Gastro management

Question 1

A 14 month old boy who weighed 10.5kg a week ago is admitted with a history of vomiting and 10-15 watery stools a day for three days. When he arrives he is irritable, has a poor circulation and smells ketotic. His weight on admission is 9.3kg. His electrolyte results are as follows: Na 153mmol/L; Cl 112mmol/L; K 5.3mmol/L; creatinine 80mmol/L.

You estimate he has lost more than 10% body weight and is hypernatraemic.

What would be an appropriate inital resuscitation solution?

Question 1Select one:

a.
4% albumin solution

b.
0.9% saline solution

c.
5% dextrose solution

d.
0.45% saline solution

Answer 1

0.9% saline solution

Severe dehydration, normal saline to get fluid volume up

Question 2

A 3 year old boy has a 3 day history of fever and 2 days of bloody diarrhoea. On examination he appears pale and dehydrated. Blood tests show a haemolytic anaemia and raised urea.

What organism is the most likely cause of his symptoms and signs?

Question 2Select one:

a.
Salmonella enterica S1

b.
Campylobacter jejuni

c.
Norovirus Genogroup IV

d.
Escherischia coli 0157

Answer 2

Escherischia coli 0157

E coli 0157 can cause haemolytic uraemia syndrome

Question 3

Kate is a 6-month-old breast-fed girl with diarrhoea and vomiting for 2 days. You estimate she is about 7 % dehydrated. What is the most appropriate food and fluid regime for her?

Question 3Select one:

a.
Rehydrate with extra breast feeds; give solid foods as normal

b.
Rehydrate orally, interrupt breast feeding and solids for 48 hours

c.
Rehydrate orally, keep breast feeding; give solids when tolerated

d.
Rehydrate intravenously; nil per mouth until the diarrhoea settles

Answer 3

Rehydrate orally, keep breast feeding; give solids when tolerated

Question 4

A 10 month old infant presents with a 2 day history of low grade fever, reduced appetite, vomiting and diarrhoea. Some stools are streaked with blood. Examination shows moderate dehydration but no abnormalities. What is the most appropriate initial management?

Question 4Select one:

a.
No stool specimen; prescribe metronidazole for Giardia

b.
Collect stool specimen; rehydrate while awaiting results

c.
No stool specimen; rehydrate baby as clinically indicated

d.
Collect stool specimen; treat empirically for Salmonella

Answer 4

Collect stool specimen; rehydrate while awaiting results

Question 5

A 12-month-old baby, Marcus, weighing 10kg is brought to your surgery after 24 hours of copious vomiting and diarrhoea. Marcus’ stool is positive for rotavirus. He has been given flat lemonade to drink at home. What is the most serious potential complication of this home remedy?

Question 5Select one:

a.
Hypernatraemia

b.
Hypokalaemia

c.
CSF acidosis

d.
Hyperglycaemia

Answer 5

Hypernatraemia

Question 6

A 12-month-old baby, Emily, weighing 10kg is brought to your surgery after 24 hours of copious diarrhoea. On examination, Emily is afebrile and alert, and the vital signs are normal. The anterior fontanelle is slightly depressed, the oral mucosa is dry and skin turgor is decreased. There is no other abnormality. What is the most appropriate rehydration plan for Emily?

Question 6Select one:

a.
Oral prochlorperazine for vomiting and loperamide syrup for diarrhea

b.
Oral rehydration solution for 4 hours then re-introduce milk feeding

c.
Nasogastric fluids for 24 hours; then test for lactose intolerance before feeding

d.
Intravenous dextrose/saline for 48 hours then clear fluids for 1 week

Answer 6

Oral rehydration solution for 4 hours then re-introduce milk feeding