PEDIATRIC MCQS: GASTROENTEROLOGY

PEDIATRIC MCQS: GASTROENTEROLOGY

MCQS#01

Vomiting is a common presenting symptom in general pediatrics. In addition, cyclic vomiting syndrome (CVS) has an estimated prevalence of 2%. 

Which of the following scenarios is consistent with a child with the diagnosis of CVS?

A. A 5-year-old boy with recurrent episodes of nonbilious vomiting that occur after he sleeps in during the weekend or after a high-protein meal

B. A 6-year-old girl with recurrent episodes of “fast”-paced vomiting (up to 4 emeses/h) every 3 weeks that begin in the morning and last about 24 hours

C. A 6-month-old girl with recurrent episodes of bilious vomiting and abdominal pain every 4 to 6 hours

D. A 5-year-old girl with recurrent episodes of nonbilious vomiting every 4 hours, occipital headache, and mild ataxia

E. A 6-week-old girl with recurrent episodes of nonbilious vomiting after every feed

MCQS#02

A 7-year-old girl presents to the emergency department (ED) after vomiting 15 times over the past 8 hours. The vomiting began suddenly on awakening that morning. After examining her medical record, you note that she has had similar 24-hour episodes of vomiting, approximately every 4 weeks for the past 3 months. All the episodes required intravenous fluid rehydration. Aside from the 24-hour vomiting episodes, she has been otherwise healthy.

She has a heart rate of 130 bpm, blood pressure of 105/76 mm Hg, and appears listless, but is able to answer your questions appropriately. She has urinated once earlier today. Physical examination reveals tacky mucous membranes. There are no focal neurologic findings or symptoms. She takes sips of water in the emergency room, but 10 minutes later, she has an episode of nonbloody, nonbilious emesis.

You suspect cyclic vomiting syndrome (CVS). What would be the next appropriate step in management of this patient?

A. Administer intravenous fluid rehydration.

B. Send blood for electrolytes, glucose, blood urea nitrogen, and creatinine.

C. Order an abdominal radiograph.

D. Administer an intravenous proton pump inhibitor.

e. Order head CT.

MCQS#03

An 11-year-old boy presents to clinic with a complaint of 1 to 2 episodes of vomiting at least 1 time per week over the past 3 months. He reports that vomiting consists of nonbloody, nonbilious food material and is preceded by several minutes of burning substernal pain. His body mass index is in the 80th percentile for age.

What is the next most appropriate step in the management of this patient?

A. A 2-week trial of H 2 -receptor antagonist.

B. Referral to pediatric gastroenterology clinic.

C. Send blood for CBC, AST, ALT, and pancreatic lipase.

D. Obtain upper gastrointestinal contrast study.

E. A 2-week trial of odansetron as needed for nausea.

MCQS#04

A 20-month-old female is seen in clinic with a 4-month history of 3 to 5 watery stools per day. She is in the 60th percentile for weight and 75th percentile for height. Her mother describes her as a playful child and has no concerns other than the diarrhea. Dietary history reveals that the girl eats 3 meals and at least 2 small snacks and drinks 2 to 3 cups of apple juice in addition to 12 oz of cow’s milk each day.

Which of the following is the next appropriate step in management of this patient?

A. Determination of stool electrolytes and osmolality

B. Determination of stool pH and reducing substances

C. Stool culture

D. Two-week trial of lactose-free diet

E. Two-week trial of juice-free diet

MCQS#05

A 32-month-old girl presents to clinic for evaluation of constipation. 

Which of the following findings in the child’s medical history suggests an organic cause of constipation rather than functional cause?

A. Daily fecal soiling in undergarments

B. Two urinary tract infections within the last 6 months

C. Large-caliber stools that sometimes clog the toilet

D. Small-caliber, thin-appearing stools

E. Episodes of posturing during which the child crosses legs and screams

ANSWERS today at 3pm