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Pediatric Questions > GASTROENTEROLOGY > Flashcards

GASTROENTEROLOGY Flashcards

1
Q

An exclusively breastfed infant has not stooled
for 5 days with no other symptoms. The stool is
soft with no rectal bleeding. The infant is gaining weight

A

Reassurance (breastfed infants may go several
days or even a week between bowel movements)

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2
Q

A 1-week-old child with frequent spit-ups,
otherwise doing well

A

Reassurance (newborn reflux is normal)

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3
Q

A 3-week-old first newborn boy presents with
nonbilious projectile vomiting, hypochloremic,
hypokalemic metabolic alkalosis, and dehydration

A

Pyloric stenosis

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4
Q

What are the upper GI series useful for?

A

To rule out anatomic or motility problems. Does
not diagnose reflux

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5
Q

What is the next best step in cases with suspected pyloric stenosis?

A

Abdominal US (pylorus)

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6
Q

Weight loss, abdominal pain, nausea, effortless
postprandial regurgitation after at least 1 meal
daily for 1 month, regurgitated food occasionally reswallowed, rechewed, or spit out

A

Rumination syndrome

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7
Q

Child with no known health problem woke up
suddenly vomiting blood. The child is stable and
acting normal. What is the most likely cause?

A

Epistaxis (nose bleeding is the most common
source in healthy children)

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8
Q

Nausea and vomiting every 1–2 months, each
episode lasts for few hours, otherwise healthy, no symptoms in-between episodes, positive family history of migraine

A

Cyclic vomiting syndrome

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9
Q

A 7-year-old healthy child, with periumbilical
abdominal pain worse in the morning prior to
school, improves during weekends with normal
growth parameters

A

Reassurance (functional abdominal pain)

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9
Q

Adolescent presents with recurrent episodes of
abdominal pain, diarrhea, and sometimes
constipation in the previous 3 months. No weight loss and all labs are normal. What is the best treatment?

A

Peppermint oil, diet modifications, cognitive
behavioral therapy

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10
Q

High achieving adolescent complains of crampy
abdominal pain, diarrhea, and at other times,
constipation; pain is relieved with stooling

A

Irritable bowel syndrome

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11
Q

A mother brought her toddler with a diaper full of undigested food, the child is holding a large bottle of apple juice

A

Toddler diarrhea

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11
Q

What is the major concern of using antimotility
drugs such as Loperamide?

A

May induce ileus

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12
Q

The best management of toddler’s diarrhea

A

Juice restriction and allow normal dietary fat

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13
Q

Child with a low-grade fever, 6 episodes of
diarrhea, otherwise reassuring medical exam.
What is the treatment of choice?

A

Oral rehydration therapy (avoid anti-diarrheal
agents)

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14
Q

An infant presents with bright red blood stool,
poor weight gain, diarrhea, and fussiness; the
infant is breastfeeding, supplemented with
standard infant formula; stool guaiac test is
positive

A

Cow milk protein intolerance

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15
Q

Child with dysphagia, recurrent food impaction;
biopsy shows an increased eosinophil?

A

Eosinophilic esophagitis

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15
Q

Child accidentally swallowed caustic liquid 6 h
ago, presents with dysphagia, oral pain, chest
pain, nausea, and vomiting

A

Endoscopy in 12–24 h after ingestion

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16
Q

Adolescent with recurrent headaches takes
ibuprofen as needed, presents with dysphagia and chest discomfort (does not like to drink water with medicine)

A

Pill-induced esophagitis

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17
Q

4 weeks passed and the coin still in the stomach
with no symptoms

A

If the coin does not pass through the stomach by 4 weeks or if the patient is symptomatic, removal by endoscopy should be considered

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17
Q

Swallowed a coin, no symptoms, and radiograph showed the coin still in the esophagus

A

Observe for 12–24 h, removal of the coin if it
does not pass to the stomach or if the patient
became symptomatic

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18
Q

Swallowed a coin, no symptoms, and radiograph showed the coin in the stomach

A

Checking the stool for passage for 4 weeks, with
weekly radiographs, if indicated

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18
Q

Swallowed a button battery (BB), and passed to
the stomach with symptoms

A

Immediate removal

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19
Q

Swallowed a coin, excessive drooling, and chest
pain, and radiograph showed the coin still in the
esophagus

A

Immediate removal

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20
Q

Swallowed a BB that got stuck in the esophagus

A

Immediate remova

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20
Q

Swallowed a BB, and passed to the stomach
without symptoms

A

Urgent removal (if age < 5 and BB ≥ 20 mm)
Elective if not moving (checking the stool for
passage for 4 weeks, with weekly radiographs)

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20
Q

The best and most definitive test for peptic ulcer disease

A

Endoscopy

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20
Q

Swallowed small pieces of magnet metals; the
abdominal radiograph showed the pieces in the
stomach

A

Immediate remova

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21
Q

An older child with bloating, constant burping,
sharp epigastric pain that awakens the child from sleep

A

Helicobacter pylori infection

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22
Q

The most common cause of chronic gastritis in
pediatrics

A

H. pylori

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23
Q

What is the treatment of H. pylori infection?

A

Amoxicillin or metronidazole + clarithromycin +
PPI for 2 weeks

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23
Q

Infant suddenly develops bilious vomiting,
abdominal distension, tenderness, and fussiness. What is the diagnostic test of choice?

A

Upper GI series with follow through

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24
Q

In the infant above, the GI series shows a bird’s
beak sign of the second portion of the duodenum

A

Volvulus

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25
Q

Intermittent crampy abdominal pain, lethargy,
bilious vomiting, and a palpable mass in the right upper quadrant

A

Intussusception

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25
Q

What is the best initial diagnostic test of choice in cases of intussusception?

A

Abdominal US (target sign, reflecting a segment
of bowel trapped within a distal segment of
bowel)

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25
Q

What is the therapeutic procedure of choice in
cases of intussusception?

A

Air contrast enema (diagnostic and therapeutic)

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26
Q

Down syndrome, bilious vomiting, double bubble sign on KUB

A

Duodenal atresia

27
Q

A mother brought her 9-month-old girl with a
diaper full of red, maroon stool; the physical
exam is normal, and the infant is feeding well and smiling (she is receiving an antibiotic for AOM)

A

Most likely the medicine, e.g., cefdinir may
change the stool color to maroon color (bloodlike color)

28
Q

A 2-year-old boy, frank rectal bleeding, anemia,
no pain, no other symptoms

A

Meckel diverticulum

29
Q

What are the 2 most common ectopic tissues
found in Meckel diverticulum?

A

Gastric and pancreatic

29
Q

Most common cause of rectal prolapse in the
USA

A

Constipation

30
Q

Infant, failure to thrive, rectal prolapse

A

Cystic fibrosis

30
Q

How is Meckel diverticulum diagnosed?

A

Technetium 99 scan

30
Q

Rectal bleeding, large and hard stool in the diaper

A

Anal fissure

30
Q

The most common cause of rectal bleeding in
infants

A

Anal fissure

30
Q

A 2-year-old boy with chronic constipation,
ineffective laxatives, fails to pass meconium in
the first 48 h of life, explosive stools on rectal
exam, KUB showed very distended colon

A

Hirschsprung disease

31
Q

A 48-h old boy did not pass the meconium; the
abdomen is slightly distended

A

Hirschsprung disease

31
Q

Most accurate diagnostic test for Hirschsprung
disease

A

Full-thickness rectal biopsy performed by surgery

32
Q

Persistent epigastric abdominal pain, vomiting;
the pain is referred to the back, tenderness in the epigastric region, elevated amylase, and lipase enzymes

A

Acute pancreatitis

32
Q

Child with type 1 diabetes mellitus and recurrent abdominal pain

A

Celiac disease

32
Q

Child with Down syndrome, intermittent
abdominal pain, and failure to thrive

A

Celiac disease

32
Q

Jaundice, abdominal pain, and fever

A

Cholangitis

32
Q

Child with a history of recurrent abdominal pain
presents with fever, abdominal pain, bloody
diarrhea, migratory arthritis, erythema nodosum,
ankylosing spondylitis, elevated ESR, positive
P-ANCA

A

Ulcerative colitis

32
Q

Recurrent aphthous ulcers, abdominal pain,
weight loss, perianal lesions, positive anti-
Saccharomyces antibodies

A

Crohn’s disease

32
Q

Hydrops of the gallbladder can be seen in

A

Kawasaki disease

32
Q

What is the most common complication of
cholelithiasis?

A

Pancreatitis

32
Q

Jaundice, abdominal pain, and a palpable mass in the right upper quadrant

A

Choledochal cyst

33
Q

Conditions associated with an increased incidence of cholelithiasis

A

Sickle cell anemia, chronic total parenteral
nutrition (TPN), adolescent pregnant females

33
Q

A 3-year-old boy presents with failure to thrive,
difficulty walking; the metabolic panel shows
elevated aspartate transaminase (AST) and
alanine transaminase (ALT). Total bilirubin,
prothrombin time, blood glucose, TSH and free
T4 are all normal, negative hepatitis viral panel.
What is the test of choice in this case?

A

Creatinine phosphokinase (CK) (muscular
dystrophy most likely)

33
Q

What are the sources of transaminases (ALT and
AST)? It is important to consider other sources of transaminases if they are elevated and the liver function is normal

A

Liver, heart, muscles, kidney, and brain

34
Q

The best laboratory test for acute hepatitis A

A

Anti-HAV IgM

35
Q

A mom is asking about prophylaxis for her
4-month-old child after she was recently
diagnosed with hepatitis A?

A

Administer IG as prophylaxis (< 1 year)

36
Q

Prophylaxis of a 3-year-old child exposed to a
documented case of hepatitis A in a child care
center

A

Hepatitis A vaccine (> 1 year)

37
Q

All hepatitis viruses are composed of RNA except

A

Hepatitis B virus is composed of DNA

38
Q

Which virus infection must have hepatitis B?

A

Hepatitis D

39
Q

Child with a family history of lupus disease
presents with jaundice, hepatomegaly, weight
loss, loss of appetite, positive anti-smooth muscle antibodies

A

Autoimmune hepatitis

40
Q

One week with jaundice, hepatomegaly, slightly
elevated ALT and AST, prolonged PT that is not
responding to IV vitamin K, and recurrent
hypoglycemia

A

Acute hepatic failure

41
Q

An 8-year-old boy has recurrent jaundice, slightly elevated indirect bilirubin; physical examination and all other labs are normal

A

Gilbert syndrome

42
Q

A 1-day-old boy with intense jaundice,
unconjugated bilirubin is 25 mg/dL, and no
conjugated bilirubin; and poor response to
phototherapy

A

Crigler–Najjar syndrome type I (exchange
transfusion is warranted)

43
Q

Mild conjugated hyperbilirubinemia with black
liver

A

Dubin–Johnson syndrome

44
Q

An infant with jaundice, dark urine, light-colored
stool, hepatomegaly, and elevated conjugated
bilirubin

A

Biliary atresia

45
Q

What is the most valuable study for neonatal
biliary atresia?

A

Percutaneous liver biopsy

46
Q

If liver biopsy confirmed biliary atresia, what is
the next appropriate test?

A

Intraoperative cholangiography

47
Q

Adolescent presents with depression, psychosis,
and elevated liver enzymes

A

Wilson disease

48
Q

Which mineral is affected in Wilson disease?

A

Copper (excess)

49
Q

How to establish the diagnosis of Wilson disease

A

Ceruloplasmin < 20 mg/dL. Hepatic copper
> 250 ug/g dry weight. Urine copper
> 100 ug/24 h. Presence of Kayser–Fleischer
rings

50
Q

Broadened forehead, jaundice, pulmonary
stenosis, and butterfly hemivertebrae

A

Alagille syndrome

51
Q

Abdominal mass, elevated liver enzyme, and high serum alpha-fetoprotein

A

Hepatoblastoma

52
Q

A 3-month-old, failure to thrive, extreme pruritus, steatorrhea, very high-conjugated
bilirubin, hepatosplenomegaly, mutilated skin, elevated serum alkaline phosphatase, and normal gammaglutamyl transferase (GGT)

A

Progressive familial intrahepatic cholestasis
(PFIC) type 1

53
Q

Prognosis of all forms of PFIC

A

Lethal during childhood unless treated early

54
Q

Hematochezia, intestinal polyp, pigmented penile lesion, large head, café-au-lait spots, intellectual disability

A

Bannayan–Riley–Ruvalcaba syndrome

55
Q

> 5 juvenile polyps

A

Juvenile polyposis

56
Q

What is the next step in children with ≥ 5
juvenile polyps or any number of adenomatous
intestinal polyps?

A

Genetic testing

57
Q

100 or more adenomatous polyps in the large and/ or small intestines

A

Familial adenomatous polyposis

58
Q

Intestinal polyps, osteoma of the mandible,
papillary carcinoma of thyroid, and
hepatoblastoma

A

Gardner syndrome

59
Q

Intestinal polyps and brain tumor

A

Turcot syndrome

60
Q

Intestinal polyps, hematochezia, mucocutaneous freckling, and a family history of polyposis

A

Peutz–Jeghers syndrome (increases the risk of
cancer)

61
Q

Hamartomas involving many areas of the body,
e.g., skin, oral mucosa, thyroid, breast, and colon

A

Cowden syndrome

62
Q

Associated risks of Cowden syndrome

A

Cancer, e.g., thyroid cancer

63
Q

Hemihypertrophy, very large extremities,
epidermal nevus, hamartomatous polyps,
intellectual disability

A

Proteus syndrome

64
Q

Potential risks of Proteus syndrome

A

Deep vein thrombosis (DVT) and
thromboembolism

65
Q

The best diagnostic test for lactose intolerance

A

Hydrogen breath test

Pediatric Questions (31 decks)

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