Gastrointestinal

Question 1

Cause of GERD

Answer 1

• transient relaxation of Lower esophageal sphincter -> gastric acid reflux -> esophageal mucosal injury

Question 2

In Barrett’s esophagus: what is occurring to the cells in the esophagus

Answer 2

• squamous -> columnar

Question 3

Nonbilious vomiting/regurgitation projectile emesis after feeding is consistent with what condition

Answer 3

• pyloric stenosis

Question 4

How is pyloric stenosis diagnosed

Answer 4

• US: showed thickening of pylorus

Question 5

95% of cases of pyloric stenosis present in what age group

Answer 5

• 3-12 weeks of life
• will feel “olive-shaped” nontender mobile hard pylorus

Question 6

What is Gilbert’s syndrome

Answer 6

• hereditary condition with reduced activity of UGT enzyme
• see an increase in indirect bilirubin

Question 7

Jaundice presents when biliruben levels reach what level

Answer 7

• > 2.5 mg/dL

Question 8

Why does hemolytic anemia result in jaundice

Answer 8

• massive RBC lysis -> an increase in indirect biliruben -> overwhelms liver’s ability to conjugate it

Question 9

An increase in what enzymes signals biliary obstruction or intrahepatic cholestasis

Answer 9

• ALP and GGT

Question 10

Dark urine seen in jaundice is due to an increase in

Answer 10

• direct biliruben

Question 11

Acholic stools in suggests what

Answer 11

• biliary obstruction
• obstruction prevents bile from getting into the intestine to be excreted causing the normal dark color of stool

Question 12

Transmission of Hepatitis A and E

Answer 12

1. fecal-oral

Question 13

Which hepatitis can become chronic

Answer 13

• HCV and HBV

Question 14

What is intussusception

Answer 14

• intestinal segment invaginates “telescopes” into adjoining intestinal lumen -> bowel obstruction

Question 15

What is the classic triad of intussusception

Answer 15

1. vomiting
2. abdominal pain
3. passage of “current jelly stools” per rectum

Question 16

How is intussusception diagnosed

Answer 16

• Barium contrast enema (often diagnostic and therapeutic)

Question 17

How is lactose intolerance diagnosed

Answer 17

• hydrogen breath test
• hydrogen is produced by undirected lactose being fermented by colonic bacteria

Question 18

Rovsing sign

Answer 18

• RLQ pain with LLQ palpation

Question 19

McBurney’s point tenderness

Answer 19

• point 1/3 distance from anterior superior iliac spine and navel

Question 20

Where do direct hernias protrude into ? Name the borders

Answer 20

• Hesselbach’s triangle
• Rectus abdominus, inferior epigastric vessels, and Inguinal ligament

Question 21

Infants may be born with an umbilical hernia. Management?

Answer 21

• usually resolves by 2 yr of age
• may need to be repaired if still present in children > 5 y.o.

Question 22

Most common cause of Vitamin C deficiency

Answer 22

• diet lacking in raw citrus and green vegetables

Question 23

Scurvy is a disease that results from deficiency in

Answer 23

vit C

Question 24

What is Rickets? What is it caused by?

Answer 24

• softening of the bones leading to bowed legs
• Vit D deficiency in children

Question 25

What is Osteomalacia? What is it caused by?

Answer 25

* vit D deficiency in adults * leads to muscle weakness and fractures

Question 26

Most common effect of Vit A deficiency

Answer 26

* visual changes: especially **night blindness** * **squamous metaplasia**

Question 27

What is Pellagra? What is it caused by?

Answer 27

* "3 D's" Diarrhea, dementia, dermatitis * Niacin/Nicotinic acid (B3) deficiency

Question 28

What is colic

Answer 28

* behavioral syndrome in neonate and infants characterized by excessive crying.

Question 29

What is Hirschsprung disease

Answer 29

* absence of ganglia in distal colon resulting in functional obstruction * should be considered in any newborn that fails to pass meconium within 24-48 hours of birth

Question 30

How is Hirschsprung disease diagnosed

Answer 30

* full-thickness rectal biopsy

Question 31

What is encopresis

Answer 31

* **Fecal incontinence** * in most cases, it is the consequence of chronic constipation

Question 32

What is duodenal atresia

Answer 32

* Congenital absense of or complete closure of a portion of the lumen of the duodenum. * Causes intestinal obstruction in newborn

Question 33

TX of pyloric stenosis

Answer 33

* Pyloromyotomy

Question 34

Duodenal atresia is most often associated with what genetic condition

Answer 34

* Trisomy 21

Question 35

Newborn does not pass meconium. "Double bubble" sign on radiography is common in what condition

Answer 35

* duodenal atresia * due to gas and dilation in both stomach and duodenum

Question 36

What is functional constipation

Answer 36

* voluntary withholding of stool

Question 37

Tx of encopresis

Answer 37

Relieve impaction with polyethylene glycol

Question 38

What is pathological jaundice

Answer 38

* clinical jaundice (\>3 mg/dL) less than **24 hours** after birth or occurring after **14 days** of life.

Question 39

Biliruben \> 20 mg/dL leads to what condition in newborns

Answer 39

* kernicterus: CNS damage

Question 40

When does neonatal physiological jaundice present? What is it caused by?

Answer 40

* 2 days - 2 weeks * liver immaturity

Question 41

Treatment of neonatal jaundice

Answer 41

* phototherapy