GI

Question 1

What is the approach you should take for abdominal pain in pediatrics?

Answer 1

Look at vital signs; FULL exam including genitalia & rectal; labs (CBC, ESR/CRP, LFT’s, H&H), plain abdominal xray; and ultrasound

Question 2

What does functional constipation lead to and what does it cause?

Answer 2

Leads to Voluntary Stool Withholding – usually occurs at the introduction of solid foods

Cause: frightening, painful/bad experience

Question 3

What would you notice on exam with constipation in a child?

Answer 3

Abdominal distention, palpable stool mass, soiled underwear, impacted stool on rectal exam

Question 4

How do you diagnose constipation in peds?

Answer 4

Abdominal x-ray

Question 5

How do you treat constipation in peds?

Answer 5

Infants = glycerin suppository; sorbitol-containing juices (apple, prune)

Children = polyethelen glycol (miralax), disimpaction, and diet change

Question 6

What is the definition of diarrhea in peds?

Answer 6

Loose or watery stools 3 or more times/day

Question 7

What do you need to look for on exam when you suspect diarrhea?

Answer 7

Eval for dehydration (urine output, HR, dry mucus membranes, delayed cap refill, and reduced skin turgor); is stool bloody; have you traveled; recent Abx

Question 8

How do you diagnose & treat diarrhea in a child?

Answer 8

Diagnose = abdominal x-ray, stool culture (for bloody), UA (to r/o UTI), or air contract enema

Treat = hydration

Question 9

What disorder is the most common congenital craniofacial anomaly that can lead to feeding difficulties and nasal regurgitation?

Answer 9

Cleft lip/palate

Question 10

If an infant has a chronic cough, wheezing, asthma, acid brash (wet burps) and vomiting shortly after feeding – what diagnosis do you think of?

Answer 10

GERD

Question 11

How do you confirm the diagnosis of GERD in peds?

Answer 11

2-4 weeks of a PPI (or just start with H2 blocker) → Barium swallow → endoscopy if sxs continue for 2 years

Question 12

How do you treat GERD in a child?

Answer 12

Lifestyle modifications, PPI’s, and H2 blockers

Question 13

What is commonly connected with GERD?

Answer 13

Asthma

Question 14

IF a brand new baby comes out and they have drooling, choking, respiratory distress, and gastric distention – what diagnosis?

Answer 14

Tracheoesophageal Fistula & Esophageal Atresia

Question 15

How would you confirm diagnosis of a tracheoesophageal fistula?

Answer 15

Inability to pass a NG tube into the stomach

Question 16

If an infant has projectile vomiting after feeding – what diagnosis? What would see on exam?

Answer 16

Pyloric stenosis & see an olive-shaped

Question 17

What is occurring in pyloric stenosis?

Answer 17

Hypertrophy of the musculature around the pyloric sphincter resulting in gastric outlet obstruction

Question 18

How would you confirm diagnosis of pyloric stenosis? How do you treat?

Answer 18

Ultrasound
Barium swallow – “string sign”
Tx = Surgery

Question 19

If an infant has sudden onset of bilious vomit (green) and is inconsolable, what diagnosis?

Answer 19

Volvulus (malrotation of the intestine – caused by lads bands)

Question 20

How do you confirm diagnosis of volvulus? How do you treat?

Answer 20

Barium study = bird-beak cut off and corkscrew of duodenum & Abdominal x-ray shows “double bubble” sign.
Treat = emergent surgery!

Question 21

What must you consider if a neonate is unable to pass Meconium within 72 hours of life?

Answer 21

Hirschsprungs disease

Question 22

What would you do on exam for Hirschsprungs disease? How would you confirm diagnosis?

Answer 22

Explosive expulsion of gas & stool after digital rectal exam (squirt sign)

Must do a rectal biopsy**

Question 23

If a child presents with painless GI bleeding and sxs similar to appendicitis (even after an appendectomy) what diagnosis do you think of? How do you confirm diagnosis?

Answer 23

Meckel’s diverticulum

Do a Meckel’s Scan! “The Rules of Twos!”

Question 24

If a child presents with sudden onset of intermittent severe abdominal pain with episodes of drawing the knees towards the chest in, what diagnosis should you have on your differential?

Answer 24

Intussusception

Question 25

What would you find on PE and how would you confirm diagnosis of intussusception?

Answer 25

PE = sausage-shaped abdominal mass on the right side of the colon & currant-jelly stools

Diagnose = Ultrasound showing “target sign” or “bulls eye”

Question 26

How do you treat intussusception?

Answer 26

Barium or Air-enema (help diagnose & treat)

Question 27

Right after a baby is born, what do you always need to check on their bum?

Answer 27

Their Anus! Making sure it’s not imperforated → if it is imperforated something else is wrong

Question 28

If you suspect appendicitis in a pediatric patient what would you do on exam and how would you confirm?

Answer 28

+McBurney’s point (peritoneal inflammation = Rovsing sign, obturator sign, psoas sign); pain with coughing or jumping; CT imaging; and if a girl has started her period be sure to R/O ectopic pregnancy!

Question 29

What are the 3 types of hernias seen in children?

Answer 29

Umbilical, diaphragmatic (diagnose with chest x-ray), and inguinal hernia

Question 30

What are the 3 ways a hernia can present?

Answer 30

Either reducible, incarcerated (cannot reduce but blood supply is not compromised) or strangulated

Question 31

What type of hernia is the worst and often seen within the first hours of life?

Answer 31

Diaphragmatic hernia allows the abdominal viscera to herniate into the chest. Do chest xray

Question 32

How do you diagnose lactose intolerance in children?

Answer 32

Lactose breath hydrogen test