diarrhea/ constipation/ GI bleed/ abdominal pain/ hepatitis/ pyloric stenosis/ intussusception/ amoebiasis/ gerd/ cholera/ hirschprung disease/ ingestions Flashcards
A 10-month old female infant arrived at the emergency department who has been having vomiting since yesterday, now followed by watery diarrhea and low-grade fever. She has been exclusively breastfed since birth and up to 6 months of age. Complementary feeding was started with mashed carrots, which the mother boils using tap water. What agent is most likely causing her diarrhea? 1/1 A. Campylobacter jejuni B. Bacillus cereus C. Adenovirus serotype 42 D. Rotavirus
Rotavirus
Lyra, a 7 year old girl was brought in to the OPD complaining of abdominal cramps. She has no appetite and mother noted her to be febrile and started to have several bouts of diarrhea and bloody stools for the last 5 days. What is your diagnosis? 1/1 A. Shigella B. Vibrio cholera C. ETEC D. Salmonella
Shigella
MOA: Noninflammatory (Enterotoxin or adherence/Superficial invasion)
- Vibrio cholera
- Bacillus cereus
- Staphylococcus aureus
MOA: Inflammatory, epithelia destruction (Invasion, Cytotoxin)
- Entamoeba histolytica
MOA: Penetrating
- Yersinia enterocolitica
Fides, a 5 year old girl was brought in to the ER by her father worried because there were blotches of fresh bright red blood on her underwear as she was having diarrhea for the past 2 days. This was accompanied by severe abdominal pain and low-grade fever. Which of the following will NOT be included in your differentials? A. Shigella B. Salmonella C. Campylobacter D. Enteric adenovirus
Enteric adenovirus
Older children and adolescents who pseudoappendicitis secondary to mesenteric adenitis often present with fever and abdominal pain with tenderness localized to the right lower quadrant, with or without diarrhea. What pathogen is responsible for this? A. Yersinia B. Pseudomonas C. STEC D. Shigella
Yersinia
Classify this patient’s dehydration according to the IMCI protocol: 5 year old with 3 days vomiting and loose stools, is restless and irritable, with sunken eyeballs, looks thirsty but when offered ORS, does not tolerate and drinks poorly. A. No Dehydration B. Mild Moderate C. Moderate Dehydration D. Severe Dehydration
D. Severe Dehydration
Stool cultures for detection of bacterial pathogens are quite expensive in our setting. When will stool culture be utmost important in the following clinical features, EXCEPT: A. Immunocompromised B. Suspected hemolytic uremic syndromes C. Moderate or severe disease D. Foul-smelling stools
D. Foul-smelling stools
Tet is a 10 year old boy who had episodes of diarrhea after ingesting expired milk from their fridge. He was immediately taken by his mother to the ER and you are the pedia resident on duty. You examine him and noted he has mild/some dehydration. How will you manage him at the ER for the first 4 hours?
A. Observe for 4 hours at the ER
B. Give IV fluid bolus at 10ml/kg BW for 4 hours
C. Give ORS 10ml/kg BW over 3-4 hours
D. Give ORS 50-100 ml/kg BW over 3-4 hours
D. Give ORS 50-100 ml/kg BW over 3-4 hours
Four hours have passed and Tet seemed to have been improved and is tolerating the ORS very well. What will be your next course of action or instructions to patient?
A. Give food every 3-4 hours then continue fluid therapy with 100-200 ml ORS for each diarrheal stool or vomiting,up to 1L/day
B. Withhold feeding for 24 hours until diarrhea abates, then continue fluid therapy with 100-200 ml ORS for each diarrheal stool or vomiting,up to 1L/day
C. Encourage feeding but instruct to refrain from eating dairy, then continue fluid therapy with 100-200 ml ORS for each diarrheal stool or vomiting, up to 1L/day
D. Advise to resume feeding as tolerated
A. Give food every 3-4 hours then continue fluid therapy with 100-200 ml ORS for each diarrheal stool or vomiting,up to 1L/day
The following are included in the ROME III Criteria of Functional constipation for infants up to 4 years of age except:
A. Less than or equal to 2 defecations per week
B. More than or equal to 1 episode of incontinence after acquisition of toilet training skills
C. History of excessive stool retention
D. History of retentive posturing or excessive volitional stool retention
D. History of retentive posturing or excessive volitional stool retention
Functional constipation is delay or difficulty in defecation present for 2 weeks or longer and significant enough to cause distress. Which of the following is true of functional constipation?
A. Fecal withholding cannot be differentiated from secondary causes to organic causes on the basis of a history and physical examination
B. Unlike anorectal malformation and Hirschsprung disease, it typically starts after the neonatal period
C. Usually there is no intentional or subconscious withholding of stools
D. In toddlers, coercive or inappropriately early toilet training is not an initiating factor of stool retention
B. Unlike anorectal malformation and Hirschsprung disease, it typically starts after the neonatal period
Pisa is a 6-year-old girl who complains of intermittent abdominal pain. She has difficulty with defecation, accompanying the abdominal and sometimes rectal pain. Her mom claims Pisa is a “picky eater”. She doesn’t eat vegetables and fruits, consumes only 1-2 tablespoons of rice and fish per meal, isn’t fond of milk either, so mom would give her yakult instead. At night, she would often go to the bathroom 3-4 x. From the history, we know she is suffering from retentive encopresis. What physical examination findings will help further your diagnosis?
A. Large volume of stool palpated in the suprapubic area
B. Rectal examination of dilated empty rectal vault
C. Presence of hair tuft over the spine or spinal dimple
D. Abdominal distention
A. Large volume of stool palpated in the suprapubic area
T/F: If an impaction is present on initial physical examination, stool softeners should be given before an enema to clear the impaction.
false
Typical regimens for disimpaction and maintenance medication for functional constipation includes the following. Except: A. Polyethylene glycol B. Lactulose C. Mineral Oil D. Senna
senna
rue of Hirschsprung’s disease:
A. Most common cause of lower intestinal obstruction in neonates
B. Prematurity is common
C. Result of an absence of ganglion cells in the bowel wall, extending proximally and intermittently from the anus
D. There is no familial incidence
A. Most common cause of lower intestinal obstruction in neonates
Hirschsprung’s disease vs Functional Constipation:
Onset after 2 years of age
Functional Constipation
