Pedi GI

Question 1

What is Rovsing’s Sign?

Answer 1

RLQ pain with palpation of LLQ

Question 2

What is Obturator Sign?

Answer 2

RLQ pain with internal rotation of the hip

Question 3

What is Psoas Sign?

Answer 3

RLQ pain with hip extension

Question 4

What is the typical initial symptom of appendicitis?

What is the treatment?

Answer 4

Crampy or “colicky” pain around the umbilicus

Surgical appendectomy

Question 5

Which of the following is the most common symptom of appendicitis in children?

A. Constipation
B. Vomiting
C. Right lower quadrant pain
D. High fever

Answer 5

Right lower quadrant pain

Question 6

A 10-year old child presents with periumbilical pain that later localizes to the right lower quadrant. What is the most likely diagnosis?

Answer 6

Appendicitis

Question 7

What is the most common complication of appendicitis in pediatric patients?

Answer 7

Peritonitis

Question 9

Which imaging study is preferred initially for diagnosing appendicitis in children?

Answer 9

Abdominal Ultrasound

Question 10

True or False: Rebound tenderness is a reliable sign of appendicitis in children?

Answer 10

True

Question 11

True or False: Appendicitis can sometimes present with diarrhea in pediatric patients

Answer 11

True

Question 12

A high fever is typically a primary symptom of appendicitis in children?

Answer 12

False

Question 13

A 9-year-old female presents with a 24-hour history of abdominal pain that initially started around the navel but has now localized to the right lower quadrant. She has vomited twice and reports a decrease in appetite. On examination, she has a fever of 37.8°C (100°F) and tenderness in the right lower quadrant with guarding. What is the next best step in management?

A. Administer IV fluids and observe
B. Order an ultrasound of the abdomen
C. Schedule for immediate surgery
D. Start broad-spectrum antibiotics

Answer 13

Order an ultrasound of the abdomen

Question 14

At what age does colic peak?

When does it typically end?

Answer 14

Peaks 2-3 months of age

4 months of age

Question 15

What is the Rule of 3’s in infantile colic?

Answer 15

Cry –> 3 hrs/day, 3d/wk, for 3 weeks

Question 16

Parents of a 2-month-old boy report that their child has been crying excessively for the past month. The episodes last up to 4 hours, usually occurring in the late afternoon and evening. The infant is feeding well, gaining weight appropriately, and has no other symptoms. Physical examination is unremarkable. What would be the most appropriate advice for the parents?

A. Prescribe an antispasmodic medication.
B. Recommend dietary changes for the breastfeeding mother.
C. Advise on various soothing techniques and reassure that this condition generally resolves by 4 months of age.
D. Order abdominal x-rays to rule out any abnormalities.

Answer 16

Advise on various soothing techniques and reassure that this condition generally resolves by 4 months of age.

Colic typically resolves around 4 months of age

Question 17

A 3-month-old infant presents with episodes of intense crying lasting more than 3 hours per day, occurring at least three days a week for the past three weeks. The infant appears healthy with normal growth and no signs of disease. What is the most likely diagnosis?

A. Gastroesophageal reflux disease
B. Colic
C. Intestinal obstruction
D. Urinary tract infection

Answer 17

Colic

Question 18

Which of the following statements is true regarding the management of colic in infants?

A. Medications are the first-line treatment for colic.
B. Changes in the mother’s diet if breastfeeding or a change in formula can be beneficial.
C. Infants with colic should be fed more frequently.
D. Colic is best treated with solid foods introduction

Answer 18

Changes in the mother’s diet if breastfeeding or a change in formula can be beneficial.

Question 19

Parents of a colicky infant should be instructed to:

A. Let the infant cry it out without consoling.
B. Increase stimulation during crying episodes to distract the infant.
C. Try soothing techniques such as swaddling, rocking, and white noise.
D. Feed the infant every time they cry to ensure they are not hungry.

Answer 19

Try soothing techniques such as swaddling, rocking, and white noise.

Question 20

Which of the following is the most common cause of constipation in children?

A. Intestinal obstruction
B. Hypothyroidism
C. Functional constipation
D. Electrolyte imbalances

Answer 20

Functional Constipation

Question 21

A 4-year-old child presents with a history of passing hard, pellet-like stools every 3-4 days with occasional episodes of painful defecation. There is no history of gastrointestinal disease or developmental delays. What is the most likely diagnosis?

A. Irritable bowel syndrome
B. Functional constipation
C. Anal fissure
D. Hirschsprung disease

Answer 21

Functional Constipation

Question 22

Which dietary recommendation is most appropriate for a child suffering from constipation?

A. Increase intake of high-fat foods
B. Increase fluid and fiber intake
C. Decrease carbohydrate intake
D. High-protein diet

Answer 22

Increase fluid and fiber intake

Question 23

What is the first-line pharmacologic treatment for children with constipation?

A. Stimulant laxatives
B. Osmotic laxatives
C. Bulk-forming agents
D. Enemas

Answer 23

Osmotic laxatives

Polyethylene glycol 3350 (MiraLAX) 1.5 per kg per day

Question 24

True or False: Constipation can lead to urinary incontinence in children.

Answer 24

True

Question 25

What are the most accurate signs of moderate to severe dehydration in kids?

Answer 25

• Prolonged capillary refill
• Poor skin turgor
• Abnormal breathing

Question 26

What congenital disorder is classified by the absence or complete closure of a portion of the lumen of the duodenum?

What is seen in utero in this diagnosis?

Answer 26

Duodenal Atresia

Increased levels of amniotic fluid (polyhydramnios)

Question 27

Which of the following is the most common presenting symptom of duodenal atresia in a newborn?

A. Bilious vomiting
B. Watery diarrhea
C. Intermittent abdominal pain
D. Jaundice

Answer 27

Bilious vomiting

Question 28

A newborn presents with bilious vomiting within the first 24 hours of life. An abdominal x-ray shows a “double bubble” sign. What is the most likely diagnosis?

A. Pyloric stenosis
B. Intussusception
C. Duodenal atresia
D. Necrotizing enterocolitis

Answer 28

Duodenal atresia

Question 29

Which of the following is associated with an increased risk of duodenal atresia?

A. Maternal diabetes
B. Maternal use of folic acid supplements
C. Paternal age over 50 years
D. Maternal obesity

Answer 29

Maternal Diabetes

Question 30

What is the most appropriate initial management for a newborn diagnosed with duodenal atresia?

A. Immediate surgical correction
B. Pharmacological closure of the patent ductus arteriosus
C. Placement of a nasogastric tube and fluid resuscitation
D. Initiation of enteral feeding

Answer 30

Placement of a nasogastric tube and fluid resuscitation

Question 31

Duodenal atresia is commonly associated with which of the following chromosomal abnormalities?

A. Trisomy 21 (Down syndrome)
B. Turner syndrome
C. Klinefelter syndrome
D. Trisomy 18

Answer 31

Trisomy 21

Question 32

What is the most frequent viral cause of diarrhea in children?

Answer 32

Rotavirus

Question 33

What is the hallmark presentation of Hirschsprungs Disease?

Answer 33

Delayed passage of meconium

Question 34

A newborn fails to pass meconium within the first 48 hours of life and has abdominal distension. Which diagnostic test is most likely to confirm a diagnosis of Hirschsprung’s disease?

A. Abdominal ultrasound
B. Barium enema
C. Rectal biopsy
D. Complete blood count (CBC)

What is the definitive treatment for Hirschsprung’s disease?

Answer 34

Rectal biopsy

Surgical resection

Question 35

Which part of the intestine is most commonly affected by Hirschsprung’s disease?

A. The entire colon
B. The rectosigmoid region
C. The ileum
D. The jejunum

Answer 35

The rectosigmoid region

Question 36

Hirschsprung’s disease is associated with which of the following genetic conditions?

A. Down syndrome
B. Turner syndrome
C. Marfan syndrome
D. Cystic fibrosis

Answer 36

Down Syndrome

Down syndrome is caused by a trisomy of chromosome 21. This chromosomal abnormality increases the risk of several congenital conditions, including Hirschsprung’s disease. Research suggests that certain genes on chromosome 21 might influence the development of the enteric nervous system, which controls the bowel.

Question 37

Encopresis in children is almost always associated to what underlying condition?

Answer 37

Severe Constipation

Question 38

What is the most likely etiology for diarrhea after a picnic (i.e. egg salad)?

Answer 38

Staph. aureus

Question 39

What is the etiology of travelers diarrhea?

Answer 39

E.coli

Question 40

Vibrio cholerae infection is associated with the consumption of what food?

Answer 40

Shellfish

Question 41

What is the preferred pharmacologic treatment for GERD in children?

Answer 41

PPI’s (PPIs or H2 blockers can be given but PPI’s are preffered)

Question 42

A 4-month-old infant presents to the clinic with symptoms of frequent regurgitation, irritability, and poor weight gain. The mother reports that the baby seems to be in pain during and after feedings. Physical examination shows no respiratory symptoms or signs of esophagitis. What is the most appropriate initial management for this patient?

A. Start an empirical trial of a proton pump inhibitor.
B. Recommend thickening of feedings and positioning changes.
C. Perform an upper gastrointestinal series.
D. Prescribe an antibiotic for suspected bacterial infection.

Answer 42

Recommend thickening of feddings and positioning changes as this child has GERD

Question 43

A 3-year-old boy presents with recurrent coughing, especially at night, and has a history of wheezing that does not respond well to bronchodilators. He also has a history of frequent vomiting after meals but is gaining weight appropriately. Which diagnostic test would be most informative to evaluate the cause of his symptoms?

A. Spirometry
B. Barium swallow study
C. 24-hour esophageal pH monitoring
D. Allergy testing

Answer 43

24-hour esophageal pH monitoring

Question 44

Is a nighttime cough associated with GERD?

Answer 44

Yes, nighttime cough can indeed be associated with gastroesophageal reflux disease (GERD). In children and adults, GERD can cause a variety of respiratory symptoms, and cough is one of the more common manifestations, particularly when it occurs at night.

Question 45

a

True/False: Esophageal pH monitoring is the gold standard for diagnosing GERD in children of all ages.

Answer 45

False (It is informative but not necessarily the standard for all ages, particularly in infants where clinical presentation is often sufficient)

Question 46

A 3-year-old boy is brought to the pediatric clinic by his parents who noticed a bulge in his groin that becomes more apparent when he cries. The bulge is reducible and the child does not appear to be in discomfort while you examine him. Based on this presentation, what is the most likely diagnosis and the recommended management?

A. Inguinal hernia; refer for surgical evaluation.
B. Umbilical hernia; reassure and observe.
C. Hydrocele; schedule a follow-up in six months.
D. Testicular torsion; immediate surgical intervention.

Answer 46

Inguinal hernia; refer for surgical evaluation.

Question 47

Neonatal jaundice appears when total bilirubin levels are above what value?

At what level does neonatal hyperbili require treatment?

Answer 47

2mg/dL

Levels greater than 18

Question 48

When is a Coomb’s test done?

Answer 48

To evaluate neonatal jaundice

Question 49

What two genetic syndromes cause jaundice?

Answer 49

Dubin-Johnson and Rotor syndrome

Question 50

A 3-day-old full-term newborn is observed to have jaundice during a routine postnatal visit. The infant is breastfeeding well, with 6-8 wet diapers a day and appears otherwise healthy. What is the most likely type of jaundice in this case, and what is the appropriate initial management?

A. Physiologic jaundice; continue to monitor bilirubin levels and ensure effective breastfeeding.
B. Breast milk jaundice; switch to formula feeding temporarily.
C. Hemolytic jaundice; order a Coombs test immediately.
D. Cholestasis; refer for liver function tests and ultrasound.

Answer 50

Physiologic jaundice; continue to monitor bilirubin levels and ensure effective breastfeeding.

Question 51

A 2-day-old neonate, born at 35 weeks gestation via emergency cesarean delivery due to fetal distress, presents with jaundice. The mother’s blood type is O+ and the infant’s blood type is B+. The infant appears lethargic and the bilirubin level is rising. What is the most appropriate next step?

A. Initiate phototherapy and perform a direct Coombs test.
B. Continue to observe as the jaundice is likely physiologic.
C. Begin exchange transfusion immediately.
D. Advise the mother to stop breastfeeding until jaundice resolves.

What rise in biliribin levels requires treatment?

Answer 51

Initiate phototherapy and perform a direct Coombs test

faster than 0.2 mg/dL per hour or 5 mg/dl per day

Question 52

What is the definitive diagnosis for lactose intolerance?

Answer 52

Lactose hydrogen breath test

Question 53

A 6-week-old male infant presents to the pediatrician with a 2-week history of progressive non-bilious vomiting after feeding. The mother reports that the vomiting is forceful and the infant seems hungry again soon after vomiting. On examination, the infant appears mildly dehydrated and a small olive-sized mass can be palpated in the right upper quadrant of the abdomen. What is the most likely diagnosis and the appropriate diagnostic test?

A. Pyloric stenosis; order an abdominal ultrasound.
B. Gastroesophageal reflux disease; perform a barium swallow.
C. Intussusception; conduct an abdominal CT scan.
D. Food allergy; recommend an elimination diet and allergy testing.

Answer 53

Pyloric stenosis; order an abdominal ultrasound

Question 54

An 8-week-old boy is evaluated for projectile vomiting that has progressively worsened over the last 3 weeks. His parents report that he vomits forcefully shortly after each feeding, but he remains eager to eat. Upon examination, the child is noted to be somewhat lethargic and has a palpable olive-like mass in the right upper quadrant. What is the most definitive treatment for this condition?

A. Surgical pyloromyotomy
B. Administration of prokinetic agents
C. Initiation of thickened feedings
D. A course of oral antibiotics

Answer 54

Surgical pyloromyotomy

Question 55

A 7-week-old infant with a history of projectile vomiting is diagnosed with pyloric stenosis based on clinical findings and confirmed by ultrasound. Prior to any surgical intervention, which complication must be corrected?

A. Hypernatremia
B. Hypoglycemia
C. Metabolic alkalosis
D. Respiratory acidosis

How should it be corrected?

Answer 55

Metabolic alkalosis

Pyloric stenosis leads to projectile vomiting, which is typically non-bilious. This condition often results in significant loss of gastric acid (hydrochloric acid). The stomach’s continual production and subsequent loss of hydrochloric acid through vomiting leads to a state where there is an abnormal increase in blood pH, known as metabolic alkalosis.

IV fluids