Abdominal

Question 1

List some differentials for acute abdominal pain

Answer 1

Gastric ulcer

Gastroenteritis, UTI, hepatitis, appendicitis, LRTI (non-localised)

NAI (non-accidental injury)

Inflammatory Bowel Disease (IBD)

Diabetic ketoacidosis

Excessive medication, intussusception

Neuroblastoma

Meckel’s Diverticulum

Constipation

Question 2

What should you ask about in a Acute Abdo pain history?

Answer 2

SOCRATES

Other symptoms: melena, vomiting, haematemesis, PR bleeding, change in bowel habits

Fever, fainting, headaches, chest pain, coughing

Have they tried any new food?

PMH and antenatal hx

DH and immunisation

FH

Question 3

What should you ask about in a vomiting history?

Answer 3

Frequency, volume and duration

Blood and bile

(also ask about other abdominal symptoms, like stool history, wet nappies etc)

Also ask about travel history

Question 4

What does bilious vomiting indicate?

Answer 4

Bowel (intestinal) obstruction

Necrotising Entercolitis

Severe gastroenteritis

Question 5

What does blood in vomit indicate?

Answer 5

Mallory-weiss tear, gastric ulcers etc

Question 6

What should you ask about if a child has a stool history?

Answer 6

Frequency of stool output

Quality/consistency of the stool (according to bristol stool chart)

Presence of blood

Presence of mucus

Question 7

What should you look for in an Abdo examination?

Answer 7

Growth deceleration

Delayed puberty

Jaundice

Pallor

Rebound/ guarding/ organomegaly

Question 8

What are the two types of Inflammatory Bowel Diseases (IBD)?

Answer 8

Crohns Disease and Ulcerative Colitis

Question 9

What is Tenesmus?

Answer 9

The feeling of needing to go to the toilet without actually having to go to the toilet.

Question 10

What is the first line treatment for IBD?

Answer 10

5-ASA (Azathioprine) or steroids

Question 11

What other treatments can be used for IBD?

Answer 11

Methotrexate, Inflixumab and Adalimumab

Question 12

What are the physical signs of dehydration?

Answer 12

Sunken fontanelles and eyes

Reduced consciousness

Dry mucous membranes

Tachycardia and tachypnoea

Reduced capillary refill time

Reduced Skin turgor

Sudden weight loss

Question 13

How is gastroenteritis treated in children?

Answer 13

Oral Rehydration Solution (ORS)

Question 14

What can increase the risk of dehydration?

Answer 14

low birth weight

age <1 year

had >2 vomiting episodes

>5 diarrhoeal episodes in the previous 24 hours

Question 15

Along with ORS, what other treatments can be suggested for gastroenteritis?

Answer 15

Continue breast feeding and other milk feeds

(Monitor rehydration)

Question 16

What is the commonest cause of gastroenteritis in the child?

Answer 16

Rotavirus

Question 17

What is the commonest bacterial cause of gastroenteritis in children?

Answer 17

Campylobacter

Question 18

What is the second commonest virus to cause gastroenteritis?

Answer 18

Adenovirus

Question 19

If a child has projectile vomiting under the age of 2 months, what does this indicate?

Answer 19

Pyloric Stenosis

Question 20

What are the anti-infective properties/cells/molecules of breast milk?

Answer 20

Secretory IgA

Bifidus factor

Lysosomes

Lactoferrin

Interferon

Question 21

Which antibiotic is usually given in the case of Campylobacter gastroenteritis?

Answer 21

Erythromycin

Question 22

Which antibiotic(s) are given in the case of gastoenteritis caused by C.difficile

Answer 22

Metronidazole or Vancomycin

Question 23

What is intussusception?

Answer 23

Telescoping of the intestines

Question 24

What are the clinical features of intussusception?

Answer 24

Colicky/crampy abdominal pain

Denying feeds

Drawing the knees upto body and turning pale

Bilious vomiting

Suasage like mass in abdomen

red currant jelly stools

Question 25

What is a red, currant jelly like stool a sign of?

Answer 25

Late sign of intussusception damage

Question 26

What does an abdominal ultrasound of intussusception show?

Answer 26

A target sign

Question 27

What does X show?

Answer 27

Meckel’s Diverticulum

Question 28

What is Meckel’s Diverticulum?

Answer 28

Outpouching of the intestines in the lower part of the smlla intestines.

Within the outpouching is gastric mucosa which is how it is diagnosed.

Question 29

What does non-bilious vomiting within in a child mean?

Answer 29

Pyloric stenosis

GORD (reflux)

Overfeeding Syndrome

Gastroenteritis

Question 30

Where is Lactase absorbed in the body?

Answer 30

Brush border of the small intestines

(so any pathology that damages this can cause lactose intolerance)

Question 31

What cause Nocturnal Enuresis in children?

Answer 31

ADH is the hormone which helps us to regulate the desire to go to the toilet during the night. In young children ADH production hasn’t fully developed yet and so they feel the same need to go to the toilet during the night as they do during the day.

Question 32

What does Enuresis mean?

Answer 32

Involuntary urinating?

Question 33

What is overflow diarrhoea?

Answer 33

Diarrhoea caused when the colon is full of hard stools. Essentially diarrhoea caused by severe constipation

Question 34

In which ages is overflow diarrhoea most common?

Answer 34

Young children and elderly patients

Question 35

What is Hirschsprungs Disease?

Answer 35

Loss of nerve endings in the end bowel, causing bowel distension

Question 36

Which intestinal obstruction is most commonly associated with Cystic Fibrosis?

Answer 36

Meconium Ileus