Pediatric Medicine Pediatric Gastroenterology: Review Questions Frank J. Genuardi, MD, MPH Dr. Genuardi is an assistant professor, Department of Pediatrics, and assistant dean for educational affairs, University of Florida Health Science Center, Jacksonville, FL. Choose the single best answer for each question.
	1. A 2-month-old male infant is brought to his physician for vomiting, which began after his first morning feeding 2 days ago and has followed each subsequent feeding. The vomitus is described by his mother as white with the appearance of undigested formula; the vomiting has been increasing in amount and has become more forceful. The infant’s last bowel movement yesterday was normal. The patient is afebrile, alert, and active. Physical examination is remarkable for dry lips with sticky mucus membranes. The patient’s abdomen has positive bowel sounds and is soft and nontender. A firm, mobile 1 × 1-cm mass is palpable in the right epigastric area. Which of the following is the most likely diagnosis? Gastroesophageal reflux Hirschsprung’s disease Intussusception Malrotation with volvulus Pyloric stenosis Click here to compare your answer. 2. A 6-month-old female infant is brought to her physician for vomiting, which began after her first morning feeding today and has continued unrelated to further feedings. The vomitus initially looked like undigested food but now appears to be mainly mucus, with the last episode having a green tinge. The infant has also become more irritable as the day has progressed. On examination, the patient is afebrile. She is initially crying but falls asleep several minutes into the interview. Physical examination is remarkable for dry lips and sticky mucus membranes. The abdomen has positive bowel sounds and is soft, and a mildly tender, ill-defined mass is palpable in the right upper quadrant extending inferiorly. Rectal examination reveals an empty vault except for a small amount of mucus, which is guaiac negative. Which of the following is the most appropriate next step in this patient’s management? Air-contrast enema Computed tomography (CT) scan of the abdomen Exploratory laparotomy Lower endoscopy Prochlorperazine administration Click here to compare your answer. 3. A 7-year-old boy is brought to his physician for evaluation of abdominal pain. The pain is described as periumbilical and dull and has occurred daily for the past 3 months. The pain does not seem to be related to food intake. The patient has missed several days of school recently because of the pain. His growth and development have been normal, he is not vomiting, and bowel movements are normal. He is afebrile and is appropriately interactive for age. Physical examination is remarkable only for periumbilical tenderness; there is no rebound, and no masses are palpable. Stool is guaiac-negative. Which of the following is the most appropriate next step in this patient’s management? Administer oral ranitidine Ask the patient to keep a pain diary Obtain an abdominal CT scan Obtain an upper endoscopic evaluation Put the patient on a lactose-free diet Click here to compare your answer.		4. A 5-month-old female infant is brought to her physician with a 1-day history of diarrhea. The diarrhea has become more watery since it began. The patient vomited once yesterday but has fed fairly well since that time. On examination, the patient has a temperature of 38.2°C (100.4°F) and is alert and active. Physical examination is remarkable for dry lips and sticky mucus membranes. Her abdomen has hyperactive bowel sounds and is soft and nontender. Rectal examination reveals watery, guaiac-negative stool. Capillary refill is less than 2 seconds. A stool sample has a pH of 5 and has less than 5 leukocytes per high-power field. Which of the following is the most appropriate next step in this patient’s management? Administer intravenous bolus of isotonic fluid Administer oral loperamide Administer oral rehydration solution Restrict diet to clear liquids only Stool cultures Click here to compare your answer. 5. A 1-month-old male infant is brought to the physician because of jaundice. The infant was born at term without complications and has been well. He was initially noted to be jaundiced on the second day of life, but it subsided by the end of the first week. The mother notes that the jaundice returned again during the third week of life and has been increasing progressively. The infant is breastfed, feeds well, and has been growing normally. On examination, the patient is afebrile. Jaundice is evident on examination of the skin and conjunctiva. Bowel sounds are present, the abdomen is soft, and the liver is palpable 2 cm below the right costal margin and is firm. On rectal examination, pale stool is noted, which is guaiac negative. Total serum bilirubin is 11.5 mg/dL (normal, ‹ 1.2 mg/dL), with a conjugated bilirubin result of 6.5 mg/dL (normal, ‹ 0.2 mg/dL). Which of the following is this patient’s most likely diagnosis? ABO incompatibility Biliary atresia Breast milk jaundice Hepatitis Physiologic jaundice Click here to compare your answer.
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