Amedco - Quiz
July JPGN 2018
1 - A 7 year old female presents to your office with a history of vomiting that has occurred 5 times over the past months. She states that her vomiting is associated with episodic attacks of intense nausea and vomiting with vomiting occurring at least 4 times for at least one hour. Attacks last 3 days and in between episodes she is well. Her episodes are occurring every 5 days and each episode has the same stereotypical pattern. Of the following what does not meet criteria for CVS?
A - Episodic attacks of intense nausea and vomiting lasting 1 h–10 days
B - Episodes occurring every 5 days
C - Stereotypical pattern and symptoms in the individual patient
D - Vomiting during attacks occurs at least 4 times/h for at least 1 hour
2 - You are evaluating a 2 year old boy that is otherwise healthy presenting with recurrent episodes of vomiting for 6 months. Mother reports vomiting is always precipitated by illness. What would be your recommendations for this mother?
A - Reassure her that her child is likely getting recurrent viral infections that are causing her vomiting and no further work up is indicated.
B - Recommend a KUB to evaluate for obstruction.
C - Discuss that it is concerning that his vomiting is precipitated by illness and recommend further evaluation.
D - Recommend immunoglobulins to assess for an immunodeficiency.
3 - You are evaluating an 8 year old girl who has recurrent episodes of nausea and vomiting since she was 2 years old. On further questioning she reports episodes of vomiting are accompanied with flank pain. What is the diagnostic study that will give you the highest yield for the diagnosis of her symptoms?
A - BMP
B - UGI
C - MRI Brain
D - Abdominal and pelvic ultrasound
4 - You are evaluating a 10 year old female whom you suspect has the diagnosis of CVS. She does not have any concerning red flags. What will be the next best diagnostic study?
A - Upper GI series
B - Abdominal and pelvic ultrasound
C - Request the following laboratory (serum amino acids, urine organic acids, plasma carnitine and acylcarnitine) to be obtained prior to receiving fluids during the next attack
D - Upper endoscopy
5 - You are evaluating a 4 year old boy who meets CVS criteria based on NASPGHAN clinical guidelines. Lifestyle changes and avoidance of triggers did not prevent his episodes from occurring and you are now considering starting a prophylactic medication. What prophylactic medication would be recommended as a first line drug for prevention of CVS episodes in a 4 year old?
A - Ondansetron
B - Amitriptyline
C - Cyproheptadine
D - Coenzyme Q
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