Gastroenterology

Question 1

Optimal oral rehydration fluids should contain how much sodium and how much glucose?

Answer 1

2% glucose and 90 mEq sodium

Question 2

“Traveler’s diarrhea”, when to treat and with what

Answer 2

Enterotoxigenic E.coli; Tx when sx persist >7days and shiga toxin is negative. Tx with Bactrim

Question 3

2 days after picnic, green malodorous diarrhea

Answer 3

Salmonella

Question 4

Treatment of salmonella typhi

Answer 4

Ceftriaxone or cefotaxime

Question 5

Watery diarrhea and fever several days after exposure, bloody diarrhea develops after fever resides. Tx?

Answer 5

Shigella; tx with bactrim

Question 6

Watery/bloody diarrhea with crampy periumbilical pain relieved by defecation 2-4 days after exposure. Tx?

Answer 6

Campylobacter; tx azithromycin

Question 7

Most common cause of chronic diarrhea in children up to age 3

Answer 7

Toddler’s diarrhea

Question 8

Infant with eczema, asthma, cow milk protein intolerance. When does this resolve?

Answer 8

Age 2

Question 9

Infant with hx polyhydramnios, low birth weight and progressively worsening non-bilious vomiting. How to dx? tx?

Answer 9

Antral web; dx with US, tx with surgery

Question 10

Metabolic derangements in pyloric stenosis

Answer 10

Hypochloremic hypokalemic metabolic alkalosis, hyponatremia

Question 11

US findings in pyloric stenosis

Answer 11

pylorus length >14 mm or muscle thickness >4 mm

Question 12

Bilious vomiting, XR with gastric and duodenal dilatation, decreased intestinal air and corkscrew appearance of duodenum

Answer 12

Volvulus

Question 13

How to dx malrotation

Answer 13

upper GI series

Question 14

Treatment of ranula

Answer 14

Excision; make sure it’s not ectopic thyroid first

Question 15

X-linked disorder with underdeveloped or absent teeth. How to dx?

Answer 15

Ectodermal Hypoplasia; Dx with Skin biopsy = lack of sweat pores

Question 16

Sydrome with underdeveloped, small teeth

Answer 16

Hallerman Streiff Syndrome

Question 17

Syndrome associated with too many teeth

Answer 17

Gardner’s Syndrome

Question 18

Best diagnostic study for PUD

Answer 18

Urea breath test, fecal antigen (gold standard but too invasive: Upper GI endoscopy)

Question 19

Tx PUD

Answer 19

PPI + 2 abx (clarithromycin + amox; OR clarithromycin + flagyl)

Question 20

Child with bulky, pale, frothy, foul smelling stools, proximal muscle wasting. How to dx?

Answer 20

Screen with IgA Ab to TTG or IgA ab to endomysium. Confirm with biopsy

Question 21

Extra teeth, polyps that are pre-malignant in large and small intestine, osteomas. Inheritance? Tx?

Answer 21

Gardner’s Syndrome. Autosomal dominant; tx with surgery

Question 22

Mucosal pigmentation of the lips and gums, colon polyps

Answer 22

Peutz-Jeghers Syndrome

Question 23

Teenager with chronic crampy lower abdominal pain, with or without bloody stools. Continuous inflammation of the colon. Tx?

Answer 23

Ulcerative colitis; ASA is first line, then steroids. Colectomy eliminates risk for cancer, but does not stop progression of AS (HLA-B27+)

Question 24

If suspect infection in patient with UC, what abx?

Answer 24

Flagyl

Question 25

Weight loss, erythema nodosum, arthritis, uveitis, liver disease and renal sones are all manifestations of what disease?

Answer 25

Crohn's disease

Question 26

Skip lesions on XR, transmural lesions, non-caseating granulomas

Answer 26

Crohn's Disease

Question 27

Perianal fistulae/oral aphthous ulcers. TX?

Answer 27

Crohn's Disease. Steroids induce remission but do not change long term course, high rate of relapse

Question 28

Crampy severe periumbilical pain. What organism?

Answer 28

Yersinia

Question 29

What to rule out in child >6 that has intussusception

Answer 29

Lymphosarcoma

Question 30

First step when intussusception highly suspected

Answer 30

Air contrast enema

Question 31

Natural hx of anal stenosis

Answer 31

resolves by age 1

Question 32

How to confirm dx of E. histolytica? Tx?

Answer 32

Serology; tx with flagyl for colitis/liver abscess and iodoquinol for asymptomatic disease

Question 33

Older child with painless rectal bleeding

Answer 33

Juvenile polyposis

Question 34

>1 month old with elevated direct bilirubin. First test?Treatment?

Answer 34

Biliary atresia. Dx with US followed by HIDA scan. Tx Kasai if under 2 months

Question 35

What deficiency in Gilbert syndrome?

Answer 35

Glucuronyl transferase deficiency

Question 36

Child with recent URI, admitted to PICU with elevated LFTs and ammonia

Answer 36

Reye's Syndrome 2/2 aspirin

Question 37

Most specific test to dx pancreatitis? Best test to determine underlying cause?

Answer 37

Ultrasound to dx; Check serum lipids

Question 38

Abdominal pain that radiates to shoulder is likely to be 2/2 to what organ?

Answer 38

Gallbladder

Question 39

Child with shoulder pain, nausea, vomiting, fever, and lethargy. How to dx?

Answer 39

Cholecystitis dx with ultrasound

Question 40

Child with jaundice, palpable RUQ mass or HSM, nasea/vomiting, and abdominal pain. How to dx?

Answer 40

Cholelithiasis

Question 41

Which Hep B marker indicates high viral load

Answer 41

HBeAg, HBV-DNA

Question 42

What does a +IgM anti-HBc indicate?

Answer 42

Recent infection with Hep B. Can remain elevated up to 6 months after infection

Question 43

How to dx acute Hep B infection?

Answer 43

Check for HBsAg, HBV-DNA, HBeAg, and IgM anti-HBc

Question 44

Most common bloodborne infection in the US

Answer 44

Hepatitis C

Question 45

First detected with ingestion of solids: Diarrhea, pain, poor growth. Inheritance? Dx? Tx?

Answer 45

Sucrase-isomaltase deficiency. Autosomal recessive. Dx. Must do acid hydrolysis of stool, or hydrogen breath testing. Tx. restriction of sucrose

Question 46

Pancreatic insufficiency, cyclic neutropenia, bone abnormalities. Inheritance?

Answer 46

Swachmann-Diamond Syndrome. Autosomal recessive.

Question 47

Electrolyte disturbances in refeeding syndrome

Answer 47

Hypophosphatemia, hypokalemia, hypomagnesemia, HYPERnatremia, hyperglycemia

Question 48

Neonate with fulminant liver failure, succinylacetone in the urine

Answer 48

Tyrosinemia (autosomal recessive)

Question 49

Neonate with onset of liver failure after introducing fruit juices

Answer 49

Fructosemia

Question 50

Which types of hepatitis typically has transaminases >1000s

Answer 50

Hepatitis A and B

Question 51

The only etiology of hepatitis that causes splenomegaly

Answer 51

EBV

Question 52

Teenage female with hepatitis, high serum protein and low serum albumin (hypergammaglobulinemia). What tests will aid in diagnosis?

Answer 52

Autoimmune hepatitis | Check for anti-microsomal Ab, anti-smooth muscle, anti-mitochondrial Ab

Question 53

Triangular facies, pulmonary stenosis, TOF, paucity of intrahepatic bile ducts, butterfly vertebrae

Answer 53

Alagilles Syndrome (Autosomal dominant)

Question 54

Female school-aged child with RUQ mass, pain, and intermittent jaundice. Dx? Tx?

Answer 54

Choledochal cyst. Dx with US, Tx surgery

Question 55

Most common primary liver tumor of childhood

Answer 55

Hepatoblastoma

Question 56

Patient with signs of cholestasis and pancreatitis. Next imaging study?

Answer 56

Magnetic resonance cholangiopancreatography or endoscopic ultrasonography (ERCP should not be attempted in the presence of pancreatitis)

Question 57

Initial treatment of eosinophilic esophagitis

Answer 57

6 food elimination diet or elemental diet

Question 58

When should a negative stool culture precede return to daycare in a child with diarrheal illness?

Answer 58

Shiga toxin-producing Escherichia coli, Shigella species, or Salmonella serotype typhi

Question 59

When should an umbilical hernia be repaired?

Answer 59

IF symptomatic, if the hernia is still present at age 5–6 years, or it increases in size between 1 and 2 years of age

Question 60

Shwachmann Diamond. How to diagnose?

Answer 60

Abdominal US or other imaging would show fatty infiltration of the pancreas