Gastrointestinal

Question 1

If a child has gastroenteritis, when can they return back to daycare?

Answer 1

after they have 2 negative stool cultures

Question 2

are antimotility drugs choice of medication?

Answer 2

No they should be used judiciously

Question 3

What is the 1st drug of choice for gastroenteritis considered when the patient has 8-10 stools per day (test does not abbreviate)

Answer 3

trimethoprim/ sulfamethoxazole (TMP/SMZ)

[bactrim]

Question 4

what is the choice for salmonella?

Answer 4

nothing! salmonella is not very responsive to antibiotics.

Question 5

which virus is the cause of 50% of viral gastroenteritis?

Answer 5

rotavirus

Question 6

Which class of GERD would you see weight loss?
physiologic
functional
pathologic

Answer 6

pahologic only

Question 7

first line treatment for GERD?

Answer 7

H2 blockers ranitidine then PPI (omeprazole, prilosec)

after trying smaller feeds, burping frequently, rice cereal or oat to thicken, elevating head after feeding

Question 8

what is one side of effective of a PPI to be aware of?

Answer 8

gynecomastia

also anemia

Question 9

time frame for pyloric stenosis?

Answer 9

3wks to 4 months

Question 10

would you expect to see bilious or non bilious emesis for pyloric stenosis. Why?

Answer 10

NON bilious
bile would indicate a problem further down (intestines)
no bile= closer to stomach, so pyloris stomach or esophageal.

Question 11

what conditions would you expect to see bilious emesis for?

Answer 11

intussusception and hirschsprung, small bowel obstruction, volvulus, malrotation.

Question 12

what is a positive obturator sign, +psoas sign?

Answer 12

psoas- pain with right thigh extension (straight leg up and pain with pressure on leg)
obturator- with internal rotation of right thigh (bend knee twist thigh inwards)

Question 13

What are some clinical signs for appendicitis? PROM?

Answer 13

Psoas sign- leg extension
Rrebound tenderness- pressing on one side that moves to another with release of pressure
Obturator sign- pain with internal rotation
Mcburneys point tenderness- point closer to iliac crest between umbilicus

Question 14

s/s concerning for appendicitis?

Answer 14

PROM, pain worse with cough, nausea, low grade fever.

Question 15

an 18 mo comes in with chronic diarrhea, abd pain, fatigue, cheilosis, foul stool. What is one of your main differentials?

Answer 15

Malabsorption disease

also IBD, chronic diarrea, maybe hepatic disease, gastro

Question 16

lactose and sucrose breath hydrogen testing is done to test for what disorder?

Answer 16

H. pylori

Question 17

sweat chloride is done for suspicion of what disorder?

Answer 17

cystic fibrosis

Question 18

what are some examples of malabsorption disorders?

Answer 18

CF, celiac disease, gluten intolerance, abnormality of intestinal mucosa

Question 19

What foods do you avoid for celiac disease?

what can they eat?

Answer 19

BAD: gluten, wheat, oats, barley, rye (bread, crackers, beer, whiskey)

GOOD: rice, soy, dairy

refer to gastro as needed

Question 20

what do CF patients require for management?

Answer 20

enzymes and fat soluble vitamins (A, D, E, K) & refer to gastro

[reminder: CF patients have trouble absorbing fats, and some vitamins need fat to be absorbed)

Question 21

neuroblastoma (wilms tumor) is most common before what age? what is often the first sign? where does this cancer usually originate?

Answer 21

age 5
first sign: lump/ swelling/ mass in abdomen or neck
orginate often: adrenal glands (from immature nerve cells called neuroblasts)

Question 22

Which of the following labs would indicate a recovery from Hep B?

a) IgM
b) anti-HBc
c) igG
d) anti-HBsAg

extra credit, what would be looked at when drawing Hep B titers?

Answer 22

D) anti-HBsAg = antibody to Hep B surface antigen

this is only ever seen if you have Hep B and have recover.

e.c. Anti-HBs this shows the pt has seroconverted
(similar to above that shows recover minus the antigen portion b/c pt was never infected)

Question 23

Which lab shows you have hep A and have not yet recovered?

a) anti-HAV
b) IgM
c) IgG

Answer 23

B- IgM (immediate) means it is still present

IgG means it is GONE, anti-HAV is present in active and recovered hep A

hint: think you are a mother before grandmother so IgM first then IgG

Question 24

what is the management for oral rehydration therapies for moderate and severe dehydration?

Answer 24

moderate= 50ml/ hr
severe= 100ml/hr

Question 25

what are the main difference between moderate and severe dehydration?

Answer 25

moderate= tachycardia, normal BP normal cap refill, decreased skin turgor, slightly sunken in fontanels severe= normal/ low BP, decreased HR, prolonged cap refill, sunken fontanel

Question 26

s/s: failure to pass meconium, bilious vomiting, explosive bowel movements, tight anal sphincter, Failure to thrive what do you suspect? how do you diagnose

Answer 26

Hirschsprung XR, rectal biopsy= definitive

Question 27

1 mo vomiting, non bilious, projectile emesis, poor weight gain what do you suspect? how do you diagnose?

Answer 27

pyloric stenosis | US

Question 28

15 mo, possibly bilious emesis, intermittent fussiness, lethargic. What is in your diff? what diagnostics would you consider?

Answer 28

intuss. | US

Question 29

3 year old comes in with fatigue, weight loss, tachycardia, sweating, enlarged abdomen. What is in your differential? what diagnostics are you considering?

Answer 29

neuroblastoma (wilms tumor) | US, CBC, urine catecholamines (b/c of likely adrenal gland involvement) abd CT

Question 30

what are the percentages of wt loss with the associated levels of dehydration for: mild: moderate: severe:

Answer 30

mild: 3-5% moderate: 6-9% severe: >10%

Question 31

what are the rehydration levels for moderate and severe dehydration?

Answer 31

(6%-9%)moderate= 50ml/r | (>10%) severe= 100ml/hr

Question 32

an 18 mo old has has v/d and presents with sunken fontanels, increased HR, dry mucous membranes, moderately increase thirst, and delayed cap refill. what level of dehydration would you consider this to be, how many ml/hr would you expect to rehydrate the pt at?

Answer 32

moderate | 50ml/hr

Question 33

``` wha clinical sign would you expect for severe dehydration? A-normal cap refill B-normal fontanel C-cool, mottled skin D-dry mucous membranes ```

Answer 33

C- cool mottled skin

Question 34

``` in the US most common parasitic gastro is caused by? enterobius vermicularis entamoeba histolytica giardia lamblia cryptosporidium parvum ```

Answer 34

Giardia`

Question 35

``` which of the following serological findings indicates chronic HBV? HBsAg neg for 6 mo anti-HBc + and HBsAg + IgM and anti-HBc + anti-HBs + ```

Answer 35

B= anti-HBc + and HBsAg +

Question 36

T/F kids with Hepatitis (A, B, C) do not often have icteric skin/ sclera.

Answer 36

true Hep A especially