How gastroenterology is examined
The RACP Divisional Written Examination for Paediatrics & Child Health has two papers: Clinical Applications (100 questions, 3 hours 10 minutes) and Medical Sciences (70 questions, 2 hours 10 minutes). Most questions are single-answer MCQs with four options, plus a small number of extended matching questions, and some use images such as X-rays or ECGs. The score is combined across both papers, and the pass mark is set with the modified Angoff method; the RACP notes it has historically ranged between 55% and 65%. The paediatric blueprint sets a target number of items for each specialty, so check the current blueprint on the RACP website.
High-yield topics
| Condition | Key points |
|---|---|
| Reflux | Common and benign in infants; red flags include bilious vomiting and poor weight gain |
| Constipation | Macrogol disimpaction and maintenance |
| Coeliac disease | tTG-IgA with total IgA on a gluten-containing diet |
| IBD | Growth failure; faecal calprotectin; exclusive enteral nutrition in Crohn disease |
| Biliary atresia | Prolonged conjugated jaundice, pale stools; surgery (Kasai) early |
| Pyloric stenosis | Projectile vomiting at 2 to 8 weeks; hypochloraemic metabolic alkalosis |
| Intussusception | Colicky pain, red currant jelly stool; air enema reduction |
| Malrotation with volvulus | Bilious vomiting is a surgical emergency |
Worked questions
Worked question 1 · Pyloric stenosis
A 5-week-old boy has projectile non-bilious vomiting. Which blood gas pattern is most likely?
- A Hypochloraemic metabolic alkalosis
- B High anion gap metabolic acidosis
- C Respiratory acidosis from aspiration of vomitus
- D Normal anion gap acidosis
- E Hyperkalaemic acidosis
Show the reasoning
Answer A. Loss of gastric acid causes hypochloraemic, hypokalaemic metabolic alkalosis. Correct fluids and electrolytes before pyloromyotomy.
Worked question 2 · Coeliac
Which test is the best initial screen for coeliac disease in a child eating gluten?
- A tTG-IgA with total IgA
- B HLA-DQ2 and DQ8 genotyping alone
- C Stool culture
- D Abdominal ultrasound
- E Faecal elastase
Show the reasoning
Answer A. tTG-IgA with total IgA (to detect IgA deficiency) is the recommended screen. HLA typing is useful to exclude coeliac disease but not to diagnose it.
A 4-week gastroenterology revision block
| Week | Focus |
|---|---|
| 1 | Vomiting, reflux and surgical emergencies |
| 2 | Constipation, diarrhoea and coeliac disease |
| 3 | IBD and liver disease |
| 4 | Nutrition, growth and mixed questions |
Pair each week with 25 timed questions a day and review every explanation, including the options you ruled out.
Common traps
- Ignoring bilious vomiting.
- Testing coeliac serology on a gluten-free diet.
- Missing biliary atresia.
- Overtreating infant reflux.
Free sample gastroenterology questions
Questions from our Paediatrics (RACP) bank. Choose your answer, then open the explanation.
A 9-month-old has episodic screaming with drawing up of legs, vomiting and redcurrant jelly stool. Diagnosis?
- APyloric stenosis
- BInfantile colic that settles by 3 to 4 months of age
- CGastroenteritis
- DIntussusception
- EConstipation
Show answer and explanation
Answer D. Intussusception (most common 6 months to 2 years) presents with episodic pain, pallor, vomiting and late redcurrant jelly stool. Ultrasound shows a target sign; air enema reduction if stable.
Learning point: Intussusception: episodic pain, pallor, redcurrant jelly; air enema.
A 5-week-old boy has projectile non-bilious vomiting after feeds. What electrolyte disturbance is typical?
- AHypochloraemic hypokalaemic alkalosis
- BHyperchloraemic acidosis
- CHypernatraemic acidosis
- DNormal electrolytes in nearly all affected infants
- EHyperkalaemic acidosis
Show answer and explanation
Answer A. Loss of gastric acid causes hypochloraemic, hypokalaemic metabolic alkalosis. Ultrasound confirms; correct fluids and electrolytes before pyloromyotomy.
Learning point: Pyloric stenosis: hypochloraemic hypokalaemic alkalosis; correct before surgery.
A 3-day-old has bilious vomiting. What must be excluded urgently?
- AMalrotation with volvulus
- BOverfeeding
- CCow's milk protein allergy
- DPyloric stenosis
- EGastro-oesophageal reflux
Show answer and explanation
Answer A. Bilious vomiting in a neonate is malrotation with midgut volvulus until proven otherwise; it can cause bowel infarction within hours. Urgent upper GI contrast study and surgical review.
Learning point: Neonatal bilious vomiting: malrotation with volvulus until proven otherwise.
Practise more gastroenterology questions free
Every gastroenterology subtopic in our bank
The bank holds 15 gastroenterology questions across 15 subtopics. You can filter by any of them, build a custom block and track your accuracy subtopic by subtopic.
- Acute liver failure1
- Appendicitis in children1
- Biliary atresia1
- Bilious vomiting1
- Coeliac in children1
- Constipation1
- Cow's milk protein allergy1
- Dehydration assessment1
- Gastro-oesophageal reflux disease1
- Gastroenteritis dehydration1
- Hirschsprung disease1
- Inflammatory bowel disease1
- Intussusception1
- Meckel diverticulum1
- Pyloric stenosis1
Common questions
Why is bilious vomiting an emergency?
It may indicate malrotation with volvulus, which needs urgent surgical assessment.
How is coeliac disease confirmed?
Serology then duodenal biopsy, or in some children a no-biopsy pathway with very high tTG levels under specialist care.
What is the first-line treatment in paediatric Crohn disease?
Exclusive enteral nutrition is commonly used to induce remission.
Sources
Clinical content is summarised from current Australian guidance at the date above. Guidelines change, so always check the latest edition.