Pediatrics - Gastroenterology(74) Flashcards
PED - 7.1
Zinc deficiency can occur in all undermentioned disorders, except:
A) Acrodermatitis enteropathica
B) Hirschsprung disease
C) Coeliac disease
D) Phenylketonuria
E) Kwashiorkor
ANSWER
B) Hirschsprung disease
EXPLANATION
Hirschsprung disease is caused by the total or partial shortage, or sometimes hypoplasia of the vegetative ganglion cells of large bowel which lead to strictures in the involved part, explaning the clinical symptoms, surgical intervention is the necessary solution. Acrodermatitis enteropathica is a specific malabsorption of zinc, in coeliac disease the subtotal atrophy caused by gluten leading to malabsorption including also the trace elements. Phenylketonuria is a defect of pehylalanin-hydroxalase enzyme which make necessary low phenylalanin containing diet. Diet which is not properly balanced may cause zinc deficiency. Kawashiorkor is a severe protein-energy malnutrition with oedema and may lead to deficiency of trace elements.
PED - 7.2
It is true for children with encopresis all undermentioned statements, except:
A) Its prevalence in average children’s population is 1-3%
B) Among children with psychiatric disturbances the prevalence is 5-7%
C) Its pathological base is the gluten sensitivity
D) Occurance is more frequent during day than night
E) Rectal stool impactation and constipation occur very frequently
ANSWER
C) Its pathological base is the gluten sensitivity
EXPLANATION
Gliadin sensitivity provoke the pathological lesions in coeliac disease and dermatitis herpetiformis Duhring. Encopresis is pathological over 4 years of age, its form with retention is caused by impactation of stool in the rectum. In the non-retention form the proper habit of defecation is late or it is happened not in the right time and place. This latter is caused frequently by psychiatric disorders.
Encopresis or fecal incontinence
PED - 7.3
All the undermentioned ones may be the causes of constipation, except:
A) Psychological problem
B) Inaccurate diet
C) Megacolon congenitum
D) Overfunction of nervus vagus
E) Hypothyreosis
F) Insufficiency of abdominal muscle
G) Gastrointestinal allergy
ANSWER
D) Overfunction of nervus vagus
EXPLANATION
Constipation is symtoms developing from the distrubance of storage, transport or emptiing ability of the large bowel. As a consequence the number of stools less than three times weekly. Its water content decreased (less than 60%) which explain the hardness of the stool. Constipation is caused organic, but most frequently from functional causes. Low fiber containing diet, neurogenic cause, as Hirschsprung disease, psychogenic problems, the decrease of stimulus for defecation, muscle insufficiency, metabolic and endocrine disorders (such as hypercalcemia, or hypothyreodism) may elicit constipation. Constipation may occur in infants with cow’s milk allergy probably caused by rectal pain. Overfunction of nervus vagus increase the parasympathic effect on the colon increasing its motility, therefore it cause diarrhea.
PED - 7.4
All of the undermentioned ones may be the causes of constipation, except:
A) Idiopathic megacolon
B) Overdosage of vitamin D
C) Insufficient fluid intake
D) Salmonellosis
E) Muscular insufficienty
F) Rectal stenosis
ANSWER
D) Salmonellosis
EXPLANATION
Salmonellosis causes diarrhea or persist without symptoms, however it never induce constipation. All other situations mentioned in this test cause constipations.
PED - 7.5
All statements are characteristic for ascariasis, except:
A) This worm goes through maturation in both man and soil
B) It causes always eosinophilia
C) Eggs can be rarely seen in stool
D) Rectal migration is not characteristic
E) The worms migrate to the lung
ANSWER
B) It causes always eosinophilia
EXPLANATION
Eosinophilia is not always observable at ascaris, only during larva migration. All other statements are true.
PED - 7.6
An exclusively breastfed infant develops properly, her or his mother has ample breast milk. When would you suggest to introduce the vegetable purée to the infant’s diet?
A) 6 weeks
B) about 6 months
C) 9 months
D) 11 months
ANSWER
B) about 6 months
EXPLANATION
6 weeks is very early even in non-breast fed infants and 9 months is too late for the introduction of vegetable puree. Infant need exclusive breast feeding during the first six months, but after this age only breast milk not ensures the proper development, therefore the introduction of complementary feeding should be started.
PED - 7.7
The absorption of vitamin B12 and bile salts are specifically located to:
A) Duodenum
B) Jejunum
C) Ileum
D) None of them
ANSWER
C) Ileum
EXPLANATION
Vitamin B12 and bile salts absorbed with active transport in the terminal ileum. the former one in a complex with intrinsic factor produced by the parietal cells of stomach.
PED - 7.8
Steatorrhea occurs in all undermentioned disease, except:
A) lactose intolerance
B) intestinal lymphangiectasia
C) coeliac disease
D) cystic fibrosis
E) bacterial overgrowth of the small bowel
ANSWER
A) lactose intolerance
EXPLANATION
Lactose intolerance does not cause steatorrhea, but osmotic, watery diarrhea
PED - 7.9
Hematochezia occurs in all undermentioned conditions, except:
A) allergic colitis
B) oesophagitis
C) Meckel-diverticulum
D) Ulcerative colitis
ANSWER
B) oesophagitis
EXPLANATION
Bleeding from the lower gastrointestinal tract, the stool contain visible red blood. This can occur at very large bleeding even from the upper gastrointestinal tract (e.g. rupture of oesopageal varices), but at oesopagitis the bleeding is mild.
PED - 7.10
The undermentioned statements are true in atrophy, except:
A) malnutrition without oedema
B) weight loss is 20-30%
C) caused by protein deficient diet
D) energy and protein intake are inadequate
ANSWER
C) caused by protein deficient diet
EXPLANATION
In atrophy both the energy and protein intake are low, but the protein/energy ratio is normal.
PED - 7.11
The undermentioned statements are true in decomposition, except:
A) it is called also athrepsy
B) weight loss is larger than 30%
C) the ratio of energy/protein intake is normal
D) mild form of protein-energy malnutrition
ANSWER
D) mild form of protein-energy malnutrition
EXPLANATION
Decomposition is the most severe form of protein-energy malnutrition.
PED - 7.12
The undermentioned statements are true for kwashiorkor, except:
A) may be caused by chronic diarrhea
B) malnutrition with oedema
C) sufficient energy intake with shortage of protein
D) caused by enzyme defect
E) the name of kwashiorkor denotes the reddish color of skin
ANSWER
D) caused by enzyme defect
EXPLANATION
Kwashiorkor develops because of low protein intake or increased catabolism caused by infection
PED - 7.13
All statements indicate protein-energy malnutrition with severe prognosis, except:
A) the weight loss is more than 30 percent
B) weight loss during treatment
C) bloodstream infection
D) age under 6 months
E) serum total protein concentration less than 30 g/l
ANSWER
B) weight loss during treatment
EXPLANATION
In hypoproteinemia oedema is the characteristic symptom, but when the oedema decrease, decrease of body weight is observable.
PED - 7.14
The undermentioned statements are true, except:
A) All forms of vegetarian diet are dangerous in childhood
B) It should talk the parents out of vegan diet by any means
C) After accepting the adequate advices the lacto ovo vegetarian diet is not dangerous for the children
D) The main danger of vegetarian diet is the B12-vitamin deficiency
ANSWER
A) All forms of vegetarian diet are dangerous in childhood
EXPLANATION
The lacto-ovo-vegetarian diet is not dangerous because cover all needs of macro- and micronutrients.
PED - 7.15
All the following statements are true, except:
A) Lifelong strict gluten-free diet is mandatory for the treatment of coeliac disease
B) Coeliac patients are fully healthy on gluten-free diet
C) Once in a while consumption of gluten-containg food does not cause problem
D) Intake of 100 mg gluten causes damage of the small intestinal mucosa
ANSWER
C) Once in a while consumption of gluten-containg food does not cause problem
EXPLANATION
Even occasional gluten consumtion impairs the small intestinal mucosa.
PED - 7.16
All undermentioned cereals contain gluten, except:
A) Wheat
B) Rye
C) Rice
D) Barley
ANSWER
C) Rice
EXPLANATION
Rice does not contain gluten and can be freely consumed by coeliac patients.
PED - 7.17
All undermentioned foodstuffs are gluten-free, except:
A) Potato
B) Rye
C) Corn
D) Rice
E) Locust seed
ANSWER
B) Rye
EXPLANATION
Rye is a gluten-containing cereals, all the other foodstuff is gluten-free.
PED - 7.18
Indicate the single statement which is true for rumination:
A) It is a cosequence of voluntary strain
B) It is a passive regurgitation of gastric content
C) It is a consequence of a retrograde duodeno-gastric contraction
D) It is a symptom a gastro-oesophaeal reflux
ANSWER
A) It is a cosequence of voluntary strain
EXPLANATION
Rumination is a voluntary action, while the other the other mentioned phenomenons are unintended.
PED - 7.19
All statements are true for infantile gastro-oesophageal reflux (GOR), except:
A) Starts in the first months of life
B) In 80% of cases it ceases at 12-24 months
C) GOR with different severity occur in 20% of infants
D) It can be continued to adult type GOR
E) It is always a physiological condition
ANSWER
E) It is always a physiological condition
EXPLANATION
Infantile gastro-oesophageal reflux can be regarded a physiological phenomen while it does not cause decrease in weight gain and does not influence the infant’s lifestyle.
PED - 7.20
All statements are true for th hypoallergenic formula used for therapeutic purposes, except one:
A) They are extensively hydrolysed
B) Does not contain cow’s milk or soya proteins
C) Contain short chain peptides
D) Molecular weight of the peptides are over 2000 Dalton
E) More than 90 percent of Infants with cow’s milk protein intolerance tolerate these formula
ANSWER
D) Molecular weight of the peptides are over 2000 Dalton
EXPLANATION
In extensive hydrolysed formula the molecular weight of peptides are under 1500 Dalton, which means that they contain 4-8 aminoacids.
PED - 7.21
All statements are true for melena, except one:
A) It originated from the upper gastrointestinal tract
B) It has a jet-black colour
C) Its other name is hematochezia
D) It is consequence of significant bleeding
ANSWER
C) Its other name is hematochezia
EXPLANATION
The colour of melena is jet-black, while that of hematochezia is red, visible blood.
PED - 7.22
Statements are characteristic for Crohn’s disease, except one:
A) It can occur anywhere in the gastrointestinal tract throughout from the oral cavity to the anus
B) Characterized with relapses
C) Blood stool is relatively rare
D) Segmental and transmural propagation is frequent
E) Occurs with the hyperplasia of lymphoid tissues and frequently involves the regional lymph nodes
F) Surgical solution brings definitive healing
ANSWER
F) Surgical solution brings definitive healing
EXPLANATION
Crohn’s disease may relapse even after surgical intervention, because recurrence can occur anywhere in the gastrointestinal tract.
PED - 7.23
All the undermentioned disease could cause liver cirrhosis, except:
A) galactosaemia
B) alfa1-antytripsin deficiency
C) hepatitis A virus infection
D) hepatitis B virus infection
E) lupus hepatitis
F) bile duct obstruction
ANSWER
C) hepatitis A virus infection
EXPLANATION
Hepatitis A virus infection has an acute course and there is not a long lasting carrier state of this virus and fibrotic process.
PED - 7.24
All statements are true for food related adverse reaction, except:
A) More frequent than food allergy
B) It has a quantity threshold value for the given food
C) For eliciting symptoms the all or nothing principle is the rule of thumb
D) It is no previous sensitization
E) The symptoms may be just the same as in food allergy
ANSWER
C) For eliciting symptoms the all or nothing principle is the rule of thumb
EXPLANATION
The rule of all or nothing is characteristic for allergic reaction, while the non-immune mediated food reaction always has a threshold value, which elicit the symptoms.
PED - 7.25
All factors are important for the pathogenesis of food allergy in infants and toddlers, except:
A) Genetic factors
B) Early foreign protein introduction to the infants diet
C) Protein rich diet of mother during pregnancy
D) Environmental factors (e.g. smoking)
E) Immaturity or disturbance of intestinal defense mechanisms
ANSWER
C) Protein rich diet of mother during pregnancy
EXPLANATION
The diet during pregnancy does not influence the development of allergy.
PED - 7.26
All the statements are true for anaphylactoid (Henoch-Schönlein) purpura, except:
A) The small purpura mostly located on the extensor side of the lower extremities and the gluteal area
B) Onset of purpura may be preceded by joint paint
C) Bloody stool and abdominal pain may also present
D) Relapse quite frequently occur
E) Platelet number decreased
ANSWER
E) Platelet number decreased
EXPLANATION
Anapylactoid purpura is a vasculitis, the number of thrombocytes is normal
PED - 7.27
Choose the answers which are true in adult type lactose intolerance.
1) Very small amout of lactose may cause severe symptoms.
2) The patients are able tolerate so much lactose which is in 2 deciliter milk.
3) Processed cheese could be consumed in any quantity.
4) It is important not to consume in one portion and in itself the lactose containing foods.
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
C) Answers 2 and 4 are correct
EXPLANATION
Patients with adult type lactose intolerance can tolerate variable quantity of lactose, but usually the lactose content of 2-2,5 deciliter milk. It is important to know that the milk products also contain lactose.
PED - 7.28
Choose the answers which are true at decreased activity of lactase enzyme.
1) Symptoms related to the quantity of consumed lactose.
2) In children frequently occurs periumbilical abdominal pain after lactose consumtion.
3) Abdominal pain may be very severe.
4) Diarrhea does not always develop after lactose consumtion.
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
E) All of the answers are correct
EXPLANATION
All statements are true. At children, it is important to consider the possibility of lactose intolerance at periumbilical abdominal pain, which could be quite severe. Abdominal distension and feeling of fullness are also frequently occuring symptoms.
PED - 7.29
When the diagnosis of coeliac disease can be established without the histologic analysis of dudenal mucosa biopsy taken by endoscopy?
1) The serum anti-transglutaminase (TTG) IgA titer is 10 times higher than the upper normal value.
2) Antiendomysium antibody titer is also positive.
3) The patient has no IgA deficiency.
4) The serum anti-TTG IgA titer is 5 times higher than the upper normal value.
A) Answers 1, 2 and 3 are correct
B) Answers 1 and 3 are correct
C) Answers 2 and 4 are correct
D) Only answer 4 is correct
E) All of the answers are correct
ANSWER
A) Answers 1, 2 and 3 are correct
EXPLANATION
If the anti transglutaminase (TTG) IgA antibody titer is higher than ten times the upper level of normal value and the endomysial antibody test is also positive, the diagnosis of coeliac disease can be established. However, in IgA deficiency for the diagnosis it is necessary the histological examination of the duodenal biopsy sample taken by upper endoscopy, because the titer of anti-TTG IgG titer does not prove with safety the presence of coeliac disease.
