Amedco - Quiz

Essential Pediatric GI


A   - RAS mutation
B   - Tumors in multiple sites
C   - Tumors of fibroblast origin
D   - Adrenal carcinoids

A   - IgA deficiency is excluded with a serum IgA level about 40 mg/dl
B   - X-linked Agammaglobulinema is associated with splenomegaly
C   - G. bethesdensis is the causative organism of Chronic Granulomatous Disease
D   - Wiskott-Aldrich Syndrome is a known mimic of ulcerative colitis

A   - Tendency to develop polyps of different histologic types
B   - Pigmented lesions of the lips and mouth
C   - High incidence of colon and breast cancer
D   - Duodenal acanthosis

A   - ABCC2
B   - UGT1A1
C   - ABCB11
D   - ATP8B1
E   - CFTR

A   - PFIC2 (ABCB11 deficiency)
B   - Bile Acid Synthesis Defect (HSD3B7 deficiency)
C   - PFIC3 (ABCB4 deficiency)
D   - BRIC1 (partial ATP8B1 deficiency)

A   - Nuclear medicine hepatobiliary scan (e.g., HIDA, DISIDA) with slow hepatic uptake and luminal radioactive material present 8 hours after injection.
B   - Liver biopsy demonstrating giant cells.
C   - Abdominal Ultrasound finding of a fluid-filled gall bladder lumen.
D   - Physical examination without splenomegaly.
E   - Parental report of yellow stools.

A   - Perform an endoscopy and colonoscopy to rule out IBD.
B   - Consider abdominal CT to rule out IBD or mesenteric adenitis
C   - Order CRP and ESR and an upper GI and small bowel follow through to evaluate for IBD
D   - No testing is needed, concentrate on her social situation
E   - Empiric treatment for H. Pylori to see if symptoms improve

A   - Send the patient for fundoplication because of the intractable nature of symptoms
B   - Try PPI and H2 antagonists in combination
C   - Trial Domperidone for intractable symptoms
D   - Perform an esophageal manometry
E   - Perform a pH probe on acid suppression therapy

A   - Order an upper GI series to assess for malrotation or other anatomic issues
B   - Start a proton pump inhibitor once a day
C   - Consider thickening trial with rice cereal
D   - Recommend prone positioning at night to improve nocturnal reflux

A   - Impedance testing should always be done while on PPIs
B   - The sensitivity and specificity to diagnose reflux of pH-impedance and pH testing in untreated patients is similar
C   - pH testing is useful while patients are getting continuous feedings
D   - NERD is diagnosed when there is a correlation between symptoms and non-acid reflux, independently of the amount of reflux present
E   - Symptoms of extraesophageal reflux are always associated with abnormal reflux testing

A   - KUBs are not sensitive or specific to diagnose constipation
B   - The first line laxatives that are recommended by the constipation guidelines are PEG based solution
C   - Functional constipation is the most common diagnosis in patients with constipation
D   - Presence of normal bowel movements from birth does not excludes Hirschsprung’s disease
E   - No tests are necessary to diagnose functional constipation

A   - An abnormal autonomic nervous system is responsible for achalasia
B   - The phenotypic characteristics allow the determination of the underlying problem in patients with possible motility disorders
C   - Severe motility disorders are always primary
D   - The relaxation of the internal anal sphincter is produced by non-adrenergic non-cholinergic neurotransmitters
E   - Bacterial overgrowth is prevented by a normal post-prandial small bowel motility

A   - Mesenteric cyst
B   - Hepatic cyst
C   - Ovarian teratoma
D   - Enteric duplication cyst
E   - Wilms tumor

A   - Gastroschisis
B   - Heterotaxi Syndrome
C   - Congenital diaphragmatic hernia
D   - Duodenal Atresia
E   - Intestinal Atresia

A   - Necrotizing enterocolitis
B   - Ompalocele
C   - Intestinal atresia
D   - Gastroschisis
E   - Malrotation/Volvulus

A   - Mushroom poisoning
B   - Wilson’s disease
C   - Autoimmune hepatitis
D   - Idiopathic
E   - Acetaminophen overdose

A   - St John’s Wort
B   - Erythromycin
C   - Amoxicillin
D   - Hydroxyzine Vitamin D

A   - Aldactone
B   - High-volume paracentesis
C   - Propanolol
D   - Sodium supplementation
E   - Octreotide

A   - H. pylori serology 4 weeks after completion of therapy
B   - C13 UBT 6 weeks after completion of therapy
C   - C14 UBT 12 weeks after completion of therapy
D   - Stool antigen test 3 weeks after completion of therapy

A   - High dose PPI, amoxicillin, clarithromycin
B   - Bismuth based quadruple therapy
C   - Sequential therapy
D   - PPI, amoxicillin, rifabutin

A   - Gastrin
B   - Histamine
C   - Somatostatin
D   - Acetycholine

A   - A palpable olive on physical exam
B   - Metabolic alkalosis
C   - A target sign on abdominal ultrasound
D   - Projectile, bilious vomiting

A   - Prior perforation
B   - Use of salicylates
C   - Recent steroid use
D   - Concurrent antibiotic use
E   - Current biologic use

A   - Visible vessel
B   - Adherent clot
C   - Hematin on ulcer base
D   - No signs of recent hemorrhage
E   - PPI withdrawal

A   - Endoscopic removal
B   - Surgical removal
C   - Miralax/Golytely
D   - Reglan or Erythromycin
E   - Observation for several days until the mass resolves

A   - 10% 
B   - 20%
C   - 30%
D   - 40%

A   - 5%
B   - 15%
C   - 30%
D   - 50%

A   - Hepatic Artery
B   - Superior Mesenteric Vein
C   - Portal vein
D   - Hepatic Veins

A   - stomach, duodenum, jejunum
B   - colon, gallbladder, duodenum
C   - ileum, duodenum, jejunum
D   - stomach, colonic, ileum

A   - 30%
B   - 20%
C   - 10%
D   - 2%

A   - Chronic inflammatory pancreatic infiltration
B   - Bands of pancreatic fibrosis, with diffuse pancreatic calcifications
C   - Exocrine and islet destruction
D   - Recurrent episodes of acute pancreatitis

A   - Corticosteroids
B   - 6MP
C   - Methotrexate
D   - Infliximab

A   - Microvillous inclusion disease
B   - Autoimmune Enteropathy
C   - Congenital Chloride Diarrhea
D   - Tufting Enteropathy

A   - History of exposure to a proton pump inhibitor
B   - History of recurrent hematochezia
C   - Distorted body image and laxative abuse
D   - Multiple tattoos and body piercings

A   - Biliary atresia
B   - Alagille syndrome
C   - Glycogen storage disease 1a
D   - Congenital hepatic fibrosis
E   - Congenital hepatic fibrosis Glycogen storage disease type VI

A   - Frequent high starch-containing meals
B   - Avoidance of excess dietary lactose and fructose
C   - Ursodeoxycholic acid
D   - Uncooked corn starch doses given enterally every several hours

A   - The child has a 50% chance of having PIZZ phenotype.
B   - Normal liver function tests in this child exclude the possibility of her being PIZZ.
C   - If the child is found to be PIZZ, then she will have had a 15-20% risk of developing liver disease during childhood.
D   - The child should undergo CT scanning to exclude a liver mass.

A   - Rarely occurs even after years of therapy
B   - Occurs quicker in children than in adults
C   - Can only be achieved after at least 1 year on GFD
D   - Occurs but only in a minority of children

A   - Long term prognosis is good
B   - Administration of Growth Hormone can reverse the disease process
C   - The diarrhea is both primary secretory and osmotic
D   - Small bowel biopsies reveal an enteropathy with dilated lacteals

A   - A gastrointestinal malabsorption syndrome
B   - Inadequate oral intake
C   - An organic feeding disorder
D   - A genetic defect

A   - Clinical symptoms that may include dysphagia, vomiting, abdominal pain, or heartburn
B   - Esophageal eosinophilia with > 15 eosinophils in at least 1 biopsy
C   - Normal biopsies of the gastric antrum and duodenum
D   - A patient with 75 esophageal eosinophils/hpf that has complete resolution of symptoms and normal histology with the use of a PPI
E   - Eosinophilic esophagitis is a clinico-pathologic diagnosis

A   - Food induced enterocolitis syndrome (FPIES)
B   - Eosinophilic Esophagitis
C   - Lactose intolerance
D   - Infant allergic protocolitis
E   - Anaphylaxis due to dairy

A   - Infliximab
B   - Mycophenolate mofetil
C   - Azathioprine
D   - Prednisone

A   - A sign of acute hepatitis
B   - A sign of improving hepatitis
C   - A sign of impending liver failure
D   - Of no significance

A   - Portal tract expansion
B   - Hepatitis
C   - Elevated hepatic venous pressure
D   - Elevated hepatic arterial pressure
E   - Lysosomal storage diseases

A   - CT scan abdomen
B   - Abdominal xray: upright and flat plate
C   - Abdominal ultrasound
D   - Abdominal and pelvic MRI with oral contrast

A   - Calories: 60 kcal/kg/day and 3 gms protein/kg/day
B   - Calories: 80 kcal/kg/day and 2 gms protein/kg/day
C   - Calories: 100 kcal/kg/day and 3 gms protein/kg/day
D   - Calories: 120 kcal/kg/day and 4 gms protein/kg/day

A   - Children with achalasia usually present with dysphagia
B   - Esophagogram may show a dilated esophagus and a “bird beak” like tapering of the distal esophagus
C   - Wet swallow during esophageal manometry shows intact peristalsis and a decreased lower esophageal sphincter pressure
D   - Esophageal dilation and Heller myotomy are the two most commonly recommended treatments for achalasia in children

A   - Majority of children are diagnosed late because of atypical symptoms and have dysphagia in late childhood
B   - These is NO known association with anal malformations
C   - Dysphagia following surgical repair can be due to anastomotic stricture or esophageal dysmotility
D   - Surveillance endoscopy in adult life is NOT necessary because there is no reported association of esophageal atresia with Barrett’s esophagus

A   - Button batteries lodged in the esophagus should be promptly removed as an emergent procedure
B   - Injury to the esophagus can still be seen even if the battery moves to the stomach and was only lodged in the esophagus for a few hours
C   - An esophago-aortic fistula which can be fatal can develop even after successful removal of an esophageal button battery
D   - Severe esophageal injury and complications from a battery lodged in the esophagus never happens 24 hours or more after the battery has been lodged and removed from the esophagus

A   - Stool sample for pH and electrolytes
B   - Stool sample for Giardia antigen
C   - Stool sample for routine bacterial culture
D   - Stool sample for fecal calprotectin
E   - Stool sample for E. histolytica testing

A   - Ulcerative colitis
B   - Crohn’s disease
C   - Celiac disease
D   - Shigella infection
E   - Clostridium difficile infection

A   - Abnormal hemoglobin A1c
B   - Elevated thyroid stimulating hormone
C   - Elevated erythrocyte sedimentation rate (ESR)
D   - Elevated IgA tissue transglutaminase antibody level
E   - Low growth hormone level

A   - Pelvic floor dyssynergia
B   - Intractable constipation
C   - Hirschsprung’s disease
D   - Lower spinal neuropathy
E   - Anismus

A   - Metoclopramide
B   - Cisapride
C   - Cyproheptadine
D   - Erythromycin
E   - Octreotide

A   - The check is in the mail
B   - Yes, Virginia there is a Santa Claus
C   - No officer I wasn’t speeding
D   - Children and adolescent do get colon cancer, but we have to remember to look for it