GIT / Nutrition

Question 1

Xerophthalmia, corneal opacity, bitot spots, night blindness, growth failure, and recurrent infection

Answer 1

Vitamin A deficiency

Question 2

Gingival bleeding, anemia, corkscrew-coiled hairs, anorexia, and irritability

Answer 2

Vitamin C deficiency

Question 3

Breastfed children should be supplemented with which vitamin from birth?

Answer 3

Vitamin D

Question 4

Child with a history of cystic fibrosis presents with ataxic gait, diminished deep tendon reflexes in the lower extremities, as well as generalized weakness in the lower extremities

Answer 4

Vitamin E deficiency

Question 5

Vitamin that affects prothrombin, factor VII, factor IX, factor X

Answer 5

Vitamin K

Question 6

Child is receiving a prophylactic antibiotic for the last few months. Prothrombin time (PT) and partial thromboplastin time (PTT) are mildly prolonged

Answer 6

Vitamin K deficiency

Question 7

Foot and wrist drop, ataxia, ophthalmoplegia, confusion, abnormal sensation, heart failure, dyspnea, and edema

Answer 7

Vitamin B1 deficiency (thiamine)

Question 8

Redness and fissuring of lips (cheilitis), soreness of tongue, anemia, fatigue

Answer 8

Vitamin B2 deficiency (riboflavin)

Question 9

Diarrhea, dementia, dermatitis, and death in severe cases

Answer 9

Vitamin B3 deficiency (niacin) pellagra disease

Question 10

Which vitamin is needed to supplement a child on a strict vegan diet?

Answer 10

Vitamin B12 (other supplements to consider: iron, zinc, and calcium)

Question 11

The site of vitamin B12 absorption

Answer 11

Ileum

Question 12

Infant drinks goat’s milk, looks pale, CBC shows macrocytic anemia

Answer 12

Folic acid deficiency

Question 13

Acute illness with diarrhea, fever, and vomiting for 2days, followed by persistent diarrhea for 3weeks, 6–9 episodes of liquid stools without visible blood or mucus, associated with generalized abdominal pain, distended and flatulent since the acute illness. A positive reducing substance in the stool. What is the best management?

Answer 13

Lactose-free diet and lactase supplement (lactose intolerance)

Question 14

Taste and smell impairment, night blindness, and depressed immunity

Answer 14

Zinc deficiency

Question 15

Deficiency associated with recurrent diarrhea, alopecia, and rash (acrodermatitis enteropathica)

Answer 15

Zinc deficiency

Question 16

Child previously healthy is living with stepfather, generalized loss of muscle mass, and no subcutaneous fat

Answer 16

Marasmus and possible calorie deprivation

Question 17

Child lives in a shelter, poor nutrition, failure to thrive, weakness, edema, moon facies, a swollen abdomen (potbelly), dark, dry skin, with pale areas between the cracks, depigmentation of hair, and fatty liver

Answer 17

Kwashiorkor (protein-energy malnutrition)

Question 18

An exclusively breastfed infant has not stooled for 5days with no other symptoms. The stool is soft with no rectal bleeding. The infant is gaining weight

Answer 18

Reassurance (breastfed infants may go several days or even a week between bowel movements)

Question 19

A 1-week-old child with frequent spit-ups, otherwise doing well

Answer 19

Reassurance (newborn reflux is normal)

Question 20

What are the upper GI series useful for?

Answer 20

To rule out anatomic or motility problems. Does not diagnose reflux

Question 21

A 3-week-old first newborn boy presents with nonbilious projectile vomiting, hypochloremic, hypokalemic metabolic alkalosis, and dehydration

Answer 21

Pyloric stenosis

Question 22

What is the next best step in cases with suspected pyloric stenosis?

Answer 22

Abdominal US (pylorus)

Question 23

Weight loss, abdominal pain, nausea, effortless postprandial regurgitation after at least 1 meal daily for 1month, regurgitated food occasionally reswallowed, rechewed, or spit out

Answer 23

Rumination syndrome

Question 24

Child with no known health problem woke up suddenly vomiting blood. The child is stable and acting normal. What is the most likely cause?

Answer 24

Epistaxis (nose bleeding is the most common source in healthy children)

Question 25

Nausea and vomiting every 1–2 months, each episode lasts for few hours, otherwise healthy, no symptoms in-between episodes, positive family history of migraine

Answer 25

Cyclic vomiting syndrome

Question 26

A 7-year-old healthy child, with periumbilical abdominal pain worse in the morning prior to school, improves during weekends with normal growth parameters

Answer 26

Reassurance (functional abdominal pain)

Question 27

High achieving adolescent complains of crampy abdominal pain, diarrhea, and at other times, constipation; pain is relieved with stooling

Answer 27

Irritable bowel syndrome

Question 28

Adolescent presents with recurrent episodes of abdominal pain, diarrhea, and sometimes constipation in the previous 3 months. No weight loss and all labs are normal. What is the best treatment?

Answer 28

Peppermint oil, diet modifications, cognitive behavioral therapy

Question 29

A mother brought her toddler with a diaper full of undigested food, the child is holding a large bottle of apple juice

Answer 29

Toddler diarrhea

Question 30

The best management of toddler’s diarrhea

Answer 30

Juice restriction and allow normal dietary fat

Question 31

Child with a low-grade fever, 6 episodes of diarrhea, otherwise reassuring medical exam. What is the treatment of choice?

Answer 31

Oral rehydration therapy (avoid anti-diarrheal agents)

Question 32

What is the major concern of using antimotility drugs such as Loperamide?

Answer 32

May induce ileus

Question 33

An infant presents with bright red blood stool, poor weight gain, diarrhea, and fussiness; the infant is breastfeeding, supplemented with standard infant formula; stool guaiac test is positive

Answer 33

Cow milk protein intolerance

Question 34

Child with dysphagia, recurrent food impaction; biopsy shows an increased eosinophil?

Answer 34

Eosinophilic esophagitis

Question 35

Adolescent with recurrent headaches takes ibuprofen as needed, presents with dysphagia and chest discomfort (does not like to drink water with medicine)

Answer 35

Pill-induced esophagitis

Question 36

Child accidentally swallowed caustic liquid 6 h ago, presents with dysphagia, oral pain, chest pain, nausea, and vomiting

Answer 36

Endoscopy in 12–24 h after ingestion

Question 37

Swallowed a coin, no symptoms, and radiograph showed the coin still in the esophagus

Answer 37

Observe for 12–24 h, removal of the coin if it does not pass to the stomach or if the patient became symptomatic

Question 38

Swallowed a coin, no symptoms, and radiograph showed the coin in the stomach

Answer 38

Checking the stool for passage for 4 weeks, with weekly radiographs, if indicated

Question 39

4 weeks passed and the coin still in the stomach with no symptoms

Answer 39

If the coin does not pass through the stomach by 4 weeks or if the patient is symptomatic, removal by endoscopy should be considered

Question 40

Swallowed a coin, excessive drooling, and chest pain, and radiograph showed the coin still in the esophagus

Answer 40

Immediate removal

Question 41

Swallowed a button battery (BB), and passed to the stomach with symptoms

Answer 41

Immediate removal

Question 42

Swallowed a BB, and passed to the stomach without symptoms

Answer 42

Urgent removal (if age

Question 43

Swallowed a BB that got stuck in the esophagus

Answer 43

Immediate removal

Question 44

Swallowed small pieces of magnet metals; the abdominal radiograph showed the pieces in the stomach

Answer 44

Immediate removal

Question 45

An older child with bloating, constant burping, sharp epigastric pain that awakens the child from sleep

Answer 45

Helicobacter pylori infection

Question 46

The most common cause of chronic gastritis in pediatrics

Answer 46

H. pylori

Question 47

The best and most definitive test for peptic ulcer disease

Answer 47

Endoscopy

Question 48

What is the treatment of H. pylori infection?

Answer 48

Amoxicillin or metronidazole + clarithromycin + PPI for 2 weeks

Question 49

Infant suddenly develops bilious vomiting, abdominal distension, tenderness, and fussiness. What is the diagnostic test of choice?

Answer 49

Upper GI series with follow through

Question 50

In the infant above, the GI series shows a bird’s beak sign of the second portion of the duodenum

Answer 50

Volvulus

Question 51

Intermittent crampy abdominal pain, lethargy, bilious vomiting, and a palpable mass in the right upper quadrant

Answer 51

Intussusception

Question 52

What is the best initial diagnostic test of choice in cases of intussusception?

Answer 52

Abdominal US (target sign, reflecting a segment of bowel trapped within a distal segment of bowel)

Question 53

What is the therapeutic procedure of choice in cases of intussusception?

Answer 53

Air contrast enema (diagnostic and therapeutic)

Question 54

Down syndrome, bilious vomiting, double bubble sign on KUB

Answer 54

Duodenal atresia

Question 55

A mother brought her 9-month-old girl with a diaper full of red, maroon stool; the physical exam is normal, and the infant is feeding well and smiling (she is receiving an antibiotic for AOM)

Answer 55

Most likely the medicine, e.g., cefdinir may change the stool color to maroon color (bloodlike color)

Question 56

A 2-year-old boy, frank rectal bleeding, anemia, no pain, no other symptoms

Answer 56

Meckel diverticulum

Question 57

What are the 2 most common ectopic tissues found in Meckel diverticulum?

Answer 57

Gastric and pancreatic

Question 58

How is Meckel diverticulum diagnosed?

Answer 58

Technetium 99 scan

Question 59

Infant, failure to thrive, rectal prolapse

Answer 59

Cystic fibrosis

Question 60

Most common cause of rectal prolapse in the USA

Answer 60

Constipation

Question 61

Rectal bleeding, large and hard stool in the diaper

Answer 61

Anal fissure

Question 62

The most common cause of rectal bleeding in infants

Answer 62

Anal fissures

Question 63

A 2-year-old boy with chronic constipation, ineffective laxatives, fails to pass meconium in the first 48 h of life, explosive stools on rectal exam, KUB showed very distended colon

Answer 63

Hirschsprung disease

Question 64

A 48-h old boy did not pass the meconium; the abdomen is slightly distended

Answer 64

Hirschsprung disease

Question 65

Most accurate diagnostic test for Hirschsprung disease

Answer 65

Full-thickness rectal biopsy performed by surgery

Question 66

Persistent epigastric abdominal pain, vomiting; the pain is referred to the back, tenderness in the epigastric region, elevated amylase, and lipase enzymes

Answer 66

Acute pancreatitis

Question 67

Child with Down syndrome, intermittent abdominal pain, and failure to thrive

Answer 67

Celiac disease

Question 68

Child with type 1 diabetes mellitus and recurrent abdominal pain

Answer 68

Celiac disease

Question 69

Child with a history of recurrent abdominal pain presents with fever, abdominal pain, bloody diarrhea, migratory arthritis, erythema nodosum, ankylosing spondylitis, elevated ESR, positive P-ANCA

Answer 69

Ulcerative colitis

Question 70

Recurrent aphthous ulcers, abdominal pain, weight loss, perianal lesions, positive antiSaccharomyces antibodies

Answer 70

Crohn’s disease

Question 71

Jaundice, abdominal pain, and fever

Answer 71

Cholangitis

Question 72

Jaundice, abdominal pain, and a palpable mass in the right upper quadrant

Answer 72

Choledochal cyst

Question 73

Hydrops of the gallbladder can be seen in

Answer 73

Kawasaki disease

Question 74

Conditions associated with an increased incidence of cholelithiasis

Answer 74

Sickle cell anemia, chronic total parenteral nutrition (TPN), adolescent pregnant females

Question 75

What is the most common complication of cholelithiasis?

Answer 75

Pancreatitis

Question 76

A 3-year-old boy presents with failure to thrive, difficulty walking; the metabolic panel shows elevated aspartate transaminase (AST) and alanine transaminase (ALT). Total bilirubin, prothrombin time, blood glucose, TSH and free T4 are all normal, negative hepatitis viral panel. What is the test of choice in this case?

Answer 76

Creatinine phosphokinase (CK) (muscular dystrophy most likely)

Question 77

What are the sources of transaminases (ALT and AST)? It is important to consider other sources of transaminases if they are elevated and the liver function is normal

Answer 77

Liver, heart, muscles, kidney, and brain

Question 78

The best laboratory test for acute hepatitis A

Answer 78

Anti-HAV IgM

Question 79

A mom is asking about prophylaxis for her 4-month-old child after she was recently diagnosed with hepatitis A?

Answer 79

Administer IG as prophylaxis (

Question 80

Prophylaxis of a 3-year-old child exposed to a documented case of hepatitis A in a child care center

Answer 80

Hepatitis A vaccine (> 1 year)

Question 81

All hepatitis viruses are composed of RNA exceptH

Answer 81

Hepatitis B virus is composed of DNA

Question 82

Which virus infection must have hepatitis B?

Answer 82

Hepatitis D

Question 83

Child with a family history of lupus disease presents with jaundice, hepatomegaly, weight loss, loss of appetite, positive anti-smooth muscle antibodies

Answer 83

Autoimmune hepatitis

Question 84

One week with jaundice, hepatomegaly, slightly elevated ALT and AST, prolonged PT that is not responding to IV vitamin K, and recurrent hypoglycemia

Answer 84

Acute hepatic failure

Question 85

An 8-year-old boy has recurrent jaundice, slightly elevated indirect bilirubin; physical examination and all other labs are normal

Answer 85

Gilbert syndrome

Question 86

A 1-day-old boy with intense jaundice, unconjugated bilirubin is 25 mg/dL, and no conjugated bilirubin; and poor response to phototherapy

Answer 86

Crigler–Najjar syndrome type I (exchange transfusion is warranted)

Question 87

Mild conjugated hyperbilirubinemia with black liver

Answer 87

Dubin–Johnson syndrome

Question 88

An infant with jaundice, dark urine, light-colored stool, hepatomegaly, and elevated conjugated bilirubin

Answer 88

Biliary atresia

Question 89

What is the most valuable study for neonatal biliary atresia?

Answer 89

Percutaneous liver biopsy

Question 90

If liver biopsy confirmed biliary atresia, what is the next appropriate test?

Answer 90

Intraoperative cholangiography

Question 91

Adolescent presents with depression, psychosis, and elevated liver enzymes

Answer 91

Wilson disease

Question 92

Which mineral is affected in Wilson disease?

Answer 92

Copper (excess)

Question 93

How to establish the diagnosis of Wilson disease

Answer 93

Ceruloplasmin  250 ug/g dry weight. Urine copper > 100 ug/24 h. Presence of Kayser–Fleischer rings

Question 94

Broadened forehead, jaundice, pulmonary stenosis, and butterfly hemivertebrae

Answer 94

Alagille syndrome

Question 95

Abdominal mass, elevated liver enzyme, and high serum alpha-fetoprotein

Answer 95

Hepatoblastoma

Question 96

A 3-month-old, failure to thrive, extreme pruritus, steatorrhea, very high- conjugated bilirubin, hepatosplenomegaly, mutilated skin, elevated serum alkaline phosphatase, and normal gammaglutamyl transferase (GGT)

Answer 96

Progressive familial intrahepatic cholestasis (PFIC) type 1

Question 97

Prognosis of all forms of PFIC

Answer 97

Lethal during childhood unless treated early

Question 98

Hematochezia, intestinal polyp, pigmented penile lesion, large head, café-au-lait spots, intellectual disability

Answer 98

Bannayan–Riley–Ruvalcaba syndrome

Question 99

> 5 juvenile polyps

Answer 99

Juvenile polyposis

Question 100

What is the next step in children with ≥ 5 juvenile polyps or any number of adenomatous intestinal polyps?

Answer 100

Genetic testing

Question 101

100 or more adenomatous polyps in the large and/ or small intestines

Answer 101

Familial adenomatous polyposis

Question 102

Intestinal polyps, osteoma of the mandible, papillary carcinoma of thyroid, and hepatoblastoma

Answer 102

Gardner syndrome

Question 103

Intestinal polyps and brain tumor

Answer 103

Turcot syndrome

Question 104

Intestinal polyps, hematochezia, mucocutaneous freckling, and a family history of polyposis

Answer 104

Peutz–Jeghers syndrome (increases the risk of cancer)

Question 105

Hamartomas involving many areas of the body, e.g., skin, oral mucosa, thyroid, breast, and colon

Answer 105

Cowden syndrome

Question 106

Associated risks of Cowden syndrome

Answer 106

Cancer, e.g., thyroid cancer

Question 107

Hemihypertrophy, very large extremities, epidermal nevus, hamartomatous polyps, intellectual disability

Answer 107

Proteus syndrome

Question 108

Potential risks of Proteus syndrome

Answer 108

Deep vein thrombosis (DVT) and thromboembolism

Question 109

The best diagnostic test for lactose intoleranceH

Answer 109

Hydrogen breath test