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Rotation 1: Pediatrics > GI/Nutritional (10%) > Flashcards

GI/Nutritional (10%) Flashcards

1
Q

There is increased incidence of pyloric stenosis with the use of what medication?

A

Erythromycin, in infants <6 months of age

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2
Q

What are risk factors for developing Vit C deficiency?

A

diets lacking raw citrus fruits & green vegetables (excess heat denatures vitamin C), smoking, alcoholism, malnourished individuals, elderly

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3
Q

What is the incubation period of salmonella gastroenteritis?

A

5-14 days

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4
Q

What is the method of transmission for Hep A?

Heb B?

Hep C?

Hep D?

Hep E?

A

A: Feco oral (international travel, water/food)

B: parenteral, sexual, perinatal, percutaneous

C: parenteral (IV drug use)

D: requires Hep B to cause co-infxn or superimposed infxn

E: feco-oral

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5
Q

How to make a dx of Crigler-Najjar syndrome?

Type 1 levels of serum indirect bilirubin?

Type 2 levels of serum indirect bilirubin? When may this level increase?

A

Isolated indirect (unconjugated) hyperbilirubinemia with normal LFTs

Type 1: 20-50 mg/dL

Type 2: 7-10 mg/dL (may increase during illness or fasting)

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6
Q
A
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7
Q

Secretory diarrhea is characterized by (low/normal/high) osmotic gap, (small/large) volume, (decrease/no change/increase) in diarrhea with fasting

A

normal

large

no change

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8
Q

Appendicitis most commonly occurs in patients in what age group?

A

10 y/o - 30 y/o

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9
Q

If a patient has persistent sx or complications of GERD, what test is often performed first?

A

Endoscopy

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10
Q

What is the incubation period of salmonella?

What are some places/things a person might contract it from?

Clinical manifestations? For a patient with sickle cell dz?

Management?

A

6-48 hours

Most common source is poultry products (dairy, meat, eggs), exotic pets (petiles, turtles) –> feco-oral

mucousy-bloody diarrhea

SCD pts: increased risk of osteomyelitis with salmonella

Fluids, if severe: Fluoroquinolones

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11
Q

What is the incubation period of enerohemorrhagic E. coli 0157:H7?

What are some places/things a person might contract it from?

Does it produce a (cytotoxin/enterotoxin/exotoxin)?

Clinical manifestations?

Management? What about abx?

A

4-9 days

undercooked ground beef, unpasteurized milk/apple cider, day care centers, contaminated water

cytotoxin

watery diarrhea early on that turns bloody, crampy abd pain, vomiting, fever low grade or absent

Fluid replacement, abx controversial as there is increased incidence of hemolytic uremic syndrome in children

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12
Q

What are some examples of protozoans that can cause enterocolitis?

A

Giardia Lamblia

Amebiasis

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13
Q

If jaundice occurs in the first 24 hours of life, (physiologic/pathologic) jaundice may be suggested, and usually indicates ______ or ______ _______

A

pathologic

hemolysis or hereditary spherocytosis

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14
Q

Pyloric stenosis is caused by _______ & ______ of the muscular layers of the pylorus, causing a functional (inlet/outlet) obstruction

A

Hypertrophy & hyperplasia

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15
Q

What is another name for Vitamin C?

A

Ascorbic acid

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16
Q

What causes osmotic diarrhea?

A

Malabsorption of nonabsorbalble substances in the intestinal lumen with secondary accumulation of fluid, the increased solutes in the GI tract promotes diarrhea by pulling water into the gut

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17
Q

What other sx are commonly associated with GERD?

What are some sx that are atypical?

A

heartburn increased with supine position 30-60 min after a meal

regurgitation

dysphagia

nocturnal cough

Atypical: hoarseness, aspiration PNA, “asthma” (bronchospasm from acid contact with the lung), nocardiac chest pain

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18
Q

What is the enzyme required to convert indirect bilirubin into direct bilirubin?

A

Glucuronosyltransferase [UGT]

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19
Q

What is often used as an initial screening test to see if a pt has hirschsprung disease?

What is used for definitive diagnosis?

A

Anorectal Manometry

Rectal Bx (can also use rectal suction bx–less invasive and do not need anesthesia)

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20
Q

What are possible complications of GERD?

A

esophagitis

stricture

barretts esophagus

esophageal adenocarcinoma

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21
Q

What is the incubation period of shigella?

What are some places/things a person might contract it from?

Clinical manifestations?

Complications? In children?

What would be seen on CBC? Sigmoidoscopy?

Management? If severe?

A

1-7 days

feco-oral contamination

lower abd pain, high fever, tenesmus, explosive watery diarrhea that is mucoid and bloody

Complications: severe cases may lead to toxic megacolon, reactive arthritis (Reiter’s syndrome), and neurologic manifestations especially in young children (febrile sz)

CBC shows leukemoid reaction (WBC >50,000)

Sigmoidoscopy: shows punctate areas of ulceration

Fluids, if severe: Trimethoprim-sulfamethoxazole 1st line

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22
Q

What are some examples of organisms that can cause invasive infectious diarrhea?

A

Campylobacter enteritis

Shigella

Salmonella

Enterohemorrhagic E Coli 0157:H7

Yersinia enterocolitica

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23
Q

What is the infective organsim that causes Whipple’s disease?

In what employment population is this condition most common?

Clinical manifestations?

Dx?

Management?

A

Tropheryma whippelii

Farmers (around contaminated soil)

Malabsorption, wt loss, statorrhea, rhythmic motion of eye muscles while chewing

Duodenal bx, showing periodic acid-schiff + macropgaes, non acid fast bacilli, dilation of lacteals

PCN or tetracycline for 1-2 years

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24
Q

There is an increased incidence of duodenal atresia in patients who also have _____ ______

A

Down syndrome

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25
Q

Crigler-Najjar Syndrome: Hereditary (unconjugated/conjugated) (indirect/direct) hyperbilirubinemia

A

unconjugated

indirect

0.6 - 1.0 per million

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26
Q

What is the management for duodenal stresia?

A

Decompression of the GI tract

electrolyte and IV fluid replacement

Duodenoduodenostomy (surgical repair or anastamosis)

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27
Q

Why do newborns present with physiologic jaundice (anatomically)?

Due to increased indirect (unconjugated) or direct (conjugated) bilirubin?

A

Immature liver uanble to efficiently conjugate bilirubin due to decreased UGT activity

Indirect (unconjugated)

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28
Q

T/F: Most patients with Gilbert’s syndrome are asymptomatic

A

True

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29
Q

What two findings are needed to make a diagnosis of Dubin-Johnson Syndrome?

What are the three D’s of Dubin-Johnson Syndrome?

A

Mild isolated coniugated (direct) hvperbilirubinemia* (often between 2 - 5 mg/dL) but can increase with concurrent illness, pregnancy or OCPs.

Grossly black liver on biopsy

3D’s: Dubin, Dark liver, Direct hyperbilirubinemiea

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30
Q

In a pt with acute Hep A, (IgM HAV Ab/IgG HAVE Ab) is positive, and in a pt with past exposure to Hep A, (IgM HAV Ab/IgG HAVE Ab) is positive

A

IgM HAV Ab

IgG HAV Ab (with negative IgM)

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31
Q

What is the recommended management of Dubin-Johnson syndrome?

A

None needed

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32
Q

What is Reye syndrome?

A

Fulminant hepatitis most commonly seen in children associated with ASA use during viral infections, but may also occur without ASA use

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33
Q

What are some places/things a person might contract vibrio cholerae from?

Clinical manifestations?

Management?

A

Contaminated food and water

Poor sanitation and overcrowding conditions, especially abroad

Grey, “rice water” stools without blood or pus, producing rapid dehydration, death caused by hypovolemia

Supportive, fluid replacement

Can Rx tetracycline abx as it may shorten dz course

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34
Q

What is the incubation period of camplylobacter enteritis?

What are some places/things a person might contract it from?

What would be seen on stool cx?

Clinical manifestations?

Management?

A

3 days

Contaminated food: i.e. undercooked poultry, raw milk, water, dairy cattle

“S, Comma, or Seagull Shaped organisms”

fever, HA, abd pain, may mimic acute appendicitis, diarrhea initially watery but turns bloody

Fluids, if severe: Erythromycin is 1st line

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35
Q

What is niacin/nicotinic acid (B3) deficiency usually secondary to?

What are the 3 Ds of Pellagra?

A

diets high in corn (lacks niacin and tryptophan) aor diets which lack tryptophan

Diarrhea, Dementia, Dermatitis, (Death)

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36
Q

What is the hallmark symptom of GERD?

When and where does this sx present?

A

Heartburn (pyrosis)

often retrosternal and postprandial

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37
Q

If upper endoscopy is normal in a pt with GERD sx, a(n) ______ _____ is used to determine if there is decreased LES pressure

A

esophageal manometer

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38
Q

Dubin-Johnson Syndrome: a hereditary (unconjugated/conjugated) (indirect/direct) hyperbilirubinemia due to decreased hepatocyte excretion of conjugated bilirubin (gene mutation at gene _____)

Usually, patients are (asymptomatic/symptomatic)

A

conjugated

direct

MRP2

Asymptomatic

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39
Q

What are some examples of antiemetic medications?

A

Ondansetron (Zofran)

  • Granisetron*
  • Dolasetron*

Dopamine Blockers (Prochlorperazine [Compazine], Promethazine [Phenergan], Metoclopramide [Reglan])

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40
Q

What are the “3 H’s” of scurvy?

A

Hyperkeratosis: hyperkeratotic follicular papules

Hemorrhage: vascular fragility, recurrent hemorrhages in gums, skin (perifollicular), and joints, impaired wound healing

Hematologic: anemia, glossitis, increased bleeding time

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41
Q

Children <6 y/o with Hepatitis ____ are usually aymptomatic

A

A

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42
Q

What condition is the most common cause of noncardiac chest pain?

A

GERD

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43
Q

Who should you not give antimotility agents to? Why?

A

Patients with invasive diarrhea (may cause toxicity)

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44
Q

In physiologic jaundice of a newborn, (indirect/direct) bilirubin rises in days ___-___ & falls in about half of the neonates during the (1st/2nd/3rd) week of life

A

indirect

3-5 days

1st

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45
Q

What are sx of Vit A deficiency?

A

Visual changes (especially night blindness), xerophthalmia (dry eyes)

Impaired immunity (poor wound healing), dry skin, poor bone growth, taste loss

Squamous metaplasia (conjunctiva, respiratory epithelium, urinary tract)

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46
Q

What is the test of choice for dx of lactose intolerance?

Why?

A

Hydrogen breath test

  • Hydrogen produced when colonic bacteria ferment the undigested lactose*
  • Usually performed after a trial of a lactose-free diet​*
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47
Q

What is + Psoas sign?

A

RLQ pain with right hip flexion/extension (raise leg against resistance)

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48
Q

Intussusception occurs when an intestinal segment _________ into the adioining intestinal lumen, which leads to obstruction of the _______

2/3 of patients are between _____ to _____ of age

MC in (males/females)

MC occurs at the _______ junction

Often occurs after _____ _____

A

invaginates/”telescopes”

bowel

6 months - 18 months

males

ileocolic

viral infection

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49
Q

What are some places/things a person might contract yersinia enterocolitica from?

Clinical manifestations?

Management?

A

contaminated pork, milk, water, and tofu

fevre, abd pain that mimics acute appendicitis and can cause mesenteric adenitis, producing abd TTP and guarding

Fluid replacement, if severe: fluoroquinolones

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50
Q

Management of Acute Hep B?

Management of Chronic Heb B?

A

Acute: Supportive

Chronic: Alpha interferon 2b, Lamivudine, Adefovir and also newer options such as Tenofovir and Entecavir (very potent)

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51
Q

What is the diarrhea described as in a patient with Giardia lamblia?

A

Frothy, greasy, foul diarrhea

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52
Q

What tx is recommended for pts with Gilbert’s disease?

A

None needed, because it is a mild, benign disease

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53
Q

What is + Rovsing sign?

A

RLQ pain with LLQ palpation

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54
Q

Appendicitis is caused by _____ of the appendix caused by ….

A

obstruction

fecalith, FB, malignancy

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55
Q

What is the initial course of management for pyloric stenosis?

Definitive management?

A

Initial: Rehydration (IV fluids), potassium repletion if hypokalemic from vomiting

Pyloromyotomy is the definitive management

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56
Q

What is the difference between a direct and an indirect inguinal hernia?

A

Their relation to the inferior epigastric vessels

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57
Q

What is the mainstay of treatment for Type 1 Crigler-Najjar Syndrome?

What is definitive tx?

A

Phototherapy

Liver transplant

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58
Q

What is an umbilical hernia?

A

Through the umbilical fibromuscular ring

Congenital (failure of umbilical ring closure)

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59
Q

In type 1 Crigler-Najjar syndrome, there is (no/very little/a lot) of UGT activity.

What is the inheritance pattern of type 1?

In type 2 Crigler-Najjar syndrome, there is (no/very little/a lot) of UGT activity. Approximately how much (%) of normal?

A

No

autosomal recessive

very little (<10% of normal)

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60
Q

What will a pt with duodenal stresia present with?

A

Intestinal obstruction shortly after birth, abd distension and bilious vomiting

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61
Q

What is osteomalacia?

A

Diffuse body pains, muscle weakness, and fractures

Looser lines (radiolucencies on XR)

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62
Q

What are some examples of organisms that can cause noninvasive infectious diarrhea?

A

Staphylococcus aureus

Bacillus cereus

Vibrio cholerae and vibrio parahemolyticus

Enterotoxigenic E. Coli

Clostridium Difficile

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63
Q

What are the three stages for management of GERD?

A
  1. Lifestyle modifications
  2. PRN pharmacological Rx (antacids, H2 receptor antagonists)
  3. Initiation of scheduled pharmacologic tx (PPI for moderate-severe dz)

Nissen fundoplicaiton if refractory to tx

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64
Q

What is the incubation period of typhoid (enteric) fever caused by S. typhi?

Clinical manifestations?

A

>1-2 weeks

Cephalic phase: HA, constipation, pharyngitis, cough, crampy abd pain, diarrhea, and PEA SOUP STOOLS, intractable fever, relative bradycardia, hepatosplenomegaly, blanching “ROSE SPOTS” appear in 2nd week

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65
Q

Post exposure prophylaxis for exposure to Hep A is _____ , and should be administered to close contacts

A

HAV immune globulin

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66
Q

Jaundice usually progresses from _____ to ____ in the body with (decreasing/increasing) bilirubin levels

A

Head to toe

increasing

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67
Q

What is + Obturator sign?

A

RLQ pain with internal and external hip rotation with flexed knee

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68
Q

What is considered gold standard for persistent symptomatic GERD?

A

24 hour ambulatory pH monitoring

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69
Q

What infectious organism is the most common antecedent event in post-infectious Guillan Barre syndrome?

A

Campylobacter enteritis

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70
Q

Bilirubin >_____ mg/dL can lead to kernicterus and neurotoxicity, from irreversible depostition of bilirubin in the ____, _____, and _____.

A

>20 mg/dL

basal ganglia, pons, cerebellum

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71
Q

What vitamin deficiency is osteomalacia in adults secondary to?

A

Vitamin D

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72
Q

What is the only definitive tx for fulminant hepatitis?

A

Liver transplant

73
Q

What are risk factors for being deficient in Vitamin A?

A

liver dz, ETOHics, fat free diets

74
Q

Increased (indirect/direct) bilirubin is always pathologic

A

direct

75
Q

What are the clinical manifestations of lactose intolerance?

A

loose stools, abd pain, flatulence, borborygmi after ingestion of milk or milk-containing products

76
Q

What is the incubation period of staphylococcus aureus?

What are some places/things a person might contract it from?

Clinical manifestations?

Management?

A

IP: onset of sx w/in 6 hours

Food contamination MC: i.e. dairy products, mayo, meats, eggs

VOMITING, cramps, HA, diarrhea

Self limited

77
Q

In a pt with intussusception, what may their abd pain be described as?

A

“colicky”

78
Q

What are some examples of stool softeners/laxatives that can be used in the management of constipation?

A

Fiber

Bulk forming laxatives: Psyllium, methylcellulose (Citrucel), polycarbophil (Fibercon), wheat dextrin (Benefiber)

Osmotic laxatives: Polyethylene glycol (Golytely, Miralax,), Lactulose, Sorbitol, Saline laxatives (Milk of Magnesia, Magnesium citrate)

Stimulant laxatives: Bisacodyl (Dulcolax), Senna

79
Q

What is the recommended tx for Type 2 Crigler-Najjar syndrome?

Can this tx be used in Type 1?

A

Tx usually is not necessary, but if required Phenobarbital has been shown to increase UGT activity

Type 1 is NOT responsive to Phenobarbital

80
Q

____% of Hep B and ____% of Hep C infections become chronic

A

10% B

80% C

81
Q

Chronic Hep B infection is ___% perinatally acquired

A

>90%

82
Q

May develop _____ swelling with indirect hernias

A

scrotal

83
Q

What are ALARM sx associated with GERD?

A

dysphagia, odynophagia, weight loss, bleeding (suspect malignancy)

84
Q

Hepatitis ____ is associated with waterborne outbreaks

A

E

85
Q

What are the possible clinical manifestations of fulminant hepatitis?

A

Encephalopathy: asterixis

Coagulopathy

Hepatitis

Jaundice (not usually seen in Reye syndrome)

86
Q

Pyloric stenosis is most commonly seen in patients who are (african american/asian/caucasian) and who are (male/female)

If seen in adults, it is associated with _____ _____ dz

A

Caucasians

Males (4:1)

Chronic ulcer dz

87
Q

What is the most common cause of intestinal obstruction in infancy?

A

Pyloric stenosis

88
Q

What will be seen on Abd XR of a pt with duodenal atresia?

A

Distended duodenum and distended stomach separated by the pyloric valve causing a “double bubble” sign

89
Q

Hirschsprung disease is the congenital absence of ______ cells most commonly in the ____ and ____ causing (dysfunctional/functional) obstruction

Increased incidence in (males/females) and children with what other diagnosis?

A

Ganglion

distal colon and rectum (75%)

functional

males

Down syndrome

90
Q

What is the management of lactose intolerance?

A

Lactase enzyme preparations, Lactaid (prehydrolyzed milk), Lactose free diet

91
Q

What is the difference between an incarcerated and strangulated hernia?

A

Incarcerated: painful, enlargement of an irreducible hernia ± nausea & vomiting if bowel obstruction present

Strangulated: ischemic, incarcerated hernias with systemic toxicity, (irreducible hernia with compromised blood supply)

Severe painful bowel movement (may refrain defecation)

92
Q

Describe the difference between invasive and noninvasive diarrhea.

A

Noninvasive: vomiting, watery, voluminous (involves small intestine), no fecal WBCs or blood

Invasive: high fever, blood and fecal leukocytes, not as voluminous (large intestine), mucus.

93
Q

Osmotic diarrhea is characterized by (decreased/increased) diarrhea with fasting, (decreased/increased) osmotic gap, and (decreased/increased) fecal fat, with a deficiency in what type of vitamins?

A

increased

increased

increased

fat-soluble

94
Q

What are the three hepatidities that are associated with chronicity?

A

Hepatitis B, C, and D

95
Q

What is the tx for Vit D deficiency?

A

Ergocalciferol (Vit D)

96
Q

Hepatitis _____ is the most common source for adults

A

A

97
Q

What are the peritoneal signs that will be present on PE of the abd in a pt with appendicitis?

A

Guarding, rebound, rigidity

98
Q

What may a pt present with if they have type 1 Crigler-Najjar syndrome?

Type 2?

A

Type 1: neonatal jaundice w/ severe progression in the 2nd week, leading to kernicterus

Type 2: usually asymptomatic. Often an incidental finding on routine lab testing.

99
Q

Gilbert’s Syndrome: Hereditary (unconjugated/conjugated) (indirect/direct) hyperbilirubinemia that is relatively (uncommon/common) (___-___% of US population)

A

unconjugated

indirect

common

5 -10% US population

100
Q

In Gilbert’s Syndrome, the patient has (no/reduced/normal/high) UGT activity at ___% of normal, and (decreased/increased) bilirubin uptake, leading to increased (indirect/direct) bilirubin

A

reduced

10-30% of normal

decreased

indirect

101
Q

What is the first line test for dx in a patient with pyloric stenosis?

What would be observed?

A

Ultrasound

elongation/thickening of pylorus

More sensitive and no radiation risk

102
Q

What lab values will be elevated in viral hepatitis?

A

ALT>AST

103
Q

What vitamin deficiency causes Rickets in children?

A

Vit D

104
Q

What is recommended for management of newborn jaundice?

For when bilirubin is >15 mg/dL

For severe cases?

A

Phototherapy, when Bili is >15 mg/dL

Exchange transfusion for severe cases

105
Q

What does Hesselbach’s triangle consist of?

A

“RIP” Rectus Abdominis (medial), Inferior epigastric vessels (lateral) & Poupart’s ligament (inferiorly).

106
Q

Describe the vomit of a patient with pyloric stenosis

Will the child be hungry or not?

What else may the pt show signs of?

What may be palpated on the abd of a pt with pyloric stenosis?

A

NON-bilious projectile vomiting after feeding

Child remains hungry

Signs of dehydration & malnutrition, hypochloremic metabolic alkalosis (from vomiting), jaundice

OLIVE-SHAPED non-tender, mobile, hard pylorus, 1-2cm in diameter (palpated especially after the infant has vomited), hyperperistalsis

107
Q

Constipation is defined as having ____ stools per week

A

<2

108
Q

What are sx of Vit A excess?

A

Teratogenicity, alopecia, ataxia, visual changes skin disorders, hepatotoxicity

109
Q
A
110
Q

What is the most common cause of diarrhea in children?

A

Rotavirus

(70%)

111
Q

In a patient with appendicitis, does vomiting come before or after pain?

A

after

112
Q

Pts with Gilbert’s syndrome have (decreased/increased) isolated indirect bilirubin levels with (abnormal/normal) LFTs

A

increased

normal LFTs

113
Q

If a pt presents with jaundice without elevated LFTs, what disorders should be suspected?

A

Familial bilirubin d/o: Dubin-Johnson Syndrome, Gilbert Syndrome

Hemolysis

114
Q

Inguinal hernias usually (do/do not) require surgical repair

A

Do

115
Q

What would be seen on an Upper GI contrast in a pt with pyloric stenosis?

A

STRING SIGN (dye through narrowed channel) and delayed gastric emptying

116
Q

By what age does an umbilical hernia usually resolve by?

If it does not resolve by age ____, surgical repair should be done to avoid incarceration or strangulation

A

2 y/o

5 y/o

117
Q

What does each result correlate with?

+ HBsAg (Surface Antigen) =

+HBsAb (Surface Antibody) =

+HBcAb (Core Antibody) =

+HBeAg (Envelope Antigen) =

+HBeAb (Envelope Antibody) =

+ HBV DNA =

A

+ HBsAg (Surface Antigen) = 1st evidence of Hep B infection, establishes infection and infectivity

+HBsAb (Surface Antibody) = distant resolved infection (recovery) OR vaccination (sole serologic marker)

+HBcAb (Core Antibody) = IgM indicates acute infection (1st Ab to appear)

IgG indicates chronic infection or distant resolved infection

+HBeAg (Envelope Antigen) = increased viral replication and increased infectivity

+HBeAb (Envelope Antibody) = warning viral replication, decreased infectivity

+ HBV DNA = active replication in the liver

118
Q
A
119
Q

What infectious organism is the most common cause of traveler’s diarrhea?

A

Enterotoxigenic E. Coli

120
Q

95% of patients with pyloric stenosis present in the 1st ___-___ weeks of life (rare >____ months)

A

3-12 weeks

rare >6 months

121
Q

Direct inguinal hernias protrude (medial/lateral) to the inferior epigastric vessels within ______ triangle.

(Does not/Does) reach the scrotum

A

medial

Hesselbach’s

Does not

122
Q

What may be seen on PE of the abd in a patient with intussusception?

A

Dance’s sign = SAUSAGE-SHAPED MASS in the RUQ or hypochondrium & emptiness in the right lower quadrant (due to telescoping of the bowel).

123
Q
A
124
Q

What is Rotor’s syndrome?

How is it differentiated from Dubin-Johsnon Syndrome?

A

Similar to Dubin-Johnson but milder in nature, associated with conjugated and unconjugated hyperbilrubinemia and not associated with grossly black liver on biopsy

125
Q

What is kernicterus?

A

Bilirubin-induced encephalopathy: increased amounts of bilirubin in CNS and basal ganglia, leading to hypotonia, deafness, lethargy, oculomotor palsy & death [often by 15 months of age in pts with Type 1 Crigle-Najjar syndrome]

126
Q

What is the most common cause of fulminant hepatitis?

Other etiologies?

A

Acetaminophen

drug reactions, viral hepatitis, Reye syndrome

127
Q

________ ________ should be performed on a patient with intussusception if refractory to air insufflation

A

Surgical resection

128
Q

What is jaundice?

Is it a disease?

At what bilirubin level is it present?

A

Yellowing of the skin, nail beds and sclera by tissue bilirubin deposition as a consequence of hyperbilirubinemia

No, but it is a sign of disease

Bilirubin >2.5 mg/dL

129
Q

What is the most common cause of chronic diarrhea in patients with AIDS?

A

Cryptosporidium

130
Q

What are the clinical manifestations of appendicitis?

A

Anorexia and periumbilical pain/epigastric pain followed by RLQ pain, nausea, and vomiting

131
Q

What are common lead points for intussusception to occur?

A

Meckel diverticulum, enlarged mesenteric lymph node, hyperplasia of Peyer’s patches, benign/malignant tumor, submucosal hematomas (Henoch-Schonlein purpura), FB

132
Q

Chronic hepatitis (disease > ____ months) may lead to end stage liver disease or hepatocellular carcinoma

A

6 months

133
Q

What test can be performed on a patient with intussusception that is considered both diagnostic and therapeutic?

A

Barium contrast enema

134
Q

What are some places/things a person might contract clostridium difficile from?

Clinical manifestations?

Management?

A

Usually nosocomial/iatrogenic, MC after course of abx (especially Clindamycin) or chemo

Abd cramps, diarrhea, fever, tenderness, striking lymphocytosis, pseudomembranous colitis

± cause bowel perforation and toxic mega colon

Metronidazole 1st line for mild dz

Vancomycin PO 2nd line (but 1st line if severe dz)

135
Q

Niacin is otherwise known as?

A

B3

136
Q

What is the mainstay of gastroenteritis management?

A

IV Fluid repletion (PO preferred)

137
Q

What are Bitot’s spots?

A

White spots on the conjunctiva due to squamous metaplasia of the corneal epithelium

138
Q

What infectious organism is the most common cause of bacterial enteritis in the US?

A

Campylobacter enteritis

139
Q

What labs will be elevated in a pt with fulminant hepatitis?

Low?

A

Ammonia

PT/INR (>=1.5)

LFTs

Hypoglycemia

140
Q

What is duodenal atresia?

What does it result in?

A

Complete absence or closure of a portion of the duodenum that leads to gastric outlet obstruction

141
Q

What are some examples of anti-diarrheal medications?

A

Bismuth salicylate [Pepto bismol, Kaopectate]

Opioid agonists [Loperamide (immodium), Diphenoxylate/Atropine (Lomotil)]

Anticholinergics [Phenobarbital,/Hyoscyamine/Atropine/Scopolomine (Donnatal)]

142
Q

What are dietary sources of Vitamin A?

A

found in the kidney, liver, egg yolk, butter, green leafy vegetables

143
Q

What will the liver look like on bx of a pt with Crigler-Najjar syndrome?

A

Normal

144
Q

If a pt with chronic Hep B is asymptomatic, they (can/cannot) transmit infxn to others

A

can

145
Q

What is an inguinal hernia?

A

Protrusion of the abdominal cavity contents through the inguinal ring

146
Q

What is encopresis?

Usually due to what underlying condition?

A

Fecal incontinence

Constipation

147
Q

What is vomiting usually due to?

A

vomiting usually due to imbalance of serotonin, acetylcholine, dopamine, and histamine

148
Q

What is the incubation period of Bacillus cereus?

What are some places/things a person might contract it from?

Clinical manifestations?

Management?

A

IP: 1-6 hours

Contaminated food: i.e. fried rice

VOMITING, cramps, diarrhea

Supportive, fluids

149
Q

What are two types of secretory diarrheas?

A

Hormonal: serotonin (carcinoid syndrome), calcitonin (medullary cancer of thyroid), gastrin (Zollinger-Ellison Syndrome)

Laxative abuse

150
Q

What are the two types of jaundice that can be observed in a newborn?

A

Physiologic

Pathologic

151
Q

IV fluid replacement in children?

A

20 mL/kg of isotonic saline

152
Q

What are options for treatment of encephalitis caused by fulminant hepatitis?

A

Lactulose: converted into lactic acid by bacteria, neutralizing the ammonia

Rifaximin, Neomycin: abx that decrease the bacteria producing ammonia in the GI tract

Protein restriction: reduces the breakdown of protein into ammonia

153
Q

What is Rickets?

A

Softening of the bones leading to bowing deformities, fractures, costochondral thickening (rachitic rosary), dental problems, muscle weakness, and developmental delays

154
Q

Lactose intolerance and celiac sprue are examples of what type of diarrhea?

A

Osmotic

155
Q

What is the recommended diet for a patient with gastroenteritis?

A

BRAT diet

Bananas, Rice, Applesauce, Toast

156
Q

What is the course of tx for Hirschsprung dz?

A

Surgical resection of the affected bowel

157
Q

When might pts with Gilbert’s syndrome develop jaundice?

A

During periods of stress, fasting, ETOH, or illness

158
Q

Barretts esophagus is when esophageal _______ _______ is replaced by precancerous metaplastic ________ cells from the ______ of the stomach

A

squamous epithelium

columnar

cardia

159
Q

What are some places/things a person might contract vibrio parahemolyticus from?

A

Raw shellfish especially in the gulf of Mexico

160
Q

What are two excellent sources of Vitamin D?

A

Fortified milk

Sun exposure

161
Q

Hirschsprung should be suspected in any full term infant who fails to pass _____ in the first ____ of life

What are other sx that may indicate a pt has Hirschsprung?

What is a potential (serious) complication?

A

meconium

48 hours

Bilious vomiting, abdominal distention, FTT

toxic megacolon

162
Q

Hep B vaccine is administered at ___, ___, and ___ months of age and is contraindicated if the patient is allergic to ______

A

0, 1, 6

Baker’s yeast

163
Q

What is the function of Vitamin A?

A

vision, immune function, embryo development, hematopoiesis, skin and cellular health (epithelial cell differentiation)

164
Q

What is lactose intolerance due to?

When does the lactase enzyme level normally drop?

Especially in what populations?

A

Inability to digest lactose due to low levels of lactase enzyme

Normally decreases in adulthood

Especially in AA, Asians, and South Americans

165
Q

What will be elevated in a pt with appendicitis?

A

Leukocytosis

166
Q

What are possible etiologies for constipation?

A

disordered movement of stool through colon/anus/rectum (usually the proximal GI tract is intact)

Slow colonic transit: idiopathic, motor d/o (colorectal CA, DM, hypothyroid), S/E of many drugs (verapamil, opioids, etc)

Outlet delay: Hirschsprung’s dz

167
Q

GERD is caused by the relaxation of the ______, which leads to gastric acid reflux, and ultimately ______ injury

A

lower esophageal sphincter

esophageal mucosal

168
Q

Highest mortality from Hep E infection is during _____, especially in ______, with an increased incidence of fulminant hepatitis

A

pregnancy

3rd trimester

169
Q

What is fulminant hepatitis?

A

Rapid liver failure + hepatic encephalopathy

170
Q

During pregnancy with a baby with duodenal atresia, what is commonly seen?

A

Polyhydramnios (increased amniotic fluid)

171
Q

What is the management for appendicitis?

A

Appendectomy (surgical removal)

172
Q

Indirect inguinal hernias protrude at the (internal/external) inguinal ring

The origin of the sac is (lateral/medial) to the inferior epigastric artery

MC in what age groups?

MC in (men/women)

(Right/Left) sided more common

A

Internal

Lateral

young children & young adults

men

Right

173
Q

Is GERD a clinical dx?

A

YES

174
Q

What is the most common overall cause of gastroenteritis in adults?

What is its presence usually associated with environmentally?

A

Norovirus

outbreaks on cruise ships, at hospitals, and at restaurants

175
Q

Hepatitis ____ is the only viral hepatitis associated with spiking a fever

A

A

176
Q

What is the incubation period of enterotoxigenic E. coli?

What are some places/things a person might contract it from?

Clinical manifestations?

Management?

A

24-72 hours

unpeeled fruits, unsanitary drinking water/ice

abrupt onset of watery diarrhea, abd cramping, and vomiting

Fluids, bismuths, if severe can Rx fluoroquinolone

177
Q

Where is McBurneys point?

A

joint 2/3 the distance from the navel to the anterior superior iliac spine

178
Q

What is the classic triad for intussusception?

A
  1. vomiting
  2. abdominal pain
  3. passage of blood per rectum “CURRANT JELLY STOOL” (stool mixed with blood and mucus)

Rotation 1: Pediatrics (13 decks)

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