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Self-Assessment Questions

Pediatric Gastroenterology

Topics in Pediatric Gastroenterology: Review Questions

Douglas G. Adler, MD

Dr. Adler is director of gastrointestinal endoscopy and assistant professor of medicine, University of Texas-Houston Medical School, Houston, TX.

Choose the single best answer for each question.

Questions 1 and 2 refer to the following case.

A 1-day-old, full-term neonate experiences coughing, frothing of the mouth, and cyanosis during attempts at breastfeeding. Because of concern about aspiration, an attempt is made to pass a nasogastric tube, but the tube meets resistance and cannot be advanced adequately.

1. What is the most likely diagnosis in this patient?
  1. Disordered pharyngeal function with abnormal swallowing
  2. Esophageal atresia
  3. Gastroesophageal reflux disease (GERD)
  4. Milk allergy
  5. Zenker’s diverticulum
Click here to compare your answer.

2. How should this patient be treated?

  1. Endoscopic reattachment of the proximal and distal esophagus
  2. Insertion of a percutaneous endoscopic gastrostomy tube for feeding and hydration
  3. Placement of an endobronchial stent to prevent aspiration
  4. Surgery to correct the anatomic defects
  5. Total parenteral nutrition
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3. A healthy 3-year-old boy reports to his mother that he accidentally swallowed a small plastic toy animal (from a farm playset) and is brought to the emergency department for evaluation. The mother recalls that the other toys in the playset are all 1 to 2 cm in length and have no sharp edges. On examination, the child appears to be in no distress and is playing in the examination room with his sister. His vital signs are normal, and he is requesting something to eat. What is the next best course of action?

  1. Barium esophagram
  2. Observation
  3. Obtain a chest and abdominal radiograph series
  4. Perform upper endoscopy to remove the toy
  5. Surgical consultation as the object could cause a bowel obstruction
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4. A 10-year-old boy presents for evaluation of a food bolus impaction. The patient has had 2 similar episodes over the past year. His past medical history is significant for asthma, but he is not taking medications at this time. In the past, large meat boluses were extracted endoscopically, but no overt esophageal abnormalities were noted. The patient is unable to control his secretions and undergoes repeat endoscopy. No overt obstruction is seen, but some white exudates are seen in the esophagus. The food bolus is successfully removed. What is the most likely underlying diagnosis in this patient?
  1. Behavior disorder
  2. Eosinophilic esophagitis (EE)
  3. Esophageal Shatzki’s ring
  4. Nutcracker esophagus
  5. Undiagnosed GERD
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5. A 7-year-old boy presents to the emergency department with clinical evidence of a small bowel obstruction. This is his third such presentation in the past year. Previously, his symptoms had resolved with nasogastric suction and bowel rest, but the child is now unresponsive to these measures. On examination, the patient has some pigmented spots on his lips and gums, a normal cardiopulmonary examination, and a grossly distended abdomen with high-pitched bowel sounds. The patient is taken to laparotomy and found to have a 5-cm obstructing polyp, which is found to be hamartomatous on pathologic analysis. What is this patient’s underlying diagnosis?

  1. Celiac sprue
  2. Familial adenomatous polyposis syndrome
  3. Hereditary nonpolyposis colon cancer syndrome
  4. Peutz-Jeghers syndrome (PJS)
  5. Sporadic polyp causing bowel obstruction
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