MTB - Pediatrics - GI

Question 1

Signs of pathological jaundice?

Answer 1

#Appears on 1st day or after 14 days
#Bilirubin rises 5+ in one day
#Bilirubin over 19.5
#Direct Bilirubin over 2

Question 2

Baby presents with hypotonia, seizures, writhing movements and elevated bilirubin. Suspected diagnosis? Order what tests?

Exchange transfusion if? (Otherwise?)

Answer 2

if bilirubin over 20 (phototherapy)

Kernicterus

#Bili and retics
#AB, Rh incompatibility
#Smear

Question 3

Child with vomiting with first feeding and cyanosis - suspected diagnosis? Possible history of? Complications?

Answer 3

Esophageal atresia; polyhydramnios

Recurrent aspirational pneumonia

Question 4

Suspected pyloric stenosis - best initial test? Most accurate test? (will see?)

Answer 4

Abdominal US

upper GI series

#String sign  - think column of barium
#Shoulder sign - filling defect in the antrum due to prolapse of muscle inward
#Mushroom sign - hypertrophic pylorus 
#Railroad track sign - excess mucosa in pylorus leads to 2 barium columns

Question 5

Baby turns blue when feeding and pink when crying - suspected diagnosis? Associated with?

Answer 5

Choanal Atresia (membrane between nostrils and pharyngeal space that prevents breathing during feeding)

CHARGE 
#Colombomas, CNS abnormalities
#Heart defects
#Atresia of choanae
#Retardation of growth
#Gential or urinary defects (hypogonadism)
#Ear abnormalities

Question 6

Baby turns blue when feeding and pink when crying - suspected diagnosis? Diagnose with?

Answer 6

Choanal Atresia (membrane between nostrils and pharyngeal space that prevents breathing during feeding)

CT

Question 7

Pt does not pass meconium. Has bowel movement on rectal exam - suspected diagnosis? Manometry will show? Associated with?

Answer 7

Hirschsprung

High anal sphincter pressures

Down syndrome

Question 8

Imperforate anus - associated with?

Answer 8

#Down Syndrome
#VACTERL

Question 9

VACTERL

Answer 9

Vertebral anomalies
Anal atresia
Cardiovascular anomalies
Tracheoesophageal fistula
Esophageal atresia
Renal anomalies
Limb anomalies

Question 10

Newborn with bilious vomiting within 12 hours of birth - suspected diagnosis? Associated with?

Answer 10

Duodenal atresia

#Down syndrome
#Annular Pancreas

Question 11

Bird’s beak sign in child- suspected diagnosis? Typical location? Best initial therapy?

Answer 11

Ileum

Volvulus

Endoscopic decompression. If fails, THEN surgery

Question 12

Currant Jelly stools - suspected diagnosis? associated with? Best diagnostic test? Therapeutic intervention? Best inital management?

Answer 12

Intussusception

#Rtavirus vaccine 
#HSP

Barium enema; Barium enema

Fluid and NGT decompression

Question 13

Pt with Intissusception - barium enema contraindicated if?

Answer 13

Peritonitis, Perforation or shock

Question 14

Painless and otherwise unremarkable BRBPR in child - suspected diagnosis? Most accurate test? Therapy?

Answer 14

Meckel’s

Technetium 99m

Surgery

Question 15

Preterm infant with abdominal distention and elevated lactate - suspected diagnosis? Imaging will show?

Answer 15

Necrotizing enterocolitis

Pneumatosis intestinalis (air within bowel wall or portal vein)

Question 16

Preterm infant with BRBPR and elevated lactate - suspect diagnosis? Management?

Answer 16

Necrotizing enterocolitis

#NPO and Fluids
#NGT
#Surgery if no resolution