Pediatric GI and Nutrition Flashcards
1
Q
99% of full-term infants stool within […] hours of birth.
A
99% of full-term infants stool within 48 hours of birth.
failure to pass meconium is often due to an underlying pathologic process (e.g. meconium ileus, Hirschsprung disease)
2
Q
Abdominal wall defects (e.g. gastroschisis) typically result in elevated maternal serum […] during pregnancy.
A
Abdominal wall defects (e.g. gastroschisis) typically result in elevated maternal serum alpha-fetoprotein during pregnancy.
3
Q
According to the AAP, cow’s milk may be introduced to infants beginning at age […].
A
According to the AAP, cow’s milk may be introduced to infants beginning at age 12 months.
earlier introduction of cow’s milk is associated with iron deficiency anemia
4
Q
According to the AAP, pureed fruits and vegetables may be introduced to infants beginning at age […].
A
According to the AAP, pureed fruits and vegetables may be introduced to infants beginning at age 6 months.
followed by pureed proteins (e.g. meats); exclusive breastfeeding is recommended for the first 6 months of life
5
Q
All exclusively breastfed infants should be started on daily […] supplements within the first month of life.
A
All exclusively breastfed infants should be started on daily vitamin D supplements within the first month of life.
the dose is 400 IU
6
Q
Approximately how many wet diapers should a 5-day-old newborn make per day?
A
> 5 wet diapers/per day
as a general rule, the number of wet diapers should equal age in days for the first week of life; after the first week, infants should have > 6 wet diapers per day
7
Q
Biliary cysts require surgical resection to relieve obstruction and prevent the development of […].
A
Biliary cysts require surgical resection to relieve obstruction and prevent the development of cholangiocarcinoma.
8
Q
Birth weight should be regained by age […] - […] days.
A
Birth weight should be regained by age 10 - 14 days.
infants normally lose up to 7% of their birth weight in the first 5 days of life
9
Q
Breast milk jaundice is distinguishable from breastfeeding failure jaundice by the absence of signs of […].
A
Breast milk jaundice is distinguishable from breastfeeding failure jaundice by the absence of signs of dehydration.
e.g. adequate voiding/stooling and no “brick-red” urate crystals in the diaper
10
Q
Breastfeeding is associated with decreased maternal risk of […] and […] cancer.
A
Breastfeeding is associated with decreased maternal risk of breast and ovarian cancer.
also associated with decreased risk of childhood cancer in the infant.
11
Q
Breastfeeding is contraindicated in infants with […].
A
Breastfeeding is contraindicated in infants with galactosemia.
12
Q
By age 12 months, an infants weight should […] and height should increase by […]%.
A
By age 12 months, an infants weight should triple and height should increase by 50%.
during the first 3 months of life, infants should gain ~30g/day (1 oz), with weight doubling by age 4 months
13
Q
Children with Beckwith-Wiedemann syndrome should be closely monitored for the development of […] and hepatoblastoma.
A
Children with Beckwith-Wiedemann syndrome should be closely monitored for the development of Wilms tumor and hepatoblastoma.
via abdominal/renal ultrasound and serum alpha-fetoprotein
14
Q
Children with Beckwith-Wiedemann syndrome should be closely monitored for the development of Wilms tumor and […].
A
Children with Beckwith-Wiedemann syndrome should be closely monitored for the development of Wilms tumor and hepatoblastoma.
via abdominal/renal ultrasound and serum alpha-fetoprotein
15
Q
Children with cyclic vomiting syndrome often have a family history of […].
A
Children with cyclic vomiting syndrome often have a family history of migraine.
thus anti-migraine agents (e.g. sumatriptan) may be beneficial in the management of CVS
16
Q
Congenital […] is due to an incomplete closure of the umbilical ring.
A
Congenital umbilical hernia is due to an incomplete closure of the umbilical ring
many close spontaneously; these hernias are covered by skin (distinguishing feature from omphalocele, which is covered by a peritoneal sac)
17
Q
Does eosinophilic esophagitis respond to GERD therapy (e.g. PPIs)?
A
No
however, a 2-month trial of PPIs is part of the diagnostic evaluation; if there is no symptom improvement, an endoscopy with esophageal biopsy is warranted
18
Q
Does physiologic jaundice of the newborn result in unconjugated or conjugated hyperbilirubinemia?
A
Unconjugated
occurs after 24 hours of life; indirect hyperbilirubinemia before 24 hours of life is pathologic (e.g. hemolytic disease of the newborn)
19
Q
Duodenal atresia is associated with […] syndrome in up to a third of cases.
A
Duodenal atresia is associated with Down syndrome in up to a third of cases.
20
Q
Eosinophilic esophagitis classically presents with dysphagia and food impaction in response to […].
A
Eosinophilic esophagitis classically presents with dysphagia and food impaction in response to food allergens.
other symptoms include epigastric pain and vomiting
21
Q
Eosinophilic esophagitis is characterized by eosinophilic infiltration of the esophagus, often in […] patients.
A
Eosinophilic esophagitis is characterized by eosinophilic infiltration of the esophagus, often in atopic patients.
a history of eczema, asthma, or other atopic conditions in common
22
Q
Eosinophilic esophagitis is characterized by esophageal […] and linear furrows on endoscopy.
A
Eosinophilic esophagitis is characterized by esophageal rings and linear furrows on endoscopy.
circular rings are non-specific; diagnosis is confirmed by > 15 eosinophils per high-power field on histology
23
Q
Esophageal atresia with distal TEF is characterized by failure to pass a […] tube into the stomach.
A
Esophageal atresia with distal TEF is characterized by failure to pass a nasogastric tube into the stomach.
24
Q
Esophageal atresia with distal TEF may present with abdominal distention due to […] in the stomach (visible on CXR).
A
Esophageal atresia with distal TEF may present with abdominal distention due to air in the stomach (visible on CXR).
the tracheoesophageal fistula permits air entry into the stomach and intestines
25
Esophageal atresia with TEF typically presents with drooling, choking, and [...] with the first feeding.
Esophageal atresia with TEF typically presents with drooling, choking, and **vomiting** with the first feeding.
may be complicated by aspiration pneumonia due to gastric acid reflux into the distal esophagus through the fistula
26
Esophageal atresia with tracheoesophageal fistula (TEF) often presents with [...] on prenatal ultrasound.
Esophageal atresia with tracheoesophageal fistula (TEF) often presents with **polyhydramniosis** on prenatal ultrasound.
due to inability to swallow amniotic fluid
27
Exclusive breastfeeding is recommended for the first [...] months of life.
Exclusive breastfeeding is recommended for the first **6** months of life.
28
Fundoplication is a procedure used to treat severe [...].
Fundoplication is a procedure used to treat severe **gastroesophageal reflux (GERD)**.
29
Healthy infants may lose up to [...]% of their birth weight in the first 5 days of life.
Healthy infants may lose up to **7%** of their birth weight in the first 5 days of life.
due to excretion of excess fluid acquired in utero and during labor; no treatment is required
30
In addition to lifestyle modifications, refractory constipation in a toddler may be managed initially with [...] therapy.
In addition to lifestyle modifications, refractory constipation in a toddler may be managed initially with **oral** laxative therapy.
lifestyle changes may include increasing water and fiber intake, limiting cow's milk to \< 24 oz a day, and sitting on the toilet after each meal
31
In children, the most common cause of intussusception is [...] (e.g. due to rotavirus or adenovirus).
In children, the most common cause of intussusception is **lymphoid hyperplasia**. (e.g. due to rotavirus or adenovirus)
Peyer's patches hypertrophy in response to viral infection, which acts as a lead point for intussusception
32
Initial management of necrotizing enterocolitis includes supportive care and initiation of [...].
Initial management of necrotizing enterocolitis includes supportive care and initiation of **broad-spectrum IV antibiotics.**
due to risk of septic shock; surgery is necessary if perforation occurs (seen as pneumoperitoneum on X-ray)
33
Intussusception is characterized by a "[...]" appearance on ultrasound.
Intussusception is characterized by a **"target sign"** appearance on ultrasound.
## Footnote
ultrasound is the first-line imaging modality for diagnosis of intussusception
34
Intussusception is occasionally palpable as a "[...]-shaped" or cylindrical mass in the right upper quadrant.
Intussusception is occasionally palpable as a "sausage-shaped" or cylindrical mass in the right upper quadrant.
invagination of the ileum into the colon causes the mass to be found in the RUQ instead of the RLQ
35
Intussusception results in compromised blood supply, which causes [...] abdominal pain (frequency) with "[...]" stool.
Intussusception results in compromised blood supply, which causes **intermittent** abdominal pain (frequency) with **"currant jelly"** stool.
pain is intermittent because the intussuscepted bowel temporarily stops contracting; children usually act normal in between episodes
36
Maternal contraindications to breastfeeding include active untreated [...], HIV infection, and herpetic breast lesions.
Maternal contraindications to breastfeeding include active untreated **tuberculosis**, HIV infection, and herpetic breast lesions.
other contraindications include varicella infection \< 5 days prior to or within 2 days of delivery and active abuse of street drugs or alcohol
37
Meckel diverticuli often contain ectopic acid-secreting [...] and, less frequently, pancreatic tissue.
Meckel diverticuli often contain ectopic acid-secreting **gastric mucosa** and, less frequently, pancreatic tissue.
acid may damage the Meckel diverticulum, resulting in brisk, painless bleeding
38
Meckel diverticulum is diagnosed using a [...] study for uptake by ectopic gastric mucosa.
Meckel diverticulum is diagnosed using a **technetium-99m pertechnetate** study for uptake by ectopic gastric mucosa .
39
Neonates should breastfeed every [...] - [...] hours for \> 10 - 20 minutes per breast during the first month of life.
Neonates should breastfeed every **2 - 3 hours** for \> 10 - 20 minutes per breast during the first month of life.
or approximately 8 - 12 times per day
40
Physiological neonatal jaundice occurs, in part, due to transiently low [...] activity at birth.
Physiological neonatal jaundice occurs, in part, due to transiently low **UDP-glucuronyl transferase** activity at birth.
adult levels are not reached until age 2 weeks; other contributing factors include increased bilirubin production and increased enterohepatic cycling
41
Preterm infants that are exclusively breastfed should be initiated on [...] supplementation in addition to vitamin D.
Preterm infants that are exclusively breastfed should be initiated on **iron** supplementation in addition to vitamin D.
full-term infants are born with adequate iron stores that prevent anemia in the first 4 - 6 months of life
42
Prior to pyloromyotomy, patients with pyloric stenosis should receive IV hydration and electrolytes to decrease the risk of post-operative [...].
Prior to pyloromyotomy, patients with pyloric stenosis should receive IV hydration and electrolytes to decrease the risk of post-operative **apnea.**
metabolic alkalosis increases the risk of post-operative apnea
43
Reye syndrome causes [...]-vesicular fatty change in the liver with hypoglycemia, vomiting, hepatomegaly, and eventually coma/death.
Reye syndrome causes **micro**-vesicular fatty change in the liver with hypoglycemia, vomiting, hepatomegaly, and eventually coma/death.
versus hepatic steatosis, which is characterized by macrovascular fatty change
44
Sandifier syndrome refers to arching of the back (opisthotonic posturing) during or after feeding and is related to pathologic [...].
Sandifier syndrome refers to arching of the back (opisthotonic posturing) during or after feeding and is related to pathologic **GERD**.
45
The initial step in the evaluation of biliary atresia is [...].
The initial step in the evaluation of biliary atresia is **abdominal ultrasound**.
may show an absent or abnormal gallbladder; the gold standard for diagnosis is intraoperative cholangiogram
46
To decrease risk of constipation, children should drink [...] oz of cow's milk per day.
To decrease risk of constipation, children should drink \< **24** oz of cow's milk per day.
47
What cause of bilious vomiting is characterized by meconium obstructing the ileum with a microcolon visualized on X-ray?
Meconium ileus (usually secondary to cystic fibrosis)
versus Hirschsprung disease, where the level of obstruction is the rectosigmoid colon and X-ray reveals a transition zone
48
What cause of bilious vomiting is characterized by meconium obstructing the rectosigmoid colon with a transition zone visualized on X-ray?
Hirschsprung disease
versus meconium ileus, where the level of obstruction is the ileum and X-ray reveals a microcolon
49
What hematologic pathology is more common in preterm infants within the first 4 - 6 months of life?
Iron deficiency anemia
other risk factors for iron deficiency include maternal iron deficiency and introduction of cows milk before age 12 months
50
What is the best initial imaging study for a newborn infant that presents with bilious vomiting and no passage of stool?
Abdominal X-ray
X-ray can identify surgical emergencies (e.g. pneumoperitoneum from perforated bowel)
51
What is the fluid of choice for initial resuscitation of a child with moderate-severe dehydration?
IV bolus of isotonic solutions (e.g. normal saline, lactated Ringer's)
dextrose is not part of initial treatment, but should be added to maintenance fluids; oral rehydration is adequate for mild-moderate dehydration
52
What is the initial treatment for rapidly rising hyperbilirubinemia in a newborn?
non-UV phototherapy (for kernicterus prevention)
exchange transfusion is indicated for total bilirubin levels \> 25 mg/dL
53
What is the likely diagnosis in a 1-month-old that presents with one week of jaundice and acholic stool with hepatomegaly and conjugated hyperbilirubinemia on further examination?
Biliary atresia
should be suspected in newborns with conjugated hyperbilirubinemia and hepatomegaly
54
What is the likely diagnosis in a 5-day-old baby that presents with unconjugated hyperbilirubinemia and signs of dehydration after exclusively breastfeeding?
Breastfeeding failure jaundice
signs of dehydration include decreased urine/stool output and "brick-red" urate crystals in the diaper; inadequate stooling results in poor bilirubin elimination and increased enterohepatic circulation of bilirubin
55
What is the likely diagnosis in a child that presents with pancreatic insufficiency, failure to thrive, and recurrent respiratory infections?
Cystic fibrosis
56
What is the likely diagnosis in a child that presents with self-limiting, recurrent nausea and vomiting at the same time each month with no symptoms in between episodes?
Cyclic vomiting syndrome
treatment with anti-emetics and anti-migraine agents may be beneficial
57
What is the likely diagnosis in a generally healthy newborn that presents with cyanosis that worsens with feeding and is relieved with crying despite a normal cardiac and respiratory exam?
Choanal atresia
failure to pass a catheter through the nose into the oropharynx is suggestive of this diagnosis; CT scan confirms the diagnosis
58
What is the likely diagnosis in a preterm newborn that presents with feeding intolerance, abdominal distention, bloody stools, and the X-ray below?
Necrotizing enterocolitis
59
What is the likely diagnosis in a well-appearing infant that presents with regurgitation after feeding, as well as eczema and painless, bloody stools?
Milk protein allergy
management includes eliminating soy and dairy protein from the diet (if breastfeeding) or switching to hydrolyzed formula (if formula feeding)
60
What is the likely diagnosis in a young child that presents with dry eyes, dry skin, and difficulty adapting to darkness?
Vitamin A deficiency
other possible symptoms include photophobia, keratomalacia, Bitot spots, and follicular hyperkeratosis on the skin
61
What is the likely diagnosis in an adolescent with a history of IBD that presents with watery diarrhea, a beefy red tongue, and an erythematous rash in sun exposed areas?
Pellagra (B3 deficiency)
the three D's of pellagra: diarrhea, dermatitis, and dementia
62
What is the likely diagnosis in an adolescent with a history of type 1 DM that presents with weight loss, iron deficiency anemia and a pruritic, vesicular rash on the elbows and knees?
Celiac disease
iron deficiency results from poor iron resorption in the duodenum
63
What is the likely diagnosis in an afebrile child that presents with abdominal pain, jaundice, and a palpable RUQ mass with a normal gallbladder on ultrasound?
Biliary cyst
most commonly a type 1 cyst, which is single and extrahepatic
64
What is the likely diagnosis in an infant that presents with macroglossia, umbilical hernia, hemihyperplasia, and hypoglycemia?
Beckwith-Wiedemann syndrome
65
What is the likely diagnosis in an infant that presents with projectile, non-bilious emesis and an olive-shaped mass in the abdomen?
Pyloric stenosis
may be visualized on ultrasound as an enlongated, thickened pylorus
66
What is the likely diagnosis in an otherwise healthy infant that presents with excessive crying for \> 3 hours per day, for \> 3 days per week, for \> 3 weeks?
Infantile colic
benign; parents should be reassured and taught soothing/feeding techniques
67
What is the most common congenital lead point for intussusception in children?
Meckel’s diverticulum
should be suspected in older children that develop intussusception, especially if it recurs
68
What is the most common presentation of Meckel's diverticulum in a toddler?
Painless hematochezia
typically asymptomatic; other manifestations include intussusception, intestinal obstruction, and volvulus
69
What is the next step in management for a child that swallowed a battery that is located in the esophagus on X-ray?
Immediate endoscopic removal
necessary to prevent further mucosal damage and esophageal ulceration; removal is necessary for both symptomatic and asymptomatic patients
70
What is the next step in management for a child that swallowed a battery that is located in the stomach on X-ray?
Observation for 24 - 48 hours
batteries located distal to the esophagus typically pass uneventfully
71
What is the next step in management for a newborn with bilious emesis and dilated loops of bowel on X-ray?
Contrast enema
## Footnote
helps differentiate between meconium ileus (microcolon on enema) and Hirschsprung disease (transition zone on enema)
72
What is the next step in management for a newborn with bilious emesis and gasless abdomen on X-ray?
Upper GI series (e.g. barium swallow)
if the bowel gas pattern is not suggestive of duodenal atresia or distal obstruction, an upper GI series is performed to evaluate for malrotation
73
What is the next step in management for a stable child with suspected intussusception and a "target sign" on ultrasound?
Ultrasound-guided air contrast enema
diagnostic and often therapeutic; critical for avoiding ischemia and peritonitis
74
What is the next step in management for a symptomatic child with evidence of a swallowed coin in the esophagus on X-ray?
Flexible endoscopy
endoscopy is both diagnostic and therapeutic; asymptomatic children may be observed for 24 hours after ingestion (coins are not sharp and the metals used are not toxic)
75
What is the next step in management for an infant with adequate weight gain that spits up formula after each feed?
Reassurance
this infant is experiencing physiologic GERD, which may be aided by positional therapy (e.g. hold infant upright for 20-30 minutes after frequent, small-volume feeds)
76
What is the next step in management for an infant with failure to thrive that spits up formula after each feed?
proton pump inhibitors and/or thickened feeds (e.g. adding oatmeal)
failure to thrive indicates that this is pathologic GERD
77
What is the recommended management for infants with breastfeeding failure jaundice?
Increase the frequency and duration of feeds
if the bilirubin continues to rise (e.g. mother's milk supply is inadequate), formula supplementation may be necessary
78
What is the recommended management of patients with biliary atresia prior to a liver transplant?
Hepatoportoenterostomy (Kasai procedure)
allows time for growth and reduces morbidity/mortality of liver transplant
79
What is the typical prognosis of milk- or soy-protein-induced colitis?
Spontaneous resolution by 1 year of age
80
What vitamin deficiency is associated with a normocytic-normochromic anemia?
Vitamin B2 (riboflavin) deficiency
81
What vitamin deficiency is associated with inflammation of the lips with scaling/fissures at the corners of the mouth (angular cheilitis)?
Vitamin B2 (riboflavin)
other symptoms include stomatitis, glossitis, normocytic anemia, and seborrheic dermatitis
82
What vitamin deficiency is associated with night blindness (nyctalopia)?
Vitamin A deficiency
83
Which abdominal wall defect, omphalocele or gastroschisis, is associated with other major malformations?
Omphalocele
e.g. cardiac disease, neural tube defects, trisomy syndromes; occurs in ~50% of patients with omphalocele
84
[...] is a congenital malformation characterized by extrusion of abdominal contents through the anterior abdominal wall.
Gastroschisis is a congenital malformation characterized by extrusion of abdominal contents through the anterior abdominal wall
typically to the right of the umbilicus with no peritoneal covering; surgical emergency
85
[...] is caused by failure of the herniated intestines to return to the body cavity during development.
Omphalocele is caused by failure of the herniated intestines to return to the body cavity during development
typically below the umbilical cord (midline) and covered by peritoneum; surgical emergency
86
Duodenal atresia is characterized by dilation of the stomach and proximal duodenum with a "[...]" sign on X-ray.
Duodenal atresia is characterized by dilation of the stomach and proximal duodenum with a **"double bubble"** sign on X-ray.
87
[...] is characterized by dilation of the stomach and proximal duodenum with a "double bubble" sign on X-ray.
**Duodenal atresia** is characterized by dilation of the stomach and proximal duodenum with a "double bubble" sign on X-ray.
88
Jejunal atresia is characterized by a "[...]" sign and gasless colon on X-ray.
Jejunal atresia is characterized by a **"triple bubble**" sign and gasless colon on X-ray.
symptoms include bilious vomiting and abdominal distention in a newborn
89
[...] atresia is characterized by a "triple bubble" sign and gasless colon on X-ray.
**Jejunal** atresia is characterized by a "triple bubble" sign and gasless colon on X-ray.
symptoms include bilious vomiting and abdominal distention in a newborn
90
Midgut volvulus is a surgical emergency that classically presents in a neonate with congenital [...], manifesting as bilious vomiting and abdominal distention.
Midgut volvulus is a surgical emergency that classically presents in a neonate with congenital **malrotation**, manifesting as bilious vomiting and abdominal distention.
diagnosed using an upper GI series, which may show a "corkscrew" pattern; untreated volvulus can progress to bowel ischemia and perforation
91
[...] is a surgical emergency that classically presents in a neonate with congenital malrotation, manifesting as bilious vomiting and abdominal distention.
**Midgut volvulus** is a surgical emergency that classically presents in a neonate with congenital malrotation, manifesting as bilious vomiting and abdominal distention.
diagnosed using an upper GI series, which may show a "corkscrew" pattern; untreated volvulus can progress to bowel ischemia and perforation
92
Reye syndrome is fulminant liver failure and encephalopathy in children with viral illness who take [...].
Reye syndrome is fulminant liver failure and encephalopathy in children with viral illness who take **aspirin.**
thus, avoid aspirin in children, except for Kawasaki disease
93
[...] syndrome is fulminant liver failure and encephalopathy in children with viral illness who take aspirin.
**Reye** syndrome is fulminant liver failure and encephalopathy in children with viral illness who take aspirin.
thus, avoid aspirin in children, except for Kawasaki disease
94
Celiac disease is associated with increased risk for small bowel carcinoma and [...] lymphoma.
Celiac disease is associated with increased risk for small bowel carcinoma and **T-cell** lymphoma.
presents as refractory disease despite good dietary control; T-cell lymphoma = enteropathy associated T-cell lymphoma (EATL)
95
Celiac disease is associated with [...], which are small, herpes-like vesicles on the skin.
Celiac disease is associated with **dermatitis herpetiformis**, which are small, herpes-like vesicles on the skin.
due to cross-reactivity between anti-gliadin IgA antibodies and transglutaminase at the dermal basement membrane
96
Celiac disease is characterized histologically by [...] of villi and [...] of crypts.
Celiac disease is characterized histologically by **flattening of villi** and **hyperplasia** of crypts.
increased intraepithelial lymphocytes is another common histological finding; normal above, celiac below
97
Duodenal atresia often presents with [...] on prenatal ultrasound.
Duodenal atresia often presents with **polyhydramnios** on prenatal ultrasound.
98
Hirschsprung disease is a congenital megacolon associated with [...] syndrome.
Hirschsprung disease is a congenital megacolon associated with **Down** syndrome.
99
Hirschsprung disease is characterized by massive dilation of the bowel [...] to the aganglionic segment (proximal or distal), resulting in a "transition zone".
Hirschsprung disease is characterized by massive dilation of the bowel **proximal** to the aganglionic segment (proximal or distal), resulting in a "transition zone".
100
Hirschsprung disease is characterized by [...] ("squirt sign") and an empty rectal vault on digital rectal exam.
Hirschsprung disease is characterized by **explosive expulsion of feces** ("squirt sign") and an empty rectal vault on digital rectal exam.
101
Hirschsprung disease is diagnosed by absence of ganglionic cells on [...].
Hirschsprung disease is diagnosed by absence of ganglionic cells on **rectal suction biopsy**.
102
Hirschsprung disease may present with abdominal distention and [...] vomiting. (bilious or nonbilious)
Hirschsprung disease may present with abdominal distention and **bilious** vomiting. (bilious or nonbilious)
103
Hirschsprung disease occurs due to a congenital failure of [...] cells to descend into the myenteric and submucosal plexus.
Hirschsprung disease occurs due to a congenital failure of **ganglion** cells to descend into the myenteric and submucosal plexus.
ganglion cells are derived from neural crest cells
104
How soon after birth does intestinal atresia typically present?
~ 1 - 2 days
e.g. duodenal, jejunal, ileal atresia
105
How soon after birth does pyloric stenosis typically present?
~ 3 - 5 weeks
takes time for hypertrophy to develop; helps distinguish from intestinal atresia (bilious vomit within 1 - 2 days)
106
Intestinal atresia presents with abdominal distention and [...] vomiting. (bilious or nonbilious)
Intestinal atresia presents with abdominal distention and **bilious** vomiting. (bilious or nonbilious)
e.g. duodenal, jejunal, ileal atresia
107
Is Meckel diverticulum a true or false diverticulum?
True (outpouching of all layers)
108
Jejunal and ileal atresia are thought to occur due to [...] accident in utero.
Jejunal and ileal atresia are thought to occur due to **vascular** accident in utero.
thus risk factors include prenatal exposure to vasoconstrictive agents (e.g. cocaine, tobacco)
109
Malrotation results in improper positioning of the bowel with formation of fibrous, "[...] bands".
Malrotation results in improper positioning of the bowel with formation of fibrous, "**Ladd** bands".
the finding of the ligament of Treitz on the right side of the abdomen is indicative of malrotation
110
Meckel diverticulum arises due to incomplete obliteration of the [...].
Meckel diverticulum arises due to incomplete obliteration of the **vitelline (omphalomesenteric) duct**.
111
Meckel diverticulum is associated with the "rule of [...]".
Meckel diverticulum is associated with the "rule of **2s**".
112
Meckel diverticulum is two times more likely to occur in [...]. (gender)
Meckel diverticulum is two times more likely to occur in **males**. (gender)
113
Necrotizing enterocolitis is a GI pathology often seen in premature, [...]-fed infants with immature immune systems.
Necrotizing enterocolitis is a GI pathology often seen in premature, **formula**-fed infants with immature immune systems.
other risk factors include low birth weight, congenital heart disease, and hypotension
114
115
Pyloric stenosis may present with visible [...].
Pyloric stenosis may present with visible **peristalsis**.
116
Pyloric stenosis often presents with a palpable "[...]-like" mass in the epigastric region of the abdomen.
Pyloric stenosis often presents with a palpable "**olive**-like" mass in the epigastric region of the abdomen.
117
Pyloric stenosis typically presents with [...], projectile vomiting. (bilious or nonbilious)
Pyloric stenosis typically presents with **nonbilious**, projectile vomiting. (bilious or nonbilious)
nonbilious vomiting is an important distinguishing feature from intestinal atresia (bilious)
118
Rickets may present with frontal bossing and [...] (soft skull).
Rickets may present with frontal bossing and **craniotabes** (soft skull).
frontal bossing is an enlarged forehead
119
Rickets may present with pathologic [...] legs (genu varum).
Rickets may present with pathologic bow legs (genu varum).
120
Rickets may present with [...] due to osteoid deposition at the costochondral junction.
Rickets may present with **rachitic rosary** due to osteoid deposition at the costochondral junction.
"bead like" deposition of osteoid at the costochondral junction
121
122
The most common presentation for a [...] is abdominal distention with a firm, irregular mass that can cross the midline.
The most common presentation for a **neuroblastoma** is abdominal distention with a firm, irregular mass that can cross the midline.
Wilm's tumor is smooth and unilateral; neuroblastoma may also present with dark discoloration under both eyes ("raccoon eyes")
123
The most common presentation for a neuroblastoma is abdominal distention with a firm, irregular mass that [...] cross the midline.
The most common presentation for a neuroblastoma is abdominal distention with a firm, irregular mass that **can** cross the midline.
Wilm's tumor is smooth and unilateral; neuroblastoma may also present with dark discoloration under both eyes ("raccoon eyes")
124
Treatment of Hirschsprung disease involves [...] of the involved bowel.
Treatment of Hirschsprung disease involves surgical resection of the involved bowel.
125
Vitamin B12 deficiency is characterized by [...] serum methylmalonic acid.
Vitamin B12 deficiency is characterized by **increased** serum methylmalonic acid.
important distinguishing feature from folate deficiency
126
Vitamin K deficiency may occur in newborns due to lack of [...] that normally synthesize vitamin K.
Vitamin K deficiency may occur in newborns due to lack of **colonic bacteria** that normally synthesize vitamin K.
thus, vitamin K injection is given prophylactically to all newborns at birth; vitamin K deficiency can also occur in patients with prolonged antibiotic use by the same mechanism
127
Vitamin K deficiency presents with [...] PT and [...] aPTT.
Vitamin K deficiency presents with **increased** PT and **normal/increased** aPTT.
128
Vitamin K deficiency presents with [...] bleeding time.
Vitamin K deficiency presents with **normal** bleeding time.
129
What demographic is associated with pyloric stenosis?
First-born boys
130
What drug is associated with pyloric stenosis?
Erythromycin
either through direct administraton or through breast milk; pyloric stenosis is also associated with formula feeds
131
What GI pathology is associated with the rotavirus vaccine?
Intussusception
132
What hookworms (2) are associated with iron deficiency anemia?
Ancylostoma duodenale and Necator americanus
133
What imaging finding is pathognomonic for necrotizing enterocolitis?
pneumatosis intestinalis
## Footnote
due to extravasation of bowel gas into damaged bowel wall (red arrows); air in the portal vein may be seen as well (yellow arrows)
134
What is the definitive treatment for pyloric stenosis?
Surgical excision (pyloromyotomy)
135
What is the most common cause of chronic pancreatitis in children?
cystic fibrosis
the most common cause in adults is chronic alcoholism
136
What is the most common cause of osteomalacia/rickets?
Vitamin D deficiency
e.g. decreased sun exposure, poor diet, malabsorption, liver failure, renal failure
137
What malabsorption disorder is associated with HLA-DQ2 and HLA-DQ8?
Celiac disease
138
What malabsorption syndrome is associated with dermatitis herpetiformis?
Celiac disease
139
What newborn screening blood test is used to screen for cystic fibrosis?
Immunoreactive trypsinogen
an increased immunoreactive trypsinogen may be indicative of cystic fibrosis
140
What parasite is associated with vitamin B12 deficiency?
Diphyllobothrium latum
141
What pathology is associated with vitamin C deficiency?
Scurvy
142
What proteins (2) have decreased activity due to vitamin K deficiency?
protein C and protein S
143
What type of anemia is associated with gastrectomy?
Iron deficiency anemia
due to decreased acid, which normally maintains iron in the Fe2+ state (more readily absorbed than Fe3+)
144
What vitamin deficiency is associated with bitot spots on conjunctiva due to squamous metaplasia of corneal epithelium
Vitamin A deficiency
goblet/columnar epithelium undergoes metaplasia to keratinizing squamous epithelium
145
What vitamin deficiency is associated with corneal degeneration, known as keratomalacia?
Vitamin A deficiency
146
Where in the GI tract does intussusception most commonly occur?
Ileocecal junction
147
Which coagulation factors (4) have decreased activity due to vitamin K deficiency?
2, 7, 9, 10
II, VII, IX, X
148
[...] disease is immune-mediated damage of small bowel villi due to gluten exposure.
**Celiac** disease is immune-mediated damage of small bowel villi due to gluten exposure.
gluten is present in wheat and grains; also known as gluten-sensitive enteropathy and celiac sprue
149
[...] disease is characterized by defective relaxation and peristalsis of the rectum and distal sigmoid colon.
**Hirschsprung** disease is characterized by defective relaxation and peristalsis of the rectum and distal sigmoid colon.
150
[...] is telescoping of a proximal bowel segment into a distal segment.
**Intussusception** is telescoping of a proximal bowel segment into a distal segment.
151
[...] is due to defective mineralization of osteoid.
**Osteomalacia/Rickets** is due to defective mineralization of osteoid.
osteoblasts produce osteoid, which is normally mineralized with Ca2+ and PO43- to form bone
152
Celiac disease is classically associated with IgA antibodies against endomysium, [...], and/or deamidated gliadin.
Celiac disease is classically associated with IgA antibodies against endomysium, **tissue transglutaminase (tTG)**, and/or deamidated gliadin.
153
[...] disease is classically associated with IgA antibodies against endomysium, tissue transglutaminase (tTG), and/or deamidated gliadin.
**Celiac** disease is classically associated with IgA antibodies against endomysium, tissue transglutaminase (tTG), and/or deamidated gliadin.
