peds gastroenterology Flashcards
Zinc deficiency can occur in all undermentioned disorders, except:
A) Acrodermatitis enteropathica
B) Hirschsprung disease
C) Coeliac disease
D) Phenylketonuria
E) Kwashiorkor
B) Hirschsprung disease
It is true for children with encopresis all undermentioned statements, except:
A) Its prevalence in average children’s population is 1-3%
B) Among children with psychiatric disturbances the prevalence is 5-7%
C) Its pathological base is the gluten sensitivity
D) Occurance is more frequent during day than night
E) Rectal stool impactation and constipation occur very frequently
C) Its pathological base is the gluten sensitivity
All the undermentioned ones may be the causes of constipation, except:
A) Psychological problem
B) Inaccurate diet
C) Megacolon congenitum
D) Overfunction of nervus vagus
E) Hypothyreosis
F) Insufficiency of abdominal muscle
G) Gastrointestinal allergy
D) Overfunction of nervus vagus
All of the undermentioned ones may be the causes of constipation, except:
A) Idiopathic megacolon
B) Overdosage of vitamin D
C) Insufficient fluid intake
D) Salmonellosis
E) Muscular insufficienty
F) Rectal stenosis
D) Salmonellosis
All statements are characteristic for ascariasis, except:
A) This worm goes through maturation in both man and soil
B) It causes always eosinophilia
C) Eggs can be rarely seen in stool
D) Rectal migration is not characteristic
E) The worms migrate to the lung
B) It causes always eosinophilia
An exclusively breastfed infant develops properly, her or his mother has ample breast milk. When would you suggest to introduce the vegetable purée to the infant’s diet?
A) 6 weeks
B) about 6 months
C) 9 months
D) 11 months
B) about 6 months
The absoption of vitamin B12 and bile salts are specifically located to:
A) Duodenum
B) Jejunum
C) Ileum
D) None of them
C) Ileum
Steatorrhea occurs in all undermentioned disease, except:
A) lactose intolerance
B) intestinal lymphangiectasia
C) coeliac disease
D) cystic fibrosis
E) bacterial overgrowth of the small bowel
A) lactose intolerance
Hematochezia occurs in all undermentioned conditions, except:
A) allergic colitis
B) oesophagitis
C) Meckel-diverticulum
D) Ulcerative colitis
B) oesophagitis
The undermentioned statements are true in atrophy, except:
A) malnutrition without oedema
B) weight loss is 20-30%
C) caused by protein deficient diet
D) energy and protein intake are inadequate
C) caused by protein deficient diet
The undermentioned statements are true in decomposition, except:
A) it is called also athrepsy
B) weight loss is larger than 30%
C) the ratio of energy/protein intake is normal
D) mild form of protein-energy malnutrition
D) mild form of protein-energy malnutrition
The undermentioned statements are true for kwashiorkor, except:
A) may be caused by chronic diarrhea
B) malnutrition with oedema
C) sufficient energy intake with shortage of protein
D) caused by enzyme defect
E) the name of kwashiorkor denotes the reddish color of skin
D) caused by enzyme defect
All statements indicate protein-energy malnutrition with severe prognosis, except:
A) the weight loss is more than 30 percent
B) weight loss during treatment
C) bloodstream infection
D) age under 6 months
E) serum total protein concentration less than 30 g/l
B) weight loss during treatment
The undermentioned statements are true, except:
A) All forms of vegetarian diet are dangerous in childhood
B) It should talk the parents out of vegan diet by any means
C) After accepting the adequate advices the lacto ovo vegetarian diet is not dangerous for the children
D) The main danger of vegetarian diet is the B12-vitamin deficiency
A) All forms of vegetarian diet are dangerous in childhood
All the following statements are true, except:
A) Lifelong strict gluten-free diet is mandatory for the treatment of coeliac disease
B) Coeliac patients are fully healthy on gluten-free diet
C) Once in a while consumption of gluten-containg food does not cause problem
D) Intake of 100 mg gluten causes damage of the small intestinal mucosa
C) Once in a while consumption of gluten-containg food does not cause problem
All undermentioned cereals contain gluten, except:
A) Wheat
B) Rye
C) Rice
D) Barley
C) Rice
All undermentioned foodstuffs are gluten-free, except:
A) Potato
B) Rye
C) Corn
D) Rice
E) Locust seed
B) Rye
Indicate the single statement which is true for rumination:
A) It is a cosequence of voluntary strain
B) It is a passive regurgitation of gastric content
C) It is a consequence of a retrograde duodeno-gastric contraction
D) It is a symptom a gastro-oesophaeal reflux
A) It is a cosequence of voluntary strain
All statements are true for infantile gastro-oesophageal reflux (GOR), except:
A) Starts in the first months of life
B) In 80% of cases it ceases at 12-24 months
C) GOR with different severity occur in 20% of infants
D) It can be continued to adult type GOR
E) It is always a physiological condition
E) It is always a physiological condition
All statements are true for th hypoallergenic formula used for therapeutic purposes, except one:
A) They are extensively hydrolysed
B) Does not contain cow’s milk or soya proteins
C) Contain short chain peptides
D) Molecular weight of the peptides are over 2000 Dalton
E) More than 90 percent of Infants with cow’s milk protein intolerance tolerate these formula
D) Molecular weight of the peptides are over 2000 Dalton
All statements are true for melena, except one:
A) It originated from the upper gastrointestinal tract
B) It has a jet-black colour
C) Its other name is hematochezia
D) It is consequence of significant bleeding
C) Its other name is hematochezia
Statements are characteristic for Crohn’s disease, except one:
A) It can occur anywhere in the gastrointestinal tract throughout from the oral cavity to the anus
B) Characterized with relapses
C) Blood stool is relatively rare
D) Segmental and transmural propagation is frequent
E) Occurs with the hyperplasia of lymphoid tissues and frequently involves the regional lymph nodes
F) Surgical solution brings definitive healing
F) Surgical solution brings definitive healing
All the undermentioned disease could cause liver cirrhosis, except:
A) galactosaemia
B) alfa1-antytripsin deficiency
C) hepatitis A virus infection
D) hepatitis B virus infection
E) lupus hepatitis
F) bile duct obstruction
C) hepatitis A virus infection
All statements are true for food related adverse reaction, except:
A) More frequent than food allergy
B) It has a quantity threshold value for the given food
C) For eliciting symptoms the all or nothing principle is the rule of thumb
D) It is no previous sensitization
E) The symptoms may be just the same as in food allergy
C) For eliciting symptoms the all or nothing principle is the rule of thumb
All factors are important for the pathogenesis of food allergy in infants and toddlers, except:
A) Genetic factors
B) Early foreign protein introduction to the infants diet
C) Protein rich diet of mother during pregnancy
D) Environmental factors (e.g. smoking)
E) Immaturity or disturbance of intestinal defense mechanisms
C) Protein rich diet of mother during pregnancy
All the statements are true for anaphylactoid (Henoch-Schönlein) purpura, except:
A) The small purpura mostly located on the extensor side of the lower extremities and the gluteal area
B) Onset of purpura may be preceded by joint paint
C) Bloody stool and abdominal pain may also present
D) Relapse quite frequently occur
E) Platelet number decreased
E) Platelet number decreased
Choose the answers which are true in adult type lactose intolerance.
1) Very small amout of lactose may cause severe symptoms.
2) The patients are able tolerate so much lactose which is in 2 deciliter milk.
3) Processed cheese could be consumed in any quantity.
4) It is important not to consume in one portion and in itself the lactose containing foods.
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
C) Answers 2 and 4 are correct
Choose the answers which are true at decreased activity of lactase enzyme.
1) Symptoms related to the quantity of consumed lactose.
2) In children frequently occurs periumbilical abdominal pain after lactose consumtion.
3) Abdominal pain may be very severe.
4) Diarrhea does not always develop after lactose consumtion.
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
E) All of the answers are correct
When the diagnosis of coeliac disease can be established without the histologic analysis of dudenal mucosa biopsy taken by endoscopy?
1) The serum anti-transglutaminase (TTG) IgA titer is 10 times higher than the upper normal value.
2) Antiendomysium antibody titer is also positive.
3) The patient has no IgA deficiency.
4) The serum anti-TTG IgA titer is 5 times higher than the upper normal value.
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
A) Answers 1, 2 and 3 are correct
Which symptoms could occur in untreated coeliac disease?
1) Abdominal pain
2) Iron deficiency
3) Tooth enamel defect
4) Ataxia
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
E) All of the answers are correct
Connect the relevant treatment signed with letter to that disease signed with number, where it has indication.
A) Medium chain triglycerides
B) Zinc supplementation
C) Gluten-free diet
D) Galactose-free diet
E) Low lactose containing diet
PED - 7.31 - coeliakia
PED - 7.32 - galactosaemia
PED - 7.33 - intestinal lymphangiectasy
PED - 7.34 - postenteritis syndrome
PED - 7.35 - acrodermatitis enteropathica
31- C
32- D
33- A
34- E
35- B
Connect the symptoms singned with letter to that disorder for which they are mostly characteristic.
A) fever, spastic abdominal pain blood streaked and mucus containing stool
B) watery, acidic smell, fermented stool
C) large volume, stinky and fatty stool
D) watery, acidic smell, greenish stool containing transparent mucus
E) subfebrility, squirting watery stool
PED - 7.36 - Pancreas hypofunction
PED - 7.37 - Campylobacter jejuni enteritis
PED - 7.38 - Rotavirus infection
PED - 7.39 - Lactose intolerance
PED - 7.40 - Pseudodyspepsia
36- C
37- A
38- E
39- B
40- D
What is the most probable diagnosis based on the case report?
An eight month old infant has abdominal distension, which observable for several months. From the history turns out that he unloaded meconium only after 48 hours of age. He had stool infrequently even during the exclusive breast feeding until 6 months, but this became more striking after introduction of complementary feeding. Last weeks his weight gain also decreased. At examination the abdomen was very distended and at rectal examination the sphincter tone was normal but the ampulla was very tight and empty.
A) Cystic fibrosis
B) Crohn’s disease
C) Functional constipation
D) Hirschsprung disease
E) Rectal stenosis
D) Hirschsprung disease
Which examination would you choose for the confirmation of diagnosis?
An eight month old infant has abdominal distension, which observable for several months. From the history turns out that he unloaded meconium only after 48 hours of age. He had stool infrequently even during the exclusive breast feeding until 6 months, but this became more striking after introduction of complementary feeding. Last weeks his weight gain also decreased. At examination the abdomen was very distended and at rectal examination the sphincter tone was normal but the ampulla was very tight and empty.
A) Small bowel follow through
B) Irrigoscopy
C) Genetic analysis of CFTR gene
D) Abdominal MRI
B) Irrigoscopy
Which disorders may cause the development of meconium ileus?
An eight month old infant has abdominal distension, which observable for several months. From the history turns out that he unloaded meconium only after 48 hours of age. He had stool infrequently even during the exclusive breast feeding until 6 months, but this became more striking after introduction of complementary feeding. Last weeks his weight gain also decreased. At examination the abdomen was very distended and at rectal examination the sphincter tone was normal but the ampulla was very tight and empty.
1) Hypothyreosis
2) Cystic fibrosis
3) Metabolic acidosis
4) Hirschsprung diseases
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
C) Answers 2 and 4 are correct
What is the most probable diagnosis according to the case descripiton?
The weight gain of a 10 month old infant was normal until 6 month of age during exclusive breastfeeding. After introduction of complementary feeding (vegetables, meat, egg, cereals) between 6 and 7 months her weight gain stoped and from the former 50 percentil fell to 25 percentil. In last four weeks diarrhea started and the stools were fatty, and abdominal distension was also observed. The earlier merry baby girl’s mood failed. In her stool blood and was not observed, hives or any rash as well as respiratory symptoms were also not detected.
A) Food allergy
B) Coeliac disease
C) Cystic fibrosis
D) Sucrose malabsorption
E) Functional diarrhea
B) Coeliac disease
Which ones of the undermentioned laboratory tests would you choose to the confirmation of the diagnosis?
The weight gain of a 10 month old infant was normal until 6 month of age during exclusive breastfeeding. After introduction of complementary feeding (vegetables, meat, egg, cereals) between 6 and 7 months her weight gain stoped and from the former 50 percentil fell to 25 percentil. In last four weeks diarrhea started and the stools were fatty, and abdominal distension was also observed. The earlier merry baby girl’s mood failed. In her stool blood and was not observed, hives or any rash as well as respiratory symptoms were also not detected.
1) Anti-transglutaminase IgA antibody
2) Sucrose hydrogen breath test
3) Serum IgA concentration
4) CFTR gene mutation analysis
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
B) Answers 1 and 3 are correct
Which examination would you choose for further confirmation of the diagnosis according to the results of previous tests, if indicated?
The weight gain of a 10 month old infant was normal until 6 month of age during exclusive breastfeeding. After introduction of complementary feeding (vegetables, meat, egg, cereals) between 6 and 7 months her weight gain stoped and from the former 50 percentil fell to 25 percentil. In last four weeks diarrhea started and the stools were fatty, and abdominal distension was also observed. The earlier merry baby girl’s mood failed. In her stool blood and was not observed, hives or any rash as well as respiratory symptoms were also not detected.
A) Colonoscopy
B) Abdominal MRI
C) Small bowel follow through
D) Irrigoscopy
E) Analysis of duodenal biopsy sample taken with upper endoscopy
E) Analysis of duodenal biopsy sample taken with upper endoscopy
Which one is the right diagnosis at this patient?
A 10 years old girl has been abdominal crampy pains for several months, sometimes she is awakening for the pain during night. She has appetite loss and lost weight and frequently has fever. Pathogen bacteria were not detected in stool.
A) Functional abdominal pain
B) Coeliac disease
C) Cholelithiasis
D) Crohn’s disease
E) Ulcerative colitis
D) Crohn’s disease
Which image forming and endoscopic examination would you choose for the further confirmation of diagnosis?
A 10 years old girl has been abdominal crampy pains for several months, sometimes she is awakening for the pain during night. She has appetite loss and lost weight and frequently has fever. Pathogen bacteria were not detected in stool.
1) Abdominal ultrasound
2) Colonoscopy
3) Upper endoscopy
4) Irrigoscopiy
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
A) Answers 1, 2 and 3 are correct
If the suspected disease is confirmed, which therapy from the undermentioned ones is the first choice for remission induction?
A 10 years old girl has been abdominal crampy pains for several months, sometimes she is awakening for the pain during night. She has appetite loss and lost weight and frequently has fever. Pathogen bacteria were not detected in stool.
A) Wide spectrum antibiotics
B) Exclusive enteral nutrition
C) Cyclosporin
D) Tacrolimus
E) None of them
B) Exclusive enteral nutrition
Which tissues contain SGOT (AST)?
A) liver
B) myocardium
C) sceletal muscle
D) kidney
E) each of them
E) each of them
Which parameters indicate the synthetic capacity of liver?
A) GOT (AST), GPT (ALT)
B) bilirubin, GGT
C) albumin, prothrombin, INR
C) albumin, prothrombin, INR
Which statement is true for biliary atresia?
A) prolonged jaundice with indirect hyperbilirubinemia
B) it has autosomal dominant inheritance
C) associate always with other malformations (e.g. polysplenia)
D) it has autosomal recessive inheritance
E) progressive fibrotizing process of intra- and extrahepatic bile ducts
E) progressive fibrotizing process of intra- and extrahepatic bile ducts
Which statement is not true for direct hyperbiliturinaemia?
A) serum concentration of direct bilirubin is higher than 25 micromol/l
B) serum concentration of direct bilirubin is higher than 20 percent of total bilirubin
C) decreased canalicular bile flow
D) cholestasis
E) its frequncy is 1:25000-1:40000
E) its frequncy is 1:25000-1:40000
Is it necessary to suspend breastfeeding in case of biliary atresia?
A) Yes
B) No
C) Depend on the serum bilirubin concentration
D) Depending on the age of child
E) Yes, for a few days
B) No
When is the most frequent the occurance of acute liver failure?
A) Under 1 year
B) Between 1-2 years
C) Between 2-5 years
D) Over 5 years
A) Under 1 year
What is the most frequent cause of acute liver failure under 1 year?
A) Autoimmune disease
B) Viral infection
C) Metabolic and indeterminated causes
D) Acute Wilson disease
C) Metabolic and indeterminated causes
How frequent is jaundice in matured neonates?
A) 30%
B) 40%
C) 50%
D) 60%
D) 60%
Is it necessary to suspend breastfeeding during jaundice elicited by mother’s milk?
A) Yes
B) No
C) Depends on the level of serum bilirubin
D) Depends on the infant’s age
E) Only for a few days
B) No
Which one is a pathological condition in neonatal period?
A) Physiologic icterus
B) Breast milk induces icterus
C) Icterus of pramature babies
D) Conjugated hyperbilirubinaemia
D) Conjugated hyperbilirubinaemia
Which one of the undermentioned factors does not decrease bilirubin binding capacity of albumin?
A) Acidosis
B) Hypoxia
C) Hypothermia
D) Hyperglycemia
D) Hyperglycemia
Which condition does not increase the bilirubin production?
A) Haemolysis
B) Crigler-Najjar syndrome
C) Extravascular blood in hematomas
D) Polycythemia
B) Crigler-Najjar syndrome
Which statement is not true for Alagille syndrome?
A) Autosomal recessively inherited
B) Triangular face
C) Butterfly verterbrae
D) Cardiovascular malformations
E) Pruritus is a common symptom
A) Autosomal recessively inherited
What is characteristic for Wilson disease?
A) Rarely onset the first clinical symptoms under 4-5 years of age
B) Rarely occur symptoms under 10 years of age
C) Liver symptoms always present earlier than the neurological ones
D) Specific findings can be seen in the liver biopsy specimens
A) Rarely onset the first clinical symptoms under 4-5 years of age
What is the definition of fatty liver disease?
A) fatty change in more than 10 percent of hepatocytes
B) fatty change in more than 5 percent of hepatocytes
C) fatty change in more than 15 percent of hepatocytes
D) fatty change in more than 20 percent of hepatocytes
E) fatty change in more than 25 percent of hepatocytes
B) fatty change in more than 5 percent of hepatocytes
Which one is a characteristic attribute for liver disease developing in cystic fibrosis?
A) In 20-25 percent presents liver disease with clinical symptoms
B) Pathological function of CFTR in hepatocytes is the causing factor
C) Pathological function of CFTR in bile duct epithaliac cells is the causing factor
D) Liver transplantation is contraindicated
E) Fatty transformation of liver is not characteristic
C) Pathological function of CFTR in bile duct epithaliac cells is the causing factor
Which statement is not true for alfa-1 antitrypsin deficiency?
A) Autosomal recessive inheritance, locus 14q32.1
B) Frequency of PiZZ homozygosity 1:10000 in Europe, decreasing from to north to south
C) Pathological changes are variable in infant and children
D) In young adults pulmonary disease
E) 20% of PiZ carriers will have pulmonary disorder
E) 20% of PiZ carriers will have pulmonary disorder
Which one is the right definiton of acute liver failure?
A) High level of transaminase enzymes
B) High level of ammonia
C) INR over 1,5 + encephalopathy or INR over 2
D) High level of ammonia and transaminase enzymes
C) INR over 1,5 + encephalopathy or INR over 2
Which one is the benefit of breastfeeding?
A) Decreases in children the frequency of allergic and autoimmune diseases
B) Decreases in mothers the risk of some malignant diseases
C) Both in children and mothers decreases the risk of cardiovascular diseases
D) Decreases of the frequency of several types of infection in children
E) All of them are true
E) All of them are true
What is the most frequent cause of bloody diarrhea in children?
A) Infection
B) Inflammatory bowel disease (IBD)
C) Intestinal polyp
D) Meckel’s diverticulum
E) Hemorrhoid
A) Infection
Which is the most frequently occuring food allergy and such as frequent cause allergic intestinal inflammation?
A) cow’s milk
B) egg
C) soya
D) peanut
E) tomato
A) cow’s milk
Which one of the undermentioned bacteria may cause bloody diarrhea in childhood?
A) Salmonella
B) Shigella
C) E. Coli
D) Campylobacter
E) All of them
E) All of them
What is the gold standard of the diagnosis of food allergy in childhood?
A) Detection of IgE antibodies against different food antigens
B) Detection of IgG antibodies against different food antigens
C) Skin prick test with different food extracts
D) Elimination and challenge with the suspected food, or double blind placebo controlled challenge
E) None of them
D) Elimination and challenge with the suspected food, or double blind placebo controlled challenge
Which could be the symptoms of inflammatory bowel disease (IBD)?
A) abdominal pain, diarrhea
B) growth retardation
C) eye-skin-joint complaints
D) bloody diarrhea
E) all of them
E) all of them
Which one is NOT belong to the presently known risk factors for the development of IBD?
A) administration of antibiotics during infancy
B) occurance of IBD in the family
C) food allergy in infancy
D) smoking for Crohn disease
E) none of them
C) food allergy in infancy
Which symptom is NOT typical for irritable bowel syndrome (IBS)?
A) chronic diarrhea
B) abdominal pain during night
C) bloody diarrhea
D) small weight loss
E) none of them
C) bloody diarrhea
What is typical rather for Crohn disease than for ulcerative colitis?
A) fistula forming
B) gastric involvement
C) large weight loss
D) symptoms can be alleviated by diet
E) all of them
E) all of them
Which one can be the symptom of malabsorption?
A) chronic diarrhea
B) abdominal distension
C) growth retardation
D) slow weight gain
E) all of them
E) all of them
Which one is NOT characteristic for adult type lactose intolerance?
A) Onset is mostly in late childhood
B) Inborn form is extremely rare
C) It may be outgrown later
D) One third to one half of population has it
E) None of them
C) It may be outgrown later
Which symptom occurs in cow’s milk allergy?
A) Disturbed weight development
B) Chronic diarrhea
C) Constipation
D) Eczema
E) All of them
E) All of them
What kind of examinations and in which sequence are suggested in otherwise healthy infant with bloody stool?
A) physical examination for exclusion of fissure, stool culture, trial of cow’s milk free diet
B) cow’s milk free diet, physical examination, stool culture
C) physical examination, stool culture, abdominal ultrasound and native abdominal X-ray
D) physical examination, abdominal ultrasound and native abdominal X-ray
E) colonoscopy is mandatory
A) physical examination for exclusion of fissure, stool culture, trial of cow’s milk free diet
Which further examination would you suggest first in this case even at the general practitioner?
A 16 years old boy arrives to the emergency deaprtment because of bloody diarrhea lasting for a few weeks associated with tenesmus. Previously abdominal pain once in a while was noticed but no examination was done. At physical examination paleness and mild left sided abdominal pressure sensitivity were observed. Perianal lesions were not detected.
A) Stool culture
B) Blood picture
C) Abdominal ultrasound
D) Stool calprotectin
E) None of them
A) Stool culture
Which disease is the most probable in case the above mentioned examination is negative?
A 16 years old boy arrives to the emergency deaprtment because of bloody diarrhea lasting for a few weeks associated with tenesmus. Previously abdominal pain once in a while was noticed but no examination was done. At physical examination paleness and mild left sided abdominal pressure sensitivity were observed. Perianal lesions were not detected.
A) Allergic colitis
B) Meckel’s diverticulum
C) IBD
D) Large bowel polyp
E) None of them
C) IBD
