Gastro

Question 1

extraintestinal signs

mouth ulcers =
perianal fistulas =

Answer 1

mouth ulcers = coeliac
perianal fistulas = Crohn’s

Question 2

IgA deficiency but ?Coeliac

Answer 2

send IgG samples

Question 3

haematemesis in CF

Answer 3

due to cirrhosis and varices

give octreotide to reduce portal HTN and transfer for banding

Question 4

jaundice in congenital CMV

Answer 4

conjugated

Question 5

treatment of pouchitis following colectomy

Answer 5

PO cipro or metro

Question 6

hernia’s vs hydroceles

Answer 6

hernias are usually indirect and may transilluminate in babies
hydroceles always transilluminate and may require ligation of the patent processes vaginalis to prevent recurrence

Question 7

treatment for baby if mum is Hep B +ve with antibodies

Answer 7

6 doses Hep B vaccine (not immunoglobulin)

additional are <24h birth, 4 weeks and 1 yr

Question 8

Which babies need Hep B immunoglobulin?

Answer 8

1) Mother is antigen positive but antibody e negative
2) had acute Hep B in pregnancy
3) infant weighing <1500g

Question 9

initial management of neuroblastoma

Answer 9

watchful waiting - may resolve on its own

Question 10

initial management of intussusception

Answer 10

IVI bolus
IV abx
NG

then insufflation

Question 11

Peutz Jeghers inheritance and symptoms

Answer 11

AD

pale patches of skin and mucosa
GI polyps causing PR bleeding

Question 12

3 tests for carbohydrate malabsorption

Answer 12

double peaked H breath test (bowel bacterial overgrowth)
stool pH <5.5
reducing substances >0.25% in stool

Question 13

part of bowel most likely to be affected in UC

Answer 13

pancolitis

Question 14

when should umbilical hernia be repaired?

Answer 14

age 4

Question 15

5 reasons for a stool MC+S

Answer 15

bloody diarrhoea
foreign travel
sepsis
diarrhoea >7/7
immunocompromised

Question 16

which test is most accurate for H pylori

Answer 16

endoscopy with biopsy

Question 17

conditions for using the breath test for h pylori

Answer 17

no PPI within 2 weeks
no abx within 4 weeks

Question 18

bilirubin level/rate for kernicterus

Answer 18

340
rise of 8.5/hour

Question 19

how does neuroblastoma cause HTN

Answer 19

renal artery compression

Question 20

management of hydrocele

Answer 20

delay surgery for 12 months

Question 21

management of inguinal hernia

Answer 21

surgical repair (won’t heal by itself)

Question 22

slightly high GGT vs very high GGT

Answer 22

slightly = liver
very = biliary atresia

Question 23

management of a recurrent episode of malrotation with volvulus due to adhesions

Answer 23

most respond to conservative, if not then surgery

Question 24

Down’s syndrome + distended abdomen

Answer 24

Hirshprung’s

Question 25

location of biliary atresia

Answer 25

intra and extrahepatic

Question 26

N+V in IBD

Answer 26

UC

Question 27

how many times a day should a baby <7 days poo

Answer 27

4

Question 28

how many times a day should a one year old poo

Answer 28

two

Question 29

diagnostic criteria for impaction

Answer 29

palpable mass overflow soiling severe symptoms

Question 30

disimpaction regime

Answer 30

movicol plain add senna if needed

Question 31

maintenence after disimpaction

Answer 31

movicol plain at half disimpaction dose add senna if necessary

Question 32

appendicitis mimic

Answer 32

Yersinia

Question 33

dehydration in gastroenteritis

Answer 33

hyponatraemia (drinking lots)

Question 34

gastroenteritis, not dehydrated

Answer 34

encourage PO fluids

Question 35

gastroenteritis, dehydrated, not shocked

Answer 35

<5yo: 50ml/kg ORS plus ORS maintenance (breastfeeding can continue) >5yo: 200ml (400 for teens) ORS after each loose stool plus normal fluids

Question 36

gastroenteritis, shocked

Answer 36

bolus at 10mg/kg + replacement + maintencene

Question 37

H pylori treatment

Answer 37

amoxicillin and clarithromycin and omeprazole for one week# (omeprazole for 4 weeks if large ulcer, haematemesis or perf) (metro if treatment failure or recent macrolide use)

Question 38

Ix for volvulus

Answer 38

contrast XR

Question 39

UGI endoscopy criteria

Answer 39

?Sandifer syndrome (?hiatus hernia) Overt regurg with faltering growth or feed aversion Dysphagia No improvement in GORD >1yr melaena or haematemesis Unexplained IDA

Question 40

only absolute CI to breastfeeding

Answer 40

maternal HIV

Question 41

presentation of volvulus

Answer 41

usually <1yo bilious vomiting absolute constipation bird beak sign

Question 42

where do PPIs act

Answer 42

Parietal cells