‑smelling diarrhea with lethargy. WBC 15,500/µL, CRP elevated. Most concerning complication that requires urgent recognition is:

• Intussusception

• Meckel’s diverticulitis

• Pyloric stenosis

• Hirschsprung‑associated enterocolitis

• Appendicitis