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Gastrointestinal Disorders Flashcards

1
Q

A 10 mo has been diagnosed with gastroenteritis. He attends a child-care facility. What is the most likely cause of his illness?

a) clostridium difficile
b) rotavirus
c) salmonella
d) cryptosporidium

A

b) rotavirus

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2
Q

In a healthy 8 mo with diarrhea but no dehydration, what would be the most appropriate advice to give parents?

a) encourage 1/2 strength formula for 12 hours
b) give oral rehydration solution for 12 hours
c) give only fluids until stools return to normal
d) give bananas and cereal as tolerated

A

d) give bananas and cereal as tolerated

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3
Q

When evaluating a child with abdominal pain, what symptom would lead to a likely organic etiology?

a) night waking
b) pallor
c) suprapubic pain
d) sweating

A

a) night waking

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4
Q

Vomiting in infancy has a long list of differential diagnoses. Which accompanying symptom would most likely point to pyloric stenosis?

a) diarrhea
b) appropriate growth
c) acts hungry after vomiting
d) sausage shaped mass in abdomen

A

c) acts hungry after vomiting

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5
Q

Which of the following is the appropriate regimen for pinworm medication?

a) daily times 7 days, repeat as needed
b) three times a day for 10 days, repeat as needed
c) twice daily for 3 days, repeat in 2 weeks
d) One dose x 1, repeat in 2 weeks

A

d) One dose x 1, repeat in 2 weeks

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6
Q

A 2 mo’s frequent vomiting has his mother convinced that something is seriously wrong. Which of the following is most suggestive of GER?

a) He’s gained 5 ounces this month
b) He has a slight wheeze today
c) He eats hungrily after vomiting
d) He drinks 7-8 ounces every 3-4 hours.

A

d) He drinks 7-8 ounces every 3-4 hours.

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7
Q

A 20 mo with normal growth and development is being seen for diarrhea. His mother tells you that he is passing up to three loose stools a day and that he drinks 20 oz of apple juice a day. What is the most likely diagnosis?

a) crohn’s disease
b) giardia lamblia
c) celiac disease
d) nonspecific toddler diarrhea

A

d) nonspecific toddler diarrhea

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8
Q 
A 6 mo was seen last week for a WCC, and her weight was 7 kg. Today she presents with diarrhea and vomiting for 4 days. Today her weight is 6.5 kg. What is her percentage dehydration? 
a) 5%
b) 7%
c) 10%
d)
A

b) 7%

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9
Q

What clinical signs would you expect to see in a pt with 7% weight loss from dehydration?

a) normal capillary refill
b) normal fontanel
c) cool mottled skin
d) dry mucous membranes

A

d) dry mucous membranes

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10
Q

The 6 mo’s vomiting and diarrhea has stopped. If she needs oral replacement therapy today, what would be the appropriate amount to recommend?

a) 325-350 cc over 4 hours
b) 600-700 cc over 4 hours
c) 600-700 cc over 12 hours
d) 325-350 cc over 8 hours

A

b) 600-700 cc over 4 hours

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11
Q

Pinworms can cause which of the following?

a) constipation
b) anal itching
c) abdominal pain
d) diarrhea

A

b) anal itching

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12
Q

In evaluating a child with bloody diarrhea, which of the following would be an appropriate first action?

a) check growth chart
b) stool culture
c) upper GI
d) hemoccult test stools

A

b) stool culture

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13
Q

A family eats at fast food restaurants 4-5 times each week. If you suspect a child’s bloody diarrhea is infectious in nature, what is the likely causative organism?

a) adenovirus
b) e. coli
c) giardia lamblia
d) s. aureus

A

b) e. coli

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14
Q

Which of the following conditions would be most likely to occur in a 4 yo boy?

a) pyloric stenosis
b) recurrent abdominal pain
c) intussusception
d) giardia infection

A

d) giardia infection

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15
Q

Which of the following findings could be expected to occur in a baby with intussusception?

a) inconsolable screaming
b) olive shaped mass
c) left to right peristaltic waves
d) weight loss

A

a) inconsolable screaming

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16
Q

Which of the following may occur with suspected appendicitis?

a) pain not relieved with ambulation
b) young children appear very ill in the early phase
c) fever of 102-103
d) leukopenia with left shift

A

a) pain not relieved with ambulation

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17
Q

In the US parasitic gastroenteritis is most commonly caused by which organism?

a) enterobius vermicularis
b) entamoeba histolytica
c) cryptosporidium parvum
d) giardia lamblia

A

d) giardia lamblia

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18
Q

Which of the following serological findings indicates a carrier state for HBV?

a) HBsAg negative for 6 months
b) IgM anti-HBc negative and HBsAg positive
c) Anti-HBc positive
d) Anti-HBs positive

A

b) IgM anti-HBc negative and HBsAg positive

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19
Q

Children in child-care facilities are at greater risk of being exposed to which of the following infections?

a) HAV
b) HBV
c) HCV
d) HDV

A

a) HAV

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20
Q

Infant immunization for hepatitis B often raises many parental questions about the disease. Which of the following is not true about hepatitis B virus?

a) it can survive for more than 1 week on fomites
b) it is the most common form of hepatitis in the world
c) contaminated water and shellfish are the major source
d) perinatally infected infants are likely to become carriers

A

c) contaminated water and shellfish are the major source

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21
Q

A 2 do baby is in the hospital nursery and still has not passed meconium. This is a red flag for what condition?

a) intussusception
b) HUS
c) pyloric stenosis
d) hirschsprung’s disease

A

d) hirschsprung’s disease

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22
Q

Consistent with findings of hirschsprung’s disease, findings on rectal exam would be which of the following?

a) tight anal canal with no stool in vault
b) impacted stool with fissure
c) large, dilated rectum
d) soft stool, normal tone

A

a) tight anal canal with no stool in vault

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23
Q

What treatment would be appropriate for hirschsprung’s disease?

a) emulsified mineral oil, 1/2 tablespoon per day
b) referral to gastro/surgeon
c) malt soup extract, 2 tsp for 3 days
d) rectal dilation with thermometer

A

b) referral to gastro/surgeon

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24
Q

When evaluating a child with suspected inflammatory bowel disease, which of the following diagnostic tests would not be helpful?

a) amylase and lipase
b) ESR
c) serum total protein and albumin
d) CBC with differential

A

a) amylase and lipase

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25
Q

Your patient has inflammatory bowel disease. Which finding is most consistent with ulcerative colitis?

a) occult blood
b) perirectal abscess
c) aphthous ulcers
d) left sided abdominal pain

A

d) left sided abdominal pain

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26
Q

Antimicrobials will improve the condition of a 4 yo child with diarrhea caused by which of the following organisms?

a) salmonella
b) rotavirus
c) shigella
d) e. coli

A

c) shigella

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27
Q

A pt has functional abdominal pain. When counseling her family on management of painful episodes, you would recommend which of the following?

a) take IBU 200 mg for pain
b) stay home from school during episodes
c) decrease milk products
d) go to school during episodes

A

d) go to school during episodes

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28
Q

Which of the following would not be consistent with a diagnosis of functional constipation in an infant?

a) vomiting
b) anal fissure
c) straining
d) starting solids

A

a) vomiting

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29
Q

A child has developed her second perirectal abscess in 6 months. She should be evaluated for which condition?

a) giardia lamblia
b) crohn’s disease
c) ulcerative colitis
d) enterobiasis

A

b) crohn’s disease

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30
Q

Which of the following symptoms are most common in the early phase of appendicitis in children?

a) abdominal pain after eating
b) fever and diarrhea
c) severe localized RLQ pain with pallor and sweating
d) anorexia, vague, diffuse pain

A

d) anorexia, vague, diffuse pain

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31
Q

Steatorrhea is not consistent with which of the following?

a) c. difficile
b) giardia lamblia
c) celiac disease
d) cystic fibrosis

A

a) c. difficile

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32
Q

A pt has had diarrhea for 3 days and his mother is concerned. Which of the following would not be helpful advice?

a) monitor stool for blood or mucus
b) encourage solid food
c) avoid milk products
d) monitor for urination at least every 6 hours

A

c) avoid milk products

33
Q

Of the following advice, which would be most helpful for the parents of a baby with gastroesophageal reflux?

a) most babies continue to vomit until they are walking; at around 1 year of age
b) laying prone after eating will decrease the amount of vomiting
c) increase the interval between feedings to a minimum of four hours
d) medications are generally necessary to prevent further problems

A

b) laying prone after eating will decrease the amount of vomiting

34
Q

Which of the following foods would be appropriate for a child with celiac disease?

a) oatmeal for breakfast
b) boiled rice with butter
c) commercially baked bread
d) cream of wheat

A

b) boiled rice with butter

35
Q

A parent requests her 6 mo child receive immunoglobulin (IG) as protection against hepatitis A prior to international travel. Which of the following does this parent need to know?

a) after IG administration a 3 month interval is needed prior to the next measles vaccine
b) there is no impact to future immunizations
c) no immunizations can be given for 1 year
d) since children do not have symptoms with hep A, IG is not necessary

A

a) after IG administration a 3 month interval is needed prior to the next measles vaccine

36
Q

The mother of a 4 mo reports episodes of vomiting and diarrhea beginning 2 days ago. He has also had several episodes of screaming and drawing up his legs. Prior to this he has been healthy with normal weight gain. The least likely diagnosis is:

a) incarcerated hernia
b) gastroenteritis
c) intussusception
d) pyloric stenosis

A

d) pyloric stenosis

Pyloric stenosis occurs during the first few weeks of life with projectile vomiting and weight loss

37
Q

The mother of a 4 mo reports episodes of vomiting and diarrhea beginning 2 days ago. He has also had several episodes of screaming and drawing up his legs. Prior to this he has been healthy with normal weight gain. PE reveals a sausage-shaped mass and guaiac-positive stool. This would confirm a diagnosis of:

a) incarcerated hernia
b) gastroenteritis
c) intussusception
d) pyloric stenosis

A

c) intussusception

Invagination of the bowel can result in a sausagelike mass being palpated in the upper right quadrant of the abdomen with occasional bloody stools.

38
Q

A 14 yo presents with abdominal pain that has occurred several times over the past 3 months. The pain is described as intermittent, sharp, and occasionally relieved with a heating pad. PE is normal. You suspect recurrent abdominal pain (RAP). Which clinical finding is most consistent with RAP?

a) periumbilical pain
b) constipation
c) pain worsens with defecation
d) weight loss

A

a) periumbilical pain

Recurrent abdominal pain is almost always nonorganic in origin. Other than complaints of pain, usually periumbilical or midepigastric, the history and physical are normal.

39
Q

Education and counseling of the parents of a 4 mo child with GER should include all of the following except?

a) thicken formula with rice cereal
b) change to a hypoallergenic formula
c) place infant in a car seat after feeding
d) avoid exposure of the infant to tobacco smoke

A

c) place infant in a car seat after feeding

Sitting the infant in a car seat or other similar device compresses the stomach, making the infant more likely to reflux. A 2 week trial of a hypoallergenic formula is suggested as reflux may be due to milk protein allergy. Secondhand smoke exacerbates reflux. Thickening the formula with rice cereal reduces regurgitation and improves quality of life for the caregivers.

40
Q

A 6 yo complains of sharp epigastric pain radiating to his back. Which lab data would be consistent with these physical signs?

a) decreased serum albumin
b) elevated serum amylase
c) elevated serum gastrin
d) decreased serum protein

A

b) elevated serum amylase

The physical signs described are characteristic of pancreatitis, which can be confirmed with serum amylase. Decreased serum albumin and protein are associated with Crohn’s disease. The clinical picture of Crohn’s usually includes cramping and does not radiate to the back.

41
Q

An umbilical hernia:

a) occurs more frequently in full term infants
b) resolves spontaneously in 3 to 6 months
c) is frequently associated with diastasis recti
d) responds well to taping

A

c) is frequently associated with diastasis recti

Umbilical hernias are a result of incomplete closure of the fascia of the umbilical ring. If small they may close in 1 year. The incidence is higher in low birth weight and premature infants. There is no evidence that manual reduction such as taping hastens closure.

42
Q

A 9 yo is brought into the clinic with abdominal pain that wakes her at night. Her parents have recently divorced and she is attending a new school. She has missed 8 days of school in the past 6 weeks. She reports occasional emesis. An appropriate management plan would be:

a) a bland diet with small frequent feedings
b) a referral to a gastroenterologist
c) to stress the importance of school attendance
d) to consult with the school psychologist

A

b) a referral to a gastroenterologist

Initially because of the social history, one might think that this recurrent abdominal pain is part of school refusal syndrome. However, the night waking and occasional emesis suggests peptic ulcer disease. Changes in diet are not usually effective in treating peptic ulcers. This warrants immediate referral to gastro.

43
Q

A 7 mo is seen with a 2 day history of diarrhea. He has had 3-4 wet diapers in the past 24 hours. The anterior fontanel is slightly depressed. Capillary refill is normal. Which degree of dehydration is most consistent with these findings?

a) 1-2%
b) 3-5%
c) 6-10%
d) greater than 10%

A

c) 6-10%

A depressed fontanel and decreased urine output are indicative of moderate dehydration.

44
Q

A 7 mo is seen with a 2 day history of diarrhea. He has had 3-4 wet diapers in the past 24 hours. The anterior fontanel is slightly depressed. Capillary refill is normal. Based on your assessment the appropriate management plan for his dehydration would be to:

a) begin BRAT diet
b) withhold formula for 24 hours and give electrolyte solution
c) begin rehydration in the office and observe for 3-4 hours
d) refer immediately for parenteral fluids

A

c) begin rehydration in the office and observe for 3-4 hours

The appropriate treatment for moderate dehydration is oral rehydration begun at the healthcare setting and observation until rehydration is complete.

45
Q

A 3 do presents with vomiting, abdominal distension, and constipation. Which of the following should you include in the differential?

a) hirschsprung disease
b) pyloric stenosis
c) celiac disease
d) meckel diverticulum

A

a) hirschsprung disease

Hirschsprung should be suspected in any newborn with abdominal distention and difficulty passing stool. Age and clinical findings are helpful in establishing this diagnosis. Celiac presents with diarrhea. Pyloric stenosis is not associated with abdominal distention, and Meckel diverticulum presents in the toddler period as painless rectal bleeding.

46
Q

A 4 yo was diagnosed with celiac at age 18 months. In addition to closely monitoring her growth, you also monitor for anemia. At this visit her lab results confirm an elevated MCV. An appropriate follow-up lab test would be serum:

a) protein
b) ferritin
c) folate
d) transferrin

A

c) folate

Celiac disease is frequently associated with folic acid deficiency. An elevated MCV indicates macrocytosis. Anemia due to folate deficiency is macrocytic.

47
Q

An 11 yo presents with complaints of chronic diarrhea and abdominal pain. You note a 5 kg weight loss from last year’s annual exam. Today his examination reveals RLQ pain and perianal skin tags. The most likely diagnosis is:

a) encopresis
b) crohn’s disease
c) irritable bowel disease
d) ulcerative colitis

A

b) crohn’s disease

While abdominal pain and diarrhea are common to all the choices, the RLQ pain is more suggestive of chohn’s disease. Perianal skin tags are common in crohn’s but would be unlikely in the others.

48
Q

A 9 yo presents with diffuse abdominal pain and acute onset of diarrhea described as frequent urge to deficate. She is passing large amounts of stool, and complains of tenderness during rectal exams. The clinical picture is highly suggestive of:

a) gastroenteritis
b) ulcerative colitis
c) giardiasis
d) appendicitis

A

d) appendicitis

Large amounts of gas and watery stools occur about 15% of the time in appendicitis, and pain upon rectal examination is a classic symptom.

49
Q

A 9 yo presents with diffuse abdominal pain and acute onset of diarrhea described as frequent urge to deficate. She is passing large amounts of stool, and complains of tenderness during rectal exams. Which of the following laboratory tests would confirm your diagnosis?

a) serum albumin
b) abdominal ultrasound
c) stool for ova and parasites
d) bone age

A

b) abdominal ultrasound

Abdominal US can reveal an enlarged appendix and help to eliminate ovarian and pelvic disease. Serum albumen and ESR would be helpful in diagnosing UC. Stool for O&P would be diagnostic of giardiasis.

50
Q

An 8 yo presents with his third episode of diarrhea in 3 months. He also complains of frequent flatulence and a decreased appetite. After going over the history, you recall that he went on a camping trip several months ago. What is his most likely diagnosis?

a) celiac disease
b) giardiasis
c) rotovirus
d) crohn’s disease

A

b) giardiasis

Giardiasis is the most common intestinal protozoal infection in children in the US. Infection is acquired through fecal-oral route and is associated with contaminated drinking water, especially in rural areas. It causes chronic, intermittent diarrhea, flatulence, poor appetite, and weight loss. there is no fever or blood in the stool.

51
Q

A 7 yo presents with a 1 week history of fever, nausea, and anorexia. His mother reports that his skin “looks funny” as well. further lab studies confirm a diagnosis of viral hepatitis. Which type of hepatitis is most likely?

a) Hep A
b) Hep B
c) Hep C
d) Hep D

A

a) Hep A

The acute onset and presence of fever as well as jaundice is associated with Hep A. Fevers are less common with other viral hepatitis conditions.

52
Q

A 2 wo is being seen for the first time since discharge from the hospital. She currently weighs 3.6 kg which is 0.3 kg below her birth weight. You learn that the mother has been using too little water when preparing formula. Which of the symptoms is least likely related to this error?

a) vomiting
b) diarrhea
c) dehydration
d) flatus

A

d) flatus

Vomiting in the newborn period may be caused by improper preparation of formula. Too little water will increase the GI and renal solute load, which may result in vomiting, diarrhea, and dehydration. Flatus is usually a result of swallowing too much air.

53
Q

Vomitus that is billous suggests:

a) GI obstruction proximal to the pylorus
b) GI obstruction below the ampulla of Vater
c) Pyloric stenosis
d) peptic ulcer disease

A

b) GI obstruction below the ampulla of Vater

Vomiting bile is generally considered a serious sign that usually indicates an obstruction below the ampulla of Vater.

54
Q

A 5 yo presents with a history of stool staining his underwear, evidence of bright red blood after wiping, and abdominal discomfort. the physical exam reveals moderate abdominal distension with a midline abdominal mass. Rectal exam is positive for an impacted rectum and two small anal fissures. The priority of management would be:

a) increasing water and fiber in the diet, and limiting milk intake
b) regular toilet sitting for 10 minutes, 3 times per day
c) two fleet enemas
d) mineral oil after breakfast and before bed

A

c) two fleet enemas

The clinical picture is consistent with encopresis. The abdomen can be distended and often a mass palpated. Anal fissures may be present from straining, but skin tags are unlikely. The first step in treatment is to remove the impaction. Once the colon is cleared, maintenance with stool softeners, diet, and regular toileting is appropriate.

55
Q

Which of the following would not be included in the management of pinworms?

a) nutritional support and iron supplementation
b) simultaneous treatment of all family members
c) washing bed linen in hot water
d) keeping fingernails short and clean

A

a) nutritional support and iron supplementation

Pinworms are a common parasite infecting children. They are easily treated with medication and simple environmental measures. No nutritional deficiencies are associated with pinworms.

56
Q

A 6 mo has been started on rice cereal sweetened with 1 TBS of honey. In addition, the infant is consuming 42oz of formula. His height and weight are at 50% on the growth curve. You would recommend:

a) adding pureed vegetables
b) substituting 4 oz juice for a formula feeding
c) adding scrambled egg whites
d) discontinuing honey

A

d) discontinuing honey

Honey may contain clostridium botulinum spores and should not be given to infants less than 1 year old. Adding vegetables is appropriate, but the risk of infant botulism is potentially life threatening. Although juice may be added, it should not be substituted for formula. Egg whites may be added at the end of the first year.

57
Q

Appropriate feeding volumes for newborn to 5 mo:

A

Age in months plus 3 = number of ounces to be fed every 3-4 hours.
1 month old + 3 = 4 ounces every 3-4 hours

58
Q

First line therapy for GERD:

A

H2 blockers:
Ranitidine 4-10 mg/kg/day in 2 divided doses (max 300 mg/day)
*Protein pump inhibitors are second-line therapy.

59
Q

Non-bloody diarrhea preceded or accompanied by vomiting and fever; symptoms last 3-8 days; dehydration may develop in severe cases:

A

Rotavirus

60
Q

Upper respiratory infection most common; symptoms similar to rotavirus (non-bloody diarrhea preceded by vomiting and fever) but last longer (5-12 days):

A

Adenovirus

61
Q

Nausea, fever, abdominal cramps, headache, malaise, vomiting more frequent than diarrhea; symptoms last 12-48 hrs:

A

Norwalk virus/ norovirus

62
Q

High fever, headache, abdominal pain and tenderness; large, watery stools in which blood and mucus may be seen; can lead to dehydration. Symptoms last 48-72 hours:

A

Shigella

63
Q

Fever, abdominal pain and cramps; water, mucoid, or bloody stools; symptoms last 2-7 days.

A

Salmonella

64
Q

Fever, malaise, abdominal pain, can mimic appendicitis or intussusception, bloody stools; symptoms last 5-7 days.

A

Campylobacter

65
Q

Flatulence, abdominal pain, FTT, anorexia, range of stools from asymptomatic to foul, steatorrhea; consider in persistent diarrhea > 7 days:

A

Giardia

66
Q

Severe abdominal pain, cramping, watery diarrhea, stools usually progress to grossly bloody; HUS can occur 1 week or more after diarrhea:

A

Escherichia coli

67
Q

Abdominal pain and cramps, pseudomembranous colitis, stools bloody with leukocytes, mucus, pus; symptom free carrier state common

A

Clostridium difficile

68
Q

Mild dehydration:

A 
3-5% body weight loss
BP: normal
Pulses: normal
Heart rate: normal
Skin turgor: normal
Fontanel: normal
Mucous membranes: SLIGHTLY DRY
Capillary refill: normal
Mental status: normal
Urine output: SLIGHTLY DECREASED
Thirst: SLIGHTLY INCREASED
69
Q

Moderate dehydration:

A 
6-9% body weight loss
BP: normal
Pulses: SLIGHTLY DECREASED
Heart rate: INCREASED
Skin turgor: DECREASED
Fontanel: SUNKEN
Mucous membranes: DRY
Capillary refill: DELAYED
Mental status: LISTLESS
Urine output:
70
Q

Severe dehydration:

A 
10% or more body weight loss
BP: normal to REDUCED
Pulses: MODERATELY DECREASED
Heart rate: INCREASED
Skin turgor: DECREASED
Fontanel: SUNKEN
Mucous membranes: DRY
Capillary refill: DELAYED, COOL AND MOTTLED
Mental status: LETHARGIC
Urine output:
71
Q

When should labs be done for gastroenteritis?

A

1) Blood or mucus in stools
2) No improvement in symptoms for > 6 days
3) Signs of severe dehydration (BUN, specific gravity, electrolytes)

Test for specific organisms:

a) virus
b) stool culture (specify E. coli 0157:H7 if bloody)
c) ova and parasites (giardia and cryptosporidium)
d) C. difficile antigen toxins A and B

72
Q

Oral rehydration replacement fluid volumes:

A

Replacement volume is given over a 4 hour period:
Mild dehydration: 50 mL/kg
Moderate/severe dehydration: 80-100 mL/kg
Additionally replace ongoing losses:
a) 5-10 mL/kg for each diarrheal stool
b) 2 mL/kg for each episode of emesis

73
Q

When should diarrhea be treated with antimicrobial?

A

1) Shigella: TMP/SMX for 5 days will shorten course and should be rx’d if in daycare, large group setting, immunosuppressed, or severe disease. NO RETURN TO DAYCARE UNTIL 2 NEGATIVE CULTURES AT LEAST 24 HRS APART 48 HOURS AFTER ABX COMPLETED; household contacts must be cultured also.
2) Salmonella: TMP/SMX or amox for infants

74
Q

Management of pinworms:

A

1) Mebendazole 100 mg single dose; repeat in 2 weeks
2) Test all family members and treat if positive (must be older than 2 and not pregnant)
3) Keep nails clean and short
4) Bathing will remove eggs from skin and decrease itching
5) Enforce excellent hand washing

75
Q

Rovsing’s sign:

A

Pain in RLQ when pressure is placed on left abdomen. Highly indicative of appendicitis in children.

76
Q

Characteristics of functional abdominal pain:

A

1) episodic or continuous abdominal pain
2) occurs at least weekly for 2 months
3) crampy/dull ache, periumbilical, nothing relieves pain
4) interferes with activity, but does not awaken at night
5) no evidence of inflammatory, anatomic, metabolic or oncological process to explain symptoms
6) uncommon under 4 years of age
7) often adversely affects school attendance (red flag)
8) unrelated to meals
9) certain personality traits:
a) maladaptive coping skills
b) anxiety
c) internalization of feelings
d) protective parents

77
Q

Characteristics of abdominal migraine:

A

1) three or more sudden episodes of acute, midline, abdominal pain
2) pain lasts at least 2 hours with intermittent symptom free periods
3) no evidence of organic disease
4) must be accompanied by at least 2:
a) headache
b) photophobia
c) family history of migraine
d) headache confined to one side only
e) aura

78
Q

Bowel retraining following constipation clean out:

A

1) Sit on toilet for one minute per year of age twice per day; don’t expect a BM with every sitting.
2) Polyethylene glycol 1 g/kg/day to keep stools soft
3) Emphasize to child that medication will help prevent painful stools
4) Goal is one soft BM every day or every-other day without encopresis

Peds (10 decks)

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