1
Q
Hi there 🫵🏼 سمِّي الله
A
بسم اللهِ الرَّحمن الرَّحيم 💡
2
Q
What is the key presentation and acid-base disturbance in pyloric stenosis ⁉️
A
• 🚼 Age: ~3 weeks
• 🤮 Non-bilious projectile vomiting
• 🧪 ➡️ Hypochloremic metabolic alkalosis
✅ MCQ مفتاح : Vomiting + alkalosis → pyloric stenosis
3
Q
How is pyloric stenosis diagnosed clinically and by imaging ⁉️
A
• 🖐️ Olive-shaped mass in RUQ
• 👀 Visible peristalsis
• 📸 Ultrasound = confirmatory
✅ MCQ مفتاح : Olive mass or peristalsis + vomiting = pyloric stenosis
4
Q
What type of hyperbilirubinemia is seen with pyloric stenosis ⁉️
A
• 📈 ↑ Indirect (unconjugated) bilirubin
• ⛔ Direct = consider other causes
##footnote
✅ MCQ مفتاح : Indirect + vomiting = pyloric; Direct = not pyloric
5
Q
What is the recommended management for non-specific functional abdominal pain ⁉️
A
• ❌ No need for CT or X-ray
• ✅ Reassurance + follow-up
• 🧠 Consider psychosocial stressors
##footnote
✅ MCQ مفتاح : Normal case → reassure, no imaging
6
Q
What are the classic symptoms of peptic ulcer disease (PUD) in older children ⁉️
A
• 🔥 Epigastric pain (worse after meals)
• 🤢 Nausea , possible melena
• 🩸 Sometimes hematemesis
##footnote
✅ MCQ مفتاح : Epigastric pain + melena/nausea → suspect PUD
7
Q
What are the most common causes of peptic ulcer disease in children ⁉️
A
• #1️⃣ H. pylori infection
• #2️⃣ NSAIDs (↓ prostaglandins → mucosal injury)
##Footnote
✅ MCQ مفتاح : NSAID history + ulcer → answer = NSAID-induced PUD
8
Q
Is a barium enema used to diagnose pyloric stenosis ⁉️
A
❌ No. Barium enema = volvulus diagnosis (mostly midgut volvulus)
##Footnote
✅ MCQ مفتاح : If they mention bilious vomiting + distended abdomen = think volvulus
9
Q
What is the best initial imaging test to confirm pyloric stenosis ⁉️
A
✅ Abdominal ultrasound → shows thickened pyloric wall
🧠 Also can use barium contrast if US inconclusive
##Footnote
✅ MCQ مفتاح: First test = US. Barium = backup, with signs like string sign or double tract
10
Q
Why is Nissen fundoplication not used in pyloric stenosis ⁉️
A
❌ Nissen is for severe GERD
##Footnote
✅ MCQ مفتاح : Pyloric stenosis = mechanical obstruction, not reflux
11
Q
When is an air enema indicated in a vomiting infant ⁉️
A
✅ Air enema = intussusception
❌ Not for pyloric stenosis (no “currant jelly”, no episodic pain)
##Footnote
✅ MCQ مفتاح : If there’s intermittent pain + bloody stools , think intussusception
12
Q
What’s the difference between breastfeeding jaundice vs breast milk jaundice ⁉️
A
• 🍼 Breastfeeding jaundice = ⏰ 1st week + ↓ intake ➡️ dehydration
• 🥛 Breast milk jaundice = ⏰ after 1st week + thriving baby ➡️ enzyme inhibition
##footnote
✅ MCQ مفتاح : Early + dehydrated = breastfeeding; Late + healthy = breast milk
13
Q
What type of bilirubin is elevated in breast milk jaundice, and what’s the treatment ⁉️
A
• 🔶 Unconjugated (indirect)
• ✅ Phototherapy
• ⏳ Stop breastfeeding 24–48h only if urgent , then resume
✅ MCQ مفتاح : High indirect + healthy baby ➡️ phototherapy, don’t stop breastfeeding
14
Q
When should other causes of jaundice be suspected ⁉️
A
🚨 Red flags:
• ↑ Direct bilirubin
• ⚠️ Poor feeding / weight loss
• 😷 Sick baby
✅ MCQ مفتاح : Direct = ⛔ not breast milk jaundice
15
Q
What is the classic presentation and key imaging sign of duodenal atresia ⁉️
A
• 📆 1st day of life
• ✅ Bilious vomiting + flat abdomen
• 📸 Double-bubble sign (stomach + duodenum)
##footnote
✅ MCQ مفتاح : Bilious vomit + no distension + double bubble = Duodenal atresia
16
Q
What are the risk factors and associated anomalies in duodenal atresia ⁉️
A
• 🔁 Cause: Failed recanalization
• 📌 50% = premature
• ♻️ Assoc.: Trisomy 21 , cardiac, renal, malrotation
• 💧 Hx of polyhydramnios (↓ GI absorption)
✅ MCQ مفتاح: Polyhydramnios + bilious vomiting + Down syndrome → think duodenal atresia
17
Q
What type of jaundice does Alagille syndrome cause, and what is its key pathology ⁉️
A
• 📊 Direct (conjugated) hyperbilirubinemia
• ⚠️ Due to ↓ or absent intrahepatic bile ducts
##footnote
✅ MCQ مفتاح : Infant + direct jaundice → think Alagille
18
Q
What are key features associated with Alagille syndrome ⁉️
A
• 🧬 AD inheritance
• 😐 Facial dysmorphism (broad forehead, deep eyes, small chin)
• 👁️ Posterior embryotoxon
• ❤️ Peripheral pulmonary stenosis
• 🦴 Butterfly vertebrae
##Footnote
✅ MCQ مفتاح: Direct jaundice + dysmorphic face or heart/vertebrae findings = Alagille
19
Q
How is Alagille syndrome diagnosed ⁉️
A
• ✅ Liver biopsy shows ↓ bile ducts
##footnote
✅ MCQ مفتاح : Direct jaundice + liver biopsy = Alagille confirmation
20
Q
What are the key signs of tracheoesophageal fistula in a newborn ⁉️
A
• 🤤 Frothing, bubbling , drooling
• 🚼 Coughing, cyanosis with feeds
• ❌ Can’t pass NG tube
• 📸 X-ray: coiled tube in esophageal pouch
✅ MCQ مفتاح : Newborn + frothing + NG tube fails → TEF
21
Q
What is the initial management of TEF ⁉️
A
• ⛔ NPO (no feeds)
• ➡️ Insert NG tube for pouch decompression
• 💧 Give **IV fluids*
• 💊 Start antibiotics
##footnote
✅ MCQ مفتاح: TEF = NPO + NG tube + IV + surgery prep
22
Q
What are associated anomalies and prenatal clue for TEF ⁉️
A
• 🧬 Assoc. with VACTERL (Vertebral, Anal, Cardiac, TE, Renal, Limb)
• 🤰 Polyhydramnios = clue antenatally
✅ MCQ مفتاح : Polyhydramnios + respiratory signs = suspect TEF
23
Q
What are the classic clinical features of celiac disease in young children ⁉️
A
• 📆 Age: <2 years
• ⚠️ Failure to thrive , chronic diarrhea, vomiting
• 😖 Abdominal distention, muscle wasting , irritability
✅ MCQ مفتاح : Malabsorption + irritability + distention in infant = Celiac
24
Q
What is the first test to order in a symptomatic child suspected of celiac disease ⁉️
A
• ✅ Anti-TG2 IgA antibodies
• ➕ Total serum IgA (to rule out IgA deficiency)
✅ MCQ مفتاح : Suspect CD → start with anti-TG2 IgA + total IgA
25
**What are the next diagnostic steps based on anti-TG2 IgA antibody levels in suspected celiac disease** ⁉️
➡️ **If anti-TG2 IgA <10× ULN** ➡️ Do **gastroscopy + duodenal biopsy** (look for Marsh score ≥2)
➡️ **If anti-TG2 IgA ≥10× ULN** ➡️ Do **EMA testing** (endomysial antibody)
✅ **MCQ مفتاح** :
• TG2 <10× = needs biopsy confirmation
• TG2 ≥10× = do EMA → may skip biopsy if EMA positive
26
**Why is colonoscopy not part of the workup for celiac disease** ⁉️
❌ Colon is not affected in CD
✅ Upper endoscopy with + **duodenal biopsy** is the correct approach
##footnote
✅ **MCQ مفتاح** : CD = affects small bowel, not colon
27
**When is HLA-DQ2/DQ8 testing useful in celiac disease workup** ⁉️
🧬 For **diagnostic uncertainty** , gluten-free diet already started, or screening of relatives
✅ **MCQ مفتاح** : HLA only for **unclear or atypical cases**
28
**Can celiac disease present with bloody diarrhea in infants** ⁉️
⛔ No – celiac disease typically causes **steatorrhea** , not bloody diarrhea
🧠 Classic signs: **foul-smelling pale stools, vomiting, failure to thrive**
29
**What is the treatment for celiac disease, and which grains must be avoided** ⁉️
• 🚫 **Wheat, barley, rye**
• ⚠️ **Oats** may trigger symptoms in some patients (avenin sensitivity)
• ✅ **Lifelong gluten-free diet**
##footnote
✅ MCQ مفتاح: Only Tx = gluten-free for life
30
**When should functional abdominal pain be suspected in a child** ⁉️
• ⏱️ **≥4 episodes/month**
• 🔍 Normal **exam + labs**
• ❌ Not related to eating, menses, or activity
• 📆 Symptoms for <2 months
##footnote
✅ **MCQ مفتاح** : Chronic abdominal pain + normal workup = **functional abdominal pain**
31
**What are red flags that suggest an organic (not functional) cause of abdominal pain** ⁉️
• 😴 Pain **wakes from sleep**
• 📍 RUQ/RLQ pain
• 🩸 Blood in stool, **anemia**
• 📉 **Weight loss** , poor growth
• 🧬 Family hx: IBD, celiac, PUD
##Footnote
✅ **MCQ مفتاح** : Any red flag → do further workup
32
**What is the treatment of choice for pyloric stenosis** ⁉️
• 🔪 **Pyloromyotomy** (Ramstedt procedure)
✅ **MCQ مفتاح** : Always choose **surgery** (not PPI or feeding change)
33
**Why is gastrostomy not appropriate for pyloric stenosis** ⁉️
❌ It bypasses the stomach but **doesn’t fix the pyloric obstruction**
✅ **MCQ مفتاح** : Treat the cause → **cut the pyloric muscle** , not bypass it
34
**Why are PPIs not indicated in pyloric stenosis** ⁉️
❌ PPIs treat **acid reflux** , not **mechanical obstruction**
✅ **MCQ مفتاح**: No bile + no signs of GERD = PPIs not helpful
35
**What is the diagnostic test of choice for peptic ulcer disease** ⁉️
• 🔍 **Gastroscopy (upper endoscopy)**
✅ **MCQ مفتاح** : PUD diagnosis → always choose **endoscopy**
36
**What are the classic clinical features of Wilson’s disease in adolescents** ⁉️
• 📉 **Academic decline** , tremor, personality change
• 😵 Neurologic: **dystonia, poor handwriting, psychiatric**
• 🩸 **Hemolytic anemia**
• 🧬 **Liver dysfunction** : jaundice, ↑ transaminases, portal HTN
##Footnote
✅ **MCQ مفتاح** : Teen + neuro + liver + anemia → think **Wilson’s**
37
**What is the role of ceruloplasmin in diagnosing Wilson’s disease** ⁉️
• ❗ **Ceruloplasmin is low** in Wilson’s disease
✅** MCQ مفتاح** : If option says “high ceruloplasmin” → ⛔ wrong
🎯 Correct = **↓ ceruloplasmin + ↑ urinary copper**
38
**What is the mainstay of treatment for Wilson’s disease** ⁉️
• 💊 **Penicillamine** = copper chelator
• 🛡️ **Zinc** to block copper absorption
✅ **MCQ مفتاح** : Never stop treatment — it’s lifelong
39
**What is the most appropriate next step in a child with suspected Wilson disease showing hepatic and neurologic signs** ⁉️
✅ **Measure 24-hour urinary copper excretion**
40
**Why is liver biopsy not the first step in the diagnostic workup of Wilson disease** ⁉️
⛔ Because it is **invasive** and used **only when noninvasive tests are inconclusive**
41
**Why is ERCP or ANA levels not used in the evaluation of Wilson disease** ⁉️
⛔ **ERCP** is used for **biliary tract disorders** , not **hepatocellular** causes like Wilson disease.
⛔ **ANA** is for **autoimmune diseases**
##footnote
workup should start with copper studies.
42
**What is the most common cause of encopresis in children >4 years old** ⁉️
✅ **Functional constipation** ➡️ large, painful stools → stool retention → **overflow incontinence**
• 🧻 **Encopresis** = involuntary passage of stool in inappropriate places after age 4
##footnote
✅ ***MCQ مفتاح** : Encopresis + hx of hard stools or stool withholding = functional constipation
43
**What are the key features of functional constipation in children** ⁉️
• 💩 ≤2 bowel movements/week
• 🧍♂️ Stool withholding
• 😣 Painful, large stools
• 🔄 Vicious cycle → more withholding
✅ **MCQ مفتاح** : Infrequent + painful stools → stool retention → encopresis
44
**Why is irritable bowel syndrome (IBS) not the correct diagnosis in most pediatric encopresis cases** ⁉️
• ❌ IBS requires ≥1x/week for **6 months**
• ❌ IBS has pain **relieved by defecation** + stool change
✅ **MCQ مفتاح** : No chronicity, no pain relief after stool → IBS ruled out
45
**What is the typical presentation of Meckel diverticulum in children** ⁉️
• 🩸 **Painless rectal bleeding**
• 🩻 Often with **iron deficiency anemia**
• 🔬 Due to ectopic **gastric mucosa** causing ulceration
##footnote
✅ **MCQ مفتاح**: Toddler + painless bleeding + anemia → **Meckel diverticulum**
46
**What is the best initial test for diagnosing Meckel diverticulum** ⁉️
• ✅ **Technetium-99m pertechnetate scan (Meckel scan)**
• Detects **ectopic gastric mucosa**
##footnote
✅ **MCQ مفتاح** : Painless GI bleed in child → choose **Meckel scan**
47
**Why is intussusception unlikely in case of painless rectal bleeding** ⁉️
❌ Intussusception causes:
• 🔁 **Intermittent severe pain**
• 😵 Vomiting
✅ **MCQ مفتاح** : Painless = NOT intussusception
48
**When is colonoscopy appropriate in evaluating rectal bleeding in children** ⁉️
• Rare: Used if **Meckel scan negative** + suspicion of other causes (e.g., **vascular malformations** )
• Clues = **skin hemangiomas** or persistent bleeding
✅ **MCQ مفتاح** : Don’t choose colonoscopy first unless skin lesions/older age present
49
**How does fecal calprotectin help in GI diagnosis, and why is it not useful here** ⁉️
• 🔥 Calprotectin = **marker of inflammation** (e.g., **IBD** )
• ❌ This case = **no diarrhea or systemic inflammation**
##footnote
✅ **MCQ مفتاح** : Bleeding without diarrhea = NOT IBD → calprotectin not needed
50
**What is the hallmark presentation of biliary atresia in neonates** ⁉️
• 🟡 **Persistent jaundice after 2 weeks of age**
• ⚪ **Acholic (pale) stools**
• 🍼 Well-appearing infant with **conjugated hyperbilirubinemia**
✅ **MCQ مفتاح** : Jaundice + acholic stool + >14 days old = biliary atresia
51
**What is the gold standard for diagnosing biliary atresia** ⁉️
✅ **Intraoperative cholangiogram** — confirms bile duct obstruction
🧠 US & liver biopsy = helpful, but **not definitive**
✅ **MCQ مفتاح** : Diagnosis needs **direct visualization of bile flow**
52
**What findings on liver biopsy support biliary atresia** ⁉️
• Bile duct proliferation
• Bile plugs
• Portal stromal edema
✅ **MCQ مفتاح** : Biopsy shows obstructive pattern with bile backup
53
**Why is abdominal ultrasound alone not sufficient to diagnose biliary atresia** ⁉️
• US may show absent or small gallbladder
• ✅ “Triangular cord sign” can be suggestive
• ❌ But lacks **sensitivity** → not enough for definitive diagnosis
✅ **MCQ مفتاح**: US helps but doesn’t rule in/out definitively
54
**Why is ABO incompatibility not the correct diagnosis in a jaundiced 5-week-old infant** ⁉️
❌ ABO incompatibility causes **early-onset jaundice** (first days of life)
• ⛔ Not associated with **acholic stools**
✅ **MCQ مفتاح** : Late jaundice + pale stools = structural problem, not hemolysis
55
**What is the most urgent step in management of a child with suspected esophageal button battery ingestion** ⁉️
✅ **Emergency endoscopic removal within 2 hours**
##Footnote
✅ Miftah el-ḥall: Button battery in esophagus = 🟥 surgical emergency
56
**How can a button battery be distinguished from a coin on an X-ray** ⁉️
**AP view** : Button battery shows a double rim (“halo sign”)
• **Lateral view** : Shows **step-off**
✅ **MCQ مفتاح** : Double ring or step = ⚠️ battery, not coin
57
**What are radiographic clues that the object is in the esophagus vs trachea** ⁉️
• **Esophagus** : Flat surface seen on **AP view**
• **Trachea** : Flat surface seen on **lateral view**
✅ **MCQ مفتاح** : Flat on AP = esophagus → needs removal
58
**Why is observation alone inappropriate for esophageal button battery ingestion** ⁉️
❌ Risk of **necrosis, perforation, or TEF** starts within 1 hour
✅ **MCQ مفتاح** : Always remove batteries <2 hours — no waiting
59
**What is the diagnostic and definitive treatment approach for intussusception in infants and young children** ⁉️
✅ **Diagnosis** : Abdominal **ultrasound** showing the classic **target sign** 🎯
✅ **Initial management** : IV access + nasogastric decompression
✅ **Definitive therapy** : **Hydrostatic reduction** (fluoroscopy or US-guided)
60
**What are the classic clinical features of intussusception in infants** ⁉️
✅ Sudden, severe, intermittent **colicky abdominal pain**
✅ Episodes with **legs flexed + loud crying**
✅ May lead to **lethargy, shock, or peritonitis** if untreated
✅ **Sausage-shaped mass** may be palpated
##footnote
👉🏼 **MCQ مفتاح** : Recurrent pain + lethargy = red flag 🚨
61
**Is nasogastric tube placement part of intussusception treatment** ⁉️
✅ Yes — for **initial decompression** , especially if vomiting or ileus
❌ But **not the definitive therapy**
##Footnote
✅ **MCQ مفتاح** : NG tube = supportive step only 🟰 prepare for reduction 💧
62
**What are the hallmark clinical features of intussusception in infants** ⁉️
Sudden episodic **colicky abdominal pain, vomiting, currant jelly stool (blood + mucus), and a palpable sausage-shaped abdominal mass** . ⚠️🍼💩
62
**What is the diagnostic test of choice for suspected intussusception** ⁉️
Abdominal ultrasound showing a **“target sign”** or **“pseudo-kidney”** sign. 🎯🧠
63
**What is the first-line treatment for intussusception in stable children** ⁉️
Non-surgical reduction using **hydrostatic or air enema** , unless contraindications exist (e.g. perforation, peritonitis, or hemodynamic instability). ✅💨⛔
64
**A child presents with hypoalbuminemia and edema, but no proteinuria or liver dysfunction. What diagnosis is most likely** ⁉️
✅ **Protein-losing enteropathy**
🔷 Key clue: Edema + low albumin + **no urinary protein loss or liver issue**
##footnote
👉🏼 **MCQ مفتاح** : Always **rule out kidneys & liver first** , then think GI protein loss.
65
**What is the most important complication of central venous nutrition, and what is the most common organism** ⁉️
🚨 **Sepsis** is the most important complication.
🦠 **Coagulase-negative Staphylococcus** is the most common pathogen.
##footnote
👉🏼 مفتاح الحل: أي طفل على TPN + حرارة = فكّر في sepsis من الخط الوريدي.
66
**What groups are at higher risk for catheter-related bloodstream infections (CRBSI)** ⁉️
⬆️ Risk in:
• **Premature infants** 👶
• **Young children**
• **Patients on TPN**
##footnote
👉🏼 مفتاح الحل: جهاز مناعي ناقص + خط مركزي = خطر عدوى
67
**What are the major metabolic complications of TPN** ⁉️
• ⚠️ **Hyperglycemia** → osmotic diuresis, dehydration
• ⚠️ **Hypoglycemia** → after sudden TPN stop
• ⚠️ **Azotemia, nephrocalcinosis**
• ⚠️ **Hyperlipidemia** → risk of hypoxemia
• ⚠️ **Hyperammonemia** → due to amino acids
68
**What is the most serious metabolic complication of long-term TPN in infants** ⁉️
🚨 **Cholestatic liver disease → liver failure**
📉 Seen in infants receiving **no enteral feeds** for a long time.
👉🏼 مفتاح الحل: TPN بدون تغذية فموية = كبد مصفر وتليف مع الوقت.
69
**What is the most appropriate first-line treatment for a child with eosinophilic esophagitis confirmed by endoscopy showing furrowing and white specks** ⁉️
✅ The **6-food elimination diet** (removes milk, soy, wheat, egg, peanuts/tree nuts, and seafood).
##footnote
🔥 **Key point** :
EoE is an allergic condition; food elimination improves mucosal inflammation.
70
**What is the classic clinical presentation of eosinophilic esophagitis (EoE) in older children and adults** ⁉️
✅ Solid food **dysphagia** and food **impaction**
71
**How does eosinophilic esophagitis typically present in infants and toddlers** ⁉️
✅ **Feeding difficulties, vomiting, and poor weight gain**
72
**What biopsy finding is required to confirm the diagnosis of eosinophilic esophagitis (EoE)** ⁉️
✅ **≥15 eosinophils per high-power field (HPF)**
73
**Why is antifungal therapy not indicated in a child with endoscopic findings of furrowing and white specks** ⁉️
⛔ Because **Candida esophagitis** typically causes white plaques (not furrows) and occurs in **immunosuppressed** patients, not allergic ones.
74
**Why is achalasia not a likely diagnosis in a child with suspected eosinophilic esophagitis** ⁉️
⛔ Because **achalasia** shows motility disorder on manometry and a dilated esophagus (“bird-beak”), not mucosal furrowing.
## footnote
🔥 **Key point** : Endoscopy shows **inflammatory** not **functional/motility** pattern.
75
**Why is infectious esophagitis (e.g. HSV or CMV) unlikely in this case of eosinophilic esophagitis** ⁉️
⛔ Infectious esophagitis causes **ulcerations and odynophagia** , usually in **immunocompromised** patients. This patient has chronic symptoms and allergic history.
##footnote
🔥 **Key point** :
**EoE** = chronic + allergy
**Infections** = acute + immune compromise.
76
**What is the VACTERL association** ⁉️
• **V** ertebral anomalies
• **A** nal atresia
• **C** ardiac defects (especially VSD)
• **T** racheoEsophageal fistula
• **R** enal anomalies (e.g. horseshoe kidney)
• **L** imb anomalies (e.g. radial dysplasia)
##footnote
🧠 Seen in infants with ≥3 of the features
77
**What is CHARGE syndrome** ⁉️
• **C** oloboma
• **H** eart defects (TOF, aortic arch anomalies)
• **A** tresia of choanae
• **R** etardation (growth/developmental delay)
• **G** enital hypoplasia
• **E** ar anomalies (hearing loss)
##footnote
🧠 Common cardiac defect = Tetralogy of Fallot
78
**What is DiGeorge syndrome** ⁉️
✅ **DiGeorge syndrome** (22q11.2 deletion) includes:
• Cleft palate
• Congenital heart disease (conotruncal defects: TOF, truncus)
• Thymic hypoplasia → recurrent infections
• Hypocalcemia due to parathyroid hypoplasia
##footnote
🧠 Mnemonic: **CATCH-22**
**C** ardiac, **A** bnormal face, **T** hymus, **C** left palate, **H** ypocalcemia
79
**What is Ataxia-telangiectasia** ⁉️
✅ **Ataxia-telangiectasia** is an AR disorder with:
• Progressive **cerebellar ataxia**
• Oculocutaneous **telangiectasias**
• **Recurrent infections** (IgA deficiency)
##footnote
🧠 Presents in early childhood; ↑ cancer risk (especially lymphoma/leukemia)
80
**What is Sturge-Weber syndrome** ⁉️
✅ **Sturge-Weber** is a neurocutaneous syndrome with:
• **Port-wine stain** (nevus flammeus) in V1/V2 area
• **Leptomeningeal angiomas** → seizures
• **Glaucoma**
##Footnote
🧠 Sporadic condition; MRI brain with contrast confirms diagnosis
81
**What is the most likely diagnosis in an infant with occasional posseting, no distress, and normal growth** ⁉️
✅ **Physiological gastroesophageal reflux (GER)**
##footnote
✅ Treatment only/ Parental **reassurance** and **follow-up**
82
**When is antacid therapy indicated in infants with suspected reflux** ⁉️
✅ Only in **symptomatic GERD** : irritability during feeds, back arching, feeding refusal, poor weight gain
83
**When should a switch to plant-based or hydrolyzed formula be considered in infants with reflux** ⁉️
✅ If **cow’s milk protein allergy (CMPA)** is suspected
📍 CMPA signs = vomiting + eczema, bloody/mucousy diarrhea, poor weight gain, or family history of atopy
84
**How does Salmonella typhi typically present in children** ⁉️
✅ **Bloody diarrhea → then constipation**
➕ Other features: fever, abdominal pain, hepatosplenomegaly, anorexia
85
**What are typical symptoms of Campylobacter jejuni enteritis in children** ⁉️
✅ Fever + myalgia + watery then bloody diarrhea
##Footnote
**Bloody diarrhea** in infants = most often due to **food allergy** (like CMPA) or
**bacterial infection**➡️ fever
86
**What condition presents with severe indirect hyperbilirubinemia in a neonate that is refractory to phototherapy but improves with phenobarbital** ⁉️
✅ **Crigler-Najjar Syndrome Type II**
87
**What is the most effective treatment for intractable GERD with aspiration risk and neurologic impairment in children** ⁉️
✅ **Nissen fundoplication**
##footnote
🧠 Especially indicated in:
➡️ Neurologically impaired children
➡️ Recurrent aspiration pneumonia
➡️ Refractory esophagitis or stricture
88
**Which inflammatory bowel disease is associated with toxic megacolon** ⁉️
✅ **Ulcerative colitis**
89
**Are oral mouth ulcers more common in Crohn disease or ulcerative colitis** ⁉️
✅ **Crohn disease**
90
**Which IBD is more commonly associated with erythema nodosum** ⁉️
✅ **Crohn disease**
91
**Which IBD is more likely to involve the perianal region (e.g., fistulas, abscesses)** ⁉️
✅ **Crohn disease**
92
**What is the leading cause of liver transplantation in children worldwide** ⁉️
✅ **Biliary atresia**
93
**What is neonatal cholestasis and its most common surgical cause** ⁉️
✅ **Neonatal cholestasis** = conjugated hyperbilirubinemia in neonates (always pathologic)
🔷 Most common surgical cause = **biliary atresia**
94
**What clinical and imaging findings suggest biliary atresia** ⁉️
✅
• **Persistent jaundice + acholic stools**
• US: nonvisualized or contracted gallbladder, no common bile duct
• Possible **“triangular cord sign”**
• Biopsy: bile duct proliferation, plugs, portal edema
95
**What is the gold standard diagnosis and treatment for biliary atresia** ⁉️
✅
• **Gold standard** = intraoperative cholangiogram
• **Treatment** = **Kasai procedure (hepatoportoenterostomy)**
96
**What is esophageal atresia with tracheoesophageal fistula (EA/TEF) and how does it present** ⁉️
✅ Congenital anomaly where the upper **esophagus ends blindly and the lower connects to the trachea** .
🧠 **Presents** : frothing, choking, cyanosis, failed NG tube, air in stomach
97
**What does chest X-ray show in EA/TEF** ⁉️
✅ **Coiled NG/OG tube in upper pouch ➕ air-distended stomach**
98
**How to differentiate EA/TEF from similar conditions** ⁉️
• Isolated EA ⛔ **Airless abdomen**
• Choanal atresia ⛔ **Nasal tube blocked**
• GERD ⛔ **Chronic spitting, no frothing**
• Duodenal atresia ⛔ **Bilious vomiting + double bubble**
99
**What is Hirschsprung disease** ⁉️
✅ A congenital absence of ganglion cells in the colon (neurocristopathy) → **aganglionic segment ➡️ obstruction**
##footnote
🧠 Presents in neonates with:
• 🚫 No meconium in first 48 hrs
• 🚨 Bilious vomiting
• 🩻 Distended abdomen
• 🔄 Explosive stool after rectal exam
100
**What is the gold standard for diagnosing Hirschsprung disease** ⁉️
✅ **Rectal suction biopsy** ➡️ absence of ganglion cells
101
**What is seen on contrast enema in Hirschsprung disease** ⁉️
✅ **Narrow distal segment with abrupt transition zone to dilated proximal colon**
102
**What are main differentials for delayed meconium passage** ⁉️
✅
• **Meconium ileus** ➡️ think cystic fibrosis, do sweat chloride test
• **Meconium plug syndrome**
• **Intestinal atresia**
103
**What is the most likely diagnosis in a child with epigastric pain 2 days after blunt abdominal trauma** ⁉️
✅ **Acute pancreatitis** ➡️ presents with epigastric pain, vomiting, ± fever
104
**What is the best next step in suspected pediatric acute pancreatitis** ⁉️
✅ **Measure serum amylase and lipase**
105
**What is a common cause of acute pancreatitis in children** ⁉️
✅ **Blunt abdominal trauma**
106
**What clinical picture should raise suspicion for autoimmune hepatitis (AIH) in an adolescent** ⁉️
Female adolescent with **fatigue, hepatomegaly, direct hyperbilirubinemia, elevated ALT/AST, and minimal or no elevation in cholestatic enzymes (GGT, ALP)** . 🧠💡
107
**What is the most important initial diagnostic test for autoimmune hepatitis (AIH)** ⁉️
**Serum autoantibodies, especially anti-smooth muscle antibody (ASMA), ANA, or anti-LKM1** . 🧪✅
108
**How do you differentiate Wilson disease from AIH in a child with hepatitis** ⁉️
Wilson shows **neuropsychiatric symptoms, low ceruloplasmin, and elevated urinary copper** .
AIH has **positive autoantibodies and no neurologic signs** . ⚠️🧠
109
**What is the gold standard for confirming autoimmune hepatitis if noninvasive tests are inconclusive** ⁉️
Liver biopsy showing **interface hepatitis with lymphoplasmacytic infiltrates** . 🔬✅
110
**When should autoimmune hepatitis be suspected over viral hepatitis** ⁉️
When transaminases are elevated without viral markers, especially in adolescent girls with autoantibody positivity. 🧪🚫🦠
111
**What serological profile defines AIH type 1 vs. type 2** ⁉️
• **Type 1** : ANA and/or ASMA positive
• **Type 2** : Anti-LKM1 positive
🧬
112
**What is the most common acute surgical condition in children** ⁉️
**Acute appendicitis** . ✅
113
**What is the usual progression of symptoms in pediatric appendicitis over 2–3 days** ⁉️
**General malaise → abdominal pain → vomiting → fever & tachycardia** . ➡️🩺🌡️
114
**What are the hallmark symptoms of achalasia in children or adolescents** ⁉️
**Dysphagia to solids and liquids ➕ vomiting undigested food ➕ weight loss ➕ chronic cough** . 🧠
115
**What is the most sensitive and confirmatory test for diagnosing achalasia** ⁉️
**Esophageal manometry** . ✅
116
**What radiologic sign is typically seen on barium swallow in achalasia** ⁉️
**Bird’s beak” sign**
##Footnote
smooth tapering of the distal esophagus at the LES. 🐦
117
**What are the two most effective treatment options for achalasia** ⁉️
**Pneumatic dilation** OR **surgical Heller myotomy* . 🔧🔪
118
**When is brain imaging indicated in a case of dysphagia** ⁉️
If upper esophageal sphincter dysfunction is suspected, especially with neurological signs. 🧠🌀
119
**What is the most common life-threatening complication of intestinal malrotation in infants** ⁉️
**Midgut volvulus** , which presents with bilious vomiting, irritability, and rapid deterioration due to bowel ischemia. 🚨🌀
120
**What is the gold standard imaging test for diagnosing malrotation and midgut volvulus** ⁉️
**Upper GI series** ➡️ shows abnormal position of the duodenojejunal junction (DJJ) or corkscrew/bird’s beak appearance. 🎯📸
121
**What is the definitive treatment for midgut volvulus** ⁉️
**Immediate surgical correction** to prevent bowel necrosis and short bowel syndrome. ⚠️🔪
122
**What is the classic presentation of food protein-induced allergic proctocolitis (FPIAP) in infants** ⁉️
**Bloody streaks** in the stool of an otherwise healthy infant (often breastfed or formula-fed), usually within the first months of life. 🚼💩
123
**What is the recommended first-line management of FPIAP** ⁉️
**Eliminate the suspected protein** (commonly cow’s milk or soy) by maternal diet restriction (if breastfeeding) or switching to hypoallergenic formula. Symptoms resolve in 48–72 hours. 🥛❌✅
124
**When can dietary proteins be reintroduced in infants with FPIAP** ⁉️
**After 9–12 months** of age or **2–3 months after symptom resolution** , to assess tolerance and reduce risk of unnecessary restriction. 🔄👶🍳
125
**What is the most likely cause of recurrent spitting in a healthy infant with normal growth and feeding** ⁉️
**Physiologic gastroesophageal reflux**
##footnote
a benign condition requiring only parental reassurance. 🍼✅
126
**When should upper abdominal ultrasonography be considered in an infant with vomiting** ⁉️
If vomiting is **persistent and associated with failure to thrive** , to rule out pyloric stenosis. ❌📉🧪
127
**Why is barium swallow not indicated in routine evaluation of infant GER** ⁉️
Because it **assesses anatomical defects** , not physiologic reflux; it’s not helpful for diagnosing uncomplicated GER. ⚠️📸
128
**What neonatal condition presents with profuse watery diarrhea indistinguishable from urine and prenatal polyhydramnios** ⁉️
**Microvillus Inclusion Disease (MVID)**
##footnote
an autosomal recessive enteropathy with secretory diarrhea from birth. 💦👶
129
**What histologic findings confirm the diagnosis of Microvillus Inclusion Disease** ⁉️
**PAS+ and CD10+ intracellular inclusions with absent or thin brush border on light microscopy** . 🔬📌
130
**Why are other causes like CF, CMPA, or congenital lactase deficiency less likely in a newborn with watery diarrhea and prenatal polyhydramnios** ⁉️
Because they do not typically cause both polyhydramnios and massive watery neonatal diarrhea like MVID does. ❌👶💦
131
**What is the best next step in a stable child who refuses to drink after caustic ingestion but has no airway compromise or oral burns** ⁉️
Admit for **monitoring, give IV fluids** , and **plan endoscopy within 24–48 hours** . 🚨🚫🧴
132
**Why are emesis induction, gastric lavage, and activated charcoal contraindicated in caustic ingestion** ⁉️
They increase the risk of **aspiration** and can **worsen mucosal injury** . ⚠️⛔
133
**What is the role and timing of endoscopy after caustic ingestion** ⁉️
Endoscopy is performed within **24–48 hours** to assess injury severity and guide prognosis. ✅🔍🕒
134
**What is the recommended sleeping position for infants with GERD to reduce the risk of sudden infant death syndrome (SIDS)** ⁉️
**Supine sleeping is recommended despite more reflux episodes, as it lowers the risk of SIDS** . ✅🛏️🍼
135
**Which awake positions can reduce reflux in infants with GERD** ⁉️
**Prone and upright carried positions** are recommended only when awake and observed. ⚠️🧸📈
136
**Why is seated position discouraged in infants with GERD** ⁉️
It increases intra-abdominal pressure and worsens reflux. ⛔🪑
137
**What is the most appropriate next step in evaluating a child with acute recurrent pancreatitis (ARP)** ⁉️
Perform a **sweat chloride test** to evaluate for cystic fibrosis. ✅🧪
138
**Which gene mutations are commonly associated with ARP and chronic pancreatitis in children** ⁉️
Mutations in **CFTR, PRSS1, SPINK1, and CTRC genes** . 🧬🧠
139
**What defines acute recurrent pancreatitis (ARP) in children** ⁉️
**≥2 distinct episodes** of acute pancreatitis with return of pancreatic enzymes to baseline between episodes. 🔄🩸
140
**What diagnosis should be suspected in a child presenting with rectal prolapse and failure to thrive** ⁉️
**Cystic fibrosis**
141
**Why does rectal prolapse occur in infants with cystic fibrosis** ⁉️
Due to **malnutrition, steatorrhea, and repetitive coughing** , leading to increased intra-abdominal pressure. ⚠️💨
142
**What key finding supports the diagnosis of hypertrophic gastropathy in a child with vomiting, diarrhea, and hypoalbuminemia but no proteinuria** ⁉️
**Periorbital edema with hypoalbuminemia and GI symptoms without renal loss** , suggesting protein-losing enteropathy due to hypertrophic gastropathy. ✅💡
143
**What is the most important initial treatment for hypertrophic gastropathy in children** ⁉️
**Supportive hydration**
##footnote
cornerstone of therapy; consider acid suppression and albumin replacement if symptomatic. 💧✅
144
**Which infection is most commonly associated with hypertrophic gastropathy in children** ⁉️
**Cytomegalovirus (CMV)**
##footnote
diagnosis via **endoscopy with biopsy and tissue CMV PCR** . 🦠🔬
145
إلى هُنا تنتهي رحلتنا لهذا الشابتر 😌
والسّلامُ عليكم ورحمة الله وبركاته💡
Pediatrics Q bank
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Decks in class (26)
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Growth and development84
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Immunology154
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Genetics188
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Cardiology199
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Metabolic Disorder44
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Otorhinolaryngology50
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Allergology47
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neonatology270
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Adolescence49
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Nutrition39
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Nephrology101
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Rheumatology73
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Gastroenterology146
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Neurology159
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Pulmonology131
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Endocrinology145
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Hematology58
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Oncology71
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Infections249
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Acid - Base / Criterial Care24
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Poisoning & Substance Use47
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Dermatology37
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Ophthalmology42
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Urology37
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Orthopedics74
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Trauma and Emergency149
