GI practice questions

Question 1

A 5-year-old child presents with a history of infrequent and difficult bowel movements for the past three weeks. The parent reports occasional soiling of the child’s underwear. The child complains of abdominal pain occasionally but is otherwise healthy.

Questions:

1. Based on the history and clinical presentation, what is the most likely diagnosis?A) Irritable bowel syndrome (IBS)B) Functional constipation with encopresisC) AppendicitisD) Celiac disease

Answer 1

Answer:** B) Functional constipation with encopresis

Question 2

Which initial dietary modification should be recommended for this child to help manage constipation?**

A) Reduce fluid intake to decrease bowel movements

B) Increase fiber intake with whole grains, fruits, and vegetables

C) Introduce a gluten-free diet

D) Eliminate dairy products completely

Answer 2

Answer:** B) Increase fiber intake with whole grains, fruits, and vegetables

Question 3

What pharmacological management could be considered for this child to relieve constipation symptoms?**

A) Proton pump inhibitors

B) Antidiarrheals

C) Laxatives, such as Miralax or lactulose

D) Antibiotics

Answer 3

Answer:** C) Laxatives, such as Miralax or lactulose

Question 4

What is a key component that should be emphasized to the parents for successful long-term management of encopresis?**

A) Short-term medication use

B) Regularly scheduled toileting and positive reinforcement

C) Taking stool softeners only as needed

D) Immediate cessation of all dairy products

Answer 4

Answer:** B) Regularly scheduled toileting and positive reinforcement

Question 5

An 8-year-old child presents with intermittent abdominal pain localized mainly around the umbilical area. The child’s growth is normal, there is no significant weight loss, and there are no alarming symptoms such as rectal bleeding.

Questions:

1. What initial diagnosis should be considered for this child based on the information provided?A) Lactose intoleranceB) AppendicitisC) Functional abdominal painD) Constipation

Answer 5

*Answer:** C) Functional abdominal pain

Question 6

What non-pharmacological strategies would be recommended first for the management of this child’s abdominal pain?**

A) Initiate gluten-free diet

B) Perform regular physical activity and maintain a structured schedule

C) Recommend daily enemas

D) Implement a regular intake of probiotics with every meal

Answer 6

Answer:** B) Perform regular physical activity and maintain a structured schedule

Question 7

When should further diagnostic testing be considered for abdominal pain?**

A) If the child complains only during school hours

B) If the pain persists beyond expected time and quality of life is affected, or if red flags like unexplained weight loss or GI bleeding appear

C) As the first approach to identify any possible abnormalities

D) Only if there is a family history of GI disorders

Answer 7

B) If the pain persists beyond expected time and quality of life is affected, or if red flags like unexplained weight loss or GI bleeding appear

Question 8

A 6-year-old child presents with passing stool containing blood and mucus, along with abdominal pain and weight loss. On examination, abnormal growth charts suggest poor weight gain.

Questions:

1. What condition should be highly suspected in this case given the presentation?A) Chronic constipationB) Inflammatory bowel disease, such as Crohn’s disease or Ulcerative ColitisC) Irritable bowel syndrome (IBS)D) Simple gastroenteritis

Answer 8

B) Inflammatory bowel disease, such as Crohn’s disease or Ulcerative Colitis

Question 9

What is the most appropriate next step in the diagnostic process?**

A) Encourage dietary changes and observe for improvement

B) Advise the use of over-the-counter probiotics

C) Refer for specialist consultation and likely endoscopic evaluation

D) Prescribe a regimen of antispasmodics

Answer 9

C) Refer for specialist consultation and likely endoscopic evaluation

Question 10

Given the potential finding of an inflammatory bowel condition, what dietary management could aid in treatment initially?**

A) High intake of raw vegetables and spices

B) A diet low in fiber and simple sugars during acute phases

C) Emphasis on a high-dairy diet for increased calcium

D) Complete fluid restriction until diagnosis is confirmed

Answer 10

B) A diet low in fiber and simple sugars during acute phases

Question 11

A 7-year-old boy is brought to your clinic with a history of not having a bowel movement for 4 days. His parents report he often strains during defecation and has intermittent episodes of abdominal pain. He sometimes leaks stool into his underwear. His dietary history reveals limited fiber intake and he dislikes vegetables.

Questions:

1. What is the most likely diagnosis?A) Gastroenteritis
   B) Functional constipation with encopresis
   C) Appendicitis
   D) Celiac disease

Answer 11

*Answer:** B) Functional constipation with encopresis

Question 12

Which dietary recommendation would be most appropriate for this child?**

A 7-year-old boy is brought to your clinic with a history of not having a bowel movement for 4 days. His parents report he often strains during defecation and has intermittent episodes of abdominal pain. He sometimes leaks stool into his underwear. His dietary history reveals limited fiber intake and he dislikes vegetables.

A) Encourage intake of high-fat foods
B) Increase intake of high-fiber fruits and vegetables
C) Start a gluten-free diet
D) Reduce fluid intake

Answer 12

Answer:** B) Increase intake of high-fiber fruits and vegetables

Question 13

Which medication is commonly used to relieve symptoms in this scenario?**

A) Proton pump inhibitors
B) Laxatives, like polyethylene glycol (Miralax)
C) Opioid analgesics
D) Antibiotics

Answer 13

*Answer:** B) Laxatives, like polyethylene glycol (Miralax)

Question 14

What behavioral strategy should parents be encouraged to try?**

A) Discouraging all snacks between meals
B) Creating a regular toileting schedule
C) Limiting playtime until symptoms resolve
D) Administering frequent enemas

Answer 14

Answer: B) Creating a regular toileting schedule

Question 15

A 10-year-old girl presents with recurrent episodes of abdominal pain primarily around the umbilical area. The pain does not wake her at night and is not associated with any other alarming symptoms like fever or weight loss. Physical exam and growth parameters are normal.

Questions:

1. Which diagnosis is most consistent with this presentation?A) Lactose intolerance
   B) Functional abdominal pain
   C) Appendicitis
   D) Celiac disease

Answer 15

Answer:** B) Functional abdominal pain

Question 16

What initial management strategy would be appropriate?**

A) Begin a lactose-free diet
B) Consider psychological support and stress-reducing techniques
C) Immediate referral for surgical consultation
D) Initiate antispasmodic therapy

Answer 16

Answer:** B) Consider psychological support and stress-reducing techniques

Question 17

When is further diagnostic testing warranted for recurrent abdominal pain?**

A) Few episodes with no severe impact on daily activities
B) Presence of systemic symptoms like fever, weight loss, or persistent vomiting
C) Only after dietary modifications fail
D) Immediately after the first complaint

Answer 17

Answer:** B) Presence of systemic symptoms like fever, weight loss, or persistent vomiting

Question 18

A 6-year-old child is brought in by his parents for chronic diarrhea, abdominal pain, blood in stools, and significant weight loss over a period of several months. His growth chart indicates failure to thrive.

Questions:

1. What condition should be highly suspected?A) Functional constipation
   B) Inflammatory bowel disease (IBD)
   C) Viral gastroenteritis
   D) Irritable bowel syndrome (IBS)

Answer 18

Answer:** B) Inflammatory bowel disease (IBD)

Question 19

What is the best next step in management?**

A) Begin a high-calorie diet
B) Immediate referral to a gastroenterologist for further evaluation
C) Prescribing antispasmodics
D) Initiating over-the-counter probiotics

Answer 19

B) Immediate referral to a gastroenterologist for further evaluation

Question 20

Which dietary modification might be suggested during active symptom periods related to IBD?**

A) High fiber intake
B) Low-residue diet
C) High dairy consumption
D) Complete fasting

Answer 20

Answer:** B) Low-residue diet

Question 21

An 8-week-old male infant is brought to the clinic by his parents, who are concerned because he has been experiencing “forceful” vomiting after feedings for the past week. The vomit is non-bilious, and the baby appears hungry soon after vomiting. The parents note that the baby has not had many wet diapers today, and the baby seems fussier than usual. On examination, you observe signs of dehydration and palpate an “olive-like” mass in the right upper quadrant of the abdomen. The infant is afebrile and lethargic, with noticeable weight loss compared to previous visits.

Questions:

1. What is the most likely diagnosis?A) Gastroesophageal Reflux Disease (GERD)
   B) Hypertrophied Pyloric Stenosis
   C) Intussusception
   D) Gastroenteritis

Answer 21

Answer: B) Hypertrophied Pyloric Stenosis

Question 21

What metabolic findings are commonly associated with hypertrophied pyloric stenosis?**

A) Metabolic acidosis with hypernatremia
B) Metabolic alkalosis with hypochloremia and hypokalemia
C) Respiratory alkalosis with hyponatremia
D) Metabolic acidosis with hypokalemia

Answer 21

Answer:** B) Metabolic alkalosis with hypochloremia and hypokalemia

Question 22

What is the first-line diagnostic tool for confirming hypertrophied pyloric stenosis **

A) Plain abdominal X-ray
B) Upper GI barium study
C) Abdominal ultrasound
D) CT scan of the abdomen

Answer 22

Answer:** C) Abdominal ultrasound

Question 23

What is the mainstay treatment for hypertrophied pyloric stenosis**

A) Dietary modification and antiemetics
B) Intravenous antibiotics and observation
C) Surgical intervention after fluid and electrolyte correction
D) Oral rehydration and proton pump inhibitors

Answer 23

Answer:** C) Surgical intervention after fluid and electrolyte correction

Question 24

Which factor from the history and examination is a red flag symptom suggesting this condition?** A) Hungry after vomiting B) Poor feeding and dehydration signs C) Palpable mass in the right upper quadrant D) Afebrile status

Answer 24

*Answer:** C) Palpable mass in the right upper quadrant

Question 25

A new mother reports her 4-week-old son has been vomiting frequently. Upon examination, an "olive-like" mass is felt in the right upper quadrant. What is the most likely diagnosis?** A) Duodenal Atresia B) Hypertrophied Pyloric Stenosis C) Intussusception D) Gastroenteritis

Answer 25

*Answer:** B) Hypertrophied Pyloric Stenosis

Question 26

Which of the following lab findings is most commonly associated with hypertrophied pyloric stenosis?** A) Metabolic acidosis with hyperkalemia B) Metabolic alkalosis with hypochloremia C) Respiratory acidosis with hypernatremia D) Metabolic alkalosis with hypercalcemia

Answer 26

Answer:** B) Metabolic alkalosis with hypochloremia

Question 27

What is the first step in the management of an infant with confirmed hypertrophied pyloric stenosis?** A) Immediate surgical intervention B) Correction of electrolyte imbalances and dehydration C) Initiate anti-reflux medications D) Introduction of hypoallergenic formula

Answer 27

B) Correction of electrolyte imbalances and dehydration

Question 28

During the abdominal exam of an infant suspected of having pyloric stenosis, which physical finding is considered classic?** A) Palpable lymph nodes in the groin B) Abdominal distention and liver enlargement C) Olive-shaped mass in the right upper quadrant D) Positive rebound tenderness in the lower abdomen

Answer 28

Answer:** C) Olive-shaped mass in the right upper quadrant

Question 29

An 18-month-old presents with vomiting for the past 2 days and exhibits signs of moderate dehydration. What is the recommended treatment for moderate dehydration in this child?** A) Initiate intravenous rehydration B) Oral rehydration solution C) Electrolyte-free liquids such as water D) Encourage clear liquids only like apple juice

Answer 29

Answer:** B) Oral rehydration solution

Question 30

Which type of vomiting is most often associated with hypertrophied pyloric stenosis?** A) Bilious vomiting B) Projectile, non-bilious vomiting C) Non-projectile, bilious vomiting D) Bloody vomiting

Answer 30

Answer:** B) Projectile, non-bilious vomiting

Question 31

A parent expresses concern about their child's difficulty swallowing and frequent regurgitation but notes the child is not losing weight. Which diagnostic study would be useful to evaluate for possible dysphagia?** A) Abdominal ultrasound B) MRI of the brain C) Barium swallow D) Chest X-ray

Answer 31

Answer:** C) Barium swallow

Question 32

Which of the following symptoms is commonly associated with abdominal migraines in school-age children?** A) Persistent fever B) Recurrent vomiting C) Constipation D) Persistent diarrhea

Answer 32

Answer:** B) Recurrent vomiting

Question 33

What is the typical prognosis for children diagnosed with abdominal migraines?** A) They often develop chronic diarrhea later in life. B) They usually need surgical intervention. C) They may develop migraine headaches later in life. D) They generally have no further symptoms as adults.

Answer 33

Answer:** C) They may develop migraine headaches later in life.

Question 34

Eosinophilic esophagitis is most closely related to which of the following factors?** A) Viral infection exposure B) Ingestion of specific foods C) Environmental allergies D) Bacterial infections

Answer 34

B) Ingestion of specific foods

Question 35

Which of the following is NOT part of the 6-food elimination diet used for managing eosinophilic esophagitis?** A) Milk B) Peanuts/tree nuts C) Chicken D) Eggs

Answer 35

Answer:** C) Chicken

Question 36

Which type of peptic ulcer is more common in adolescents and often recurs?** A) Gastric ulcer B) Duodenal ulcer C) Stress ulcer D) Idiopathic ulcer

Answer 36

Answer:** B) Duodenal ulcer

Question 37

Which of the following tests is a non-invasive method used to detect H. pylori infection?** A) Serum IgG antibody titer B) Stool monoclonal antibody test C) C-urea breath test D) Esophagogastroduodenoscopy (EGD)

Answer 37

Answer:** C) C-urea breath test

Question 38

What is the initial first-line therapy for managing idiopathic peptic ulcers?** A) NSAIDs B) H2-receptor antagonists (H2RAs) C) Proton pump inhibitors (PPIs) D) Antacids

Answer 38

Answer:** B) H2-receptor antagonists (H2RAs)

Question 39

A rare syndrome characterized by gastric hypersecretion and refractory PUD is known as:** A) Eosinophilic Esophagitis B) Abdominal Migraine C) Zollinger-Ellison Syndrome (ZES) D) Gastroesophageal Reflux Disease (GERD)

Answer 39

C) Zollinger-Ellison Syndrome (ZES)

Question 40

Sophie is a 9-year-old girl brought to the clinic by her mother because of recurrent abdominal pain. Her mother reports that Sophie has episodes of severe, midline, periumbilical pain about once a month. During these episodes, Sophie appears pale, listless, and sometimes vomits. There are no other accompanying gastrointestinal symptoms, and physical examination today is unremarkable. Sophie’s school performance has been affected slightly due to these absences. Her family history reveals that her mother and grandmother have a history of migraines. What condition does Sophie most likely have, based on her symptoms and family history?**

Answer 40

Answer:** Abdominal migraine

Question 41

What non-pharmacological management strategies might be beneficial for Sophie?**

Answer 41

Answer:** Identifying and avoiding triggers, ensuring that Sophie gets adequate sleep, which may relieve symptoms.

Question 42

What is a possible long-term prognosis for Sophie?**

Answer 42

* Sophie may develop migraine headaches later in life.

Question 43

James is a 6-year-old boy who presents with recurrent episodes of vomiting and abdominal pain. His parents note that after meals, James often complains of pain and sometimes refuses to eat. Upon further questioning, they mention that similar symptoms were present since he was a toddler. They also report that he has had issues with feeding in the past, including what seemed like choking episodes. What condition should be considered in James' case?**

Answer 43

*Answer:** Eosinophilic esophagitis

Question 44

What diagnostic procedure would you recommend to confirm the suspected diagnosis?**

Answer 44

*Answer:** Upper endoscopy with biopsy

Question 45

What dietary management plan might be initiated upon confirmation of eosinophilic esophagitis?**

Answer 45

Answer:** A 6-food elimination diet, eliminating milk, soy, egg, wheat, peanut/tree nuts, and fish/shellfish.

Question 46

Lucas, a 17-year-old male, arrives at the clinic with complaints of a dull, aching pain in the abdomen. He mentions the pain worsens when eating and sometimes wakes him from sleep. His history reveals occasional use of over-the-counter NSAIDs for joint pain related to sports activities. Lucas's father also had similar symptoms and was treated for an ulcer. Physical examination shows mild epigastric tenderness. Based on Lucas' history and symptoms, which gastrointestinal condition is most likely?*

Answer 46

*Answer:** Peptic ulcer disease

Question 47

Which type of test would help confirm whether H. pylori infection is present?**

Answer 47

Answer:** The C-urea breath test or a stool monoclonal antibody test

Question 48

What initial treatment should be considered for managing Lucas's symptoms?**

Answer 48

Answer:** Proton pump inhibitors (PPIs) should be started as first-line therapy, with caution regarding ongoing NSAID use.

Question 49

What is the "rule of threes" in the context of infantile colic?** - A. Crying for more than 3 minutes after feeding, occurring more than 3 times per week, and lasting for more than 3 weeks. - B. Crying for more than 3 hours per day, occurring more than 3 days per week, and lasting for more than 3 weeks. - C. Crying occurring before 3 months of age, lasting for more than 3 hours, with a peak at 3 a.m. - D. Crying for 3 periods every day, each lasting 3 minutes, for 3 or more weeks.

Answer 49

. **B.** Crying for more than 3 hours per day, occurring more than 3 days per week, and lasting for more than 3 weeks.

Question 50

Which of the following is considered a red flag symptom indicating a possible underlying condition in an infant presenting with colic-like symptoms?** - A. Demands frequent feedings - B. Excessive gas - C. Abdominal distention - D. Apnea or cyanosis

Answer 50

2. **D.** Apnea or cyanosis

Question 51

What is true about the management of infantile colic?** - A. Specific medication can quickly resolve symptoms in almost all cases. - B. Management includes a set of proven effective treatments. - C. Allowing parents to express concerns about family impact is a part of management. - D. Long-term dietary adjustments are mandatory.

Answer 51

3. **C.** Allowing parents to express concerns about family impact is a part of management.

Question 52

Which of the following complications is not commonly associated with infantile colic?** - A. Shaken baby syndrome - B. Unnecessary treatment for GERD - C. Early termination of breastfeeding - D. Sudden infant death syndrome (SIDS)

Answer 52

4. **D.** Sudden infant death syndrome (SIDS)

Question 53

What does the acronym PURPLE in the context of "Period of PURPLE Crying" refer to?** - A. Promoting Urgency, Responsiveness, Patience, Listening, and Empathy - B. Peak crying, Unpredictability, Resistance to soothing, Pain-like expression, Long crying bouts, Evening clustering - C. Period of Unprovoked Responses to Parental Love and Emotions - D. Persistent Understanding of Risk, Patience, Listening, and Empathy

Answer 53

*B.** Peak crying, Unpredictability, Resistance to soothing, Pain-like expression, Long crying bouts, Evening clustering

Question 54

Which age group is most commonly affected by foreign body ingestion?** - A. 0-6 months - B. 6 months to 3 years - C. 4-7 years - D. 8-12 years

Answer 54

**B.** 6 months to 3 years

Question 55

Which type of foreign body ingestion necessitates emergency intervention due to the risk of severe erosion?** - A. Coins - B. Small plastic toys - C. Disk batteries - D. Food particles

Answer 55

C.** Disk batteries

Question 56

What initial symptoms might indicate an esophageal foreign body in a child?** - A. Fever and rash - B. Choking, excessive salivation, and dysphagia - C. Diarrhea and abdominal pain - D. Sneezing and nasal congestion

Answer 56

B.** Choking, excessive salivation, and dysphagia

Question 57

Which of the following foreign bodies in the gastrointestinal tract may require retrieval due to potential complications?** - A. A coin with a diameter of 2 cm - B. A toy part measuring less than 5 cm in size - C. An object longer than 10 cm - D. A spherical marble

Answer 57

*C.** An object longer than 10 cm

Question 58

What is the recommended management for a blunt object lodged in the rectum?** - A. Emergency endoscopy - B. Conservative management and observation for passage - C. Immediate surgery - D. Administration of laxatives only

Answer 58

*B.** Conservative management and observation for passage

Question 59

Which type of foreign bodies should be removed emergently due to the risk of significant complications?** - A. Small plastic toys - B. Wooden objects - C. Disk batteries and magnets - D. Partially digested food particles

Answer 59

C.** Disk batteries and magnets

Question 60

Age:** 2-year-old child - **Presenting Symptoms:** The mother reports the child suddenly started drooling and can't stop coughing after playing with a set of toy blocks. **Case Description:** The child is brought to the clinic with signs of respiratory distress, including intermittent coughing, excessive salivation, and occasional wheezing. What is the most likely location of the foreign body?

Answer 60

The most likely location of the foreign body is in the esophagus, potentially at the thoracic inlet or mid-esophagus, where it is causing irritation and symptoms of obstruction.

Question 61

Age:** 2-year-old child - **Presenting Symptoms:** The mother reports the child suddenly started drooling and can't stop coughing after playing with a set of toy blocks. **Case Description:** The child is brought to the clinic with signs of respiratory distress, including intermittent coughing, excessive salivation, and occasional wheezing. Which imaging study would be most appropriate to confirm the diagnosis?

Answer 61

A chest X-ray would be the most appropriate initial imaging study to check for a radiopaque foreign body, particularly if swallowing a metallic or toy object is suspected.

Question 62

Age:** 2-year-old child - **Presenting Symptoms:** The mother reports the child suddenly started drooling and can't stop coughing after playing with a set of toy blocks. **Case Description:** The child is brought to the clinic with signs of respiratory distress, including intermittent coughing, excessive salivation, and occasional wheezing. What immediate management steps should be taken?

Answer 62

mmediate management includes ensuring the airway is clear to prevent aspiration, and considering an emergency endoscopy to remove the object if it's causing significant symptoms (especially if a disk battery is suspected).

Question 63

Age:** 4-year-old child - **Presenting Symptoms:** Abdominal pain and refusal to eat following ingestion of multiple small magnetic balls. **Case Description:** The child swallowed multiple small magnetic balls that were part of a toy set. Currently, the child shows signs of abdominal distention and discomfort. Why are small magnetic objects concerning if ingested?

Answer 63

Small magnetic objects are concerning because if more than one is ingested, they can attract each other through different segments of the intestinal tract, leading to pressure necrosis and possible perforation.

Question 64

Age:** 4-year-old child - **Presenting Symptoms:** Abdominal pain and refusal to eat following ingestion of multiple small magnetic balls. **Case Description:** The child swallowed multiple small magnetic balls that were part of a toy set. Currently, the child shows signs of abdominal distention and discomfort. What complications can arise from ingesting multiple magnets?

Answer 64

Complications from ingesting multiple magnets include bowel obstruction, perforation, fistulization between loops of the bowel, and tissue necrosis.

Question 65

Age:** 4-year-old child - **Presenting Symptoms:** Abdominal pain and refusal to eat following ingestion of multiple small magnetic balls. **Case Description:** The child swallowed multiple small magnetic balls that were part of a toy set. Currently, the child shows signs of abdominal distention and discomfort. What would be the appropriate management for this case?

Answer 65

The appropriate management would include prompt radiologic evaluation to assess the location of the magnets and potential surgical intervention to prevent or address intestinal complications if the magnets are impacting any structures.

Question 66

Age:** 8-year-old boy - **Presenting Symptoms:** Rectal pain with trouble sitting down after admitting to inserting a toy part into the rectum. **Case Description:** The child is embarrassed but admits to inserting a small toy gear into his rectum. He now complains of discomfort but denies any more serious symptoms such as bleeding or severe pain. In cases of rectal foreign bodies, when is retrieval necessary?

Answer 66

Retrieval is necessary when the foreign object is sharp, causing significant discomfort, appearing too large to pass naturally, or causing symptoms of obstruction.

Question 67

ge:** 8-year-old boy - **Presenting Symptoms:** Rectal pain with trouble sitting down after admitting to inserting a toy part into the rectum. **Case Description:** The child is embarrassed but admits to inserting a small toy gear into his rectum. He now complains of discomfort but denies any more serious symptoms such as bleeding or severe pain. What immediate examination or investigation is indicated in this scenario?

Answer 67

physical examination, including a gentle digital rectal exam and potentially an abdominal X-ray if the object is not palpable, is indicated to assess the position and features of the foreign body.

Question 68

Age:** 8-year-old boy - **Presenting Symptoms:** Rectal pain with trouble sitting down after admitting to inserting a toy part into the rectum. **Case Description:** The child is embarrassed but admits to inserting a small toy gear into his rectum. He now complains of discomfort but denies any more serious symptoms such as bleeding or severe pain. How would you approach the management of this case, assuming the object is blunt?

Answer 68

If the object is blunt and not causing serious symptoms, conservative management and close observation for passage might be sufficient. If there's any risk of harm or discomfort persists, consider referral for manual or surgical extraction by a specialist.

Question 69

Which of the following is most closely associated with appendicitis in children?** A) High fever B) Constant, generalized abdominal pain C) Anorexia and pain starting in the periumbilical area then shifting to the RLQ D) Bloody diarrhea

Answer 69

Answer: C** - Anorexia and pain initially in the periumbilical area that migrates to the right lower quadrant (RLQ) are classic symptoms in appendicitis.

Question 70

A 7-year-old boy presents with abdominal pain, difficulty walking, and tenderness at McBurney's point. Which sign/test involves pain upon extending the right thigh?** A) Rovsing's sign B) Obturator sign C) Psoas sign D) Rebound tenderness

Answer 70

Answer: C** - The psoas sign involves pain upon extension of the right thigh and is indicative of irritation of the iliopsoas muscle, typically seen in appendicitis.

Question 71

A child presents to the clinic with suspected appendicitis. Which imaging study is known for having the highest accuracy in diagnosing appendicitis?** A) Ultrasonography (US) B) Abdominal X-ray C) Computed Tomography (CT) scan D) Magnetic Resonance Imaging (MRI)

Answer 71

*Answer: C** - A CT scan has the highest accuracy in diagnosing appendicitis as it can clearly visualize the appendix and any signs of inflammation or enlargement.

Question 72

*After an appendectomy, which complication should be discussed with the patient's parents during postoperative follow-up?** A) Hypertension B) Abscess formation C) Chronic kidney disease D) Diabetes mellitus

Answer 72

Answer: B** - Abscess formation is a potential complication following an appendectomy, particularly if there was perforation prior to surgery.

Question 73

Which of the following laboratory findings supports the diagnosis of appendicitis in a pediatric patient?** A) Elevated amylase B) Elevated lipase C) Elevated absolute neutrophil count (more than 6.75 × 10^3/µL) D) Elevated bilirubin

Answer 73

Answer: C** - An elevated absolute neutrophil count suggests a bacterial infection, which supports the diagnosis of appendicitis.

Question 74

What is an important differential diagnosis to consider in a teenage girl presenting with lower abdominal pain that could mimic appendicitis?** A) Gastroenteritis B) Pelvic Inflammatory Disease (PID) C) Asthma D) Migraine

Answer 74

Answer: B** - Pelvic inflammatory disease could mimic appendicitis, especially in adolescent girls presenting with lower abdominal pain. Pregnancy should also be considered and ruled out.

Question 75

A 9-year-old girl comes to the clinic with a 2-day history of abdominal pain. She describes the pain as beginning around her belly button but now localized to the right lower quadrant (RLQ). Her mother reports she has had nausea and vomited once yesterday. The child has a low-grade fever, tender abdomen primarily around the RLQ, but no rebound tenderness. You note that she grimaces when trying to lift her right leg while in the supine position. **Questions:** 1. What is the likely diagnosis? 2. Which test what you just performed? 3. What would your next step in management be?

Answer 75

1. The likely diagnosis is appendicitis. 2. The movement tested is indicative of the **psoas sign**, which can be positive when appendicitis irritates the iliopsoas group. 3. The next step in management is to refer for imaging, particularly an abdominal ultrasound or CT scan, to confirm the diagnosis. Following confirmation, a surgical consultation would be appropriate for possible appendectomy.

Question 76

A 4-year-old male is brought to the emergency department by his parents. They report he has been lethargic, with low-grade fever and complaining of stomach pain for the past three days. The boy has been refusing food and drinks. Parents mentioned that his stomach looked more swollen today, and he now appears dehydrated. On examination, diffuse abdominal tenderness with minimal point tenderness in the RLQ is noted. **Questions:** 1. Why might appendicitis be suspected in this case despite diffuse tenderness? 2. What specific risk does a 4-year-old face more commonly than an older child with appendicitis? 3. What is the immediate management plan for this child?

Answer 76

Appendicitis might be suspected due to symptoms such as prolonged abdominal pain, anorexia, fever, and change in activity (lethargy) despite diffuse tenderness in young children. 2. A 4-year-old is at a higher risk of perforation compared to older children, because early symptoms are often not localized, resulting in delayed diagnosis. 3. The immediate management plan includes intravenous fluids for dehydration, diagnostic imaging (particularly an ultrasound or possibly a CT scan), and surgical consultation for appendectomy. Intravenous antibiotics may be started if a perforation is suspected.

Question 77

A 16-year-old female presents with lower abdominal pain she describes as dull and diffuse initially, shifting to sharp and localized to the RLQ over the past 12 hours. Her last menstrual period was 2 weeks ago. She denies any vaginal discharge or bleeding. Physical examination shows RLQ tenderness with rebound tenderness and a positive Rovsing's sign. **Questions:** 1. Outline the differential diagnoses that should be considered. 2. What is a crucial lab test to perform, aside from confirming appendicitis? 3. What would you expect to discuss with this patient and her family regarding her condition and management plan?

Answer 77

1. The differential diagnoses may include appendicitis, ectopic pregnancy, ovarian cyst/torsion, and pelvic inflammatory disease (PID). 2. It is crucial to perform a pregnancy test (hCG) to rule out ectopic pregnancy as a possible cause of the symptoms. 3. After ruling out pregnancy and confirming appendicitis with imaging, you should discuss the potential need for an appendectomy, the nature and benefits of the procedure, and the risks of complications such as abscess or perforation if untreated. Postoperative follow-up and recovery expectations should also be addressed.

Question 78

What is the most common cause of intussusception in children? A) Viral gastroenteritis B) Invagination of the bowel into another portion of the bowel C) Bacterial infection D) Appendicitis

Answer 78

Answer:** B) Invagination of the bowel into another portion of the bowel

Question 79

Which of the following is part of the classic triad of symptoms associated with intussusception? A) Upper abdominal pain B) Intermittent colicky pain C) Headache D) Constipation

Answer 79

*Answer:** B) Intermittent colicky pain

Question 80

What diagnostic tool is both a diagnostic and therapeutic procedure for intussusception? A) CT Scan B) MRI C) Air contrast enema D) Blood culture

Answer 80

Answer:** C) Air contrast enema

Question 81

What physical examination finding might you expect in a child with intussusception? A) Rigid abdomen B) Decreased bowel sounds C) Sausage-like mass in the right upper quadrant (RUQ) D) Swollen lymph nodes

Answer 81

*Answer:** C) Sausage-like mass in the right upper quadrant (RUQ)

Question 82

Which of the following is not considered part of the management plan for intussusception? A) Rehydration and stabilization B) Urgent pediatric surgical consultation C) Immediate appendectomy D) Observation after radiologic reduction

Answer 82

**Answer:** C) Immediate appendectomy

Question 83

Which of the following complications should providers be vigilant about when managing intussusception? A) Swelling and hematoma of the testicles B) Hemorrhage and necrosis of the bowel C) Mastoiditis D) Pyelonephritis

Answer 83

*Answer:** B) Hemorrhage and necrosis of the bowel

Question 84

What condition should be ruled out if a child presents with symptoms resembling intussusception? A) Diabetes B) Testicular torsion C) Asthma D) Otitis media

Answer 84

Answer:** B) Testicular torsion

Question 85

Jacob is a 2-year-old boy brought to the clinic by his parents. They report Jacob has been irritable and crying intermittently for the past day, with his knees drawn up. He had a few episodes of vomiting and has passed stool that was described as "currant jelly-like." Upon examination, Jacob appears lethargic between episodes of crying and has a fever of 101°F (38.3°C). **Questions:** 1. **What classic triad of symptoms does Jacob present with, suggesting intussusception?**

Answer 85

Answer:** Intermittent colicky pain (irritability with knees drawn up), vomiting, and "currant jelly-like" stools (blood and mucus).

Question 86

What physical examination finding might you look for to support your suspicion of intussusception?**

Answer 86

Answer:** A sausage-like mass in the right upper quadrant (RUQ) of the abdomen.

Question 87

What diagnostic procedure can be used to both confirm and treat intussusception in Jacob?**

Answer 87

Answer:** An air contrast enema can be both diagnostic and therapeutic for intussusception

Question 88

Considering Jacob’s fever and symptoms, how would you manage him if there are signs of bowel perforation or peritonitis?

Answer 88

*Answer:** Immediate surgical consultation is needed, along with antibiotic prophylaxis, rehydration, stabilization, and surgical intervention if needed.

Question 89

Emily, a 50-year-old woman, presents to the clinic with complaints of abdominal pain over the last few days, accompanied by nausea and vomiting. She mentions her last bowel movement was 4 days ago, and she has had no relief with home remedies. On examination, her abdomen is distended and tender, and hypoactive bowel sounds are noted. **Questions:** 1. **What are some potential causes of intestinal obstruction you should consider in Emily's case?**

Answer 89

*Answer:** Possible causes include adhesions from previous surgeries, hernias, tumors, volvulus, or strictures.

Question 90

What initial imaging study would you order to evaluate Emily’s condition?**

Answer 90

Answer:** An abdominal flat-plate radiograph (X-ray) to assess for signs of intestinal obstruction, such as air-fluid levels and dilated bowel loops.

Question 91

If the X-ray is inconclusive and clinical suspicion remains high, what additional imaging modality could provide further diagnostic information?**

Answer 91

Answer:** An abdominal CT scan would give a more detailed view and help identify the cause and location of the obstruction.

Question 92

How would you initially manage Emily’s intestinal obstruction before confirming the diagnosis with imaging?**

Answer 92

Answer:** Management would involve bowel rest (NPO), IV fluid resuscitation, nasogastric tube insertion for gastric decompression, and pain management.

Question 93

Michael, a 13-year-old boy, presents to the clinic with sudden onset of right lower quadrant (RLQ) abdominal pain, nausea, and vomiting. His parents report that he has had a low-grade fever and has not been eating well. Upon examination, tenderness and guarding in the RLQ is noted. **Questions:** 1. **What are the potential differential diagnoses to consider for Michael's RLQ pain?**

Answer 93

Answer:** Differential diagnoses include appendicitis, intussusception, testicular torsion, or Meckel's diverticulum.

Question 94

Which physical exam maneuver might you perform to assess for appendicitis?**

Answer 94

Answer:** Perform the McBurney's point tenderness check, Rovsing's sign, and/or assess for rebound tenderness.

Question 95

What imaging study is commonly used to evaluate suspected appendicitis in children like Michael?*

Answer 95

Answer:** An abdominal ultrasound is often used as the initial imaging modality due to its non-invasive nature and lack of radiation; however, a CT scan can be used if necessary for further clarification.

Question 96

If appendicitis is confirmed, what is the next step in management for Michael?**

Answer 96

*Answer:** Surgical consultation for an appendectomy is necessary, along with preoperative IV fluids and antibiotics.

Question 97

*Case Description Reminder:** Michael, a 13-year-old, has sudden onset RLQ abdominal pain, nausea, and low-grade fever. **Questions:** 1. Which condition is least likely given Michael’s presentation of RLQ pain? - A) Appendicitis - B) Testicular torsion - C) Gastric ulcer - D) Intussusception

Answer 97

**Answer:** C) Gastric ulcer

Question 98

Which examination finding would most support appendicitis as a diagnosis? - A) Murphy’s sign - B) Positive Romberg test - C) Rebound tenderness at McBurney's point - D) Positive Phalen’s test

Answer 98

Answer:** C) Rebound tenderness at McBurney's point

Question 99

If ultrasonography is inconclusive in diagnosing appendicitis, what is the next preferred imaging method? - A) MRI of the abdomen - B) Chest X-ray - C) CT scan of the abdomen - D) Endoscopic ultrasound

Answer 99

Answer:** C) CT scan of the abdomen

Question 100

What immediate management step should follow confirmation of appendicitis? - A) Start high doses of corticosteroids - B) Schedule an appendectomy - C) Begin a broad-spectrum antiviral medication - D) Implement a high-fiber diet

Answer 100

Answer:** B) Schedule an appendectomy

Question 101

Which symptom is not typically associated with intussusception in children? - A) Persistent cough - B) Intermittent colicky pain - C) Vomiting - D) Currant jelly-like stools

Answer 101

Answer:** A) Persistent cough

Question 102

Which of the following signs on physical examination would further support the diagnosis of intussusception? - A) Hyperactive bowel sounds - B) Sausage-shaped mass in the right upper quadrant - C) Hepatosplenomegaly - D) McBurney’s point tenderness

Answer 102

Answer:** B) Sausage-shaped mass in the right upper quadrant

Question 103

f Jacob shows signs of bowel perforation, what immediate intervention is indicated? - A) Administer oral rehydration solution - B) Prepare for surgical consultation - C) Schedule an elective colonoscopy - D) Administer a barium enema

Answer 103

**Answer:** B) Prepare for surgical consultation

Question 104

What are the Rome III criteria used to diagnose Irritable Bowel Syndrome (IBS) in children? - A) Persistent abdominal pain for at least 3 months - B) Abdominal discomfort associated with two or more of the following at least 25% of the time: improvement with defecation, onset with a change in frequency of stool, onset with a change in form of stool - C) Abdominal bloating and diarrhea occurring daily - D) Weight loss and nocturnal diarrhea

Answer 104

Answer:** B) Abdominal discomfort associated with two or more of the following at least 25% of the time: improvement with defecation, onset with a change in frequency of stool, onset with a change in form of stool

Question 105

Which of the following is NOT typically considered an alarm signal in the physical examination of IBS? - A) Unexplained weight loss - B) Persistent fever - C) Abdominal tenderness and bloating - D) Rectal bleeding

Answer 105

*Answer:** C) Abdominal tenderness and bloating

Question 106

When considering the differential diagnosis of functional abdominal pain (FAP) in IBS, which factor is primarily used to rule out other serious conditions? - A) The presence of chronic worsening pain - B) The absence of evidence for inflammatory, anatomic, metabolic, or neoplastic processes - C) The frequency of bowel movements - D) Family history of allergies

Answer 106

Answer:** B) The absence of evidence for inflammatory, anatomic, metabolic, or neoplastic processes

Question 107

Which of the following management goals is NOT typically pursued for IBS in children? - A) Complete eradication of symptoms - B) Improving quality of life - C) Implementing dietary changes - D) Biopsychosocial therapy

Answer 107

**Answer:** A) Complete eradication of symptoms

Question 108

Among the following options, which treatment is NOT commonly recommended in the standard management of IBS in children? - A) Dietary changes - B) High-dose corticosteroids - C) Probiotics - D) Biopsychosocial therapy

Answer 108

**Answer:** B) High-dose corticosteroids

Question 109

Which of the following is the least likely method used in treating IBS symptoms in children? - A) Antidepressant medications - B) Inclusion of a psychotherapist as part of the care team - C) Use of probiotics - D) Educating the family about the condition

Answer 109

Answer:** A) Antidepressant medications