GI, Misc + CDB Flashcards Preview

► Med Misc 54 > GI, Misc + CDB > Flashcards

Flashcards in GI, Misc + CDB Deck (240):
1

MC type of TEF

Type A: Proximal EA with distal TEF

2

Best to do lumbar tap at

L4-5

3

MC and life-threatening complication of esophageal atresia with TEF

Aspiration pneumonia (gastric contents, chemical pneumonitis)

4

-h/o of polyhydramnios -vomiting w/ 1st feeding -choking/coughing & cyanosis -recurrent aspiration pneumonia

EA with TEF

5

Inability to pass an NGT or OGT in the NB

EA with TEF

6

___% of EA have TEF

90

7

Sequence associated with EA

VACTERL V-vertebral anomalies A-anal atresia C-cardio anomalies T-TEF E-esopageal atresia R-renal anomalies L-limb anomalies

8

In EA, the esophagus ends blindly approximately ___ from the nares

10 to 12 cm

9

T/F All TEFs are congenital

F, may be acquired

10

T/F EA is a surgical emergency

T

11

Types of TEF

A image thumb
12

___ is the least common but the most likely to be seen in ED

H-type tracheoesophageal fistula (Type C)

13

New born infant with frothing and bubbling at the mouth with episodes of coughing and cyanosis noted to be exacerbated on feeding

EA

14

MC esophageal disorder in children of all ages is

GERD

15

Loss of normal peristalsis and failure of LES to relax in response to swallowing

Achalasia

16

Pathophy of achalasia

Decreased ganglion cells surrounded by inflammatory cells

17

Bird's beak on barium swallow

Achalasia

18

Achalasia is confirmed by the most sensitive test for it which is

Manometry

19

Medical management for achalasia when surgery cannot be done

Nifedipine Botulinum toxin injection

20

Surgical management for achalasia

Heller myotomy or pneumatic dilatation

21

Syndrome of familial achalasia, alacrima, corticotropin insensitivity

Allgrove syndrome

22

What is the primary mechanism of GER

Transient LES relaxation

23

Main stimulus for transient LES relaxation is ___

Gastric distention

24

Neck contortions seen in GER is called what syndrome

Sandifer syndrome

25

What position worsens the infant GER

Seated position

26

Recommended position in infants with GER

If the patient is asleep -- supine ( for risk of SIDS); if the patient is awake, prone position or upright carried position

27

What are the most important predictor of successful surgical outcome of GER

Preoperative accuracy of diagnosis; skill of the surgeon

28

It is seen in males and blood type O and B presenting as non billous vomiting after feeding at 3rd wk of life , jaundice, with olive size non movable mass above and right of the umbilicus

Hypertrophic pyloric stenosis

29

Shoulder sign (bulge of pyloric muscle into the antrum), double tract sign (parallel streaks of barium in the narrow channel; excess mucosa), or string sign (from elongated pyloric channel) on barium studies (upper GI series)

Hypertrophic pyloric stenosis

30

Management for hypertrophic pyloric stenosis

Surgery: Ramstedt pylorotomy

31

MC cause of pyloric stenosis

Idiopathic

32

T/F Hypertrophic pyloric stenosis is usually present at birth

F

33

Drug associated with pyloric stenosis if given to infants within the first 2 weeks of life

Erythromycin

34

Congenital anomalies associated with hypertrophic pyloric stenosis

Turner's, Trisomy 18

35

Systemic conditions assoc with hypertrophic pyloric stenosis

Eosinophilic GE, epidermolysis bullosa

36

Hypertrophic pyloric stenosis may appear as late as

5 months

37

Most sensitive test to detect hypertrophic pyloric stenosis; initial test

Ultrasound 􏱄 Elongated pyloric channel (> 14 mm) 􏱄 Thickened pyloric wall (> 4 mm)

38

__ is the most common clinical association of pyloric stenosis

Unconjugated hyperbilirubenemia ( icteropyloric syndrome)

39

Acid-base abnormality in hypertrophic pyloric stenosis

Hypochloremic, hypokalemic metabolic alkalosis: acid loss in vomit

40

Mushroom sign in upper GI series

Hypertrophic pyloric stenosis; Hypertrophic pylorus against duodenum

41

MC cause of non bilous vomiting in children

Hypertrophic pyloric stenosis

42

Best test for hypertrophic pyloric stenosis

Barium swallow

43

Triad: S I R ( sudden onset of severe epigastric pain, inability to pass tube into stomachl, retching with emesis)

Gastric volvulus

44

Management for gastric volvulus

Emergency surgery

45

First month of life, bilious vomiting, crampy/colicky abd pain, blood/mucus in stool

Intestinal volvulus (congenital malrotation of midgut)

46

MC location for volvulus (twisted loop) in children

Ileum

47

XR: air fluid levels upper GI series: "bird beak" at rotation sight

Intestinal volvulus

48

Initial management for intestinal volvulus

Endoscopic decompression, fluids

49

Inverted U sign of volvulus represents

Distended sigmoid loop

50

Midline crease in the coffee bean sign of volvulus represents

Mesenteric root in a greatly distended sigmoid

51

T/F Ligament of treitz is abnormally located in intestinal volvulus

T

52

Duodenal atresia is due to failure to recanalize (lack/absence of normal duodenal apoptosis) the lumen after the ___ phase of intestinal development during the ___ weeks AOG

solid, 4th-5th

53

Duodenal atresia is associated with what chromosomal abnormality

Down syndrome

54

What is the hallmark of duodenal obstruction

Billous vomiting without abdominal distention

55

Double bubble sign

Duodenal atresia

56

What GI anomaly is commonly assoc w/ down syndrome

Duodenal atresia

57

Bile stained vomitus w/in 12 hrs after birth, dehydration; Annular pancreas: wraps around duodenum

Duodenal atresia

58

Management of duodenal atresia

Decompress w/ NG tube, correct electrolytes, treat life-threatening anomalies, surgery (duodenoduodenostomy)

59

Presents in infancy w/ coughing, vomiting, gagging after feeding; Resp distress and frothy bubbles in oral cavity

TEF

60

Distended abdomen w/ dilated loops of bowel

Malrotation

61

Triple bubble sign

Jejunal atresia

62

"Ground glass" appearance in the RLQ with trapped "soap bubbles"; egg-shell pattern

Meconium ileus

63

Meconium ileus is diagnostic for what other disease

Cystic fibrosis

64

What is meconium ileus

Obstruction of the small intestine (terminal ileum) in the newborn caused by impaction of thick, dry, tenacious meconium

65

Failure to pass meconium w/in first 24 hours of life; bilious vomiting, h/o polyhydramnios, family history of CF

Meconium ileus

66

Intestinal perforation--> pneumoperitoneum (after birth) or intrabdominal calification (before birth)

Meconium ileus (complications)

67

Similar presentation to meconium ileus (bilious vomit, failure to pass meconium w/in first 24 h) BUT non-cystic fibrosis babies; no complication with intestinal perforation

Meconium plug syndrome

68

___ % of meconium ileus are due to CF

99

69

The most common presentation of cystic fibrosis in the neonatal period

Meconium ileus

70

MC congenital GI anomaly

Meckel diverticulum

71

What is the cause of meckels diverticulum

Failure of omphalomesenteric duct/vitelline duct to obliterate

72

Omphalomesenteric duct/vitelline duct is a remnant of

Yolk sac

73

Significant sudden intermittent painless rectal bleeding with brick-colored or currant jelly stool

Meckel diverticulum

74

MCC of LGIB in children

Meckel diverticulum

75

Diagnostic test for Meckel

Technetium 99M scan aka Meckel scan (scintigraphy)

76

Management for Meckel

Diverticular resection with transverse closure of the enterotomy

77

The only true congenital diverticulum

Meckel diverticulum

78

MC tissue in Meckel

Gastric

79

When is a diverticulum considered "true"

If involves all layers of bowel

80

What is the meckel's diverticulum rule of 2's

-2% of population -2 feet from ileocecal valve -2 types of ectopic tissue (gastric/pancreatic) -2x more affects males than females -less than 2 years of age

81

MC complication of Meckel

LGIB

82

Omphalomesenteric (vitelline) duct should disappear by

7th week AOG

83

Meckel’s diverticulum may mimic ___ and also act as lead point for ___

Acute appendicitis; intussusception

84

MC cause for emergent surgery in childhood

Appendicitis

85

Perforation rates are greatest in youngest children because ___

They can’t localize symptoms

86

Peak age of appendicitis

10-12

87

Appendicitis is rare in children younger than

5

88

Stages of appencidicits

1) Luminal obstruction 2) Bacterial invasion 3) Necrosis of wall

89

Appendiceal lumen is most commonly obstructed by

Fecalith (other: lymphoid hyperplasia from viral infection, appendices carcinoid)

90

Appendiceal rupture usually occurs within ___ hours of onset of symptoms

48

91

It is the single most reliable finding in the diagnosis of acute appendicitis

Localized abdominal tenderness

92

Congenital lack of distal bowel innervation by auerbach plexus -> constant contracture of muscle tone

Hirschprung disease (Congenital aganglionic megacolon)

93

What syndrome is hirschsprung disease freq assoc w/

Down syndrome (less frequently, MEN type 2 and Waardenburg, Laurence-Moon-Bardet-Biedl)

94

Hirschprung disease, boys vs girls

Boys

95

Do not pass meconium in 1st 48 hrs or at all (normal = 1st 24 hrs); bilious vomiting

Hirschprung disease

96

Treatment of choice for Hirschprung

Single stage laparospcopic endorectal pullthrough is the tx of choice

97

How to dx hirschsprung disease, confirmatory, GOLD STANDARD

Full thickness biopsy 2 cm above the dentate line: Absence of ganglion cells on the submucosal and myenteric plexus

98

XR: distended bowel loops + no air in rectum Contrast enema: barium retention for >24 hrs, narrow distal colon, proximal dilation Manometry: high pressure anal sphincter

Hirschprung disease

99

Most common cause of lower intestinal obstruction in neonates

Hirschprung disease

100

Currarino triad: Anorectal malformation, sacral bone anomaly, presacral masses

Hirschprung disease

101

Abd distention, *explosive discharge* of stool following a rectal exam

Hirschprung

102

How to dx hirschsprung disease, initial

Barium enema

103

DRE, rectal vault is empty

Hirschprung

104

It is the most common cause of intestinal obstruction in children between 3 mos to 6 years and most common abdominal surgery in children less than 2 years

Intussusception

105

2 types of intussusception

Ileocolic and ileoileocolic

106

What does the doughnut sign specify in GI tract imaging

Intussusception

107

MCC of Intussusception

Idiopathic (Other: Polyp, hard stool, lymphoma, viral inflammation)

108

Currant jelly stool + bilious vomiting

Intussusception

109

Right upper quadrant sausage-shaped abdominal mass

Intussusception

110

Initial test for Intussusception

UTZ: Target sign (echogenic mucosa + hypoechogenic submucosa)

111

Diagnostic & therapeutic modality for Intussusception

Barium enema

112

Coiled spring sign

Intussusception

113

T/F Intussusception is a pediatric emergency

T, do air-contrast barium enema

114

Syndrome associated with Intussusception with polyp as leading intussuseptum

Peutz-Jeghers syndrome

115

Mode of inheritance of Peutz-Jeghers syndrome

Autosomal dominant

116

Management for Intussusception

Hydrostatic reduction in stable patients; if not stable do not do hydrostatic reduction

117

Intussusception, upper part of bowel that invaginated into distal part, dragging its mesentery along

Intussuseptum (distal part, intussusipiens)

118

Light colored (echoic) stools at 3 to 6 weeks, dark urine, hepatomegaly, jaundice due to increased direct hyperbilirubinemia (direct hyperbilirubinemia)

Biliary atresia

119

___ is an indication for evaluating neonatal jaundice even if the infant seems normal otherwise

Direct hyperbilirubinemia (>2)

120

What are the two inborn disorders of bilirubin metabolism that lead to a CONJUGATED bilirubinemia?

Dubin-Johnson, Rotor syndrome (biliary atresia and alpha1 antitrypsin def. can present this way also)

121

Lack of gallbladder and triangular cord sign on ultrasound

Biliary atresia

122

Extrahepatic cholestasis

Biliary atresia, choledochal cyst

123

Management for biliary atresia

Kasai procedure before 8 weeks of life

124

MCC of conjugated hyperbilirubinemia (direct) in neonates

Idiopathic neonatal hepatitis (diagnosis of exclusion) and biliary atresia

125

Distal segmental bile duct obliteration with patent extrahepatic ducts up to porta hepatis

Extrahepatic Biliary Atresia

126

Prolonged elevated levels of conjugated bilirubin after 14th day of life

Neonatal cholestasis

127

Omphalitis in newborn is associated with

Leukocyte adhesion deficiency (no pus with minimal wound inflammation) , inadequate care of umbilical cord (with bacterial colonisation from maternal genital tract and envt; often results in sepsis)

128

Delayed separation of umbilical cord is associated with

Leukocyte adhesion deficiency

129

Leukocyte defect in leukocyte adhesion deficiency

Leukocyte chemotaxis

130

It is the most common life threatening emergency of the GI in newborns characterized by mucosal necrosis of the intestines

NEC

131

Gas accumulation in the submucosa of the bowel wall produced by bacteria seen in NEC is called

Pneumatosis intestinalis

132

Intestinal ischemia Enteral nutrition Bacterial translocation

NEC triad

133

The finding of __ confirms the clinical suspicion of NEC and is diagnostic

Pneumatosis intestinalis

134

Most significant risk factor for NEC

Prematurity

135

Diseases associated with prematurity

NEC, ROP

136

MC site of NEC

Distal ileum, proximal colon

137

Mgt for NEC

NPO, bowel decompression, antibiotics (G-, G+, anaerobic)

138

mechanism of diarrhea with normal osmolality

secretory

139

mechanism of diarrhea that stops with fasting

osmotic diarrhea

140

diarrhea that persists even with fasting

secretory diarrhea

141

it is seen if the mechanism of diarrhea is mucosal invasion

dysentery evident --- blood wbc mucus in stool

142

diarrhea common in less than 4 years old with, associated with hemolytic uremic syndorme

enterohemorrhagic e.coli (O157H7)

143

___ causes diarrhea from inadequately pasteurized milk

listeria monocytogenes

144

salmonella typhi specimen of choice after 1st week of infection

urine, stool

145

salmonella is seen in blood cs on what day

1st 1 week

146

incubation period of vibrio cholerae toxin causing diarrhea

24-72 hrs

147

cholera etiologic agent common in immunocompromised or with chronic liver diase

vibrio vulnificus

148

ciguatera fish poisoning is common in what type of fish

barracuda

149

the most common complication of shigellosis

dehydration

150

SIADH is associated with ____ diarrhea

shigella dysenteriae

151

this syndrome is caused by shiga toxin mediated endothelial injury

HUS

152

syndrome of severe toxic convulsion, extreme hyperpyrexia, headache, brain edema, dehydration caused by shigella

Ekiri syndrome or lethal toxic encephalopathy

153

presumptive data supporting the diagnosis of bacillary dysentery include the____

finding of fecal leukocytes and blood leukocytosis with left shift ( bands> neutrophils)

154

treatment regimen of shigellosis

ceftriaxone 50mkd as single dose for empiric therapy ( continued for 5days if patient responds despite negative culture results); zinc 20mg/day for 14 days

155

travelers diarrhea is caused by

ETEC

156

major cause of infant acute and persistent diarrhea

enteropathogenic e. coli

157

this bacteria cause copious watery diarrhea, having fishy odor without the abdominal cramps

v. cholera

158

bacteria associated with IgA nephropathy

campylobacter

159

In IMCI, the treatment of choice for bloody diarrhea is

Ciprofloxacin

160

What is the dose of ciprofloxacin if given to treat bloody diarrhea

15mg/kg bid for 3 days

161

Zinc supplement for diarrhea should be given for how many days

10-14

162

cause of toddlers diarrhea

drinks excessive carbohydrate containing drinks

163

occurs when the transfer of food bolus from the mouth to the esophagus is impaired

oropharyngeal dysphagia

164

occurs when there is difficulty in transferring down to the esophagus

esophageal dysphagia

165

vomiting begin with involuntary ___

retching

166

acute diarrhea is best defined as onset of excessive loose stools of ___ ml/kg/day and ___ g/day which lasts for ___

>10mlkgday; > 200g/day; less than 14 days

167

a young infant normally has ___ of stool output

5ml/kg/day

168

secretory diarrhea is often caused by __

secretagogue

169

diarrhea caused by ingestion of poorly absorbable solute

osmotic diarrhea

170

anion gap of osmotic diarrhea

> 100 mOsm

171

7 yr old who have soft stool every 3 days but without difficulty. is this constipation?

No. HARD stool passed every 3 days WITH difficulty is treated as constipation

172

in visceral pain, the pain and tenderness is felt over the site of the disease. true or false

FALSE

173

when will central incisors errupt

6.5 months for mandibular (lower); 7.5 months (upper)

174

cleft lip is more common in what gender

males

175

surgical correction of cleft lip is done at what age?

3 months

176

what technique is commonly used in the repair of cleft lip

mod of millard rotation technique

177

what happens when patients with velopharyngeal dysfunction phonates the vowel U

the soft palate does not contact the posterior pharyngeal wall

178

what organsim is associated with dental carries

streptococcus mutans

179

children should only consume juices at mealtime and not to exceed ___ per day to prevent dental carries

6 oz

180

necrotizing peridontal disease or trench mouth is caused by

spirochetes and fusobacterium

181

well circumscribed ulcerative lesion with a white necrotic base and surrounded by red halo that last 10-14 days and heals without a scar

apthous ulcer (canker sore)

182

disease of the salivary gland is rare except for ___

mumps

183

suppurative parotitis is caused by

staph aureus

184

swallowing is seen in utero at what age of gestation

16-20

185

7 year old male presenting with feeding problems, vomiting, associated with atopic disease and on laboratory there is peripheral eosinophilia and IgE elevation. on microcopy, esophagus has eosinophilia. it is refractory to anti reflux medication and has no esophageal erosion on endoscopy

eosinophilic esophagitis

186

what is the treatment of eosinphilic esophagitis

6 food elimination ( seafood, egg, wheat, nuts, soy,milk)

187

position of the coin if inside the esophagus in AP view

we see the flat surface ( round shaped)

188

position of the coin if inside the trachea in AP view

the edge is seen ( line shaped)

189

position of the coin if inside the esophagus in lateral xray view

we see the edge ( line shaped)

190

the intrinsic factor required for GI absorption is ___

vit b12

191

apple peel appearance is seen in ___

jejunoileal atresia

192

what is the most common type of malrotation

malrotation that involves failure of the cecum to move into the right lower quadrant

193

what is the imaging test of choice for malrotation

Upper GI series

194

treatment of duplications

surgical resection

195

there is intentional or subconscious withholding of stool

functional constipation

196

it is the failure of intestinal peristalsis caused by coordinated gut motility without obstruction

ileus

197

abdominal xray shows air fluid levels through out the abdomen

abdominal ileus

198

primary ulcer is associated with ___ infection

helicobacter pylori infection

199

secondary peptic ulcer is a result of

stress, sepsis, shock

200

what is the method of choice in diagnosing peptic ulcer disease

esophagogastroduedenoscopy

201

peptic ulcer caused by gastrimona

zollinger ellison syndrome

202

what disease is associated with zollinger ellison syndrome

MEN1, tuberous sclerosis; neurofibromatosis

203

perianal disease is common in what IBD

crohns diasease

204

___may be the only manifestation of Crohns disease

growth failure

205

__ is the mainstay therapy for acute exacerbations of crohns

corticosteroids

206

__ is the main clinical expression of malabsorption

diarrhea

207

if celiac disease is suspected what test should be determined

serum IgA and transglutamate TG2

208

measurement of carbohydrate using this reagent identifies carbohydrate reducing substances

clinitest reagent

209

breath hydrogen test is used to identify the specific ___ malabsorbed

carbohydrate

210

screening tool for protein loosing enteropathy

stool a1 antitrypsin

211

what is the most common cause of exocrine pancreatic insufficiency in children and what test must be done

cystic fibrosis; sweat chloride test

212

what is the gold standard for exocrine pancreatic function

direct analysis of duodenal aspirate

213

what is the hallmark of celiac disease

increase density of CD8 cytotoxic intraepithelial lymphocytes

214

what is the most common extraintestinal manifestation of celiac diases

iron def anemia unresponsive to iron therapy

215

the most commonly recognized cause of congenital diarrhea

congenital microvillus atrophy ( microvillous inclusion disease)

216

what are the nutrients absorbed in duodenum and proximal jejunun

FIMP-C; folic acid, iron, magnesium, phosphorus, calcium

217

nutrient absorbed in distal ileum

vit b12; bile acids

218

test that is useful to differentiate between lack of intrinsic factor or malabsorption of cobalamin

schilling test

219

severe deficiency of body zinc after birth in bottle fed infants or after weaning from breasteeding

acrodermatitis enteropathica

220

it is the 2nd most common cause of child death worldwide

diarrhea

221

persistent diarrhea is defined as episodes beginning acutely but lasts for __

more than or equal to 14 days

222

management for minimal diarrhea

*if less than 10kg --> 60-120 ml ors for each vomiting, diarrhea; * if more than 10 kg --> 120-240 ml ORS

223

management of mild to moderate dehydration

* ors 50-100 ml/kg over 3-4 hr; * same replacement of loss as no dehydration

224

management of severe dehydration

* LR 20ml/kg until perfusion and mental status improve; *100 ml/kg D5.5 NSS twice the maintenance fluid OR ors over 4 hours; * for replacement of loss NGT same as no dehydration OR D5.35 NSS with 20 meq kcl IV

225

lactose load exceeding ___ may be associated with higher purging in children with diarrhea

5 d/kg/day

226

oral zinc after acute diarrhea is given how?

10mg/day for infants and 20mg/day for more than 6 months for 10-14 days

227

chronic diarrhea is defined as diarrhea episode that last for ___

more than or equal to 14 days

228

it is the most common cause of severe and protracted diarrhea in AIDS

enteric cryptosporodiosis

229

what is the gold standard for imaging in patients with appendicitis

ct scan

230

most common intestinal tumor of childhood

hamartomas

231

the most common primary GI carcinoma

colorectal Ca

232

the most common GI malignancy ( wether benign or malignant)

lymphoma

233

what is the hallmark of hepatorenal syndorme

renal vasoconstiriction

234

persistence of unconjugated bilirubin (>20) after the 1st week of life without hemolysis, jaundice with normal stool color, is seen in what disease

crigler-najar I ( gluc transferase def)

235

wilsons disease there is a decreased biliary ___ excretion

copper

236

what is the firs serologic marker to appear in hepa b infection

hbsAg

237

what is the marker of infectivity of hepa B

HbeAg

238

wha vaccine is given in infants with hsbAg + mother

HBIG and hepa vaccine within 12 hours of birth

239

preterm infants with HsBAg negative mother should receive vaccine when?

unti 1 month or before discharge

240

HBIG can be given until __ after sexual exposure

14 days