gastroenterology

Question 1

Vit A deficiency

Answer 1

night blindness, xerophthalmia

Question 2

vit d def

Answer 2

rickets/osteomalacia, dental caries, hypocalcemia, hypophosphatemia

Question 3

vit e def

Answer 3

anemia/hemolysis, neuro deficicts, altered prostaglandin synthesis

Question 4

vit k def

Answer 4

coagulopathy/prolonged prothrombin tiome, abnormal bone matrix synthesis

Question 5

vit b1 (thiamine) def

Answer 5

beriberi (cardiac failure, peripheral neuropathy, hoarsenss or aphonia, wernicke’s)

Question 6

vit B6 (pyridoxine) def

Answer 6

dermatitis, cheilosis, glossitis, microcytic anemia, peripheral neuritis

Question 7

vit B12 (cobalamin) def

Answer 7

megaloblastic anemia, demyelination, methylmalonic acidemia

Question 8

vit c def

Answer 8

scurvy (heme abnl, edema, spongy swelling of gums, poor wound healing, impaired collagen synthesis)

Question 9

folic acid def

Answer 9

megaloblastic anemia, neutropenia, impaired growth, diarrhea

Question 10

niacin def

Answer 10

pellagra (diarrhea, dermatitis, dementia), glossitis, stomatitis

Question 11

zinc def

Answer 11

skin lesions, poor wound healing, immune dysfunction, diarrhea, growth failure

Question 12

celiac disease

Answer 12

intolerance to gluten, autoimmune
- age 6 months and 2 years
Sx: diarrhea, vomiting, bloating, anorexia, failure to thrive
- foul smelling stools, abd pain
Dx: small bowel biopsy (GOLD STANDARD) –> short flat villi, deep crypts, vacuolated epithelium with lymph
- serum IgA endomysial and serum tissue transglutaminase antibody testing

Question 13

sandifer syndrome

Answer 13

torticollis with arching of back caused by painful esophagitis –> related to GERD

Question 14

Diagnosis of GERD

Answer 14

pH probe measurement gold standard –> correlate with clinical findings

Question 15

pyloric stenosis

Answer 15

first born boys
Sx: non bilious milky fluid vomiting, projectile
- irritable patients but hungry
- olive sign on physical examination
- hypochloremic hypokalemic metablic alkalosis
Dx: ultrasound, string sign on UGI
Tx: surgical correction with partial pyloromyotomy

Question 16

malrotation/volvulus

Answer 16

males
Sx: bilious vomiting, sudden onset abd pain in otherwise healthy infant
Tx: surgical emergency to untwist gut, fluid resuscitation, nasogastric suctioning, abx

Question 17

Duodenal atresia and stenosis

Answer 17

congenital obstruction of duodenum by failure of lumen to recanalize at 8-10 weeks gestation
- most common cause of obstruction in neonate, males, associated with downs
Sx: polyhydramnios, scaphoid abd with epi distension, emesis, weight loss FTT
Dx: double bubble sign, intestinal contrast studies
Tx: decompression, hydration, duodenoduodenostomy

Question 18

intussusception

Answer 18

males, 3-9 months
- ileocolic most common
Sx: colicky/crampy abdominal pain with vomiting and lethargy
- currant jelly stools, sausage mass possible
Tx: fluids, air or contrast enema gold standard

Question 19

gray turner sign

Answer 19

bluish discoloration of flanks in acute pancreatitis

Question 20

cullen sign

Answer 20

bluish discoloration of periumbilical area in acute pancreatitis

Question 21

most common cause of organic constipation in children

Answer 21

hirschprung disease

Question 22

Serologic testing for UC and Crohn’s

Answer 22

antineutrophil cytoplasmic antibody and anti saccharomyces cerevisisae antibody

Question 23

extraintestinal manifestations UC

Answer 23

uveitis, arthropathy, pyoderma gangrenosum, sclerosing cholangitis

Question 24

extraintestinal manifestations crohns

Answer 24

FTT, delayed sex development, oral aphthous ulcers, erythema nodosum, arthritis, renal stones

Question 25

cause of false negative result of GUAIAC

Answer 25

large doses of vit C

Question 26

cause of false positive GUAIAC

Answer 26

iron, red meats, beets

Question 27

necrotizing enterocolitis

Answer 27

considered in any newborn with rectal bleeding, feeding intolerance, or abd distension

Question 28

juvenile polyps

Answer 28

most common cause of significant GI bleeding beyond infancy

Question 29

meckel’s diverticulum

Answer 29

outpouching of bowel in terminal ileum in 2% of infants
- cause of lower GI bleeding in infants and children
- ectopic gastric mucosa that produces acid
Sx: painless acute rectal bleeding

Question 30

infant jaundice

Answer 30

conjugated (direct) hyperbilirubinemia is marker for cholestasis
Cause: neonatal hepatitis or biliary atresia

Question 31

gilbert’s syndrome

Answer 31

50% UDP glucuronyl transferase deficiency, mild unconjugated bilirubinemia

Question 32

crigler najjar type 1

Answer 32

auto rec 100% deficiency in UDP glucuronyl transferase

unconjugated bilirubinemia

Question 33

crigler najjar type 2

Answer 33

auto dom 90% deficiency in UDP glucuronyl transferase

unconjugated bilirubinemia

Question 34

biliary atresia

Answer 34

progressive fibrosclerotic disease affecting extrahepatic biliary tree
- 4-6 weeks have jaundice, dark urine, pale stools
- elevated bilirubin levels
Path: bile duct obliteration and cirrhosis by 4 months of age
Sx: HSM, ascites, poor growth, steatorrhea, periph edema, coagulopathy
Tx: kasai portoenterostomy, liver transplant, supportive

Question 35

alagille syndrome

Answer 35

auto dom, paucity of intrahepatic bile ducts
Sx: cholestatic liver dx, pruritus
- broad forehead, deep set and wide spaced eyes, saddle nose, pointed chin, large ears
- cardiac disease
- renal disease
- eye abnl
- butterfly vertebrae and broad thumbs
- growth failure and short stature
- pancreatic insufficiency
- hyper cholesterolemia

Question 36

serology of autoimmune hepatitis

Answer 36

ANA or anti smooth muscle antibody - Type 1