GI

Question 1

a separation of abdominal muscles from the xiphoid bone to the symphysis pubis

Answer 1

normal unless it is with hernia

Question 2

Pyloric stenosis risk factors

Answer 2

males 5:1 and familial

Question 3

Non bilious vomiting

Answer 3

pyloric stenosis

Question 4

Most common ages for pyloric stenosis

Answer 4

3 week to 6 week old

Question 5

Non bilious vomiting with plyloric olive
RUQ hard/non tender with mobile mass
Hungry 30 to 60 mins later

Answer 5

pyloric stenosis

Question 6

Consequence of pyloric stenosis

Answer 6

hyopchloremic metabolic alkalosis

Question 7

Pyloric stenosis diagnostic

Answer 7

ultrasound

Question 8

What to do about an umbilical hernia

Answer 8

Most resolve by 1 year
Refer to surgery if >5 years of age, nonreducible, dramatically enlarges, fascia defects
>1.5 cm refer esp if hard to close

Question 9

age ranges for appendicitis

Answer 9

10-19 years

Question 10

Psoas sign

Answer 10

Sign for appendicitis
have kid lay supine, place hand above rght knee, direct kid to raise leg against pressure or have kid drop right leg over exam table. kid will have pain

Question 11

obturator sign

Answer 11

Sign for appendicitis
pain in internal and external rotation of the flexed thigh
flex child’s right thigh at the hip and knee bend
rotate leg internally at the hip

Question 12

tests for appendicitis

Answer 12

Psoas sign
Obturator sign
Heel strike
Rovsing sign
Rebound tenderness

Question 13

intussusception patho

Answer 13

telescoping or invaginating of one portion of the bowel into itself. this produces obstruction and vascular compromise

Question 14

What is the most common cause of mechanical obstruction in infants and toddlers

Answer 14

intussusception

Question 15

intussusception etiology

Answer 15

50% younger than 1 year and 2:1 male to female ratio.

Peaks at 5-10 months

Question 16

Classic signs of intussusception

Answer 16

current jelly stool
vomiting
intermittent abd pain with palpable sausage shaped mass

Question 17

current jelly stool
vomiting
intermittent abd pain with palpable sausage shaped mass

Answer 17

intussusception

Question 18

colicky abd pain, infant pulls knees to chest, altered mental status, sausage shaped mass during crying

Answer 18

intussusception

Question 19

Dance’s sign

Answer 19

used to check for intussusception. It is concavity in the right lower quadrant due to absence of underlying bowel

Question 20

physical finding of intussusception

Answer 20

palpable mass in right upper quadrant

Question 21

Diagnosis of intussusception

Answer 21

barium enema 100% diagnostic

Question 22

intussusception treatment

Answer 22

pneumatic reduction. operation of it doesnt work

Question 23

no stool within first 48 hours of life

Answer 23

hirshsprung’s

Question 24

history of passing stool occasionally and massive or more frequent and pellet like. stools have pungent odor, abd distension, vomiting with lethargy

Answer 24

hirshsprung’s

Question 25

newborn that is constipated and distended with soft abd and normal hyperactive bowel sounds

Answer 25

hirshsprung's

Question 26

Rectal exam reveals slight pressure on opening and ampulla is empty, on remove explosive evacuation of stool or gas

Answer 26

hirshsprung's

Question 27

Most common source of significant lower GI bleeding in children

Answer 27

Meckel diverticulum

Question 28

Meckel diverticulum age

Answer 28

preschooler

Question 29

Meckel diverticulum patho

Answer 29

Bleeding from peptic ulceration of the ileal mucosa from HCL. secreted from ectopic gastric mucosa within the diverticulum

Question 30

Meckel diverticulum diagnostic

Answer 30

Technetium-99m pertechnate

Question 31

meckel treatment

Answer 31

surgery if intestinal obstruction, diverticulitis, and umbilicoileal fistulas and hemorrhage

Question 32

Inguinal hernia etiology

Answer 32

highest in first year of life, boys affected six times more than girls

Question 33

abd distention, bilious emesis, edema, erythema over mass, crying with distention of inguinal ring, scrotum may be swollen, irritability

Answer 33

inguinal hernia

Question 34

inguinal hernia tx

Answer 34

surgery within 2 weeks

Question 35

gold standard for swallowing issues

Answer 35

videofluoroscopy

Question 36

regurgitation

Answer 36

not forceful and effortless passage of formula into the pharynx or mouth

Question 37

vomiting

Answer 37

forceful expulsion of gastric contents through the mouth and maybe nose

Question 38

GERD

Answer 38

may not be visible as the gastric contents may only go into the esophagus that results in uncomfortable symptoms or complications

Question 39

Sandifer syndrome

Answer 39

arching done to prevent refluxant from going into the pharynx or mouth

Question 40

best indication of dehydration

Answer 40

cap refill best indication of hydration status. CRT of 2 to 2.9 indicates a 50-90 m;/kg loss of fluids

Question 41

Vomiting treatment

Answer 41

Ondansetron 2mg for kids 8-15kg, 4mg for kids 15-30 kg, 8mg if >30mg. A period of gut resting is not recommended Breast feeding infants should cont breastfeeding if possible Formula fed infants should resume formula asap

Question 42

Patho of normal GER

Answer 42

Decreased lower esophageal pressure Increased abdominal pressure Alterations in gastric motility

Question 43

GERD in infancy

Answer 43

``` Recurrent regurg Weight loss or poor weight gain Irritable Ruminative bx Wheezing or coughing ```

Question 44

GERD in kids

Answer 44

``` heartburn/chest pain Hematemesis Dysphagia Cough Hoarse voice Asthma trigger ```

Question 45

Gerd signs and symptoms

Answer 45

``` Esophagitis Esophageal stricture Barrett esophagus Laryngeal inflammation Recurrent pnx Anemia Dental erosion Sandifer syndrome posturing ```

Question 46

``` Esophagitis Esophageal stricture Barrett esophagus Laryngeal inflammation Recurrent pnx Anemia Dental erosion Sandifer syndrome posturing ```

Answer 46

GERD

Question 47

Gold standard for GERD dx

Answer 47

pH probe but most feel it is unnecessary. Dx with history and physical

Question 48

GERD infancy non medication tx

Answer 48

``` prone positioning at 30 degree angle after feeding Thicken formula Less volume more frequently Hypoallergenic formula Gentleease ```

Question 49

Formula's for cow's milk protein allergy

Answer 49

Alimentum and nutramigen

Question 50

Formula's for kids with allergies

Answer 50

Elecare, Alfamino, Neocate

Question 51

GERD tx in older kids

Answer 51

PPI Histamine 2 receptor antagonists (approved in infants) Metoclopramide can stimulate stomach movement

Question 52

abd cramps, flatulence, bloating, anorexia and weight loss, bouts of watery diarrhea. day care kid or trip to a lake or something

Answer 52

giardia

Question 53

giardia lab

Answer 53

enzyme immunoassay or stool specimen for trophozoites

Question 54

giardia treatment

Answer 54

Metronidazole/flagyl 15 mg/kg per day in 3 divided doses for 5 days

Question 55

perirectal itch, nervous, irritable, hyperactive, insomina

Answer 55

enterobius vermicularis (pinworms)

Question 56

pinworm diagnostic

Answer 56

1cm long worms at night and microscopic exam of worms at night stool exam not productive

Question 57

pinworm tx

Answer 57

Mebendazole 100mg tab Pyrantel pamote 11mg/kg Albendazole Tx family members

Question 58

Worms in stool or vomit | Bowel or biliary obstruction

Answer 58

Ascaris lumbricoides (round worm)

Question 59

Ascaris lumbricoides (round worm) diagnostic

Answer 59

Seen on microscopy and see marked eosinophilia

Question 60

Ascaris lumbricoides (round worm) tx

Answer 60

Albendazole 400 mg Mebendazole 100 mg bid for 3 days or 500mg once Ivermectin

Question 61

worms in stool, abd pain, nausea, diarrhea, excessive appetite

Answer 61

Taenia (tapeworm)

Question 62

Taenia (tapeworm) diagnostic

Answer 62

stool microscopy. ova and parasites

Question 63

Taenia (tapeworm) tx

Answer 63

Praziquantel 5-10 mg/kg | Niclosamide 50mg/kg

Question 64

stool incontinence after an age when kids should be able to control bowel movements, usu at 4 years

Answer 64

encopresis

Question 65

stained underwear, report of fewer than 3 bm's per week. difficult or painful defecation. kid become still suddenly during play (to hide urge to poo). Bloating feeling and pain.

Answer 65

encopresis

Question 66

Mass felt at midline in suprapubic area, anal fissures, abd distention and abd tenderness. Impactions on rectal exam

Answer 66

encopresis

Question 67

encopresis treatment

Answer 67

bowel cleanse (bisacodyl suppository) then miralax

Question 68

delay of defecation for 2 or more weeks

Answer 68

constipation

Question 69

constipation w/o objective evidence of pathological condition. caused by painful bowel movements w resultant voluntary withholding of feces by a kid who wants to avoid unpleasant defecation

Answer 69

functional constipation

Question 70

Pain or bleeding when passing stools, abd pain, waxing and waning symptoms, nausea/vomiting, abd distention

Answer 70

constipation

Question 71

how many stools do infants have infants have per day during first week of life

Answer 71

4

Question 72

stools gradually decline to __ per day at 2 years of age

Answer 72

1.7

Question 73

__ stools per day at age 4 years of age

Answer 73

1.2

Question 74

some breast feed babies do not have stools for several days or longer

Answer 74

true

Question 75

constipation diagnosis

Answer 75

history and physical is sufficient stool test for occult blood is recommended in all infants and kids w abd pain. ftt. diarrhea, or fam hx of polyps/colon cancer

Question 76

6month to 5 year old with diarrhea. 3 weeks of frequent loose stools, and no other GI illness

Answer 76

FTT

Question 77

Toddler's diarrhea tx

Answer 77

most symptoms resolve in 90% of kids by age 3.

Question 78

Toddler's diarrhea patho

Answer 78

excessive fluid intake that overwhelms gi tract

Question 79

happy kid that is active w normal growth, 5-10 large loose stools a day, frequent stooling in the morning, no illness vomiting or abd pain

Answer 79

Toddler's diarrhea

Question 80

diarrhea diagnostic

Answer 80

stool speicmen

Question 81

1st line test for chron's

Answer 81

ESR

Question 82

Test for celica disease

Answer 82

anti gliadin antibodies

Question 83

anal skin tag

Answer 83

indicative of chron's

Question 84

triad of gerd in older kid

Answer 84

heartburn, epigastric pain, regurgitation

Question 85

pathological gerd

Answer 85

ftt, frequent vomiting, sandifer syndrome

Question 86

Cows milk protein intolerance patho

Answer 86

non ige mediated, milk protein isnt broken down

Question 87

Cows milk protein intolerance tx

Answer 87

resolves by 1-3 years

Question 88

cows milk protein allergy patho

Answer 88

IgE mediated

Question 89

cows milk protein allergy symptoms

Answer 89

bloody stool, diarrhea, vomiting, food refusal, hives, or anaphylaxis

Question 90

cows milk protein allergy tx

Answer 90

dx with food challenge and keep on dairy free diet

Question 91

diagnostic test for appendicitis

Answer 91

CT scan gold standard. may have inc wbc count

Question 92

initial signs of appendicitis

Answer 92

vague periumbilical pain that moves to RLQ

Question 93

Impaired growth, diarrhea, steatorrhea, abd distention, wasting, fatigue, delayed puberty, dermatis herpecticum. triggered after eating gluten

Answer 93

celiac disease

Question 94

diagnostic of celiac

Answer 94

endoscopy/biopsy is definitive

Question 95

Colic treatment

Answer 95

supportive, will resolve over time. Dry diet alterations and limiting over stimulation.

Question 96

What is infantile colic

Answer 96

persistent crying in infant less than 3 mos of age, for 3 hrs a day 3 days a week

Question 97

bloody diarrhea, weight loss, delayed growth, anorexia, arthritis, abd pain, oral ulcers, skin lesions usu in teenager

Answer 97

ulcerative colitis

Question 98

ulcerative colitis dx

Answer 98

esr, crp, cbc, stool culture, colonoscopy. Endoscopy=definitive dx

Question 99

abd pain and recurrent vomiting=major criteria | hematemesis, heart burn, anorexia, n, belching, anemia=minor

Answer 99

peptic ulcer disease

Question 100

peptic ulcer diagnostic

Answer 100

endoscopy + biopsy

Question 101

peptic ulcer tx

Answer 101

antacid and amoxicillin

Question 102

String sign on upper GI

Answer 102

pyloric stenosis

Question 103

pyloric stenosis tx

Answer 103

surgical

Question 104

weight loss, delayed growth, large joint pain, abd pain, bloating and abd pain after meals, jaundice, perinal skin tags and annal fissures

Answer 104

chron's disease

Question 105

chrons diagnostic

Answer 105

esr and crp | endoscopy=definitive diagnosis

Question 106

chron's tx

Answer 106

antidiarrheals, corticosteroids, aminosalicylates, immune modulators

Question 107

acute abdominal LUQ pain assc with back pain, fever and vomiting

Answer 107

pancreatitis