9/7/2019 Pediatric Gastroenterology Flashcards | Memorang

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Pediatric Gastroenterology

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Multiple Choice Flashcards

A 1-year-old Caucasian girl presents to the

outpatient clinic with one week of crying during Next best step in management Treatment with stool softener
bowel movements. She has a history of constipation
and hard stools that occasionally are coated in Most likely diagnosis (pediatric gastroenterology) Anal ssure
bright red blood.
A 2-month-old Caucasian girl presents to the Next best step in management Feeds thickened with oatmeal, or antacid
outpatient clinic with one week of fussiness and
therapy
regurgitation of formula after each feed. She
remains irritable even after burping. Her weight has
Most likely diagnosis (pediatric gastroenterology) Pathologic
started falling o the 25th percentile growth curve,
which she’s been on since birth. gastroesophageal re ux
A 5-week-old Caucasian girl presents to the Next best step in management Provide counseling on techniques to
outpatient o ce with 3 weeks of inconsolable
crying. She cries for at least 3 hours every night and soothe the child This fact is tagged as "Most
common pathophysiology." Tags
nothing seems to stop her crying. Otherwise, she is
help organize
Most likely diagnosis yourgastroenterology)
(pediatric content. Colic
healthy with little crying during the day.
Most common pathophysiology Short esophagus, incomplete closure of
lower esophageal sphincter, and long amounts of time in the supine position
A 2-month-old Caucasian girl presents to the
→ postprandial regurgitation
outpatient clinic with fussiness and regurgitation of
formula after each feed. After she is burped, she Next best step in management Reassurance and education on strategies
calms down. She has no gagging or breathing
di culties. She has normal weight, height, and to ↓ episode frequency
head circumference.
Most likely diagnosis (pediatric gastroenterology) Physiologic
gastroesophageal re ux

Next best step in management Oral laxative therapy, such as polyethylene

glycol
A 3-year-old Caucasian boy presents to the
outpatient clinic with di culty toilet training, Most common disease complication Enuresis or encopresis
especially at school. He has hard, small bowel
movements every other day and strains with Most common disease complication Anal ssure
defecation. He drinks up to 32 ounces of milk a day.
Normal height, weight, development, and Most common disease complication Vomiting
abdominal exam.
Most common disease complication Urinary tract infection

Most likely diagnosis (pediatric gastroenterology) Constipation

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A 3-year-old Caucasian girl presents to the
outpatient clinic with crying during urination and
urinary frequency. She has a history of 3 previous
bladder infections, as well as constipation treated
with a laxative. Culture shows 100,000 colonies of
Escherichia coli.
Pediatric Gastroenterology Flashcards | Memorang
Most common pathophysiology Fecal retention → bladder compression →
urinary stasis→ bacteria ascends the urethra
Most likely diagnosis (pediatric gastroenterology) Urinary tract infection
due to constipation
Most likely abnormal laboratory nding Positive leukocyte esterase,
positive nitrites, and elevated white blood cells on urinalysis

Most common disease complication Migraine headaches in adulthood

A 6-year-old Caucasian girl presents to the
outpatient clinic with 4 days of frequent non- Next best step in management Hydration, sumatriptan, and ondansetron
bloody, non-bilious vomiting. She has had 3 similar
episodes in the past six months, which occur at the Most likely diagnosis (pediatric gastroenterology) Cyclic vomiting
beginning of the month, last a few days, and stop
syndrome
spontaneously. She is healthy between episodes.
Normal exam, labs, and imaging studies. Family Most likely abnormal laboratory nding Hypokalemic, hypochloremic
history of migraines.
metabolic alkalosis

Next best step in management Flexible endoscopy

Most likely diagnosis (pediatric gastroenterology) Emergent foreign body

ingestion
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A 6-year-old Caucasian boy presents to the
emergency department with 5 days of progressively
worsening dry cough, vomiting, food refusal, and
dysphagia. He has Down syndrome. Respiratory rate
is 22 per minute and pulse oximetry is 97% on room
air. Physical exam is normal. Chest x-ray is shown.

Next best step in management Observation

Most likely diagnosis (pediatric gastroenterology) Non-emergent foreign

body ingestion

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A 6-year-old Caucasian boy presents to the
emergency department after swallowing a coin one
hour ago. He does not have any symptoms, and his
vital signs and physical exam are normal. Chest- x-
ray is shown.
A 6-year-old Caucasian boy presents to the Next best step in management Flexible endoscopy
emergency department after swallowing a disk-
shaped battery one hour ago. He had non-bloody Most common disease complication Mucosal damage and ulceration
vomit once, which did not contain the battery. His
vital signs are normal. X-ray shows the battery in his Most likely diagnosis (pediatric gastroenterology) Emergent foreign body
esophagus. ingestion
A 6-year-old Caucasian boy presents to the
emergency department after swallowing a disk- Next best step in management Observation
shaped battery one hour ago. He had non-bloody
vomit once, which did not contain the battery. His Most likely diagnosis (pediatric gastroenterology) Non-emergent foreign
vital signs are normal. X-ray shows the battery in his body ingestion
stomach.
A 13-year-old Caucasian girl presents to the
emergency department with 3 days of fever,
vomiting, and abdominal pain, and 1 day of jaundice. Next best step in management Provide vaccination or immunoglobulin to
Physical exam shows hepatomegaly. Labs show the patient's family members
elevated aspartate aminotransferase (670 U/L) and
alanine aminotransferase (860 U/L). Other people at Most likely diagnosis (pediatric gastroenterology) Hepatitis A
school recently had a similar illness, which was
linked to food from the cafeteria
A 16-year-old Caucasian boy presents to the
outpatient clinic was 3 days of severe pain with
swallowing. He has plantar fasciitis for which he has Most likely diagnosis (pediatric gastroenterology) Pill esophagitis
been taking ibuprofen. Otherwise, he is healthy.
Physical exam is normal.
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9/7/2019 Pediatric Gastroenterology Flashcards | Memorang
Next best step in management Avoidance of both dairy and soy in

A 2-week-old Caucasian boy presents to the mother's diet

outpatient clinic with one day of painless, blood-
Most common pathophysiology Non-IgE mediated immunologic response
streaked, yellow, seedy stools. He has been
exclusively breastfed 6-8 times per day since birth, to soy or milk proteins in breast milk or formula → rectal and colonic
stools 2-3 times per day, and regurgitates after
in ammation
every feed. Physical exam shows well-appearing
infant with di use eczema. Most likely diagnosis (pediatric gastroenterology) Milk protein-induced
enterocolitis

Next best step in management Air or water-soluble contrast enema

A 1-year-old Caucasian boy presents to the
emergency department with one day of repeated 2-
Most common pathophysiology Lead point → Ileum telescopes into cecum
3 minute episodes of acute abdominal pain which
cause him to cry and bring his legs up to his chest. → pain, obstruction, and edema of the intestines → bowel ischemia → rectal
His most recent bowel movement was bloody, and bleeding (“currant jelly stools”)
he has vomited. Exam shows a mass in the right
upper quadrant of the abdomen. Most likely diagnosis (pediatric gastroenterology) Intussusception

Next best step in management Abdominal X-ray

Most common pathophysiology Gut immaturity in premature infants → ↑

A 3-week-old Caucasian female presents in the
neonatal intensive care unit with 4 hours of gut wall permeability → bacterial penetration → in ammation
increased gastric residual volume, bloody stool, and
vomiting. She was born 900 grams at 28 weeks Most common disease complication Sepsis and death
gestation. She has been tolerating continuous
nasogastric formula feeds until today when she Most likely abnormal laboratory nding Leukocytosis and metabolic
developed abdominal distension and became acidosis
lethargic.
Most likely diagnosis (pediatric gastroenterology) Necrotizing
enterocolitis

Next best step in management Broad-spectrum antibiotics

Most common pathophysiology Congenital heart disease → ↓ mesenteric

perfusion → intestinal ischemia and infarct → ↑ gut wall permeability →
bacterial penetration → in ammation and damage
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Most likely diagnosis (pediatric gastroenterology) Necrotizing
A 1-week-old Caucasian girl presents in the
neonatal intensive care unit with 12 hours of poor enterocolitis
feeding and bloody stool. She was born with
DiGeorge Syndrome at 38 weeks gestation. She is
being hospitalized until she gains enough weight
for surgical repair of her truncus arteriosus and has
been gaining weight steadily on formula. Abdominal
X-ray shows air in the bowel wall and portal veins.
Most likely abnormal laboratory nding ↑ transaminases, ammonia,
A 4-year-old Caucasian girl presents to the prothrombin time, and international normalized ratio
emergency department with one day of vomiting
and agitation, which progressed to lethargy and Most common pathophysiology Viral infection + aspirin use in children →
altered mental status. Other than having a fever Microvesicular fatty in ltration → hepatic mitochondrial dysfunction →
and cough ve days ago for which she took aspirin,
she has been healthy. Exam shows hepatomegaly encephalopathy and acute liver failure
with no jaundice. Nasal testing is positive for
in uenza B. Most common disease complication Cerebral edema

Most likely diagnosis (pediatric gastroenterology) Reye syndrome

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