Child with vomiting and diarrhea. On exam .. Sunken eyes.. Skin turgor.. Depressed fontanelle.. The degree of dehydration is
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.
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
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
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)
B. Gilbert disease
C. Abo incompatibility
D. Crigler najjar syndrome
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
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
(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 )
Circular muscles hypertrophy
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 ,
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?
child with flat buttocks. What investigation will you do (celiac)?
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
• Diagnosis –
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.
child with chronic diarrhea , endoscopy showed sickle shaped parasite adherent to the bowl wall , what is it?
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
Formula milk comparing to Breast milk contain more …..what ?
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
breast feeding mother known history of seizure with phyntoin ask about breast feed ?
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
child with jaundice, elevated direct bilirubin
Answer : pic
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
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,
Child ingested a caustic material he present to ER crying drooling what to do 1st ? A. Maintain airway
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.
16 years old female . Fever and Chronic diarrhea for 10 months, Post meal periumbilical pain, Sometimes blood mixed with stool?
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
the most part in impaction of foreign body in the :
A. left bronch
B. right bronch