FRCPC GI Review Flashcards
1
Q
What is the typical clinical presentation of acrodermatitis enteropathica?
A
- AR inherited disorder in zinc absorption
- Babies present in the first months of life usually when weaning from breastfeeding
- Rash around mouth and bum, diarrhea, stomatitis, glossitis, delayed wound healing and super infection with candida
2
Q
What is the treatment for acrodermatitis enteropathica?
A
Zinc supplementation
3
Q
List four drugs associated with folate deficiency
A
- NSAIDs
- Methotrexate
- Phenytoin
- Phenobarbitol
4
Q
What would you supplement for a child who drinks only goat’s milk?
A
- Folate
5
Q
List three groups of infants who should not drink soy formula
A
- Congenital hypothyroidism
- Non-IgE mediated CMPA (high risk of cross reactivity)
- Premature infants (high risk they will not grow adequately)
6
Q
List one indication for soy formula
A
- Galactosemia
- Babies who cannot consume cows milk for religious reasons or babies from vegan families
7
Q
List 5 clinical features of vitamin C deficiency
A
- Leg swelling
- Pseudoparalysis
- Subperiosteal hemorrhage
- Scorbutic rosary
- Gum changes: purplish blue, swelling, bleeding
- Anemia
- Perifollicular petechiae, purpura, ecchymoses
8
Q
How to decrease amount of trans fats in the diet?
A
Avoid fast food
9
Q
Compare and contrast Kwashiorkor and Marasmus
A
- Kwashiorkor: adequate calories but not enough protein, present puffy with big bellies and red hair
- Marasmus: total malnutritional state due to low protein and low overall calories. Present wasted.
10
Q
List 5 non pharmacological reflux strategies for infants
A
- Small more frequent feedings
- Adding teaspoon of rice cereal to feeds to thicken
- Frequent burping with feeds
- Keep upright for 30 mins following feeding
- Elevate head of crib in supine position
- Eliminate smoke exposure
11
Q
List 5 non pharmacological reflux strategies for older kids
A
- Eat small volumes
- Avoid eating before bed
- Stay upright for 30 minutes following a meal
- Weight loss in obese children
- Chew gum/throat lozenges to increase saliva production to neutralize acid
- Eliminate smoke exposure
12
Q
List 4 medications to manage GER
A
- Antacids: gaviscon, maalox, milk of magnesia, rolaids, tums
- Histamine 2 receptor blockers: ranitidine, cimetidine, nizatidine, famotidine
- PPI: omeprazole, lansoprazole, pantoprazole
- Prokinetics: metachlopromide, erythromycin, domperidone
13
Q
List 6 risk factors for TPN cholestasis
A
- Prolonged TPN
- Prematurity
- Low birth weight
- Sepsis
- NEC
- Short bowel syndrome
14
Q
List 5 metabolic complications of TPN
A
- TPN cholestasis
- Hyperglycemia/hypoglycemia
- Hyperammonemia
- Hyperlipidemia
- Electrolyte, mineral and protein imbalance
- CHF and pulmonary edema from excessive infusate
15
Q
List four effects of excess vitamin D
A
- Hypercalcemia: confusion, polyuria, polydipsia, anorexia, N/V, muscle weakness
- Nephrocalcinosis
- Bone demineralization
- Pain
16
Q
Define underweight, normal weight, overweight, obese and severely obese by BMI definitions
A
- Underweight: BMI < 5%ile
- Normal weight: BMI 5 - under 85%ile
- Overweight: BMI 85-95%ile
- Obese: BMI > 95%ile
- Severely obese: BMI > 120% of 95%ile BMI or BMI > 35 whichever is lower
17
Q
List 5 aspects of good oral hygiene for children
A
- No bottle in bed
- No sugary drinks
- Drink fluoridated water
- Use fluoridated toothpaste
- See a dentist within 6 months of the first tooth appearing and no later than age 1 year
18
Q
What is the formula for calculating BMI?
A
weight in kg / (height in metres x height in metres)
19
Q
List 10 differential diagnoses of dysphagia
A
- Vascular ring
- Vascular sling
- Double aortic arch
- Eosinophilic esophagitis
- Myotonic dystrophy
- Cerebral palsy
- Achalasia
- Congenital web
- Post TEF repair
- Corrosive injury or medication use
- Structural: abscess, pharyngitis, dental issues, bullous skin lesion
- Zenker diverticulum
- Infectious: meningitis, botulism, diptheria, Lyme disease, neurosyphilis, coxsackievirus, herpes, CMV
20
Q
List contraindications to hydrostatic reduction of intussusception
A
- Prolonged intussusception
- Profound shock
- Peritoneal irritation (peritonitis)
- Perforation
- Pneumatosis intestinalis
21
Q
List the ROME III criteria for functional constipation in children
A
- Criteria fulfilled once per week for at least 2 months
- Must include 2 or more of the following in a child with a developmental age of at least 4 years with insufficient criteria to make the diagnosis of IBS:
1. 2 or fewer defecations in the toilet per week
2. At least one episode of fecal incontinence per week
3. History of retentive posturing or excessive volitional stool retention
4. History of painful or hard BMs
5. Presence of a large fecal mass in the rectum
6. History of large dimeter stools that may plug the toilet
22
Q
List the ROME III criteria for cyclic vomiting syndrome
A
- Diagnostic criteria must include both of the following:
1. 2 or more periods of intense nausea and unremitting vomiting or retching lasting hours to days
2. Return to usual state of health lasting weeks to months
23
Q
List the NASPGHAN criteria for cyclic vomiting syndrome
A
- 5 attacks in any interval or minimum 3 attacks in 6 months
- Episodic attacks of intense nausea and vomiting lasting 1h to 10d and occurring at least 1 week apart
- Stereotypical pattern and symptoms in the individual patient
- Vomiting during attacks occurs at least 4 times per hour for at least 1 hour
- Return to baseline health between episodes
- Not attributed to another disorder
24
Q
List conditions associated with Celiac Disease
A
- Down syndrome
- Turner syndrome
- William syndrome
- IgA deficiency
- Type 1 DM
- Other autoimmune diseases: thyroid, arthritis, liver
- First degree relative with celiac disease
25
List 5 atypical presentations of celiac disease
- Short stature
- Delayed puberty
- Dermatitis herpetiformis
- Dental enamel hypoplasia
- Osteopenia/osteoporosis
- Occipital lobe epilepsy with calcifications
- Anemia resistant to treatment with iron
- Arthritis
- Hepatitis
26
List 5 differential diagnoses for terminal ileitis
- Crohn's
- Lymphoma
- Yersinia
- TB
- Chronic granulomatous disease
- Severe eosinophilic gastroenteropathy
- Lymphonodular hyperplasia --> not ilieitis but often confused with ileitis
27
List 5 organic causes of constipation
- Hypercalcemia
- Hypokalemia
- Hypothyroidism
- Ulcerative colitis
- CNS disease: CP, NTD, Hirschprung
- Celiac disease
- Lactose intolerance (rare)
- Lead poisoning
- Mercury poisoning
- Medications
28
List the diagnostic criteria for abdominal migraine
> 2 episodes in the preceding year
- Paroxysmal episode of intense acute periumbilical pain lasting longer than 1 hour
- > 2 of: anorexia, nausea, vomiting, headache, photophobia, pallor
- Interepisodes healthy for weeks to months
- Interferes with normal activity
- No organic cause
29
List the diagnostic criteria for irritable bowel syndrome
> 1 episode per week for 2 months
- Abdominal pain or discomfort associated with > 2 of the following:
1. Improved with defecation
2. Onset associated with change in frequency
3. Onset associated with change in form
4. No organic cause
30
List the Rome III Diagnostic Criteria for Colic
- All of the following in infants < 4 months of age
1. Paroxysms of irritability, fussiness or crying that start and stop without obvious cause
2. Episodes lasting 3 or more hours and occurring at least 3 days per week for 1 week
3. No failure to thrive
31
List 3 conditions associated with IBD
- Turner syndrome
- Glycogen storage disorders
- Immunodeficiencies
32
List 5 infectious agents that mimic IBD
- Campylobacter
- Yersinia
- E. coli O157:H7
- Salmonella
- Shigella
- TB
- Giardia lamblia
33
List 5 clinical manifestations of Alagille syndrome
- Conjugated hyperbilirubinemia
- Facies: triangle shaped, broad forehead, deeply set eyes, widely spaced eyes, long/straight nose, underdeveloped mandible
- Cardiac defects: pulmonary stenosis, TOF, PA, VSD, ASD, coarctation
- Butterfly vertebrae
- Posterior embryotoxon
- Tubulointerstitial nephropathy
34
List the diagnostic criteria for functional dyspepsia
> 1 episode per week for > 2 months
- Functional abdominal pain or discomfort in the upper abdomen/epigastric area
- Pain not relieved with defecation or no change in stool frequency/consistency
- No organic cause
35
List the diagnostic criteria for functional abdominal pain syndrome
> 1 episode per week for > 2 months
- Episodes of continuous abdominal pain
- Insufficient criteria for other functional abdominal pain
- No organic cause
36
Name 3 non renal causes for abdominal mass in a one month old baby
- Neuroblastoma
- Hepatoblastoma
- Teratoma
37
List 5 nutritional deficiencies that vegan children are at risk for
- Iron
- Vitamin B12
- Zinc
- Vitamin D
- Calcium
38
List 5 dermatologic manifestations of IBD
- Erythema nodosum
- Epidermolysis bullosa acquisita
- Pyoderma gangrenosum
- Psoriasis
- Perianal skin tags
- Polyarteritis nodosa
- Sweet syndrome
- Metastatic Crohn disease
39
List 5 indications for removal of an esophageal foreign body
- Sharp or long (>5cm) object
- High powered magnets
- Button batteries
- Signs of airway compromise
- Evidence of near complete esophageal obstruction
40
List 5 red flags for vomiting
- Bilious vomiting
- Bloody vomiting (GI bleeding)
- Pneumonias (recurrent: ? aspiration)
- Peritonitis
- Failure to thrive
- Fever
- Toxic appearance
41
List three non infectious complications following liver transplant
- Graft versus host disease
- Recurrence of primary liver disease
- Portal vein thrombosis
- Hepatic artery thrombosis
- Malignancy
- Post transplant lymphoproliferative disorder
- Biliary obstruction due to strictures, etc.
42
List 4 indications for fundoplication in a child with GERD
- Recurrent aspiration
- Refractory or Barrett esophagus
- Reflux associated apnea
- GERD associated FTT not responsive to medical therapy
43
List 5 differential diagnoses for villous atrophy other than celiac disease
- CMP enteropathy
- Crohn disease
- Primary immunodeficiency
- Autoimmune enteropathy
- Eosinophilic gastroenteritis
- GVHD
- Lymphoma
- Infectious: giardia, HIV, TB
44
List four possible differential diagnoses for hypoalbuminemia in a child with history of FTT and diarrhea
- Celiac disease
- Crohns disease
- Ulcerative colitis
- Immunodeficiency
- Protein losing enteropathy
- Intestinal lymphangiectasia
45
Name 2 important risk factors that increase the risk of colon cancer in patients with UC
- Extent of colitis
| - Duration of disease
46
List 4 anomalies associated with malrotation
- Diaphragmatic hernia
- Omphalocele
- Gastroischisis
- Heterotaxy syndrome
47
List 5 complications associated with obesity
- OSA
- HTN
- DM2
- SCFE
- NAFLD
- Dyslipidemia
- Metabolic syndrome
- Depression, poor self esteem
