Vomiting and children

Question 1

How do you define apnea in an infant?

Answer 1

greater than 20 seconds

Question 2

What are the 5 warning signs of vomiting that require medical investigation?

Answer 2

1. HSM
2. Diarrhea
3. Constipation
4. Emesis after 6 mo
5. Difficulty eating

Question 3

What is GER?

Answer 3

Passage of gastric contents into the esophagus

Question 4

What is regurgitation?

Answer 4

Spitting up is an effortless passage of gastric contents into the pharynx and mouth

Question 5

What is rumination?

Answer 5

Voluntary, habitual, and effortless regurgitation of recently ingested food

Question 6

How common is GER in infants?

Answer 6

very–about 50% in infants

Question 7

By what age do most infants stop spitting up?

Answer 7

12 mo

Question 8

Pea soup emesis = ?

Answer 8

Bilious emesis–worrisome for pyloric stenosis

Question 9

What are the ssx of pyloric stenosis?

Answer 9

Projective vomiting

Question 10

Emesis beginning after what age is concerning?

Answer 10

6 mo

Question 11

Bulging fontanelle is concerning or not?

Answer 11

Is

Question 12

What happens developmentally around 12 months that is relevant to children GI symptoms?

Answer 12

More vertical time

Question 13

Where is the emetic center?

Answer 13

reticular formation the medulla

Question 14

Where is the chemoreceptor trigger zone?

Answer 14

Floor of the 4th ventricle

Question 15

What are the ssx of gastroenteritis?

Answer 15

Fever
Abdo pain
diarrhea
n/v
h/o ill contacts

Question 16

What are the viral causes of gastroenteritis?

Answer 16

Rotavirus
Adenovirus
Norwalk
AStrovirus
Caliciviridae

Question 17

What is the treatment for viral gastroenteritis?

Answer 17

Hydration

Fever control

Question 18

What is the 5HT receptor antagonist that is used for nausea?

Answer 18

Ondansetron

Question 19

What are the ssx of meningitis?

Answer 19

Fever
Irritability
Lethargy
HA
emesis
Petechia

Question 20

What is the viral cause of meningitis? When is this most common?

Answer 20

Enterovirus

Summer

Question 21

What is the usual cause of meningitis

Answer 21

GBS

Question 22

What is the usual cause of meningitis 1-23 mo?

Answer 22

S. Pneumo

Question 23

What is the usual cause of meningitis 2-18 yrs?

Answer 23

N. Mening

Question 24

What is the usual cause of meningitis 19-59 yrs

Answer 24

S. pneumonia

Question 25

What is the usual cause of meningitis >60 yo?

Answer 25

S. Pneumonia

Question 26

Why does meningitis cause vomiting?

Answer 26

meningeal inflammation and ICP

Question 27

What is gastroesophageal reflux cause disease?

Answer 27

Passage of gastric contents into the esophagus

Question 28

What are the ssx of GERD in infants?

Answer 28

Persistent cough Stridor Wheezing Apnea`

Question 29

What is the cause of stridor in emesis in children?

Answer 29

Protection of vocal cords

Question 30

What is sandifer syndrome?

Answer 30

Reflux in the esophagus causing szs like symptoms d/t pain (not actual szs)

Question 31

What should always be looked at when investigating GERD?

Answer 31

Growth charts

Question 32

When should work up be initiated for GERD?

Answer 32

If significant complications or ALTE

Question 33

What is the initial diagnostic study with GERD?

Answer 33

Ba swallow (upper GI series)

Question 34

What is the purpose of doing a Ba swallow?

Answer 34

Anatomic abnormalities

Question 35

Bird's beak = ?

Answer 35

Achalasia

Question 36

What is an esophageal pH probe?

Answer 36

Measures the frequency of acidic esophageal reflux episode over a period of time

Question 37

What is the test for muscle/nerves problems in the GI tract?

Answer 37

Manometry

Question 38

What is a scintigraphy?

Answer 38

Nuclear med scan and watch it digest

Question 39

What is combined multiple intraluminal impedance and pH monitoring?

Answer 39

Measure fluids, air an solids in the esophagus along with pH changes

Question 40

What is the treatment for GERD in infants?

Answer 40

- Increased caloric density - Thicken feedings with rice cereal - Use formula with rice starch

Question 41

What is the MOA of similac?

Answer 41

Thickening when hitting stomach acid

Question 42

What is the treatment for GERD in adolescence?

Answer 42

Avoid fatty/spicy/caffeine | Maintain healthy weight

Question 43

What are the meds that are useful for GERD?

Answer 43

Antacids

Question 44

Is a PPI indicated for GERD in children?

Answer 44

If neurologically intact, yes for 4 weeks

Question 45

What is the suffix that denotes a PPI?

Answer 45

-prazole

Question 46

How are PPIs administered?

Answer 46

Qd PO before meals

Question 47

What is the MOA of cimetidine, famotidine, ranitidine, and nizatidine?

Answer 47

H2 receptor blockers

Question 48

What is the MOA of metoclopramide?

Answer 48

opioid agonist

Question 49

What is a nissen fundoplication?

Answer 49

Cardia of the stomach is wrapped around the esophagus, to increase the tone of the esophageal sphincter

Question 50

What are the complications of untreated GERD in kiddos?

Answer 50

Asthma (?) Dental caries Aspiration pneumonia