Review Test

1.A 2-month-old female infant presents with acute onset of crying and bilious vomiting. On examination, her abdomen is tender and distended. Upper intestinal contrast imaging demonstrates intestinal malrotation with midgut volvulus. Which of the following conditions is also associated with this diagnosis?

A.Hypertrophic pyloric stenosis

B.Ulcerative colitis

C.Renal anomalies

D.Down syndrome

E.Heterotaxy

2.A 6-week-old male infant is admitted to the pediatric ward with vomiting and dehydration. The parents note that their child has been vomiting for the past 3 weeks with increasing severity and frequency. Initially, he would spit up a small amount after every other feeding. However, for the past week, he has vomited forcefully after each breastfeeding. To the parents, it seems like he vomits the entire feeding. He has remained hungry, with no fever and no diarrhea. During the past 2 days, he has had only two wet diapers per day. After admission, serum electrolytes are drawn. Based on the most likely diagnosis, which of the following would be the most likely electrolyte pattern?

A.Hypernatremic, hypokalemic metabolic acidosis

B.Hypernatremic, hypokalemic metabolic alkalosis

C.Hypochloremic, hypokalemic metabolic alkalosis

D.Hyperchloremic, hypokalemic metabolic alkalosis

E.Hypochloremic, hypokalemic, metabolic acidosis

3.You are called to evaluate a newborn in the nursery who has been vomiting after every feeding. The prenatal history is notable for polyhydramnios, and the physical examination is significant for a scaphoid abdomen and paucity of bowel sounds. Which of the following is the most likely diagnosis?

A.Congenital diaphragmatic hernia

B.Hypertrophic pyloric stenosis

C.Intestinal malrotation

D.Duodenal atresia

E.Hirschsprung disease

4.An 8-year-old girl is brought to the emergency department with a 3-day history of periumbilical abdominal pain that radiates to the back, as well as nausea, vomiting, and anorexia. The girl’s mother denies any recent travel, ill contacts, and trauma to her abdomen. Laboratory assessment reveals an elevated white blood cell count, mild hyperglycemia, and elevated amylase and lipase. Which of the following is the most likely underlying cause of her disorder?

A.Idiopathic

B.Sepsis

C.Viral infection

D.Drug or toxin exposure

E.Congenital anomalies of the pancreas

5.A previously healthy 9-month-old girl is brought to the emergency department with an 18hour history of intermittent, inconsolable crying interspersed with periods of lethargy. She has vomited twice and has had one bowel movement that the mother describes as bloody. Based on the clinical presentation, which of the following is the most appropriate diagnostic procedure at this time?

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A.Plain abdominal radiography

B.Upper gastrointestinal imaging with small bowel follow-through study

C.Barium enema

D.Surgical exploration

E.Abdominal ultrasound

6.A 3-year-old boy is brought to the office by his parents, who are concerned because he has hard, painful stools. For the past 4 months, their son defecates every 3–4 days and cries during the stooling. The resulting stool is very hard. Physical examination of the child is normal. Which of the following is correct regarding his constipation?

A.His constipation is unlikely to lead to encopresis.

B.A barium enema should be ordered to evaluate for Hirschsprung disease.

C.His constipation likely resulted from a traumatic triggering event, such as a severe, painful diaper rash or painful diarrhea.

D.Abdominal radiographs should be ordered to evaluate for an underlying organic cause of his constipation.

E.The parents should be instructed to encourage their son to drink juice with each meal, and the boy should be reevaluated in 3–4 months.

7.A 4-week-old, formula-fed male infant has a history of blood-tinged stools with mucus for the past few days. His mother reports that he has been fussier than usual lately but has had no fever, vomiting, or cold symptoms. Physical examination reveals mild abdominal distension but is otherwise normal. You suspect cow’s milk protein allergy. Which of the following is the most appropriate next step to confirm diagnosis?

A.Abdominal radiographs

B.Small bowel biopsy

C.Allergen skin testing

D.Stool-reducing substances and pH

E.Change his diet to an alternative protein source

The response options for statements 8 and 9 are the same. You will be required to select one answer for each statement in the following set.

A.Celiac disease

B.Crohn disease

C.Ulcerative colitis

D.Irritable bowel syndrome

E.Lactase deficiency

For each patient, select the likely diagnosis.

1.A 15-year-old girl presents with abdominal cramps and diarrhea for 2 weeks. Examination reveals two perianal skin tags and pubertal delay.

2.A 10-year-old boy has a history of bloody diarrhea and abdominal pain. He now presents with high fever, low blood pressure and abdominal distension.

3.A 4-year-old girl is brought to the urgent care center with an acute onset of vomiting blood. Her parents report that her symptoms began abruptly 3 hours ago, and since then she has had four episodes of bloody emesis. Vital signs reveal a heart rate of 152 beats/minute and a blood pressure of 110/56 mm Hg. Which of the following is the most appropriate first step in management?

A.Begin intravenous H2-blockers.

B.Order urgent upper endoscopy.

C.Order a complete blood count to assess the patient’s hemoglobin.

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D.Place two large-bore peripheral lines and administer a 20 mL/kg normal saline fluid bolus.

E.Place a nasogastric tube and aspirate to assess for blood.

4.A 12-month-old female infant with failure to thrive is brought to the office. Her parents note that she is very fussy and often spits up after feedings. She also has two loose foul-smelling stools each day. Serologic testing reveals elevated serum tissue transglutaminase antibody.

Which of the following foods can she eat safely without aggravating or inducing her symptoms?

A.Rice

B.Wheat

C.Oats

D.Barley

E.Rye

5.A 4-month-old female infant has gastroesophageal reflux disease confirmed by pH probe. She has failed to respond to conservative management that included positioning and thickened feeds. Which of the following is the most appropriate next management step?

A.Initiation of medical therapy

B.Changing her diet to a hydrolyzed amino acid formula

C.Nissen fundoplication

D.Gastric antroplasty

E.Gastrostomy tube feedings

6.A 5-week-old male infant has been brought to the clinic by his parents, who have concerns about jaundice. He was born at full-term, weighing 8 pounds, 9 oz, and he had an uncomplicated delivery and neonatal course. Today, his weight is 9 pounds, 1 oz, and his vital signs are normal. On examination, his liver is enlarged and 4 cm below the right costal margin. Jaundice is present. Laboratory evaluation reveals a total bilirubin of 12.9 mg/dL with a direct component of 5.9 mg/dL. Which of the following is the next most appropriate step in management?

A.Begin phototherapy to treat the patient’s jaundice.

B.Refer the patient for a liver transplant.

C.Begin ursodeoxycholic acid to enhance bile flow.

D.Order an urgent abdominal ultrasound and refer for a liver biopsy.

E.Reassure the parents that no treatment is required as he likely has neonatal hepatitis.

7.A 5-year-old girl has a 4-day history of nausea, vomiting, diarrhea, and loss of appetite. On physical examination, her conjunctiva are icteric and the right upper quadrant of her abdomen is tender. You suspect hepatitis A infection. Which of the following is correct regarding this diagnosis?

A.The presence of jaundice is unusual in a child of her age with hepatitis A infection.

B.She should also be tested for hepatitis D infection, which may occur in association with hepatitis A.

C.Chronic infection occurs in 25% of patients.

D.She is likely to be noninfectious at this point in her illness.

E.Serologic testing at this point in her illness will reveal elevated IgM antibody to hepatitis A only; IgG antibody to hepatitis A rises late in infection.

8.A 10-year-old girl is in the office for follow-up of abdominal pain that first occurred 5 months ago. The pain is periumbilical in location and is described vaguely as sometimes sharp, sometimes dull, and sometimes burning. The pain occurs only during the day; she denies waking up at night secondary to pain. She is able to participate in her soccer practice and games after school and on weekends. Fever, vomiting, diarrhea, and dysuria are all absent. Examination is normal, except for very mild abdominal tenderness on palpation of her

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periumbilical region. She is otherwise a very healthy-appearing girl with normal growth and development. You suspect functional abdominal pain. Which of the following is correct regarding this likely diagnosis?

A.Almost all patients have resolution of their symptoms by adulthood.

B.Most cases of chronic abdominal pain have an organic cause.

C.Your counseling should include making sure the patient understands that her pain is not real but imagined.

D.Even though her pain is functional, she may also have a minor disturbance in her sympathetic or parasympathetic nervous system that has put her at risk for pain.

E.Given the degree of pain, she should be given permission to miss school when the pain is present.

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