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NY-Pediatric Nurse Practitioner > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

If a child has gastroenteritis, when can they return back to daycare?

A

after they have 2 negative stool cultures

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2
Q

are antimotility drugs choice of medication?

A

No they should be used judiciously

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3
Q

What is the 1st drug of choice for gastroenteritis considered when the patient has 8-10 stools per day (test does not abbreviate)

A

trimethoprim/ sulfamethoxazole (TMP/SMZ)

[bactrim]

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4
Q

what is the choice for salmonella?

A

nothing! salmonella is not very responsive to antibiotics.

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5
Q

which virus is the cause of 50% of viral gastroenteritis?

A

rotavirus

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6
Q

Which class of GERD would you see weight loss?
physiologic
functional
pathologic

A

pahologic only

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7
Q

first line treatment for GERD?

A

H2 blockers ranitidine then PPI (omeprazole, prilosec)

after trying smaller feeds, burping frequently, rice cereal or oat to thicken, elevating head after feeding

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8
Q

what is one side of effective of a PPI to be aware of?

A

gynecomastia

also anemia

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9
Q

time frame for pyloric stenosis?

A

3wks to 4 months

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10
Q

would you expect to see bilious or non bilious emesis for pyloric stenosis. Why?

A

NON bilious
bile would indicate a problem further down (intestines)
no bile= closer to stomach, so pyloris stomach or esophageal.

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11
Q

what conditions would you expect to see bilious emesis for?

A

intussusception and hirschsprung, small bowel obstruction, volvulus, malrotation.

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12
Q

what is a positive obturator sign, +psoas sign?

A

psoas- pain with right thigh extension (straight leg up and pain with pressure on leg)
obturator- with internal rotation of right thigh (bend knee twist thigh inwards)

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13
Q

What are some clinical signs for appendicitis? PROM?

A

Psoas sign- leg extension
Rrebound tenderness- pressing on one side that moves to another with release of pressure
Obturator sign- pain with internal rotation
Mcburneys point tenderness- point closer to iliac crest between umbilicus

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14
Q

s/s concerning for appendicitis?

A

PROM, pain worse with cough, nausea, low grade fever.

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15
Q

an 18 mo comes in with chronic diarrhea, abd pain, fatigue, cheilosis, foul stool. What is one of your main differentials?

A

Malabsorption disease

also IBD, chronic diarrea, maybe hepatic disease, gastro

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16
Q

lactose and sucrose breath hydrogen testing is done to test for what disorder?

A

H. pylori

17
Q

sweat chloride is done for suspicion of what disorder?

A

cystic fibrosis

18
Q

what are some examples of malabsorption disorders?

A

CF, celiac disease, gluten intolerance, abnormality of intestinal mucosa

19
Q

What foods do you avoid for celiac disease?

what can they eat?

A

BAD: gluten, wheat, oats, barley, rye (bread, crackers, beer, whiskey)

GOOD: rice, soy, dairy

refer to gastro as needed

20
Q

what do CF patients require for management?

A

enzymes and fat soluble vitamins (A, D, E, K) & refer to gastro

[reminder: CF patients have trouble absorbing fats, and some vitamins need fat to be absorbed)

21
Q

neuroblastoma (wilms tumor) is most common before what age? what is often the first sign? where does this cancer usually originate?

A

age 5
first sign: lump/ swelling/ mass in abdomen or neck
orginate often: adrenal glands (from immature nerve cells called neuroblasts)

22
Q

Which of the following labs would indicate a recovery from Hep B?

a) IgM
b) anti-HBc
c) igG
d) anti-HBsAg

extra credit, what would be looked at when drawing Hep B titers?

A

D) anti-HBsAg = antibody to Hep B surface antigen

this is only ever seen if you have Hep B and have recover.

e.c. Anti-HBs this shows the pt has seroconverted
(similar to above that shows recover minus the antigen portion b/c pt was never infected)

23
Q

Which lab shows you have hep A and have not yet recovered?

a) anti-HAV
b) IgM
c) IgG

A

B- IgM (immediate) means it is still present

IgG means it is GONE, anti-HAV is present in active and recovered hep A

hint: think you are a mother before grandmother so IgM first then IgG

24
Q

what is the management for oral rehydration therapies for moderate and severe dehydration?

A 
moderate= 50ml/ hr
severe= 100ml/hr
25
Q

what are the main difference between moderate and severe dehydration?

A

moderate= tachycardia, normal BP normal cap refill, decreased skin turgor, slightly sunken in fontanels

severe= normal/ low BP, decreased HR, prolonged cap refill, sunken fontanel

26
Q

s/s: failure to pass meconium, bilious vomiting, explosive bowel movements, tight anal sphincter, Failure to thrive

what do you suspect? how do you diagnose

A

Hirschsprung

XR, rectal biopsy= definitive

27
Q

1 mo vomiting, non bilious, projectile emesis, poor weight gain what do you suspect? how do you diagnose?

A

pyloric stenosis

US

28
Q

15 mo, possibly bilious emesis, intermittent fussiness, lethargic. What is in your diff?
what diagnostics would you consider?

A

intuss.

US

29
Q

3 year old comes in with fatigue, weight loss, tachycardia, sweating, enlarged abdomen. What is in your differential? what diagnostics are you considering?

A

neuroblastoma (wilms tumor)

US, CBC, urine catecholamines (b/c of likely adrenal gland involvement) abd CT

30
Q

what are the percentages of wt loss with the associated levels of dehydration for:
mild:
moderate:
severe:

A

mild: 3-5%
moderate: 6-9%
severe: >10%

31
Q

what are the rehydration levels for moderate and severe dehydration?

A

(6%-9%)moderate= 50ml/r

(>10%) severe= 100ml/hr

32
Q

an 18 mo old has has v/d and presents with sunken fontanels, increased HR, dry mucous membranes, moderately increase thirst, and delayed cap refill. what level of dehydration would you consider this to be, how many ml/hr would you expect to rehydrate the pt at?

A

moderate

50ml/hr

33
Q 
wha clinical sign would you expect for severe dehydration?
A-normal cap refill
B-normal fontanel
C-cool, mottled skin
D-dry mucous membranes
A

C- cool mottled skin

34
Q 
in the US most common parasitic gastro is caused by?
enterobius vermicularis
entamoeba histolytica
giardia lamblia
cryptosporidium parvum
A

Giardia`

35
Q 
which of the following serological findings indicates chronic HBV? 
HBsAg neg for 6 mo
anti-HBc + and HBsAg +
IgM and anti-HBc +
anti-HBs +
A

B= anti-HBc + and HBsAg +

36
Q

T/F

kids with Hepatitis (A, B, C) do not often have icteric skin/ sclera.

A

true

Hep A especially

NY-Pediatric Nurse Practitioner (12 decks)

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