GI_UW_pretest Flashcards
Mesenteric adenitis presents how?
RLQ pain, abdominal guarding, and tenderness
Recurrent self limiting episodes of V/N without an apparent cause with family hx of migraines suggests?
Cyclic vomiting syndrome
Pyloric stenosis leads to what electrolyte derangement
Hypokalemia hyponatremia metabolic alkalosis
Tx for pyloric stenosis
IV rehydration, correction of electrolyte imbalances to reduce risk of post op apnea, and then pyloromyotomy
Pyloric stenosis found in what population and typically diagnosed when?
First born males. Diagnosed at ages 3-5 weeks.
What is the first line modality for ID-ing intususseption
U/S
What is the classic sign for intussusception on U/S?
Target sign
What are characteristic signs of biliary cysts?
Abdominal pain, jaundice, palpable mass. Majority of cysts present
Hirschsprung disease aka
Congenital aganglionic megacolon
Meconium ileus is pathognominic for
Cystic fibrosis
Hirschsprung is a/w which disorder?
Down syndrome
Primary diagnoses consideration in infant that fails ot pass meconium within 48 hours
Hirschsprung and meconium ileus
Why is there polyhydramnios with duodenal atresia
inability to swallow and remove amniotic fluid
What does x ray show for duodenal atresia
Air trapped in stomach, and duodenum => double bubble. No air in distal part of the GI tract.
Duodenal atresia is strongly a/w
Down Syndrome
What is a volvulus
Small bowel twists around the superior mesenteric artery resulting in vascular compromise to large portions of midgut
How does midgut volvulus usually present
What is the fastest and most accurate way to diagnose a volvulus?
Contrast in a corkscrew pattern => volvulus
What is the Ladd procedure
Fixing the bowel in a non-rotated position to minimize recurrent volvulus risk.
Pellagra classic ppt
Diarrhea, dermatitis dementia and if severe, death
Pellagra is due to deficiency in what?
Vitamin B3 (niacin)
Riboflavin deficiency presentation
Cheilosis, glossitis, seborrheic dermatitis (often affecting genital areas), pharyngitis and edema/erythema of the mouth
Pyridoxine deficiency is a known risk factor for?
Venous thromboembolic disease and atherosclerosis
What solution should be used for IV fluid resuscitation in children?
Isotonic crystalloid is the only crystalloid solution recommended - isotonic saline
Presentation of Beckwith-Wiedemann Syndrome
Overgrowth disorder. PE = macrosomia, macroglossia, ompahlocele or umbilical hernia, hemihyperplasia.
What are the complications of Beckwith-Widemann
Wilms Tumor, hepatoblasoma
NEC presentation
Feeding intolerance, increased gastric residual volume, abdominal distension, bloody stools.
Risk factors for NEC
Prematurity,low birth weight, hypotension, congenital heart disease.
Hallmwark x-ray finding for NEC
Pneumostasis intestinalis and portal venis air
PE findings and X -ray findings for osteosarcoma
Large tender mass. X-ray finding: sun-burst periosteal pattern and “codman” triangle.
Lymphoblast histology/staining
Lack peroxidase positive material, often contain +PAS staining material, 95% immunostain for TdT. (TdT is only present in pre B and T lymphocytes)
Example of clotting disorders
Hemophilia A and B
Activated PTT time in hemophilias
Increased activated PTT
Examples of platelet defects
Von Willebrand and Bernard Soulier Syndrome
Ewing’s sarcoma is often confused with
Osteomyelitis because of the intermittent fevers, leukocytosis, malaise, joint swelling
Characteristic x-ray findings for Ewing’s sarcoma
Lytic, central bone lesion with periosteal reaction leading to onion skin appearance, followed by mottled appearance/moth eaten and extension into soft tissue
Cobalamin deficiency presents as
Macrocytic anemia
Most common inherited bleeding disorder
Impaired Von Willebrand factor
Primary dose limiting side effect of hydroxyurea
Myelosuppression
Brainstem is composed of
Midbrain, pons, medulla
Pineal gland secretes
Melatonin
What is parinaud syndrome
Downward gaze preference (sun setting gaze) with limited upward gaze, ptosis, upper eyelid retraction, pupillary abnormalities
What are the clinical sx of pineal gland mass
Parinaud syndrome, obstructive hydrocephalus, precocious puberty (if the pineal gland mass is a germ cell tumor that secretes b-HCG)
What are the clinical sx of obstructive hydrocephalus
papilledema, vomiting, headache, ataxias
What kind of masses can arise from pineal gland?
variety but most common is the germ cell tumor
Wht is the triad of hemolytic uremic sydnrome
renal failure, thrombocytopenia and microangiopathic hemolytic anemia
clinical ppt of HUS
abdominal pain and diarrhea followed by bloody diarrhea. Within 5-7 days => anemia, thrombocytopenia and renal insufficiency.
PE of HUS
Pallor, jaundice (hemolysis), edema, petechiae, HTN
What is the characteristic peripheral smear of HUS
Schistocytes and large platelet
Lead poisoning causes what kind of anemia
Microcytic anemia. Basophilic stippling on peripheral blood smear.
Triad of Wiskott Aldrich Syndrome
Eczema, thrombocytopenia (from decreased platelet production), hypogammaglobulinemia leading to recurrent bacterial infections.
How does polycythemia lead to cyanosis?
High red blood cell mass and hyperviscosity leads to cyanosis
What is the definition of neonatal polycythemia
Hematocrit greater than 65%
Wht are the risk factors for neonatal polycythemia
Increased erythropoiesis from Maternal diabetes, maternal hypertension, IUGR, smoking. Or erythrocyte transfusion from delayed cord clamping or twin twin transfusion
Clinical presentation of neonatal polycythemia
Neurologic manifestations (irritability, jitteriness), respiratory distress and hypoglycemia.
Doughy skin is indicative of
Hypernatremic dehydration
Dilated stool filled megacolon on x-ray, stool-filled anal canal with poor tone on PE of a well-grown child supports diagnosis of?
Functional constipation
Presence of nocturnal abdominal pain and GI bleeding in patient with positive family hx supports diagnosis of
PUD
Dx of PUD can be made by what procedure?
Endoscopy is preferred method althoug upper GI series can sometimes reveal an ulcer.
Tx of eosinophilic esophagitis
Avoidance of specific food allergens. Inhaled or systemic steroids have been helpful.
Sx of eosinophilic esophagitis
Similar to GERD but are not relieved with acid blockade.
Dilated stomach, proximal loops of bwel, curly Q twist of barium suspicious for?
Malrotation.
Patients with malrotation commonly present when with what?
First weeks of life with bilious vomiting, indicated of bowel obstruction and or intermitted abdominal pain
When does pyloric stenosis present?
Not until after around 3 wee os life. Presents with non bilious vomiting
Intusussception usually presents starting when?
Starting around 6 months or older
Jujenal and duodenal atresia usually present?
Very leafly in life. First day or so.
Meconium ileus is pathognomonic for?
Cystic fibrosis
Most serious complication of ulcerative colitis is
Toxic megacolon.
Intractable chronic constipation without fecal soiling- suspsect dx of?
Hirschsprung disease.
Cholecystitis and cholelithiasis are unusual in children and are almost always a/w
CF, pregnancy, hemolytic anemia, Crohns, obesity, or prior ileal resection. Dx confirmed on U/S of gallbladder
Usual presentation of intusussecption of infant? Age and sx
Usually 4-10 months of age, sudden onset of abdominal colicky abdoinal pain. Passage of stool containing blood nad mucus, described as currant jelly. Early exam can be unremarkable but passage of time shows sausage shaped mass in URQ.
What is Sandifer syndrome
Bending or arching of the neck caused by reflux.
Classic triad of Crohn’s disease. Other ppt?
weight loss, diarrhea and abdominal pain. A/w with transmural, granulomatous intestinal lesions that are discontinus. Can appear in both small and large intestines. Risk of colonic carcinoma is increased but not to same degree as UC.
Giardia dx?
Identifying cysts or trophozoites makes the dx.
Tx option for Giardia
single dose of tinidazole or course of metronidazole.
What is mecekls diverticulum
Embryonic duct connecting the yolk sac to the intestine fails to regress completely and persists as a diverticulum attached to the ileum.
Diagnostic techniques for lactose intoelrance
Hydrogen breath test (basically bacterial metabolism of unabsorbed carb in colon into CO2 and h2.) and resolution of sx after removal of lactose from diet.
High concnetrations of sugars promotes dental disease in teeth but which teeth remain normal
Mandibular frontal teeth.
Congenital indirect hernia is a result of
incompelte closure of the processus vaginalis. In conrast to less commonly acquired direct inguinal hernia, caused by weakness in musculature of the inguinal canal.
activated charcoal can be effective for clearance of?
phneobarbital and TCAs (drugs with enterohepatic circulation or with prolonged absorption like sustained release theophylline). Not effect for alcohols, acids, ferrous sulfate, strong bases like drain cleaners and oven cleaners.
Lab must use what to assess for enterhemorragic E coli (shiga like toxin)
Sorbitol-macConkey agar.
Isoniazid competitively inhibits utlization of what vitamin
Pyridoxine. Vitamine B6
Vitamin A deficiency first manifests with what kind of clinical sx?
Visual changes, including night bldiness. Can also cause drying of conjunctiva and sclear. Skin is frequently dry.
