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Clinical Medicine - GI Exam > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

A 4 week old male presents with projectile, non-bilious, vomiting commonly related to feedings.

On physical, the infant has been losing weight since his last appointment, is slightly jaundice, and has a sunken fontanel and skin tenting. On abdominal exam you feel a mass near the epigastric region.

What do you suspect?

A

Pyloric stenosis

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2
Q

Is pyloric stenosis more common in males or females?

A

Males

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3
Q

What class of antibiotics can increase the risk of pyloric stenosis?

A

Marcolides

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4
Q

In a patient with pyloric stenosis, it is common to be able to palpate the pyloris.

This is often described as a “______” mass.

A

Olive

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5
Q

Pyloric stenosis can often be miss diagnosed as what?

A

GERD

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6
Q

What is the first line imaging study for pyloric stenosis diagnosis?

A

Ultrasound

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7
Q

What TWO signs may be seen on a barium swallow in a patient with pyloric stenosis?

A
  1. Shoulder Sign

2. String Sign

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8
Q

In a pyloric stenosis patient, a metabolic panel would show what?

(HINT: Remember these patients are projectile vomiting)

A

Hypochloremic metabolic alkalosis

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9
Q

_____ _____ is an autoimmune disease that arises due to gluten protein sensitivity.

A

Celiac Disease

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10
Q

A 5 yo female presents with complaints of diarrhea, emesis and after eating a meal containing a high amount of wheat and rye. Their parents have also noticed she has stopped gaining weight.

On physical examination, you note a very thin stature (suspect muscle wasting) and abdominal bloating.

What do you suspect?

A

Celiac Disease

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11
Q

_______ celiac disease presents with GI symptoms after the introduction of gluten containing foods.

A

Typical Celiac Disease

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12
Q

_______ celiac disease accounts for 70% of newly diagnosed Celiac Disease and these patient DO NOT present with typical GI symptoms.

Anemia is the most common presentation in teenagers and young adults.

A

Atypical Celiac Disease

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13
Q

What TWO labs are most diagnostic for celiac disease?

What might the stools be like?

Will the patient have hypo or hyperproteinemia?

Could you see an anemia?

A

IgA anti TG2 and D-AGA

Steatorrhea

Hypoproteinemia

Anemia due to iron deficiency

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14
Q

What would be the most diagnostic procedure for celiac disease?

A

Small Bowel Biopsy whil on gluten diet

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15
Q

What scoring system is used in correlation with the small bowel biopsy?

A

Marsh Grading System

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16
Q

How is celiac disease treated?

A

Lifelong avoidance of gluten ingestion

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17
Q

This occurs when the intestine ‘telescopes’ into the adjoining intestine.

This is the most common cause of obstruction in children ages 3 months to 6 years old.

A

Intussusception

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18
Q

Where is the most common site of intussusception?

A

Ileocecal junction

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19
Q

How is the stool commonly described in a patient with intussusception?

A

Currant Jelly Stool

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20
Q

A 4 year old male presents with paroxysmal abdominal pain over the last 24 hours that he is able to relieve when he draws his knees into his chest. His mom noticed that his emesis has changed to a green color in the last few hours and his stool have this ‘dark jelly like appearance’.

On exam, he is somnolent with a distended abdomen. You are able to feel a ‘sausage-shaped’ mass in his right mid to upper abdomen.

What is your suspicion?

A

Intussusception

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21
Q

What would be seen on US in a patient with intussusception?

A

Ultrasound showing a ‘coiled-spring’ appearance

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22
Q

What would be seen on plain abdominal XRs in a patient with intussusception?

A

Lack of colonic gas

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23
Q

What is used for diagnosis and treatment of intussusception

A

Contrast enema

24
Q

Other than reduction, when is surgery indicated in intussusception?

A

If the bowel requires resection due to ischemia

25
Q

______ ____ are benign hamartomas, commonly found in the rectum, and have no risk for future malignancy

A

Juvenile Polyps

26
Q

What is the common presentation for juvenile polyps?

A

Bright red blood per stool or protusion from the anus

27
Q

How are juvenile polyps treated?

A

Endoscopic resection

28
Q

______ _______ are true diverticulum (contain all layers of the bowel) commonly found in the small intestine.

A

Meckel’s Diverticulum

29
Q

What are the “rules of 2” in regards to Meckel’s Diverticulum?

A

2% of the population
2:1 Males to females
2 feet of the terminal ileum
2 inches in length

30
Q

A 3 y.o. males presents with his mother who has noticed the patient’s stools have been ‘brick colored’ and a ‘jelly-like’ consistency. She has not noticed him complaining of abdominal pain.

What do you suspect?

A

Meckel’s Diverticulum

31
Q

How are Meckel’s Diverticulum diagnosed?

Treated?

A

Radionuclide scan

Surgical resection

32
Q

A 9 y.o. male presents complaining of RLQ pain over the last 24 hours. At first he noticed the pain around his belly button but it has since migrated to his RLQ. He has had one episode of vomiting in the last 6 hours and complains of a decreased appetite.

On exam, he is tender in his RLQ and has a positive McBurney’s point as well as a positive Rovsing’s sign. There is no rebound tenderness.

What is your clinical suspicion?

A

Appendicitis

33
Q

A patient with appendicitis might have a ________ on CBC as well as an elevated ____

A

Leukocytosis

Elevated CRP

34
Q

What is the first line diagnostic imaging modality when evaluating for appendicitis?

What may also be used to avoid radiation in younger children, although this test is not as sensitive as the above?

A

CT Abdomen/Pelvis

Ultrasound

35
Q

_______ hernias have protrusion that is visible

______ hernias have protrusion into another space that is not visible.

A

External

Internal

36
Q

______ hernias are typically noticed at birth.

_______ hernias are typically asymptomatic and are linked to a congenital defect.

A

Umbilical

Inguinal

37
Q

How may parents describe a hernia on presentation?

A

They may notice an intermittent bulge when the patient is straining or crying

38
Q

In regards to hernia management…

An ______ referral can be considered in an asymptomatic, reducible hernia.

An ______ referral should be considered in a reducible hernia with symptoms.

An ________ referral is need in a non-reducible hernia

A

Elective Referral

Urgent Referral

Emergent Referral

39
Q

At what three times during childhood are you likely to see constipation?

A
  1. Infancy: Transition to solid foods
  2. Toddler: Transitioning to toilet training
  3. School-age: Entry into school
40
Q

Is hypothyroidism or hyperthyroidism seen with constipation

A

Hypothyroidism

41
Q

What should be avoided in the treatment of constipation in children? Why?

A

Do not use Karo Syrup b/c of botulism

42
Q

Toddler’s squatting in the corner to have or withhold a bowel movement may be showing signs of what?

A

Stool Withholding

43
Q

_______ is the voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4 has been reached

A

Encopresis

44
Q

What may be found on DRE in a patient with Encopresis?

What could an abdominal XR show?

A

Typically find hard stool in the rectal vault

XR could show a large amount of stool (FOS)

45
Q

How is encopresis treated?

A

Bowel re-training

46
Q

In children, body fat levels decrease for the first __ years.

After this, there is a period of _____ _____.

A

5 years

Adiposity Rebound

47
Q

At what two times in a child’s life are they most at risk for obesity?

A
  1. Adiposity Rebound Period

2. Puberty

48
Q

BMI is expressed in percentiles in children?

What percentile is considered obese?

Overweight?

A

Obese: > 95th

Overweight: 85th - 95th

49
Q

T/F: BMI is used in infants (<2 y.o.)

A

False

50
Q

What growth curve is used in patients from birth to 2 years of age?

What does it plot?

A

WHO Growth Standard Chart

Plots: Weight, Length, Weight for Length, Head Circumference

51
Q

What growth curve is used in patients 2 y.o. to 20 y.o.?

What does it plot?

A

CDC Charts

Plots: Height, Weight, BMI

52
Q

What are SIX classifications of childhood obesity?

A
  1. Iatrogenic causes (medications, surgery)
  2. Diet
  3. Neurendocrine Obesities
  4. Social / Behavorial
  5. Sedentary Lifestyle
  6. Genetic
53
Q

Children should get up to ____ minutes of physical activity a day

A

60

54
Q

What is the 5-2-1-0 Guideline for preventing childhood obesity?

A

5 or more fruits and vegetables
2 hours or less of screen time
1 hour or more of physical activity
0 sugary drinks

55
Q

What is a great tool when discussing childhood obesity with patients and parents?

A

Motivational Interviewing

Clinical Medicine - GI Exam (4 decks)

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