GI and Fluid therapy

All PYQ before 2020 (4th + 6th year)

1) What is the underlying cause for a patient that had bloody diarrhea
with convulsion and loss of consciousness then went back normal?
a) Vibreo Cholera
b) +Shigellosis
c) Clostridium Difficile
d) Giardia Lamblia
Note: Bloody diarrhea causes: (C.A.S.E.S): Campylobacter,
Ameobahistolytica, Shigella-E.coli and Salmonella

2) A case of dysentery and self limiting seizure, Diagnosis:

a) +Shigella dysentery

3) Bloody stool and vomiting:

a) Shigella toxin in stool

4) A boy ate atlocal restaurant 3days ago,now he isvomiting and has

bloody diarrhea but looking well:
a) +Shigella sonnei
b) Shigella dysentery
c) Entamena histiloytica

5) A child with severe bloody diarrhea, was diagnosed as having Shigella

dysentery. Only one of the following is correct:
a) May be transmitted with animal contact
b) Less resistant for stomach acidity than Salmonella
c) His 2month old sister may benefit from Shigella vaccination
d) +Can resolve spontaneously without antibiotics

6) Notaninvasivediarrhelorganism:
a) +Mycobacterium
b) E.coli
c) Shigella
d) Yersinia
Note: Invasive bacteria are: shigella, salmonella,
yerseniaenterocolitica, enterovasive E.coli, aeromonas,
plesiomonas, listeria monocytogenes
7) The commonest cause of gastroenteritis in developing countries is:
a) Campylobacter
b) +Rotavirus
c) Shigella
d) E. Coli
Note: Viruses in general are the most common cause of G/E.
Measuring Rotazyme in stool helps us to identify Rotavirus in
diarrhea rapidly. A positive Rotazyme negates the need for a stool
culture and antibiotic therapy.

8) A long case of gastroenteritis (fever, watery diarrhea, vomiting, no

blood or mucus in stool). What's the most likely cause?
a) +rorotavirus

9) Gastroenteritis in child wearing diapers, what type of precaution?

a) air born
b) +contact

10) Which vaccine is used to prevent gastroenteritis:

a) +Rota vaccine

11) A case of gastroenteritis admitted to hospital what to do?

a) +prevent spread by contact
b) positive pressure room
c) airborne
d) droplets

12) Which of the following statements about gastroenteritis in

pediatrics is correct?
a) +vaccine is available for the most common cause of gastroenteritis
in the pediatrics age group
b) Hypernatremic dehydration is the most common form of
dehydration present

13) A patient presenting with gastroenteritis. Therapy?

a) +20 cc/kg (bolus) of normal saline
b) From both parents "(this choice doesn't make any sense :D)
14) A 3 year old female with gastroenteritis where lost fluids were
partially replaced presented to the hospital. The following are her lab
results Na+: 126 mEq/L, Urea: 8 mmol/L, Creatinine: 53 mmol/L K+:
3.8 mEq/L, Urine specific gravity was 1.025 And a bunch of other labs
were there. Which of the following in the urinalysis will be observed?
a) Urine sodium <10
b) +Urine potassium <10
c) Urine osmolarity<350

15) A patient came to your clinic suffering of gastroenteritis with

severe dehydration (hypotension) and he is 4 kg calculate his fluid
needs in the upcoming 24 hours:
a) 800 mL
b) +1000 mL
c) Note: maintinance fluid= 4 x 100 = 400, deficit fluid =4 x 15% x 10=
660, Total fluid 1000 cc.

16) A 50 kg patient with gastroenteritis has serum sodium of 160

mEq/L. What is the correct change in his water status?
a) +3 Liters
b) 5 Liters
c) 1 Liter
d) 2 Liters
Note: Water deficit= (160-145)(50)(4)

17) A case of gastroenteritis, bloody diarrhea, pallor and dyspnea.

After 2 days, what might you find:
a) +hyponatremia
b) metabolic acidosis
c) salmonella +ve culture

18) Case about gastroenteritis, which of the following is false:

a) E.coli is the most common cause of HUS
b) Clostridium difficile is suspected In case of ABX over use
c) Staph. Aureus is the most common cause of food poisoning in the
first 12 hours
d) Entamoeba histolytica can cause acute bloody diarrhea
e) +If I suspect E.coli ,I Have to give Abx
Note: Abx is going to increase THE risk OF HUS, so don’t give.
19) Patient with Hx of vomit and bloody diarrhea, then develops
metabolic acidosis, anemia, hematuria:
a) Rheumatic Fever
b) Vibrio Cholera in renal failure patient
c) +HUS S
d) Shigella

20) 12 year old girl with hx of diarrhea, after 2 days she developed
papular rash over her skin, oliguria and abdominal pain. What is you
diagnosis:
a) + HUS

21) A 18 month old baby with 2 days history of vomiting and diarrhea,
now presenting with petechia and facial swelling, what is your
diagnosis?
a) +HUS
b) HSP
c) C1 esterase deficiency

22) A 18 month old baby with 2 days history of vomiting and diarrhea,
now presenting with petechia and facial swelling ,what is the test to
order to make the diagnosis:
a) Stool analysis
b) LFT
c) +KFT
d) CT abdomen
e) CSF analysis

Note: a case of HUS: common cause of ARF due to E.coli, stool

culture is GOLD standard to know the causative agent , KFT : to make
the diagnosis.

23) A case about child continuously vomit without losing weight.

Mostly the diagnosis is:
a) +GERD

24) Spits up milk, appropriate growth?

a) +GERD

25) statement u can say about GERD :

 a) +Associated with reactive airway disease

26) What is the diagnostic test of GERD?

a) +24 hours pH monitoring
b) Endoscopy
c) Barium Meal
d) MRI
Note: It is the current gold standard for diagnosis of
gastroesophageal reflux disease (GERD). It provides direct
physiologic measurement of acid in the esophagus and is the most
objective method to document reflux disease, assess the severity
of the disease and monitor the response of the disease to medical
or surgical treatment. It can also be used in diagnosing
laryngopharyngeal reflux.

27) A case of GERD, 3 times after meals in 6 meales, Next step :

a) +Small thick meals
b) Endoscopy
c) H2 blockers + prokinetic drug

28) True about GERD:

a) +24 hrs pH monitoring is diagnostic
b) Prone position is recommended in newborns

29) Case of GERD, first step in management is :

a) +Small thick formula

30) One of the following doesn't cause bilous vomits:

a) +GERD
b) ilieal atresia
c) Hirshprung disease

31) case presented with recurrent aspiration & vomiting (I think), your
diagnosis was GERD , what do you advise the parents :
a) Do 24 PH probe monitoring
b) Do Upper GI barium swallow
c) +thickening the meals

32) Wrong about GERD:

a) +Barium swallow confirm diagnosis
 b) Antacids drugs used when non-pharmacological treatment fails
c) milk scan can show the milk reflux
d) Endoscopy is not necessary.

33) In brucellosis :
a) Least common zoonotic infection
b) Doxycycline is not useful in the treatment
c) Brucella Abortus lives in dogs
d) +We have many symptoms but little signs

34) All are false about Brucella except :

a) Human to human
b) +A lot of symptoms and few of signs
c) Neuro brucellosis CSF finding is similar to aspetic meningitis

35) A picture of acute hepatits A investigation:

a) HAV IgGAb positive
b) Normal AST & ALT
c) HBsAg positive
d) +HAV IgMAb positive

Note: IgM anti-HAV antibodies indicate a recent infection with

hepatitis A virus. IgM anti-HAV antibodies generally can be detected
in the blood as early as 2 weeks after the initial HAV infection. These
antibodies disappear from the blood 3 to 12 months after the
infection. IgG anti-HAV antibodies mean that you have had a hepatitis
A viral infection. About 8 to 12 weeks after the initial infection with
hepatitis A virus, IgG anti-HAV antibodies appear and remain in the
blood for lifelong protection (immunity) against HAV.

36) What's wrong about functional abdominal pain?

a) +High ESR
b) No fever
c) Childhood age
d) No constipation or diarrhea

Note: Chronic Functional Abdominal Pain (CFAP) is characterized by

chronic pain, with no physical explanation or findings (no structural,
infectious, or mechanical causes can be found).
 It is theorized that CFAP is a disorder of the nervous system where
normal nociceptive nerve impulses are amplified "like a stereo
system turned up too loud" resulting in pain. This visceral
hypersensitivity may be a stand-alone cause of CFAP, or CFAP may
result from the same type of brain-gut nervous system disorder that
underlies IBS. As with IBS, low doses of antidepressants have been
found useful in controlling the pain of CFAP.

37) What is wrong concerning constipation?

a) In hirschprung disease there is small caliber stool (it is pencil like)
with failure of anal sphincter relaxation
b) Constipation can also have periods of diarrhea
c) Lactulose is safe if used along a long period
d) +Glycerin is a stimulant laxative

Note: Glycerin is a hyperosmotic laxative, which is given rectally, and

it usually produces a bowel movement within 15 minutes to 1 hour.
The laxative effect of glycerin is due to the local irritant effect of
sodium stearate and glycerin's osmotic effect.

38) Biopsy showed villous atrophy in small intestine, diagnosis:

a) Premalignant lesion
b) +Celiac disease
c) Ulcer
d) Cystic Fibrosis

Note: In Celiac Disease, the inflammatory process, mediated by T

cells, leads to disruption of the structure and function of the small
bowel's mucosal lining and causes malabsorption as it impairs the
body's ability to absorb nutrients, minerals and fat-soluble vitamins
A, D, E and K from food. Lactose intolerance may be present due to
the decreased bowel surface and reduced production of lactase but
typically resolves once the condition is treated.

39) One of the following is not present in celiac disease:

a) Constipation
b) Villousatrophy
c) +something else
 Note: Common symptoms:diarrhea,Fatigue,
Borborygmusabdominalpain,weightloss,abdominaldistention,
flatulence.Uncommon includes: osteopenia/osteoporosis, abnormal
liver function, vomiting,Iron deficiency anemia, Neurologic
dysfunction,constipation,nausea.

40) A 12 month old (I think) was on breast milk previously andnow

he’s having diarrhea and dermatitis and abdominal distention …
what’s the next investigation?
a) Lactase levels in small intestine
b) Drugs from the mother's milk
c) +Celiac workup
d) Immunedefiiency work up

NOTE: 5 possible presentations of celiac disease are recognized, as

follows:
>Typical: This presentation is primarily characterized by GI signs and
symptoms.
>Atypical: GI signs and symptoms are minimal or absent, and various
extraintestinal manifestations are present. Extraintestinal symptoms
like: dermatitis herpitiformis, aphthous ulcer, dental hypoplasia,
chronic hepatitis, short stature, iron deficiency, delayed puberty,
infertility or subfertility, neurological or psychological, osteopenia
and arthritis.
>Silent
>Potential
>Latent

41) Celiac disease except:

a) IgA deficiency
b) down syndrome
c) +transglutaminase
d) gluten free diet
e) intestinal biopsy
Note: Anti-transglutaminase is correct, transglutaminase alone is
wrong!

42) One can be given in celiac disease:

a) + Corn
b) Barely
43) In celiac disease, what’s wrong?
a) Gluten free formula given indefinitely
b) It's related to intestinal T-cell lymphoma
c) it's an autoimmune disease
d) +Clinical presentation is strictly dependent on GI symptoms

44) A 11 months old infant, his mother started to give him cerelac and
formula from the age of 9 months, He now has anemia,
hypoalbuminemia, abdominal distention, and edema. The diagnosis
is:
a) +Celiac disease
b) Cow milk protein losing
c) Secondary lactase deficiency

45) Celiac disease one is true :

a) +Gluten free for life

46) Celiac, one is true :

a) Appetite is good
b) +Biopsy shows flat jejunum is diagnostic

47) False about celiac disease:

a) +high fecal elastase

48) False about celiac disease:

a) +3m old female hydrolyzed formula

49) True about celiac:

a) diagnosis by blood
b) Affect girls and boy equally
c) not increase in offspring after every birth"elfekra heek ta8reba"
d) + can be treated by a diet

50) A 10 kg child was muffled and shocked presented to the ER what

is to be done immediately
a) 2000 cc normal saline in 10-20 minutes
b) 200 cc normal saline over 24 hrs
c) +200 cc normal saline in 10-20 minutes
d) 2000 cc normal saline over 24 hrs
51) Note: Boluses are given by 20cc/kg in 20 minutes. And they are
given as necessary until the intravascular volume returns as normal.

52) A 10 kg child that is severely dehydrated, what is the total fluids

required
a) +2000 cc on 24 hours with 500 cc in boluses
b) 1250 cc over 24 hours
c) 2500 cc over 24 hours
d) 1500 cc over 24 hours

Note: Severe dehydration indicates 15% dehydration. give bolus

resuscitation of 20 cc/kg 2.5x times and over 50 minutes
(20min/bolus). This will decrease the dehydration to 10%. Since each
10cc/Kg decrease dehydration by 1%.
Total Fluid requirement = Maintenance + Deficit (severe) + Boluses
(2.5x)
= (10kg x 100cc/kg) + (100cc/kg x 10kg) + (2.5 x 20cc/kg x 10 kg)
= 1000cc + 1000cc + 500cc
= 2000cc for 24 hours and 500cc in boluses.

53) What is the most important thing to do when having a febrile child
who is shocked due to vomiting and diarrhea
a) +Restore body fluids
b) Manage the infectious cause with suitable antibiotics
c) Lumbar puncture
d) Send rectal swab for culture
Note: Fluid resuscitation and intravascular volume repletion is the
most essential and life-saving step in any dehydrated and shocked
patient.

54) Typhoid fever which is true:

a) +insidious
b) Almost all typhoid fever present with diarrhea
c) treats only with cefuroxime
d) diagnosed by stool

Note: The protean manifestations of typhoid fever make this disease

a true diagnostic challenge. The classic presentation includes fever,
malaise, diffuse abdominal pain, and constipation.
 It doesn't always show symptoms. A because it starts slowly then
reaches high temp in second week (over 40) Salmonella typhi is not a
cause of gastroenteritis... Other salmonella cause it Fluoroquinolones
are also highly effective (drugs of choice). Best diagnosed by bone
marrow samples and also blood samples do the job.

55) Child presented with vomiting and diarrhea, on physical exam,

normal skin turgor, normal vitals, what to do next?
a) Give him anti-motility drug and send home
b) +Give ORS
c) admit to hospital
d) gives antibiotics and discharge

56) A 15kg child needs to be given fluids IV in prep for surgery, what’s
his fluid maintenance?
a) 1500 ml/24hr
b) 1000 ml/24hr
c) +1250 ml/24hr
d) 1800 ml/24hr

Note: (10kg x 100cc/kg + 5kg x 50cc/kg) = 1000cc + 250cc = 1250cc

over 24 hours.

57) What’s the initial step in hypovolemic shock?

a) Cardio-version, vagal stimulation, propranolol
b) +Normal saline 0.9%
c) Defibrillation
d) History taking before anything

58) Child came to ER with vomiting and diarrhea, sunken eyes, his wt
was reduced from 10 to 9, what is the expected sign:
a) +Pulse 100 bpm
b) BP 90/70
c) BP 60/20
d) RR 65 per min
Note: We are expecting tachycardia, he lost 10% of weight & no
change in mental status; case of moderate dehydration.

59) Urethral ablation was applied to a 5kg child with urine output of
15ml/kg/hr, how much fluid to give?
 a) 500 ml D/S
b) +1900 ml D/S
c) 1800 ml D/S
d) 2000 ml D/S

Maintenance= UO+insensible loss = (15*5*24) +(20*5) = 1900 ml/d

Insensible loss = (20-40)cc/kg ...bas el dr 2alat esta5demo 20

60) Normal saline contains:

a) 154 mg/dl of sodium
b) +154 mmol/L Sodium
c) +154 mEq/L Sodium
d) 9 mg/L Sodium

61) Child with diarrhae came shocked to ER, how to know from
physical exam that he has severe dehydration?
a) Tachycardia
b) Tachypnia
c) Skin turgor is lost
d) +BP is low

62) A case of ingesting some washing material what to do?

a) Admit and observe
b) +Consult for endoscope

Note: Endoscope for acid or alkali material

ACID ingestion will lead to Coagulation necrosis of stomach
ALKALINE ingestion will end with Liquefaction necrosis of Esophagus.

63) Picture of Hep B in a mother:

a) + Give the son IVIG and Hep B vaccine

64) A case with lab results of low albumin and prolonged PT , what do
you think this is :
a) +Chronic liver diseas

Note: Low albumin indicate Chronic disease.Prolong PT is the earliest

sign of Liver disease and indicate Active liver disease.
65) A child with Hx of soiling of stool that does not happen during the
night , he refused PR examination , the most likely cause is:
a) Functional pathology
b) +Psychological pathology

Note: Soiling of stool = leakage of fluid DOES NOT happen during

night" indicate PSYCHOLOGICAL underlying causes, thus EXCLUDE
Functional pathology.

66) What type of fluids used in resuscitation :

a) + 0.9 NS
b) Half saline
c) 5% dextrose

67) A case of hypertonic dehydration (Na=164) , his Wt. was 10 kg a

week ago and now its 9 kg, what is the fluid maintenance:
a) 3000ml/48 hrs
b) 3500ml/48 hrs
c) 2500ml/24 hrs
d) +1800ml/48 hrs

68) Most common cause of HCV in infants:

a) Blood transfusion
b) +Feto-maternal

69) All can be seen in shock, except:

a) +Urine output 2.5 ml/kg/hr

Note: in shock , UO < .5 ml/kg/hr

70) Regarding brucella, one is false:

a) +Rapid detection by culture
b) A lot of symptoms, few signs
c) Best to be detected in bone marrow culture
d) Organism infection by conjunctival secretions

Note: culture needs 21 days

71) A 12 Kg child with severe hyper natremic dehydration. Fluids
requirements:
a) +3400 cc/48 hrs
 b) 2300 cc/24 hrs
c) 2300 cc/48 hrs

Note :ANSWER BY EXCLUSION.

Fluid requirement = Maintenance + Deficit (severe) + Free water
= (1100cc for 24 hours) + (100cc/kg x 12kg) + Free Water
= (1100 cc/d) + (1200cc) + Free water
= 2300 cc for 24 hour PLUS FREE WATER
At this point, we can't get into final answer without knowing NA lavel.
So, depends on this point (2300 cc for 24 hours PLUS FREE WATER), we
can EXCLUDE ANSWER (C) coz 2300cc/48 hours is not enough. While
ANSWER (B) 2300cc/24 hours WITHOUT including FREE WATER. Thus,
THE MOST suitable and possible answer now is (A) 3400cc/48 hours.
That's what i mean by ANSWER BY EXCLUSION.

72) False about functional abdominal pain:

a) +Occurs in toddlers
b) Diffuse pain
c) Rarely awake the pt from sleep
d) No growth retardation

73) True about H.pylori:

a) +Stool Ags is helpful in the diagnosis
b) Serology test in the acute infection is helpful
c) Rare in children

74) A mother with hepatitis B since 10 years, her daughter has

hepatitis surface antigen, anti-core antibodies, hepatitis e antigen,
and has not hepatits surface antibodies. Her liver enzymes are
elevated (3 times the normal). Which one of the followings is true:
a) +She has a risk of liver cirrhosis
b) Treat by passive and active immunizations
c) She is a healthy carrier 150
Note: The daughter has NOT hepatitis surface antibodies, so she is
NOT a healthy carrier. Rx for HBV is LaLamivud. Since her liver
enzyme elevated (ACUTE case), thus she has a RISK of liver cirrhosis.

75) A boy weighting 15 kgs presented with signs of severe

hyponatremic dehydration, calculate the fluid requirements.
 a) + 2750 cc

76) Note: Fluid requirement = Maintenance + Deficit (severe)

= (10kg x 100cc/kg + 5kg x 50cc/kg) + (100cc/kg x 15 kg)
=1250 cc + 1500 cc = 2750 cc

77) In a case of necrotizing enterocolitis , which of the following

indicates occurrence of intestinal necrosis :
a) Erythema in the abdomen
b) Abdominal tenderness
c) Bloody stool (not sure)

Note: According to Nelson Essentials: Early clinical signs of NEC

include: abdominal distention, feeding intolerance/increased gastric
residuals, emesis, rectal bleeding, and occasional diarrhea. As the
disease progresses, patients may develop marked abdominal
distention, bilious emesis, ascites, abdominal wall erythema,
lethargy, temperature instability, increased episodes of
apnea/bradycardia, disseminated intravascular coagulation, and
shock. With abdominal perforation, the abdomen may develop a
bluish discoloration. so the disease has a spectrum of sxs,, and all the
sxs in the qs do occur sometime in the disease,, so according to the
stem we answer

78) Best to prevent gastro-enteritis :

a) +Hand washing

79) Child swallowed button-sized alkaline battery , stuck in the

esophagus, what to do?
a) +Endoscopy
b) Give laxative and observe him
c) Induce emesis

80) A 14 kg child with 10% hypernatremicdehydration , maintenance

of fluids to give:
a) 3800 cc/48 hrs
b) +2400 cc/48 hrs
Note: Maintenence for 24 hours = 10kg x 100cc/kg + 4kg x 50cc/kg
=1200cc/ 24 hour , Thus, in 24 hours we need 1200cc/24 hours x 2
 days = 2400 cc/ 48 hours.

81) One of the following is seen more in UC than Crohn's:

a) +Rectal bleeding
b) Granuloma
c) Abdominal mass
d) Fistula
e) Segmental involvement

82) One of the following is not given in IBD:

a) Azathioprine
b) Steroids
c) Pentasa
d) +Ibuprofen (aminosalicytes)
e) Inflixmab

83) One of the following goes with CHO malapsorption:

a) +Stool pH of 5.5
b) 24hrs stool collection test reveal high fructose
Positive Sudan IV stain
Note: (In the other form, the question was what goes with fat
malabsorption: Sudan)
Note: CHO malabsorption is carbohydrate intolerance, bacteria
fermantation of carbs in the colon will produce gases (H2, CO2 and
mathane) which will cause the stool to have as low pH < 6.

84) An 18 month old baby crying and irritable. On examination: knee

flexed and sausage shaped abdominal mass. The best investigation:
a) Abdomen X-Ray
b) Abdomen CT scan
c) Barium enema
d) +Abdomen US

Note: Sausage shaped mass (single) is a sign of Intesusseption ,

Ultrasound is today considered the imaging modality of choice for
diagnosis and exclusion of intussusception due to its high accuracy
and lack of radiation. A target-like mass, usually around 3 cm in
diameter, confirms the didiagnose. air enema is used for diagnosis as
the same procedure can be used for treatment.
85) A 5 year old patient who lives in a goat farm presented with fever,
lethargy, anorexia and back pain. On exam: mild splenomegaly. The
cause:
a) Brucella abortus
b) +Brucella melitensis
c) Brucellasuis
d) T. canis153

86) Correct about Hep B vertical transmission:

a) +Infection in the young more likely to become chronic
b) Most occur during intrauterine life
c) Anti-hepatitis surface antigen indicate active infection

87) In acute liver failure, the most important as a bad prognostic

factor is:
a) +Prolonged PT
b) Elevated bilirubin
c) Elevated liver enzymes
d) Infection with coagulase negative staph

88) A 10 year old boy presenting with progressive liver failure,

behavioral changes, and massive upper GI bleeding. He has a sister
who died at the age of 11 with the same disease. Next step to
establish the diagnosis:
a) +Ophthalmic consult
b) Lead level.
c) Surgical consult
d) Psychiatric consult

Note: the Q asked what is the next step TO ESTABLISH DIAGNOSIS

not management thus the answer is Ophthalmic consult to diagnose
Wilson's disease (Keisserflecher ring). The best treatment for this
disease is Liver transplant, but the initial treatment included
penicillamine (which chelates the excessive amount of copper), many
people are intolerant to penicillamine , thus trientine hydrochloride is
a substitute.
89) One is wrong about Crohns:
a) +Aphthous ulcer is pathognominic

90) Gastrostomy indicated in:

a) +Infants has trouble swallowing (or infant with TEF in the other
form).

91) Intrahepatic cause of portal hypertension:

a) Budd chiari syndrome
b) Hepatic vein thrombosis
c) Portal vein thrombosis
d) +Granuloma

92) Typhoid fever :

a) +Rose spots appear after 1 week

93) A boy (10 kilo) with severe dehydration , you don’t give :
a) +oral rehydration (other form u give bolus of 200 ml)

Note: Contraindication for ORS: Severe dehydration and LOC. ORS for
mild and moderate dehydration: MILD = 50cc/kg for every 4 hours
MODERATE = 100cc/kg every 4 hours.

94) H pylori can cause all of the following in children except:

a) Iron deficiency anemia
b) Gastritis
c) Gastric ulcer
d+) Celiac disease
e) Nodular gastric body by endoscopy

95) 30kg pt 9yrs old calculation "insensible loss"

a) +600 ml

Note: insensible loss is(20-40 cc/kg), use 20 cc/kg; 20 x 30= 600

96) Most common type of shock:

a) +Hypovolmic
b) Septic
97) A case and the question was Which of the following doesn't cause
bleeding:
a) +Gastritis
b) Ulcer
c) Esophagal varices

98) Most common cause of constipation in a 3 year child?

a) +Functional constipation
b) Hypothyroidism
c) Cystic fibrosis
d) Celiac

99) How to avoid vancomycin flushing side effect:

a) +decrease infusion rate
b) Pre- medication anti histamine Stop the medication

100) There was a question about right abdominal mass , abdominal

swelling,, "crossing the right to left" what is Dx?
a) Wilms tumor
b) Neuroblastoma

101) Constipation, osmotic laxative 1 month no benefit, what not to

order?
a) +Urinalysis & culture

102) Abd pain, diarrhea, streaks of stool?

a) + Crohn’s

103) Abd pain, what not to tell them?

a) + Reduce daily juice intake

104) K requirement in a 30kg child?

a) +35 mEq/L

105) 20kg child. Sever dehydration...sodium 140...calculate the dificit

fluid required for him:
a) 2L
b) + 3L
c) 800 ml
d) 600 ml
106) A 3 year old female child presents complaining of bleeding per
rectum. You are suspecting a juvenile polyp. Which of the following is
the best investigation for this condition?
a) +Colonoscopy
b) Technetium scan
c) Angiography
d) Barium enem

107) Not a cause of hyponatremia?

a) Diuretics
b) SIADH
c) Heart failure
d) LiverFailre
e) +Diabetes insipuds

108) A case of dehydration which of these is not found :

a) capillary refill of 4 s
b) +urine output was 4 ml / kg / hour
c) mottled skin

109) Antibiotic treatment is NOT to be prescribed in all of the following

EXCEPT:
a) +Shigella
b) Rotavirus
c) E. Coli O7:H157
d) Salmonella typhi

110) Doesn't cause lower GI bleeding:

a) Celiac
b) +constipation
c) Meckel's diverticulum
d) Coagulopathy
e) Juvenile polyps

111) 50kg patient with gastronetritis has serum sodium 160 ,whats
correct change in water status?
a) + 3 L

Note: free water= 4 x 50 x (160-145)= 3000 cc

112) Best dx of malrotation vulvolus:
a) technetium scan
b) US
c) + upper GI enema

Note: Abdominal X-ray – Reveals any intestinal obstruction. Barium

swallow upper GI test – Examines the small intestine for
abnormalities and to check the position of the jejunum.

113) Not in the managment of dehydration :

a) albumin
b) +dopamine
c) albuterol
d) ringer lactate

Note: Ringer Lactate is found to be superior to Normal saline for fluid

resuscitation because Normal saline has vasodilator effects with the
increase in serum potassium levels and risk of metabolic acidosis.
Dehydration can cause breathing changes. Without enough fluids, the
body cannot supply cells with enough fluid to breath normal.

114) Patient with diarrhea the least likely differential diagnosis:

a) + inflamatory bowel disease

115) Which of the following isn’t true about celiac disease:

a) +Gluten free diet is continued for 2 years after diagnosis
b) Malabsorption is due to intestinal injury by gluten
c) It can be associated with hypothyroidism
d) It can be associated with lactose intolerance

116) All of the following are seen in shock except:

a) +Metabolic alkalosis

117) Which of the following statements about lactose intolerance

following acute gastroenteritis in children is incorrect:
a) Restriction of lactose containing food can help improve the
symptoms
b) Administration of lactase can help relieve the symptoms
c) +It is rare to occur after acute gastroenteritis
118) One is true about celiac :
a) Symptoms resolve after one month of treatment
b) Associated with hyperpigmentation
c) +It may associated with hyper pigmentation in case of Addison’s
disease (both are Autoimmune)

119) Which of these is least likely to cause liver cirrhosis in children:

a) hepatic vein thrombosis
b) Budd chiari syndrome
c) +portal vein thrombosis
d) granulomatous disease

120) The amount of sodium in 0.9 NaCl :

a) + 154
b) 149
c) 14

121) 14 kg child presented with 10 % dehydration , how much fluid to

give?
a) 1800
b) 2400
c) +2600

Note: maintinance fluid= 10 x 100 + 4x 50= 1200

Deficite fluid= 14 x 10% x 10 = 1400
Total fluid= 2600

122) Most common cause of hypernatremia in children

a) renal failure
b) +loss of free water
c) primary hypodipsia

123) A patient with K+ =8 how to treat?

a) IV insulin
b) +IV calcium gluconate

Note: not sure about other options

124) Celiac disease case

a) +gluten free diet
125) Patient with jaundice, pale stool , dark urine and elevated liver
enzyme most common cause:
a) AR polycystic kidney disease and liver fibrosis
b) + biliary atresia

126) 16kg child with 10% isonatremic dehydration. How much required
fluid for him?
a) +2900cc

Note: maintinance fluid= 10 x 1000 + 6 x 50 = 1300

Deficite fluid= 16 x 10% x 10 =1600
Total fluid = 2900

127) How much sodium the 30 kg child need to increase his sodium
from 115 to 125?
a) +180

128) Note: the amount of Na we need to correct is 10 mEq, Na deficit=

0.6 x 30 x 10= 180

129) Most common cause of encopresis in 4.5 years old:

a) Sexual abuse
b) +Chronic constipation
c) Urethral anal fistula
d)
130) Note: Encopresis is the involuntary discharge of feces (ie, fecal
incontinence). In most cases, it is the consequence of chronic
constipation and resulting overflow incontinence.Wrong about cyclic
vomiting syndrome:
a) +At least 10 episodes in 6 months period
b) Normal health between episodes
c) Vomiting more than 4 times in 1 hour
d) Episodes range from 1 hour to 10 days
Note: episodes usually occu4 to 12 times per year.
131) A patient with perianal pruritis and positive clear adhesive test.
What is the best treatment:
a) +Mebendazole
b) Iquimoid
132) which of the following Is false about ORS?
a) +given enteral and parenteral
b) has NA, K , Cl
c) bicarboante helps the absorption of water and electrolytes

133) fluid therapy : Na = 125 , wt = 30 kg , what is Na deficit?

a) + 180 mEq

Note: the amount of Na we need to correct is 10 mEq, Na deficit= 0.6

x 30 x 10= 18

134) Helminth infx, perianal pruritus, +ve scotch tape test, what is trx?
a) + Mabendazole

135) Which of the following is an appropriate fluid for exchange

transfusion reaction:
a) Glucose
b) Normal Saline
c) Albumin
d) +Fresh frozen plasma

Note: The procedure involves slowly removing the person's blood

and replacing it with fresh donor blood or plasma. In conditions such
as neonatal polycythemia, a specific amount of the child's blood is
removed and replaced with a normal saline solution, plasma (the
clear liquid part of blood), or albumin (a solution of blood proteins).
This decreases the total number of red blood cells in the body and
makes it easier for blood to flow through the body.

136) An infant presents to the hospital while seizing. His serum sodium
is 123 mEq/L . What is the first step in the management of the
patient?
a) + 3% hypertonic saline 100cc over 10 mins

137) Which of the following isn’t a cause of indirect hyperbilirubinemia:

a) +biliary atresia

138) are risk factors for neonatal jaundice weeks newborn except:
a) ABO incompatibility
 b) + Exclusive bottle feeding
c) Jaundice at the first day
d) Age 35-36 weeks
e) History of phototherapy in his brother

139) Which one of the following is not a feature of infantile colic:

a) + Vomiting
b) Not associated with change in bowel habits
c) Paroxysmal
d) Highpitched cry in pain
e) Inconsolability

140) A 4monthold infant, exclusively breastfed, presented complaining

of vomiting 23 times per day and 23 soft stool
a) + Small size meals and keep him upright after feeding
b) Give PPI

141) A child presented with moderate dehydration. he had tachycardia,

dry mucous membrane. He was able to tolerate oral feeds. The best
step of management is:
a) ORS then clearliquid diet
b) +ORS then vegetables,fruits and meat
c) Admission, IV fluids and rest the gut

NOTE: Answered by DrRula after the exam

142) Regarding shock in children, all of the following are true EXCEPT:
a) Most common is hypovolemia
b) Septic is usually due to gram +ve bacteria
c) Viral infections can cause cardiogenic shock
d) +Fluids are useful in all types of shock

143) A case of a shocked child (BP 60/50). What is the first step in the
management?
a) +IV access with 100cc normal saline immediately
b) Arrange for NICU admission
c) Tell the nurse to withdraw blood for electrolytes

144) A child presented with high fever. Diagnosis of enteric fever was
entertained. All are trueexcept:
 a) + Fever is usually early and of sudden onset

145) A child brought by his mother because he swallowed a plastic toy,

his mother reports that the toys he was playing with are about 1x2
cm and no sharp edges. The child looks healthy and is active playing
around. What is your management?
a) Consult the surgeons for the probability of causing intestinal
obstruction
b) Observation
c) barium esophagogram
d) +Upper GI endoscopy to remove the object ?
e) Abdominal and chest Xray

146) A child with presented with bleeding per rectum , technitium t99
showed gastric mucosa within ileum, most probable diagnosis is:
a) +Meckel's diverticulum

147) A known case of congenital hypothyroidism, oresented with

increasing fatigue over the last weeks, upon investigation, she was
found to have normal TSH & T4 & increased ALT, AST. What is your
next investigation?
a) +ASMA

148) Which if not true about hypernatremic dehydration

a) May present with high-pitched cry, fever, lethargy, muscle
wealmess, and coma
b) Rapid treatment may result in cerebral edema
c) The serum sodium concentration should not decrease more than
12 mEq/L /day
d) +The initial resuscitation should be done by 0.5 Normal Saline

149) A 25 kg child with significant head trauma was admitted to the

hospital. His sodium was 145. A few days later, his sodium was 170,
had polyurea and urine specific gravity was low. What is the correct
change in his water status?
a) 1.5 L
b) + 2.5 L
c) 3.5 L
d) No change in his water status
 Note: change in Na = 170-145 = 25,, free water = 4 x 25 x 25 =2500cc

150) A 12 months old child with history of spitting his milk since 1
month old. His growth is on the 95th percentile. What's your
diagnosis?
a) +gastroesophageal reflux
b) tracheoesophageal fistula
c) congenital pyloric stenosis
d) incomplete duodenal atresia

151) A 13 years old girl with history of 9 months abdominal pain,

bloody diarrhea, fatigue and weight loss. The most likely diagnosis is:
a) +crohn's disease
b) chronic pancreatitis
c) acute appendicitis
d) gallstones
e) acute pancreatitis

152) About celiac disease, which is false:

a) +gluten free diet is given until 12 years of age
b) malabsorption is due to intestinal injury caused by gluten
c) may be associated with Hypothyroidism (both are Autoimmune)

153) A 2.6 Kg baby, his mother insists on bottle feeding, his caloric
need is 100 Kcal/Kg/day. You counsel the mother to give him:
a) 70 ml every 3 hours
b) 80 ml every 3 hours
c) 120 ml every 3 hours
d) +50 ml every 3 hours
e) 70 ml every 4 hours

154) Awake, alert 10 Kg baby, has dry mucus membranes, decrease

skin turgor, and sunken eyes. His water deficit would be:
a) 800 cc
b) +1000 cc
c) 1500 cc
d) 100 cc
e) 500 cc
155) Note: pt has sign of moderate dehydration (loss 10%). No
hypotension or change in mental status; no sign of severe
 dehydration (loss 15%)
The deficit= body weight x %of dehydration x 10 = 10 x 10 x 10

156) A child complaining of belly ache, day and night, occasionally

vomits after the pain, and found to have occult blood in stool. His
father also has attacks of stomach ache. What is the most likely
cause:
a) functional abdominal pain
b) +peptic ulcer
c) meckel's disease
d) pinworm infestation
e) appendicitis

157) A patient presented with severe abdominal pain, vomiting, bloody

stool, purpuric rash on the lower limbs with lower limb edema. His
vital signs were stable. What is the least important to be done
immediately:
a) urinalysis
b) abdominal ultrasound
c) +25 cc/kg normal saline bolus
d) Steroids
e) explanation about the condition & reassurance

158) A patient represented by jaundice, known case of crohns disease

on Methotrexate, the least likely to be the cause:
a) Primary biliary cirrhosis
b) Primary sclerosing cholangitis
c) Gallbladder stones
d) Autoimmune hepatitis
e) + Side effect ofMethotrrxate

159) case of hepatitis A , one of the following is not an indication for

admission:
a) bleeding tendency
b) persistent vomiting
c) hypoglycemia
d) +elevated liver enzyme
160) A known case of cystic fibrosis patient with pancreatic insufficient,
the best test to be done is:
a) + fecal elastase
161) A 12 year old boy with cystic fibrosis required recurrent
admissions for respiratory complaints his gastrointestinal symptoms
were partially controlled with maximum dose of pancncreatic
replacement therapy. the best approach to improve the pancreatic
enzymes efficacy is to:
a) Increase protein in diet
b) + add acid suppressant agents ?
c) increase the dose more
d) give the enzymes 15 to 30 minutes after the meal
e) add multivitamins to the treatment

Note: It remains unclear if including an acid suppression medication

in a PERT regimen does or does not aid in absorption. The CF
Foundation preschool guidelines suggest adding a histamine-2-
blocker or a proton pump inhibitor if PERT is maximized and
malabsorption is still present (Lahiri 2016, Sander-Struckmeier 2013).

162) A case about dehydrated and hypotensive , first thing to do:

a+) Give NS bolus

163) A case suggestive of celiac disease in 1 or 2 y/o child.. what is the

best confirmatorytest to to be done:
a) Anti endomesial antibodies test of IgA type
b) +Endoscopy and intestinal biopsy

164) A case about an infant i dont remember was in the age of week or
months presented with a complaint of repetitive vomiting mainly
after meals with normal growth and no hx of choking or any
problem.. what to do?
a) Barium swallow
b) +Reassurance

165) All are characteristic of septic shock in 3 years old 15 kg child

except:
a) Thrombocytopenia
b) Hypotension
c) + urine output of 7 ml/kg/min
d) Hr 120
e) Bp 95/70
166) In cases of shock there is oliguria or anuria with urine output
a) +less than 0.5-1 ml/kg/hr

167) Best INITIAL test for diagnosis of celiac disease:

a) anti giladin antibody
b) bowel biopsy
c) +Anti-tissue glutaminase (tTG) IgA antiboides and total IgA

168) What the best test for pancreatic insufficiency in cystic fibrosis?
a) Fecal pancreatic enzyme
b) serum trypsinogen level

169) Baby with diarrhea for months, growing well. History, physical
examination, ESR, Chemical tests and stool analysis; ALL ARE
Negative. Diagnosis most likely?
a) Celiac
b) cystic fibrosis
c) +Primary intestinal lymphangiectasia

Note:Primary intestinal lymphangiectasia (PIL) is a rare digestive

disorder characterized by abnormally enlarged (dilatated) lymph
vessels supplying the lining of the small intestine. The main
symptoms are swelling (edema) of the limbs and abdominal
discomfort. The disorder is usually diagnosed before three years of
age but is sometimes diagnosed later in life.
https://rarediseases.org/rare-diseases/primary-intestinal-
lymphangiectasia/

170) Intestinal Biopsy can be used to diagnose:

a) Chloride loosing enteropathy
b) +tufting enteropathy
Note: All other choices can be diagnosed by presence of reducing
sugar in stool

171) pancreatic insufficiency in CF : ???

a) +Fecal enzyme

172) Case about milky vomiting with no blood or mucus :

a) +Reassure the parents and teach them about post feeding
173) Which of the following has the same serum osmolarity ?
a) + Normal saline

174) False about ORS:

a) Ineffective in moderate dehydration

175) which will not indicate liver function:

a) +ALT or AST
b) prothrombin
c) blood glucose
d) Albumin

Note: glucose (blood sugar) levels. The cirrhotic liver does not
respond to insulin. Thus, glucose cannot enter the cells and stays
elevated in the blood (diabetes). People with cirrhosis are not able to
mobilize glucose out of the body’s reserves, and they can easily
develop low blood sugar (hypoglycemia).

176) The main extracellular anion?

a) Na
b) +Cl
c) K

177) Case about 12 y/o girl with RUQ pain and two girls in class same
her condition:
a) Cystitis
b) Renal colic
c) +Acute hepatitis

178) A newborn with epicanthic fold, flattened nasal bridge and single
palmar crease. All the following tests should be performed at the
beginning, except:
a) Eye test
b) + X-ray for duodenal atresia
c) Karyotyping
Note: answered by the doctor.
179) Case about celiac disease. Asking about treatment:
a) +Gluten-free diet
180) case about a child with chronic diarrhea with failure to gain weight
after starting to eat foods. Mostly is:
a) +celiac disease

181) Not in cystic fibrosis:

a) + small intestine hypomotility
b) pancreatic insufficiency
c) chronic diarrhea
d) malabsorption

Note: Gastrointestinal tract manifestations of cystic fibrosis are

related to mucous inspissation and dysmotility and include
meconium ileus (MI), constipation, distal intestinal obstruction
syndrome (DIOS), gastroesophageal reflux disease (GERD), and small
bowel bacterial overgrowth. DIOS is caused by inspissated intestinal
contents that completely or partially block the small intestinal lumen,
most commonly at the ileocecal junction.5 This is thought to be
related to a cascade of intestinal inflammation in the setting of the
defect in the CFTR
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865785/)

182) 7kg infant presented to ER with signs and symptoms of severe

dehydration, what amount of fluid should be given to resuscitate him
in thefirst20minutes:
answer: 140cc IV normal saline.

183) congenital diarrhea, causes by all except:

a) cystic fibrosis
b) +celiac disease
NOTE: Celiac is due to allergy to gluten, so the baby need to be
exposed to it first. Dr mentioned this idea in the lecture; the cause of
diarrhea in newborns may Not be celiac diseas;it causes a chronic
diarrhea.

Done by: Rahaf Alyousef