| Post Name | Assistant Professor in Paediatric Gastroenterology |
|---|---|
| Department | Medical Education |
| Question Paper Code | 140/2026/OL |
| Category Code | 874/2025 |
| Date of Test | 13 August 2026 |
| Exam Type | Online Examination |
| Total Questions | 100 |
1
Eosinophilic granules of Paneth cells contains all of the following except
Answer
C. Chromogranin A
2
Regarding Abernethy malformation, which of the following is not true?
Answer
A. It is more common in boys
3
Which of the following modulators decreases lower oesophageal sphincter (LES) Pressure?
Answer
D. Secretin
4
Which is the most common hematological manifestation of Shwachman Diamond syndrome?
Answer
A. Neutropenia
5
Regarding Bile acid formation and enterohepatic circulation of bile acids, which transporter gene in the hepatocyte is located in canalicular membrane?
Answer
D. BSEP (ABCB11)
6
Which of the following clinical condition is least likely to progress to Hepatocellular carcinoma?
Answer
C. Wilson disease
7
Which of the following clinical condition is least likely to associated with secondary iron overload?
Answer
D. Wilson disease
8
In which among the following Porphyrias, the site of expression is not liver?
Answer
C. Congenital Erythropoitic Porphyria
9
In Auto immune hepatitis, the diagnostic accuracy of Smooth Muscle Antibodies (SMA) if Anti Nuclear Antibodies (ANA) also present is
Answer
C. 74%
10
Which of the following is an endogenous agonist of intestinal ļ¬uid and electrolyte absorption?
Answer
A. Aldosterone
11
A 24-year-old woman presents with chronic watery diarrhea, weight loss, iron deļ¬ciency anemia and recurrent oral ulcers. Tissue transglutaminase IgA is positive. Which histological ļ¬nding is most characteristic?
Answer
B. Villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes
12
A 5-year-old child presents with acute bloody diarrhea, abdominal pain and fever. Which organism is most likely to cause inļ¬ammatory diarrhea by invading colonic mucosa?
Answer
C. Shigella dysenteriae
13
A 32-year-old man has heartburn occurring twice weekly without alarm symptoms. Initial management should be:
Answer
C. Empirical proton pump inhibitor therapy with lifestyle modiļ¬cation
14
A patient with recurrent dysphagia undergoes endoscopy showing concentric rings and linear furrows. Biopsy demonstrates >15 eosinophils/HPF. Diagnosis?
Answer
C. Eosinophilic esophagitis
15
Which feature best diļ¬erentiates ulcerative colitis from Crohn disease?
Answer
C. Continuous involvement beginning in the rectum
16
Anorectal manometry shows paradoxical anal sphincter contraction during attempted defecation. First-line treatment?
Answer
C. Biofeedback therapy
17
A bleeding duodenal ulcer (Forrest IIa) is found. Recommended endoscopic management?
Answer
B. Combination endoscopic hemostatic therapy
18
Which fulļ¬lls Rome IV criteria for IBS?
Answer
A. Abdominal pain atleast once weekly in last 3 months associated with defecation or change in stool frequency/form
19
Meckel diverticulum arises from persistence of which embryological structure?
Answer
A. Vitelline duct
20
In acute variceal bleeding, which should be started before endoscopy?
Answer
B. Octreotide (or terlipressin) with prophylactic antibiotics
21
Which of the following statement is/are correct about biliary atresia in infants? (i) Diagnostic accuracy of hepatobiliary ultrasonography is only 40-50% (ii) Bile ductular proliferation, portal ļ¬brosis and widening of portal tracts are important histological ļ¬ndings in liver biopsy (iii) Biliary atresia account for 70-80% cases among all aetiologies of neonatal cholestasis in Indian setting. (iv) Hepatobiliary scintigraphy need to be done only when stool are ambiguous.
Answer
A. Only (ii and iv)
22
Which of the following statement is/are correct about progressive familial intrahepatic cholestasis in children? (i) BSEP gene is associated with a variety of extrahepatic manifestations like diarrhoea, pancreatitis and sensorineural hearing loss (ii) Serum Gamma-glutamyl transferase (GGT) is elevated in Progressive Familial Intrahepatic Cholestasis 2 (iii) Progressive Familial Intrahepatic Cholestasis 2 have more rapid progression to cirrhosis without therapy (iv) Progressive Familial Intrahepatic Cholestasis 1 show bland hepatocellular and canalicular cholestasis without inļ¬ammation in liver biopsy
Answer
D. Only (iii and iv)
23
Which of the following statement is incorrect about diagnosis and management of cerebral edema in paediatric acute liver failure?
Answer
C. Hypertonic saline should be used for the prevention and treatment of cerebral edema with target serum sodium level 155-160 meq/L
24
Which of the following statement is incorrect about aetiology of paediatric acute liver failure?
Answer
C. Neonatal hemochromatosis is common aetiology in neonate because of excess iron intake by mother
25
Which of the following statement is incorrect about of autoimmune liver disease (AILD) in children? (i) Azathioprine is recommended as ļ¬rst line of immunosuppressive therapy (ii) Acute liver failure due to AILD can be easily manage on immunosuppressive therapy. (iii) Relapse is rare in LKM-1 antibody positive AILD (iv) AILD with Autoimmune sclerosing cholangitis respond to same immunosuppressive treatment as recommended for AILD alone.
Answer
D. only (i, ii and iii)
26
Which of the following statement regarding management of ascites due to cirrhosis are/is true? (i) Total protein of ascites ļ¬uid <1.0 g/dL is associated high susceptibility to spontaneous bacterial peritonitis (ii) Urinary sodium excretion determination assess the eļ¬cacy of any diuretic regimen (iii) Rapid diuresis can be achieved safely in children in peripheral edema accompanies ascites (iv) Ascites is associated less frequently with peripheral edema in children than in adults.
Answer
A. (i), (ii), (iii) and (iv)
27
Which of the following statement regarding perinatal transmission of hepatitis B from mother to infants is incorrect? (i) Maternal HBeAg positivity increase the chances of hepatitis B intection in neonate (ii) High HBV DNA titre in mother increase the chance of liver dysfunction or liver failure in neonates (iii) All neonate born to HbsAg positive mother should receive Hepatitis B immunoglobulin with in ļ¬rst 7 days with or without active immunization. (iv) 90% of perinatally acquired hepatitis B infected baby developed cirrhosis or liver disease mostly in ļ¬rst 20 year of their age.
Answer
B. only (ii,iii and iv)
28
Which of the following statement regarding metabolic liver disease is/are incorrect? (i) Glycogen storage disease type 1b present same as GSD type 1a with additional neutrophil dysfunction. (ii) Kidney enlargement is commonly seen in GSD type III. (iii) Gaucher disease type 1 presents in early infancy with hepatosplenomegaly and neurological involvement. (iv) Pearson syndrome is a multisystem disorder of infancy that is characterized by exocrine pancreatic insuļ¬ciency and sideroblastic anemia.
Answer
A. only (ii and iii)
29
Which is the most common indication for Liver transplantation among the following disorders in pediatric age group?
Answer
B. Biliary atresia
30
A 6-year-old child with chronic cholestatic Liver disease has severe pruritus causing excoriations, steep disturbance, and poor school performance despite maximal medical therapy. The next best management is:
Answer
C. List the child for Liver transplantation
31
Which of the following is/are components of PELD score? (i) Albumin (ii) Total bilirubin (iii) Growth Failure (iv) Age
Answer
D. All of the above
32
All of the following infections can have bile duct paucity except
Answer
A. Hepatitis A
33
Which infection is Least likely to be responsible for fever occurring within the ļ¬rst postoperative week after Liver transplantation?
Answer
D. Viral infection
34
All of the following are causes for elevated transaminase levels in Transplant recipient except-
Answer
D. Graft congestion
35
Which complication has Limited the use of belatacept in pediatric solid organ transplantation?
Answer
C. Increased PTLD and serious CNS infections
36
A child with biliary atresia develops recurrent cholangitis after Kasai portoenterostomy. The next deļ¬nitive treatment is:
Answer
C. Liver transplantation
37
The minimum acceptable graft-to-recipient weight ratio (GRWR) is approximately:
Answer
B. 0.8%
38
Which among the following is an ABSOLUTE contraindication for liver transplantation in pediatric population?
Answer
B. Non-reversible pulmonary hypertension
39
In calculating the Pediatric End-Stage Liver Disease (PELD) score for prioritizing organ allocation, which speciļ¬c set of parameters is utilized that distinguishes it from the adult Model for End-Stage Liver Disease (MELD) score?
Answer
B. Serum Bilirubin, INR, Serum Albumin, Age (< 1 year), and Growth Failure parameters
40
A 7-year-old child presents 3 years post-liver transplantation with severe hypersplenism, esophageal variceal beeding, and intractable ascites, An angiogram demonstrates a complete presinusoidal obstruction/thrombosis of the extrahepatic portal vein with cavernous transformation, while the intrahepatic portal veins remain patent. What is the most anatomical and physiological surgical shunt procedure indicated for this condition?
Answer
C. Mesenterico-Left Portal Bypass (Rex Shunt)
41
A 4-year-old child who underwent liver transplantation with a Roux-en- Y hepaticojejunostomy 1 year ago presents with ļ¬uctuating jaundice, pruritus, and multiple episodes of bacterial cholangitis. Magnetic resonance cholangiopancreatography (MRCP) reveals a tight localized isolation/stricture at the biliary-enteric anastomosis. What is the most appropriate initial interventional management strategy?
Answer
B. Percutaneous Transhepatic Cholangiography (PTC) followed by balloon dilation and internal-external biliary drainage/stenting
42
A 2-year-old child develops early Hepatic Artery Thrombosis (HAT) on Postoperative Day 3 following a living donor lateral segment liver transplant. The patient is currently hemodynamically stable but demonstrates rising transaminases. Doppler ultrasound shows zero ļ¬ow in the hepatic artery. What is the standard surgical management strategy of choice?
Answer
C. Urgent surgical re-exploration, thrombectomy, and revision of the arterial anastomosis
43
The most commonly used ļ¬rst-line imaging modality to evaluate graft perfusion immediately after pediatric liver transplantation is:
Answer
C. Doppler ultrasonography
44
A 3-year-old child is diagnosed with a biopsy-proven hepatoblastoma. Imaging demonstrates involvement of all four sectors of the liver (PRETEXT IV) along with involvement of the main portal vein trunk and all three major hepatic veins. There is no extrahepatic disease. What is the most appropriate deļ¬nitive therapeutic strategy according to current international pediatric liver tumor consensus guidelines?
Answer
C. Neoadjuvant chemotherapy followed by deļ¬nitive assessment for primary orthotopic liver transplantation if extrahepatic clearance is maintained
45
I. Alagelli syndrome Byler disease and non-syndromic intrahepatic biliary hypoplasia are disorders of biliary system that may require liver transplantation in pediatric age group. II. Disorder of metabolism like Wilson disease, tyrosinemia, glycogen storage disorders and gaucher syndrome are the most common indications of liver transplantation In pediatric population III. Growth retardation and development of metabolic bone disease are not indications for liver transplantation in pediatric population
Answer
C. I correct, II and III incorrect
46
Maldigestion of fat and protein becomes clinically evident when more than _________of pancreatic exocrine function is lost.
Answer
D. 90%
47
The combination of CFTR mutation plus SPINK1 mutation increases pancreatitis risk by approximately:
Answer
D. 900-fold
48
In chronic pancreatitis, serum amylase and lipase levels are usually:
Answer
A. Normal or minimally elevated
49
Which ļ¬nding favours Type 1 autoimmune pancreatitis over Type 2?
Answer
C. Elevated serum IgG4
50
Discolouration of the ļ¬anks in necrotising pancreatitis is called
Answer
B. Turnerās sign
51
Which of the following is Not true, regarding Piagets work in the ļ¬eld of development of children?
Answer
C. It needs sophisticated equipments to be replicated in pediatric practice
52
Which country was not included in the MGRS study (Multicentre Growth Reference Study)
Answer
B. Pakistan
53
Select the most appropriate choice
Answer
D. 30 months ā Circulatory jaw rotation
54
Four statements are given below regarding dental development. Choose the most appropriate answer (1) Mineralization begins at the crown of the teeth (2) Eruption begins laterally and progress medially (3) Dental development is well correlated with other growth and maturation (4) Cyclic neutropenia causes early exfoliation
Answer
C. Statements (1) & (4) are true
55
Read the following statements regarding enteral nutrition and select the most appropriate choice (1) Energy density of 0.5 Kcal/ ml is most appropriate for most of the children (2) Polymeric feeds are usually based on Cows milk protein (3) Low molecular formulas are feeds are based on free amino acids (4) The recommended osmolality is 300-350 Osm/kg
Answer
B. Statements (2) & (4) are true
56
All the statements are true except
Answer
B. The ļ¬rst visible sign of puberty in boy is penile enlargement
57
Read the following assertion and reason 1. Assertion : The level of adiponectin is reduced in obese children 2. Reason : Obese children are prone to have insulin resistance
Answer
C. Both assertion and reason are true and the reason is the correct explanation of assertion
58
Which of the following statement(s) regarding Orlistat is true? 1. Can be given for children less than 16 years 2. Acts by inhibiting pancreatic lipase 3 Should not be used for more than 3 months 4. Very eļ¬ective in severely obese adolescents
Answer
A. 1 and 2 are correct
59
Read the following assertion and reason 1. Assertion : Medium chain triglycerides are absorbed by passing the pancreatic and biliary secretory components 2. Reason : Poly unsaturated fatty acids are necessary for brain development.
Answer
D. Both assertion and reason are true, but the reason is not the correct explanation of assertion
60
Choose the wrong statement
Answer
C. In steatosis grade 3 (CAP-3), fatty change in liver is approximately 50%
61
Which of the following is the most common type of esophageal atresia associated with a tracheoesophageal ļ¬stula?
Answer
C. Type C
62
String of sausages appearance of suggestive of which type of intestinal atresia?
Answer
D. Type IV
63
Louw and Barnard classiļ¬cation is for
Answer
B. Intestinal atresia
64
Intestinal malrotation is congenital failure of the midgut to undergo the normal ______ rotation around the superior mesenteric artery (SMA) axis during fetal development.
Answer
B. 270Ā° counterclockwise
65
Steps of Laddās procedure include all except
Answer
C. Plication of the Mesentery
66
Modiļ¬ed Bells Staging Criteria is for
Answer
A. Necrotising Enterocolitis
67
The entire ileum, the ileocecal valve, and varying portions of the colon are resected and end Jejunostomy is done in which type of Short Bowel Syndrome
Answer
A. Type I
68
In congenital abdominal wail defects, staged reduction or immediate termination of a primary closure is triggered if
Answer
A. Intravesical (bladder) or intragastric pressure exceeds 20 cm H2O.
69
Silon Chimney Procedure is done for
Answer
B. Severe Gastroschisis
70
The classic signs (3 Cs) of tracheoesophageal ļ¬stula include the following except:
Answer
D. Crying at night
71
A 10-year-old with dysphagia undergoes endoscopy. The esophagus appears normal. Which biopsy protocol is recommended?
Answer
C. Six biopsies from at least two esophageal levels
72
A 9-year-old boy with extrahepatic portal vein obstruction (EHPVO) presents with his ļ¬rst episode of massive hematemesis. Endoscopy reveals large esophageal varices with active bleeding. The preferred endoscopic therapy is:
Answer
D. Endoscopic variceal ligation
73
A liver biopsy from a child with suspected Alagille syndrome is most likely to demonstrate ,
Answer
B. Bile duct paucity
74
Which laboratory abnormality after large-volume paracentesis is the earliest indicator of circulatory dysfunction?
Answer
B. Rising plasma renin activity
75
Which statement regarding the Lewis Score is TRUE?
Answer
A. It includes villous edema, ulcers and stenosis
76
Which statistical parameter is considered the most robust for assessing symptom association during MII-pH monitoring?
Answer
D. Symptom Association Probability
77
According to Chicago Classiļ¬cation V 4.O, the integrated Relaxation Pressure (IRP) primarily evaluates:
Answer
C. Lower esophageal sphincter relaxation
78
A child with known ulcerative colitis develops cholestatic liver enzyme abnormalities. MRCP demonstrates multifocal intrahepatic and extrahepatic biliary strictures with intervening dilatation. What is the MOST likely diagnosis?
Answer
A. Primary sclerosing cholangitis
79
A duodenal biopsy from an 8-year-old shows: ā¢ Increased intraepithelial lymphocytes (>30/100 enterocytes) ā¢ Normal villous architecture ā¢ Normal crypt depth According to the modiļ¬ed Marsh classiļ¬cation this lesion is:
Answer
A. Marsh I
80
Which immunohistochemical marker is most useful for conļ¬rming loss of ganglion cells in Hirschsprung disease?
Answer
C. Calretinin
81
A 56-year-old man with alcohol-related cirrhosis (Child-Pugh C, MELD 27) presents with massive hematemesis. Blood pressure is 80/50 mmHg, pulse 132/min. After endotracheal intubation, restrictive transfusion, terlipressin, ceftriaxone and emergency endoscopic variceal ligation, active bleeding persists. The next best management is:
Answer
D. Early covered TIPs within 24 hours
82
Restrictive blood transfusion in acute upper GI bleeding recommends transfusion when Hb falls below:
Answer
D. 7 g/dL
83
A 24-year-old woman presents 48 hours after an intentional paracetamol overdose. Despite N-acetylcysteine (NAC), she develops grade III hepatic encephalopathy. Arterial pH is 7.18 after adequate ļ¬uid resuscitation, serum lactate is 5.8 mmol/L, INR is 7.2, and creatinine is 3.5 mg/dL. Which of the following alone fulļ¬lls the King's College Criteria for emergency liver transplantation?
Answer
D. Arterial pH
84
Which mechanism is primarily responsible for cerebral edema in acute liver failure?
Answer
B. Astrocyte swelling from ammonia metabolism
85
Which dynamic parameter is the best predictor of ļ¬uid responsiveness in a mechanically ventilated patient with severe dehydration?
Answer
C. Pulse pressure variation
86
Which electrolyte abnormality is most commonly responsible for refractory hypokalemia in severe GI ļ¬uid loss?
Answer
C. Hypomagnesemia
87
According to the Revised Atlanta Classiļ¬cation (2012), persistent organ failure is deļ¬ned as organ failure lasting:
Answer
C. >48 hours
88
A patient develops fever on day 10 after severe acute pancreatitis. CT demonstrates gas within an area of walled-oļ¬ pancreatic necrosis. The best management is:
Answer
C. Percutaneous or endoscopic drainage as the ļ¬rst step
89
A 32-year-old man with extensive ulcerative colitis presents with severe abdominal distension, fever, tachycardia, and bloody diarrhea. Abdominal radiograph demonstrates transverse colon dilatation measuring 7.2 cm. Laboratory investigations reveal WBC 19,000/mm3 and serum albumin 2.4 g/dL According to the Jalan criteria, which additional ļ¬nding is required to diagnose toxic megacolon?
Answer
C. Atleast three systemic toxicity criteria plus one additional feature
90
A patient with toxic megacolon secondary to ulcerative colitis fails intensive medical therapy after 48 hours. The preferred surgical procedure is :
Answer
C. Subtotal colectomy with end ileostomy
91
Which of the following statements is/are CORRECT? 1. Genotype-Phenotype correlation is well established for Bile-salt export pump deļ¬ciency (ABCB11 mutations) 2. Genotype-Phenotype correlation is strong for familial intrahepatic cholestasis 1 deļ¬ciency (ATP8B1 mutations). 3. Doublecortin domain containing protein 2 (DCDC2) mutations present commonly as neonatal cholestasis and portal hypertension. 4. Mutations in tight junction protein-2 (TJP2) gene cause Cholestasis end stage liver disease and hepatocellular carcinoma. 5. Neonatal ichthyosis-sclerosing cholangitis syndrome is due to mutations in tight junction protein, claudin- 1. 6. Alagille syndrome is not associated with any genotype-phenotype correlation. 7. NOTCH2 mutations are present in 40% of probands with Alagille syndrome. 8. Arthrogryposis-Renal dysfunction cholestasis (ARC) syndrome is caused by mutations in VPS33B or VIPAR genes.
Answer
B. 1,3,4,5,6,8
92
Which of the following statements is/are CORRECT about the diagnosis of Pediatric liver disorders? 1. Leipzig score for Wilson disease includes Serum copper. 2. Simpliļ¬ed score for Autoimmune hepatitis includes presence of Concurrent extrahepatic autoimmune disorder. 3. Portal vein replaced by cavernoma on ultrasound doppler or computerized tomography is diagnostic for extrahepatic portal venous obstruction. 4. Giant cell transformation is a histological feature diagnostic of Biliary atresia.
Answer
D. 3
93
Which of the following is TRUE regarding prognostication of pediatric liver diseases?
Answer
D. Newer version of Pediatric end-stage liver disease score includes creatinine
94
Which of the following statement/statements is/are TRUE about Autoimmune hepatitis in children? 1. Females are commonly aļ¬ected 2. Autoimmune sclerosing cholangitis is associated with inļ¬ammatory bowel disease and has better prognosis than autoimmune hepatitis in children. 3. Vitiligo and type 1 Diabetes are the two commonest extrahepatic immune disorders associated with autoimmune hepatitis. 4. Low litres (>/=1:20) of autoantibodies are diagnostic in children. 5. Central perivenulitis is a common histological feature of those presenting with acute liver failure. 6. Minocycline can trigger drug-induced autoimmune hepatitis 7. Worldwide incidence of autoimmune hepatitis is rising 8. Titres of antinuclear antibodies are helpful in prognostication.
Answer
C. 1,4,5,6,7
95
Which of the following is FALSE about Pediatric Liver transplantation?
Answer
C. Primary hyperoxaluria ā Isolated kidney transplantation
96
Which of the following treatment is FALSE about Pediatric Inļ¬ammatory bowel disease?
Answer
A. Ustekinumab is a fully human IgG1 antibody against IL-1 and IL-6.
97
Which of the following combination is INCORRECT about Polyposis syndromes in children?
Answer
B. Single juvenile polyp needs regular surveillance colonoscopy
98
Which of the following is FALSE about management of refractory Constipation in children?
Answer
B. Lubiprostone is a secretagogue, a guanylate cyclase-C receptor agonist
99
Which of the following is NOT a component of Eckardt score?
Answer
D. Pneumonia
100
Which of the following is FALSE about Celiac disease?
Answer
B. Potential Celiac disease patients have absence of clinical symptoms but evidence of villous atrophy on duodenal biopsy
Discussion
Ask a doubt or share a tip.
No comments yet ā start the discussion.