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Flashcards in Gastrology Deck (21):

Child  with  vomiting  and  diarrhea.  On  exam  ..  Sunken  eyes..  Skin  turgor..  Depressed  fontanelle..  The  degree  of dehydration  is

A.  5%

B.  10%  

C.  15%

D.  20%


Answer:  b

Degree  of  dehydration  for  uptodate:

mild  dehydration  (3  to  5  percent  volume  loss)  –  a  history  of  fluid  losses  may  be  the  sole  finding,  as  clinical  signs  may  be  absent or  minimal.  

moderate  dehydration  (6  to  10  percent  volume  loss)  –  signs  and  symptoms  are  now  apparent  and  can  include  the  following: tachycardia,  orthostatic  falls  in  blood  pressure,  decreased  skin  turgor,  dry  mucous  membranes,  irritability,  decreased  peripheral perfusion  with  a  delay  in  capillary  refill  between  two  and  three  seconds,  and  deep  respirations  with  or  without  an  increase  in respiratory  rate.  There  may  be  a  history  of  reduction  in  urine  output  and  decreased  tearing,  and,  in  infants,  an  open  fontanelle will  be  sunken  on  physical  examination.

severe  dehydration  (>10  percent  volume  loss)  –  such  children  typically  have  a  near-shock  presentation  as  manifested  by hypotension,  decreased  peripheral  perfusion  with  a  capillary  refill  of  greater  than  three  seconds,  cool  and  mottled  extremities, lethargy,  and  deep  respirations  with  an  increase  in  rate.  Severe  hypovolemia  requires  immediate  aggressive  isotonic  fluid resuscitation to restore the effective circulating volume (ecv) and prevent ischemic tissue injury. 



A.  Low protein  and  low  carbohydrate.  (marasmus)

B.  High protein  and  low  carbohydrate.

C.  Low protein  and  high  carbohydrate.

D.  High protein  and  high  carbohydrate.


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Answer:  c   

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case of intussusception) child came with colicky abdominal pain, vomiting, bloody stool. Us showed doughnut sign. What is the most important step in management of this case ? A. Urgent surgery referral

B. Ngt decompression

C. Iv fluid resuscitation

D. Barium enema  


Answer: c

Iv fluid resuscitation, then decompression, afterward, air enema or barium if air unavailable ( pediatric master the board )


Baby  hypotension  sever  vomiting  and  watery  diarrhea  what  is  the  electrolyte  abnormality :

A.  L na

B.  H na

 C.  H k

D.  Hyperglycemia


Answer: a


 6  weeks  old  baby  pale,  jaundice  on  examination  there  is  palpable  spleen  2  cm  below  the  costal  margin.  Lab  shows  total bilirubin  =205  mg\dl,  direct  bilirubin =  60  mg/dl,  positive  direct  &  indirect  combs  test.  Peripheral  blood  smear(attached photo  shows  spherocytosis)

A.  Spherocytosis  

 B.  Gilbert  disease

 C.  Abo incompatibility

D.  Crigler  najjar  syndrome


Answer: ??

should be autoimmune   


What  measurement   you  should  take  to  relieve  an  infant  abdominal  colic?  

A.  Antispasmodic  drugs

B.  Increase  bottle  feeding

C.  Warm baths  

D. Prevent child abuse


Answer:  C

  Reassure  the  parents  and  drug treatment  generally  has no  place  in  management  of  colic unless  gerd  appears  likely

although the anticholinergic  agent  dicyclomine  hydrochloride  is  effective  against  colic,  it  has rare  but  serious  adverse  effects  and  cannot  be recommended


4  weeks  old  boy  with  acute  onset  forceful  non  bilious  vomiting  after  feeding.  On  abdominal  examination:  There  is  olive  mass  at  epigastric  area.  What  is  the  1st  investigation  should  you  do?

a.    PH monitoring

b.    Abdominal  US


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Answer:  B

  (The  diagnosis  of  choice  is  US  to and  the  most  accurate  test  is  an  upper  GI  series)

Prestalisis which is visible  

Yuk ! Vomiting non boilus 

Lump on the left side ( olive sign )

Olive mass 

Ramstedit operation

Imbalance electrolyte 

Circular muscles hypertrophy


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6  years  old  boy  presented  with  gingivitis,  petechiae  and  rash.  What  is  the  diagnosis?  


Answer: Vitamin  C  deficiency

 Explaination  :  Vit  C  deficiency cause  impaired  collagen  synthesis  symptoms  occurs  after  3  months  of  deficiency,  which  includes  ecchymoses,  bleeding  gum,  petechiae,coild  hair,hyperkeratosis  and  impaired wound healing.  

Its  common  is  severely  malnourished  and  alcohol  abusers  ,

 Tx  supplementation.



boy came to your clinic  with  yellow  discoloration  of  the  eyes  noticed  3  days  back  and  hepatomegaly.  His  liver  enzymes  are  increased.  What  is  the  diagnosis?

A. Hepatitis  A

b. Hepatitis  B

c. Hepatitis  C

d. Hepatitis  D



2  weeks  neonate  passed  unformed  stool.  What  will  you  do?

A. Prescribe  formula  milk.

B. Give  oral  rehydration  solution

C. Prescribe  Lactose-free  milk.




Malnourished  baby  with  fair  coiled  hair  and  abdominal  distension.  What  is  the  most  likely  diagnosis?




Answer:  A 

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child  with  flat  buttocks.  What  investigation  will  you  do  (celiac)?

A. Antibody

 B.Intestine  biopsy


Answer:  A  

Antibody  testing,  especially  IgA  anti-tissue  transglutaminase  antibody  (IgA  TTG),  is  the best  first  test,  although  biopsies  are  needed  for  confirmation

;  in  children  younger  than  2  years,  the  IgA TTG  test  should  be  combined  with  testing  for  IgG-deamidated  gliadin  peptides.   

Celiac disease : gluten sensitive enteropathy

Classical presentation is at 8–24 months with abnormal stools, failure to thrive, abdominal distension, muscle ( buttock) wasting and irritability

• Other modes of presentation – short stature, anaemia ( iron deficiency) , screening, e.g. children with diabetes mellitus


1- positive serology (IgA tissue transglutaminase and endomysial antibodies)

2- mucosal changes (flat mecosa , increased intraepithelial lymphocytes and a variable degree of villous atrophy and crypt hypertrophy) on jejunal biopsy

3- resolution of symptoms and catchup growth upon gluten withdrawal

 • Treatment – gluten free diet for life.

The incidence of small bowel malignancy ( lymphoma, carcinoma )  in adult hood is increased in coeliac disease, although a gluten free diet probably reduces the risk to normal.

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child  with  chronic  diarrhea  ,  endoscopy  showed  sickle  shaped  parasite  adherent  to  the  bowl  wall ,  what  is  it?

A. Giardia

B. Entemebea  histolytica 

Answer : A

Biopsy  specimens  from  duodenum  are  often  teeming  with  sickle-shaped  Giardia  trophozoites,which  are tightly  bound  by  the  concave  attachment  disc  to  the  villus  surface  of  the  intestinal  epithelial  cells 


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Formula  milk  comparing  to  Breast  milk  contain  more  …..what ?


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Formula contains  more  protein  1.5-1.9  g  ,  Carbohydrate  7-8.6  g  ,  sodium  0.65-1.1  mmol  ,  Calcium  0.88 - 2.1  mmol ,  phosphorus  0.9-1.8  mmol  and  Iron  8 -12.5  umol  


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breast  feeding  mother  known  history  of  seizure  with  phyntoin  ask  about  breast  feed ?

A. Reassurance

B. feeding  after  8  hrs


Answer:  A.  Reassurance

Breast-Feeding  Considerations:  Phenytoin  is  excreted  in  breast  milk;  however,  the  amount  to  which  the infant  is  exposed  is  considered  small.  The  manufacturers  of  phenytoin  do  not  recommend  breast-feeding during  therapy.  

phenytoin,  carbamazepine  and  valproate  are  probably  safe 

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child  with  jaundice,  elevated  direct  bilirubin


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Answer  : pic 

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baby 6 month show regurgitation  after  every meal  he  esophagus  ph  is  low  he  is  normally  developing  what  is  the  Rx?

A. Close  follow  up

B. Surgical  fundal

c. Esophageal  manometry 

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Answer:  A 

no  treatment is  required may be because I think this  is a case of normal physiological  gastroesophageal reflux  which  happen  in  baby  younger  than  8months  &  presented  with  effortless  regurgitation  but  otherwise  the  baby  is  normal

Gastrooesophageal reflux :  is the involuntary passage of gastric contents into the oesophagus.

It is extremely common in infancy. It is caused by inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity. A predominantly fluid diet, a mainly horizontal posture and a short intraabdominal length of oesophagus all contribute.

nearly all symptomatic reflux resolves spontaneously by 12 months of age.

Most infants with gastrooesophageal reflux have recurrent regurgitation or vomiting but are putting on weight normally and are otherwise well,

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Child  ingested  a  caustic  material  he  present  to  ER  crying  drooling  what  to  do  1st  ? A. Maintain  airway

B.Activated  charcoal


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Answer:  A

I  think  because  activated  charcol  is  contraindicated  in  causatic  material  ingestion  ,And  Because  of  the  risk of  rapidly  developing  airway  edema,  the  patient’s  airway  and  mental  status  should  be  immediately  assessed and continuously monitored.   

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16  years  old  female  .  Fever  and  Chronic  diarrhea  for  10  months,  Post  meal  periumbilical  pain, Sometimes  blood  mixed  with  stool?


B.chronic  pancreatitis


Answer: A 


baby  was  playing  with  his  father  which  suddenly  his  father  looks  the  watch  is  not  working  baby become  agitated  and  refuse  food  what  you  will  do  :  


Answer: upper  Gi  endo

Battery ingestion 


the  most  part  in  impaction  of  foreign  body  in  the  :

A. left  bronch

B. right  bronch 

C. bifurcation


Answer: b