Module 13 - GI + GU

Question 1

A 16-year-old girl presents with persistent abdominal pain, intermittent diarrhea, constipation, rectal bleeding, and weight loss. She undergoes a colonoscopy that reveals an inflammatory reaction of the entire colon without intervening areas of normal mucosa. The pathological findings are limited to the mucosa and submucosa. She has which of the following conditions?

A. Whipple disease
B. Crohn disease
C. Ulcerative colitis
D. Celiac disease

Answer 1

C. Ulcerative colitis

BLEEDING
MUCOSA

Question 2

What is the most common presentation of ulcerative colitis?

A. Abdominal pain
B. Bowel obstruction
C. Bloody diarrhea
D. Rectal Pain

Answer 2

C. Bloody diarrhea

Question 3

Crohns, clinical manifestations

Answer 3

• Characterized by a transmural inflammatory pattern with skip lesions present
• RLQ

Question 4

Ulcerative colitis, clinical manifestations

Answer 4

• Involves the mucosa but is NOT transmural
• LLQ
• Bleeding

Question 5

A 2-year-old boy presents with a 48-hour history of abdominal pain and anorexia. He can localize pain to the right lower quadrant. Examination demonstrates rebound tenderness and guarding. What is the appropriate management?

A. Consult surgery
B. Empirical antibiotic therapy
C. Intravenous pain medication with serial abdominal examinations
D. CT of the abdomen and pelvis

Answer 5

A. Consult surgery

• Ultrasound can confirm the diagnosis but not exclude it.
• Computerized tomography scans can make or exclude the diagnosis. A child that complains of pain upon bumping the stretcher, or bumps in the road during a car ride, may have peritoneal irritation. High fevers are uncommon with appendicitis unless perforation is suspected. Infants rarely get appendicitis.

Question 6

A 10-year-old boy presents with abdominal pain that started last night after dinner. The patient points towards the umbilical area. He vomited before arrival and still feels nauseated. He has a history of constipation. He reports moderate pain, which has worsened since last night. On arrival, he is alert but uncomfortable. Vital signs are temperature 100.6 F (38.2 C). heart rate 120 bpm, respiratory rate 26 breaths/min, and blood pressure 110/78 mmHg. There is significant tenderness in the right lower quadrant. Which of the following should be the next step in his evaluation?

A. Plain radiograph of the abdomen
B. Ultrasound of the abdomen
C. CT scan abdomen
D. MRI abdomen

Answer 6

B. Ultrasound of the abdomen

• Ultrasound is the preferred diagnostic method for evaluating suspected appendicitis in pediatric patients
• In a patient with abdominal pain, acute appendicitis cannot be reliably excluded by ultrasound unless a normal appendix is visualized.
• A CT scan should be obtained in an abdominal pain patient if ultrasound findings are inconclusive.

Question 7

A 9-year-old boy presents with 2 days of worsening abdominal pain. The pain began in the periumbilical region and then migrated to the right lower quadrant. He reports vomiting that is non-bilious and contains food particles. Vital signs are temperature 101.8 F (38.7 C), heart rate 90 bpm, respiratory rate 22 breaths/min, and blood pressure 110/72 mmHg. His abdomen is soft, with tenderness in the right lower quadrant. Initial laboratory evaluation shows WBC 11000 cells/mm3, hemoglobin 12.8 mg/dl, and platelet 220000 cells/microliter. Which of the following is the most important next step in the evaluation?

A. Admit for serial abdominal examination
B. Obtain CBC with differential
C. Obtain an ultrasound of the abdomen
D. Outpatient surgery clinic follow up

Answer 7

C. Obtain an ultrasound of the abdomen

Question 8

A 9-year-old boy was admitted to the emergency department (ED) with acute abdominal pain. History is significant for moderate to severe periumbilical abdominal pain that started 4 days ago and migrated to the right lower quadrant the next day. He reports two vomiting episodes that were non-bilious and contained his last meal. Vital signs are blood pressure 112/60 mmHg, heart rate 90 bpm, respiratory rate 18 breaths/min, and oral temperature: 38.8 C (101.8 F). His WBC count is 14000 cells/mm^3, Hb 12.8 mg/dL, and platelet count 198000 cells/microliter. What is the most appropriate next step?

A. Observation
B. Barium enema
C. Ultrasound
D. Appendectomy

Answer 8

C. Ultrasound

• Ultrasound is the best investigative procedure as it is fast, inexpensive, and avoids radiation exposure.

Question 9

A 4-week-old infant presents with projectile, nonbilious vomiting aggravated during the past week. Physical examination is remarkable for a non-tender, hard pylorus measuring 2 cm in diameter in the right upper quadrant. However, physical examination is not remarkable for depressed fontanelles, dry mucous membranes, decreased tearing, poor skin turgor, and or lethargy. Which of the following is pertinent to the further findings and appropriate treatment?

A. Pyloric wall thickness 3 mm or greater and pyloric channel length 15 mm or greater are predicted
B. Profound hypochloremia and hypokalemia are predicted
C. String signs and double-track signs in abdominal sonography are predicted
D. Emergent division of the pyloric muscle followed by keeping the nasogastric tube for 3 weeks is recommended

Answer 9

A. Pyloric wall thickness 3 mm or greater and pyloric channel length 15 mm or greater are predicted

• A neonate with projectile vomiting and blood-stained, nonbilious emesis who is losing weight and is dehydrated should be evaluated for hypertrophic pyloric stenosis.
• Ultrasonography is done for diagnosis. Treatment includes intravenous fluids and electrolyte replacement. Surgically pyloromyotomy is performed to release the stricture.
• Infants with prolonged uncorrected pyloric stenosis may show dehydration. Signs of dehydration in infants are depressed fontanelles, dry mucous membranes, decreased tearing, poor skin turgor, and lethargy.

Question 10

A 6-week-old white baby boy is brought to the emergency department with 2 days of projectile vomiting after feeding. Vital signs are stable. CBC is normal. Physical exam is limited as the infant is in severe distress. What is the first radiological test that should be ordered?

A. Abdominal X ray
B. Upper GI series
C. Abdominal ultrasound
D. Barium enema

Answer 10

C. Abdominal ultrasound

Question 11

A 3-month-old infant presents with 2 weeks of vomiting. The vomiting is often projectile, and appears to be mostly food, but is not blood-stained. The infant has no known illness. On physical examination, a small, olive-like mass is palpated in the right upper quadrant, and many peristaltic waves are seen. Which of the following electrolyte abnormalities is NOT associated with this disorder?

A. Metabolic alkalosis
B. Hyperkalemia
C. Paradoxical aciduria
D. Dehydration

Answer 11

B. Hyperkalemia

Question 12

A 5-week-old infant presents with projectile, non-bilious vomiting. Ultrasound reveals a thick pylorus. Which of the following is true regarding this condition?

A. Blood work will reveal hyperchloremic, metabolic alkalosis
B. Most common in African Americans and Asians
C. Condition occurs with equal frequency in both genders
D. Underlying metabolic alkalosis needs to be corrected prior to surgery

Answer 12

D. Underlying metabolic alkalosis needs to be corrected prior to surgery

• This is most commonly seen in whites of Scandinavian decent.
• The male to female ratio is 4:1.

Question 13

A 2-year-old male presents for a follow-up with his mother for an umbilical hernia. His mother denies any acute skin changes, or inability to tolerate diet. He has no difficulty with potty training and has normal bowel movements. The patient has had the hernia since birth. The mother is concerned about the preferred management and the prognosis. Which of the following describes the relevant answer to her concern?

A. It should be repaired by age two and may recur in 10% of patients
B. Repair should be performed if the hernia persists beyond six months of age due to the risk of strangulation; he is overdue for repair and requires urgent repair
C. Most close spontaneously by age 5, repair is not indicated at this time, and observation is reasonable
D. Repair should be performed only if the patient is symptomatic; repair is not indicated at this time

Answer 13

C. Most close spontaneously by age 5, repair is not indicated at this time, and observation is reasonable

• Most pediatric surgeons will wait until the patient is at least five years before surgery is indicated unless there are signs of strangulation or incarceration.
• Most umbilical hernias in children are small and will close by two years of age, particularly if the defect is less than 1 cm in size. If closure does not occur by age five years, elective repair is reasonable. Urgent surgery is not indicated at this time as the patient is asymptomatic.
• In children, umbilical hernias are congenital. They are formed by a failure of the umbilical ring to close, causing a central defect in the linea alba. If closure does not occur by age five years, elective repair is reasonable.
• Umbilical hernias in children rarely incarcerate. If the patient presents with abdominal pain, bilious emesis, and a tender, hard mass protruding from the umbilicus, immediate exploration and hernia repair are indicated regardless of age.

Question 14

A 4-month-old female is being evaluated for a bulging umbilicus. Her history is significant for two urinary tract infections, for which she has had several laboratory tests. Radionucleotide imaging scans demonstrate grade 2 vesicoureteral reflux. She is on prophylactic antibiotics. Physical examination demonstrates a reducible umbilical hernia with a crescent-shaped component above it. What is the next best step in management?

A. Surgical correction
B. Strapping of the umbilical hernia
C. Watchful waiting and care instructions
D. Abdominal sonography

Answer 14

C. Watchful waiting and care instructions

REPAIR BY 5

Question 15

A newborn is found to have a 2 cm midline defect in the anterior abdominal wall. In which of the following cases is spontaneous closure of the defect seen by age 5?

A. Umbilical hernia
B. Patent vitelline duct
C. Omphalocele
D. Epigastric hernia

Answer 15

A. Umbilical hernia

Question 16

A 6-year-old boy is brought to the clinic for a school physical. Physical examination is normal except for a small reducible umbilical hernia. What is the most appropriate management strategy for this patient?

A. Emergency repair with mesh
B. Emergency repair with absorbable suture
C. Elective repair with non-absorbable suture
D. Elective repair with absorbable suture

Answer 16

C. Elective repair with non-absorbable suture

Question 17

A 4-week-old male presents for a routine neonatal check-up. Growth parameters and vital signs are within normal limits. Physical examination shows a 1.5 cm reducible umbilical hernia. What is the most appropriate management strategy for this patient?

A. Elective repair at one year for persistent hernia if still present
B. Elective repair at five years for persistent hernia if still present
C. Emergency surgical repair now
D. Apply abdominal strapping

Answer 17

B. Elective repair at five years for persistent hernia if still present

Question 18

A 1-month-old male is brought in by his parents with swelling of his belly button. His mother reports the swelling increases when the baby cries or coughs. The patient was born at 35 weeks gestation by vaginal delivery. Physical examination findings include a reducible swelling at the umbilicus with no signs of incarceration or strangulation. Which of the following is the underlying pathophysiological mechanism?

A. Abrupt formation of Wharton’s jelly during the 6th week of gestation
B. Impaired development of primitive umbilical ring
C. Decreased intra-abdominal pressure during the 16th week of gestation
D. Failure of the umbilical ring to be obliterated after separation of the umbilical cord

Answer 18

D. Failure of the umbilical ring to be obliterated after separation of the umbilical cord

Question 19

A 4-year-old female is brought in for her annual physical. A reducible umbilical hernia is found on examination. She is asymptomatic. Her parents are concerned about the consequences of the hernia. Which of the following factors predict a likely failure of spontaneous closure in this patient?

A. Fascial defect of 2.5 cm
B. Female gender
C. Childhood obesity
D. Recurrent bulging with straining or bowel movements

Answer 19

A. Fascial defect of 2.5 cm

• Umbilical hernias with a defect of 1.5 cm to 2 cm or more in children over two years of age are less likely close spontaneously.

Question 20

The mother of an infant seen in the clinic describes swelling of the belly button, which increases in size when the baby cries, coughs, or strains. On physical examination, there is no abdominal tenderness, distension, or skin erythema. What is the preferred management?

A. Request a genetics consult
B. Instruct the mother about the symptoms of incarceration and strangulation
C. Assess the reducibility and measure the fascial defect size
D. Abdominal sonography and specific evaluation to exclude a connection with the bladder

Answer 20

C. Assess the reducibility and measure the fascial defect size

Question 21

Which of the following is most likely to be positive in a patient who has recently traveled to South America and presents with signs of jaundice, hepatomegaly, elevated liver enzymes, bilirubinemia, and normal alkaline phosphatase?

A. IgM anti-hepatitis A
B. IgM hepatitis B core antibody
C. IgG hepatitis B surface antibody
D. Polymerase chain reaction (PCR) for hepatitis C RNA

Answer 21

A. IgM anti-hepatitis A

• The history of travel suggests hepatitis A infection which is diagnosed with a positive test for IgM antibodies to the virus.
• Person-to-person contact is a common method of transmission. In the USA, food handlers are sometimes a source of outbreaks. The prognosis is excellent and chronic hepatitis is very rare. The disease severity depends on the age, most deaths are known to occur in older individuals.

Question 22

IgM

Answer 22

Acute Infection

Question 23

IgG

Answer 23

Past Infection

Question 24

Which of the following is transmitted by the fecal-oral route?

A. Campylobacter jejuni
B. Hepatitis A
C. Hepatitis B
D. Hepatitis C

Answer 24

B. Hepatitis A

Question 25

Which of the following can be prevented by passive immunization?

A. Hepatitis A virus
B. Influenza A virus
C. Parainfluenza type 2 virus
D. Rubella virus

Answer 25

A. Hepatitis A virus

Question 26

What measure has had the greatest impact on the incidence of hepatitis A?

A. Vaccination
B. Sanitation
C. Antibiotics
D. Condoms

Answer 26

B. Sanitation

Question 27

When is the second dose of hepatitis B vaccine given to an infant born of HBsAg-positive mother?

A. 1 day
B. 1 month
C. 6 months
D. 12 months

Answer 27

C. 6 months

• 1st Dose: Birth
• 2nd Dose: 1 Month
• 3rd Dose: 6 Month

Question 28

A 16-year-old boy is brought in with facial swelling. He has pretibial and periorbital edema. Blood pressure is 135/90 mm Hg, BUN is 15 mg/dL, creatinine is 1.0 mg/dL, and albumin is 1.7 mg/dL. Urine dipstick analysis reveals proteins and is negative for blood. Histology of a renal biopsy segment reveals the effacement of podocytes. Immunofluorescence is negative. What is the most probable diagnosis?

A. End stage liver disease
B. Membranoproliferative glomerulonephritis
C. Minimal change disease
D. Focal segmental glomerulonephritis

Answer 28

C. Minimal change disease

Question 29

A 16-year-old boy presents with facial edema and weight gain over the past 3 months. Urine examination reveals protein in the urine. Which of the following disorders can present with selective proteinuria?

A. Lupus
B. Post streptococcal glomerulonephritis
C. Minimal change disease
D. Membranous nephropathy

Answer 29

C. Minimal change disease

Question 30

A 6-year-old girl presents with 2 days of periorbital and lower extremity edema, and foamy urine. Vital signs are oxygen saturation 98% on room air, respiratory rate 20 breaths/min, heart rate 100 bpm, blood pressure 90/60 mmHg, and temperature 98.6 F (37 C). On examination, there is bilateral lower extremity edema. Blood tests confirm normal complement levels and hypoalbuminemia. Urinalysis shows 4+ protein and microscopy is unremarkable. Which of the following most likely preceded the patient’s signs and symptoms?

A. Upper respiratory tract infection
B. Molluscum contagiosum infection
C. Herpes simplex infection
D. Penicillin therapy

Answer 30

A. Upper respiratory tract infection

also remember hodkins can cause this

Question 31

Minimal change disease

Answer 31

• Causes hypoalbuminemia and generalized edema
• How would you work this up: what labs are important?
• Mild edema (diffuse), foamy urine
• UA: protein
• Treatment: extended PO steroids

Question 32

A 4-year-old male presents with a 4-day history of periorbital and lower extremity edema, accompanied by foamy urine. His blood pressure is 90/60 mmHg, his pulse is 100/min, his respirations are 20 breaths/min, and his temperature is 98.6 F (37 C). Examination shows bilateral lower extremity edema. A urinalysis shows 4+ protein present. Laboratory studies confirm normal complement levels and hypoalbuminemia. What is the most beneficial investigation to establish a diagnosis?

1. Light microscopy
2. Electron microscopy
3. Immunofluorescence
4. Serum studies

Answer 32

2. Electron microscopy

Question 33

A 3-year-old male is brought to evaluate increased swelling in his hands and feet. The mother states she has seen foam in his urine. The patient’s urine is positive for proteins and red blood cells. Which one of the following findings will be consistent with the underlying diagnosis?

A. Hypolipidemia
B. Proteinuria of greater than 3.5 g/24 hours
C. Creatine kinase of more than 1000 U/L
D. Hyperalbuminemia

Answer 33

B. Proteinuria of greater than 3.5 g/24 hours

Question 34

A 16-year-old girl presents with swelling. She has no significant history and takes no medications. Her blood pressure is 150/93 mmHg. Physical examination demonstrates periorbital edema, 3+ peripheral edema, and normal cardiovascular exam. Laboratory results are creatinine 0.7 mg/dL, albumin 2.2 g/L, 3+ urine protein, 0 RBC/HPF, 0 WBC/HPF, and oval fat bodies. What should be the first diagnostic test ordered?

A. Renal ultrasound
B. Measurement of urine protein to creatinine ratio
C. Serum protein electrophoresis
D. Test for antineutrophil cytoplasmic antibodies (ANCA)

Answer 34

B. Measurement of urine protein to creatinine ratio

Question 35

A 6-year-old female patient is brought in for the evaluation of puffiness around the eyes, which is usually worse in the morning. The mother states that she had a flu-like illness a few days ago. Her mother also reports noticing frothy urine. On examination, there is pedal edema, and labs show hypercholesterolemia and hypertriglyceridemia. Her urine dipstick shows 3+ protein but no red blood cells. There is no hematuria. What is the most likely diagnosis?

A. Poststreptococcal glomerulonephritis
B. Angioedema
C. Nephrotic syndrome
D. Nephritic syndrome

Answer 35

C. Nephrotic syndrome

Question 36

A 16-year-old otherwise healthy female on no medications presents complaining of generalized swelling and is found to have a blood pressure of 150/93 mmHg, periorbital edema, 3+ peripheral edema, normal cardiovascular exam, and the following lab values: creatinine 0.7 mg/dL, albumin 2.2 g/L, urinalysis 3+ protein, 0 red blood cells per high power field, 0 white blood cells per high power field, and 1+ oval fat bodies. Which of the following should be avoided?

A. Ramipril
B. High carbohydrate diet
C. Low fat diet
D. High sodium diet

Answer 36

D. High sodium diet

Question 37

The parents of a 6-year-old male brought him to the clinic for an evaluation. On examination, he has pedal edema and puffiness of the eyes. The patient recently had pharyngitis, for which he received ibuprofen and antibiotics. The mother states that she has noted foam in the child’s urine. Which one of the following would be the most appropriate test to make the diagnosis?

A. Complete blood count
B. Urinary electrolytes
C. 24-hour urinary protein
D. Abdominal ultrasound

Answer 37

C. 24-hour urinary protein

Question 38

A mother complains that her 3-year-old son has had frothy urine for the past week. She denies any trauma or medical problems. He has had an uneventful growth pattern. Examination of the urine reveals a white froth. What substance is most likely causing this effect on the urine?

A. Ethylene glycol
B. Protein
C. Glucose
D. Lipids

Answer 38

B. Protein

Question 39

A 3-year-old female was brought in with a complaint of abdominal pain. On physical examination, she was afebrile, her blood pressure was 125/80 mmHg, and her heart rate was 86 beats per minute. The abdomen was soft and non-tender, but there was a palpable abdominal mass on the right side of the abdomen. Ultrasound of the abdomen revealed a mass with cystic areas adjacent to the lower pole of the right kidney. Blood work showed hemoglobin of 8.5 mg/dL, a mean corpuscular volume (MCV) of 59.5 fL, a white blood cell count of 3,450 cells/microliter, and a platelet count of 258,000 platelets/microliter. Based on the given findings, the clinician made two possible differential diagnoses, including Wilms tumor and neuroblastoma. Which of the following imaging studies is the investigation of choice to differentiate between the two?

A. Computed tomography (CT) angiography
B. Magnetic resonance angiography
C. Doppler ultrasonography with resistive index
D. Magnetic resonance imaging diffusion studies

Answer 39

D. Magnetic resonance imaging diffusion studies

Question 40

A 3-year-old boy is brought to the clinic by his mother because she discovered a mass in his abdomen. She reports that the child has been irritable and intermittently complaining of pain in his abdomen for the last few months. Two days ago, she noticed some blood in his urine, but this resolved. Physical examination reveals a palpable abdominal mass. CT scan suggests that there is a 6 x 6 cm mass arising from the right kidney. What is the most likely diagnosis?

A. Nephroblastoma
B. Rhabdoid renal tumor
C. Renal medullary carcinoma
D. Clear cell renal sarcoma

Answer 40

A. Nephroblastoma

Question 41

A newborn male is being evaluated in the nursery, who was born via a spontaneous vaginal delivery to a 30-year-old female. His Apgar scores were 7 and 9 at 1 minute and 5 minutes, respectively, and his vital signs are stable. The examination of the genitalia reveals a penile curvature with an abnormally located urethral opening on the ventral aspect of the penile shaft. Which of the following is the definitive management of this patient’s condition?

A. Surgery
B. Observation
C. Hormonal therapy
D. Circumcision

Answer 41

A. Surgery

Class: BEFORE 12 mo
Statpearl: Hypospadias surgery should ideally be done between 6 and 18 months of age to have the best cosmetic and functional outcome.

Question 42

A healthy 4-week-old male presents to the clinic for a well-baby visit. Examination of his genitalia reveals a glandular groove, hooded foreskin, incomplete prepuce ventrally, and a urethral meatus on his midshaft. Which is the most common abnormality associated with this condition?

A. Cerebellar arteriovenous malformation
B. Unilateral retractile testicle
C. Renal agenesis
D. Inguinal hernia

Answer 42

D. Inguinal hernia

Question 43

A 5-year-old male is brought in with facial puffiness. On examination, it is noted that there are many insect bite marks on his skin, some of which are infected. His father reveals that these are bed bug bites. The patient further describes that his urine has become frothy. What is the next step in management?

A. Topical antibiotic for the skin infection
B. Complete blood count and electron spin resonance
C. Urinalysis
D. Renal ultrasound

Answer 43

C. Urinalysis

post strep glom

• urinalysis may detect red blood cells and red blood cell casts, making the diagnosis of post-streptococcal glomerulonephritis (PSGN).

Question 44

Poststreptococcal glomerular nephritis, presentation

Answer 44

• periorbital swelling, dark urine, hematuria

Question 45

An 8-year-old boy presents with bed-wetting problems for the past 5 years. His mother tried multiple things and requests treatment. Which of the following medications is most appropriate?

A. Imipramine
B. Paroxetine
C. Bupropion
D. Sertraline

Answer 45

A. Imipramine

Question 46

Recurrent female UTI

Answer 46

• Perform pelvic visualization which may reveal a fusion of labia minors at the midline near the clit and multiple scratch marks
• Treat with topical estrogens
• Labial adhesions, treatment (topical estrogen cream)

Question 47

A two-year-old female is brought in by her parents for straining during micturition and passage of urine in two urinary streams. She has no significant past medical history. On examination, she has stable vital signs and is well appearing. Pelvic examination reveals a normal clitoris. However, the middle portion of the vestibule is not visualized. Which of the following is the best next step in managing this patient?

A. Sitz baths
B. Topical estrogen application in the labial area
C. Surgical lysis
D. Genitoscopy

Answer 47

B. Topical estrogen application in the labial area

Question 48

A 5-year old girl is brought to the clinician by her parents for repeated urinary tract infections from the past few months. She has no significant past medical history. On examination, the patient is vitally stable. Pelvic examination reveals a fusion of labia minora at the midline near the clitoris. Which of the other presenting features are commonly seen in girls with labial adhesions?

A. Straining during micturition, urinary retention, and post-void urine dribbling
B. Continuous dribbling of urine without any dry period
C. Double urinary streams
D. Flank mass

Answer 48

A. Straining during micturition, urinary retention, and post-void urine dribbling

Question 49

A 5-year-old female is brought to the office by her mother for evaluation of recurrent episodes of urinary tract infections in the past nine months. The mother states that she brought her child to the office with the same complaints two months ago and was prescribed antibiotics. The patient has no developmental delay, her vaccinations are up to date, and there is no significant past medical history except for repeated urinary tract infections. Physical examination reveals a fusion of the labia minora at the midline near the clitoris and multiple scratch marks. Ultrasonography reveals normal and age-appropriate development of internal sex organs. What is the most appropriate management in this patient?
A. Surgery
B. Apply topical estrogen
C. Digital dilatation
D. Oral contraceptives

Answer 49

B. Apply topical estrogen

Question 50

An infant with eczema is being tested for peanut allergy with the skin prick test. According to recent guidelines, at what wheal diameter should the infant be administered 2 gram of peanut protein?

A. 2 mm
B. 5 mm
C. 20 mm
D. Any diameter as long as it is not raised

Answer 50

A. 2 mm

a wheal diameter of 3-7mm is high risk

Question 51

A 12-year-old female is brought in by her mother for concerns of a food allergy. The mother states that when she eats foods that contain tree nuts, she develops stomach pain, nausea, and sometimes vomiting. The mother requests that she be tested for this. The gold standard for confirmation of an actual food allergy in this child is which of the following?

A. Skin prick test test
B. Radioallergosorbent test (RAST)
C. Serum IgA tissue transglutaminase antibodies
D. Double-blind food challenge

Answer 51

D. Double-blind food challenge

Question 52

Celiac disease testing

Answer 52

IgA Anti TTG will be +