PCM!!!!!! Peds- GI Dow

Question 1

Step 1 in fluid replacement for dehydration

Answer 1

Restore intravascular volume for hemodynamic stability- BOLUS!

• typically for severe dehydration, or if child is not tolerating oral rehydration therapy

Question 2

Calculating pediatric bolus

Answer 2

20ml/kg of isotonic NS (a crystalloid solution, ~mineral content as human plasma)

Question 3

Step 2 in fluid replacement for dehydration

Answer 3

24hr water requirements

1. Maintenance
2. Deficits

Question 4

Calculating Maintenance fluids

Answer 4

4-2-1
4ml/kg/hr for first 10kg
2ml/kg/hr for additional 11-20kg
1ml/kg/hr for remainder >21kg

kg = based on child’s pre-illness weight

Question 5

Calculating Deficit fluids

Answer 5

% dehydration x kg x 1000ml/kg

Question 6

% dehydration for infant

Answer 6

Mild = 5% 
Moderate = 10% 
Severe = 15%

Question 7

% dehydration for child

Answer 7

Mild = 3% 
Moderate = 6% 
Severe = 9%

Question 8

Rate of fluid replenishment- maintenance volume

Answer 8

first 8hrs - 1/3
second 8hrs - 1/3
third 8hrs - 1/3

Question 9

Rate of fluid replenishment- deficit volume

Answer 9

first 8hrs - 1/2
second 8hrs - 1/4
third 8hrs - 1/4

Question 10

When to give K+

Answer 10

AFTER pt has voided

Question 11

Isonatremic solution given for child <10kg

Answer 11

1/4 NS

Question 12

Isonatremic solution given for child >10kg

Answer 12

1/2 NS

Question 13

Duodenal atresia

Answer 13

congenital obstruction of duodenum part 2 d/t failure of recanalization of bowel segment

Question 14

Epidemiology of duodenal atresia

Answer 14

M > F

Question 15

Duodenal atresia is associated with…

Answer 15

Polyhydramnios

Down syndrome

Question 16

Radiographic finding of duodenal atresia

Answer 16

double bubble sign

Question 17

duodenal atresia type I

Answer 17

mucosal webs with normal muscular wall (most common)

Question 18

Viral gastroenteritis

Answer 18

more common than bacterial 
low grade fever 
vomiting, followed by watery diarrhea 
3-9 days 
typically self-limited

Question 19

Bacterial gastroenteritis

Answer 19

bloody bowel movements 
high fever 
shaking chills 
abdominal cramping 
fecal leukocytes

Question 20

Causative agents of viral gastroenteritis

Answer 20

rotavirus!

Question 21

Causative agents of bacterial gastroenteritis

Answer 21

Campylobacter
salmonella 
shigella 
yersinia 
E. coli 
C. diff is antibiotic use is associated

Question 22

Workup of gastroenteritis

Answer 22

majority do not require a workup

Question 23

GER vs GERD

Answer 23

GER is physiologic

GERD is symptomatic, peaks at 4m/o, usually resolves by 12m/o

Question 24

symptoms of GERD

Answer 24

recurrent regurgitation with/without vomiting

cough

Question 25

Treatment of GERD

Answer 25

1st line treatment --> non-pharmacologic! 
Try 
1) adjusting amount of formula given
2) adding rice cereal to formula
3) prone position

Question 26

Etiology of Constipation

Answer 26

most often functional fecal retention (voluntary stool withholding, typically seen in 3y/o)

Question 27

Constipation can be associated with…

Answer 27

Encopresis (overflow stool)

UTI

Question 28

obstipation

Answer 28

infrequent stooling

Question 29

Intusussception

Answer 29

intermittent episodes of severe abdominal pain (in between these episodes, child is completely asymptomatic)

“Currant jelly” stools

Question 30

diagnosis of intussusception

Answer 30

air contrast enema (can also be therapeutic)

Question 31

functional abdominal pain

Answer 31

6-14y/o 
normal PE 
normal labs 
symptoms >3mths 
Further investigate if pain awakens child at night

Question 32

Esophageal foreign bodies require emergent intervention if…

Answer 32

object is 
-sharp
-long
-multiple magnets 
-disc battery! 
< 1% of FB's cause significant morbidity

Question 33

Most esophageal foreign bodies are stuck at…

Answer 33

thoracic inlet
level of aortic arch
GE junction

Question 34

Meckel Diverticulum

Answer 34

MCC of serious lower GI bleeding in children

Question 35

treatment of Meckel diverticulum

Answer 35

blood transfusion

Question 36

Clinical features of Meckel diverticulum

Answer 36

painless rectal bleeding

currant jelly stool

Question 37

Age of onset of pyloric stenosis

Answer 37

3-5w/o

rarely occur >12w/o

Question 38

Clinical features of pyloric stenosis

Answer 38

non-bilious vomiting, forceful/projective

olive-like mass in RUQ