Quiz: pediatrics

1. Complications of GERD in infants include the following, except:

A a. Iron deficiency anemia. B b. Aspiration pneumonia. C c. Metabolic acidosis D d. Esophageal stricture

2. Glucose in oral rehydration solution (ORS) is added to:

A a. Improve the taste B b. Meet the child's energy requirements C c. Prevent malnutrition D d. Facilitate sodium absorption

3. Drug therapy in diarrhea:

A a. Is highly effective B b. Shortens the duration of bacterial excretion in stools C c. Helps rehydration D d. Adds unnecessary cost.

4. All the following are manifestations of hypokalemia, except:

A a. Hyperreflexia B b. Abdominal distension C c. Decreased urine flow D d. Cardiac arrhythmia

5. Manifestations of dehydration include all the following except:

A a. Weight loss B b. Fontanel affection C c. Decreased urine flow D d. Shortened capillary refill time

6. Causes of metabolic acidosis include all the following, except:

A d. Shortened capillary refill time B a. Pyloric stenosis C b. Severe gastroenteritis. D c. Diabetic ketoacidosis.

7. Hypotonic dehydration is characterized by:

A a. Fluid movement from intracellular to extracellular compartment B b. Skin turgor is mildly affected C c. The tongue is moist D d. Serum sodium is normal

S. Which of the following is true in cases of hypotonic dehydration:

A a. Polyuria commonly occurs B b. Tongue is usually moist. C c. Skin turgor is not affected D d. Shigella is the best example of this type

9. Post-enteritis (persistent) diarrhea maybe caused by all the following, except:

A a. Sugar intolerance B b. Cow milk allergy C c. Bacterial colonization D d. Pancreatic dysfunction

10. A 4 kg infant with severe dehydration (10% loss of his body weight) needs the following amount of intravenous fluid in the first 24 hours:

A a. 1200 ml B b. 800 ml C c. 600 ml D d. 400 ml

11. Persistent diarrhea is a term that describes diarrhea lasting for more than:

A a. 7 days. B b. 10 days C c. 14 days D d. 1 month

12. Which of the following pathogens cause entero-invasive diarrhea:

A a. Rotavirus. B b. Cholera. C c. Staph. D d. Shigella

13. 1-month-old boy is brought to emergency department by his mother, who states that he has projectile vomiting for the past several days. She states that he vomits every time she feeds him and his vomitus is non-bilious. On examination, the infant is mildly dehydrated and there is a palpable firm movable mass in the right upper quadrant. I. The most likely diagnosis is:

A a. Duodenal atresia. B b. Intussusception. C c. Hirschsprung disease. D d. Pyloric stenosis.

IL Expected findings do not include:

A a. Metabolic alkalosis. B b. Constipation C c. Double bubble sign D d. Visible peristaltic waves

14. A 5-week-old male presented with projectile vomiting after feeding and poor weight gain. On examination, visible peristalsis seen as a wave moving from left to right across the abdomen.I. The most likely diagnosis:

A a. Pyloric stenosis B b. Gastro-esophageal reflux C c. Acute gastritis. D d. Esophageal stricture

IL The recommended initial treatment is:

A a. Drugs enhancing gastric emptying B b. Correction offluid and electrolyte disturbance C c. Anti-emetic drugs D d. Thickening agents to the feeds

15. The function of glucose in oral rehydration solution (ORS) is to:

A a. Increase sodium absorption by cotransport B b. Give good taste to ORS C c. Increase osmolality of ORS. D d. Increase Na + /K+ pump activity

16. A 5-week-old boy presents to clinic with vomiting for the last 2 weeks. He is not gaining weight properly. The mother states that the vomiting is projectile, non-bilious but she feels that he has a good suck and swallow. Examination revealed an olive-like mass felt to the right of the umbilicus. One of the following is not expected in this patient:

A a. Diarrhea B b. Metabolic alkalosis C c. Dehydration. D d. Good outcome

17. Watery diarrhea is commonly caused by which of the following:

A a. Rotavirus. B b. Shigella. C c. Campylobacter D d. Entamoeba histolytica

18. The pathogenesis of persistent diarrhea includes all the following, except:

A a. Sugar intolerance B b. Toxin production by entero-toxigenic E. coli C c. Cow milk allergy D d. Bacterial overgrowth in upper small intestine

19. Persistent diarrhea:

A a. Maybe associated with macerations of peri-anal skin. B b. Secretory type of diarrhea. C c. Considered if acute diarrhea lasts for 10 days or more. D d. Usually associated with alkaline stools.

20. 1-year-old girl was brought to ER with temperature of 39oC, watery diarrhea (6 times in the last 24 hours) and vomiting (4 times in the last 24 hours). On examination, the girl has sunken eyes, lost skin turgor, mottling, cold extremities and capillary refill time was 7 seconds. Serum electrolytes: Na+ 140 mEq/L and K+ 4 mEq/L. Normal serum potassium is 3.5-5mEq/L. I. The most appropriate diagnosis is:

A a. Acute gastroenteritis B b. Hypovolemic shock complicating gastroenteritis and dehydration C c. Septic shock complicating gastroenteritis and dehydration D d. Hyponatremic dehydration.

IL Which of the following is not expected in this child:

A a. Low CVP B b. Paralytic ileus C c. Weight loss >10% D d. Rehydration by ORS(oral rehydration solution)

21. A 5-week-old infant was brought to the pediatrician because of what was described by the mother as persistent vomiting that started at the age of 2 weeks. The vomiting used to be forceful and white-yellow in color. It follows every meal. Revising the weight of the child, it was found to be 3400 gm at birth, 3350 gm at the age of 2 weeks, 3000 gm at the age of 4 weeks. An oval mass could be palpated in the right upper quadrant of abdomenI. The most likely diagnosis is:

A a. Congenital pyloric stenosis B b. Duodenal atresia C c. Inborn error of amino acid metabolism. D d. Milk allergy

IL Which of the following is likely in this child:

A a. Double bubble appearance in plain abdominal x-ray. B b. Metabolic acidosis. C c. Need for surgical intervention D d. Bile-stained vomitus.

22. A one year old presented to the emergency room with severe colicky abdominal pains associate with vomiting and bleeding per rectum. PR examination by the surgeon revealed a mass and blood on the finger on withdrawal. What is the most likely diagnosis

A a. Pyloric stenosis B b. Volvulus C c. Intussusception D d. Gastroenteritis

23. Painful oral ulcers include:

A a. Mondial stomatitis B b. Herpetic gingivostomatitis C c. Traumatic ulcer of a broken tooth D d. Allof the above

24. Monilial stomatitis is characterized by which of the following:

A a. It is due to Candida albicans infection B b. Usually starts after one year of age C c. Cioxacillin is the drug of choice for management D d. Formed of brown easily removed plaques

25. Possible complications of severe gastroenteritis include all the following, except:

A a. Dehydration B b. Metabolic alkalosis. C c. Acute renal failure. D d. Bleeding.

27. One of the following is suggestive of organic origin of abdominal pain:

A a. Being periumbilical B b. Presence of family problems. C c. Interfering with activity and sleep D d. Severity of pain is mild to moderate

28. Recurrent abdominal pain may occur in all of the following except:

A a. Parasitic infestations. B b. Lactose intolerance C c. Bad selection of food D d. Hypertrophic pyloric stenosis

29. Features suggestive of an acute surgical abdomen in a 1-year-old infant include all except:

A a. Periumbilical B b. Intermittent screaming episodes C c. Guarding. D d. Red currant jellystool

30. A previously healthy 7-year-old girl comes to the office with complaints of episodic abdominal pain over the past several months. The pain is periumbilical that doesn’t wake her from sleep or interfere with play. She has no fever, joint complaints or constipation or diarrhea. Growth and development have been normal. The physical examination is within normal limitsI. The most likely diagnosis is:.

A a. Acute appendicitis. B b. Acute cholecystitis C c. Parasitic infestation. D d. Functional abdominal pain

IL The most appropriate next step is:

A a. CT scan of abdomen B b. Anti-parasitic medication C c. Reassurance and follow up. D d. Surgical consultation

31. A 2-year-old boy is seen casualty with the complaint of significant abdominal distention. According to the mother the condition started 20 hours ago with what she describes as severe paroxysms of colic accompanied by loud crying. This was associated with repetitive vomiting. The vomitus is bile stained and stool contains blood and mucusI. The most likely diagnosis is: .

A a. Strangulated inguinal hernia. B b. Mid gut volvulus C c. Gastroenteritis D d. Intussusception

II. One of the following can’t be present:

A a. Fluid levels on erect abdominal x-rays B b. Sausage-shaped mass in right upper quadrant C c. Double bubble appearance on abdominal x-rays D d. Red currant jellystools

32. A 10-day old male presents with bilious emesis. What is the most likely diagnosis:

A a. Appendicitis B b. Pyloric stenosis C c. Malrotation with midgut volvulus D d. Feeding intolerance

33. A 21-month-old is seen because of intermittent abdominal pain that causes him to become still while drawing up his legs. He also presents with irritability & vomiting that initially was clear then become bilious. The child is lethargic between the pain episodes and he passes dark red stool. Abdomen is mildly tender with an ill-defined mass in upper right quadrant. What is most likely diagnosis:

A a. Intussusception B b. Dysentery C c. Acute appendicitis D d. Constipation.

34. A 1-day-old male born at home is brought to the ER because of bilious vomiting, irritability, poor feeding, lethargy and an acute onset of rectal bleeding. Examination shows a temperature of 38°C, pulse of 170, evidence of poor perfusion and a distended abdomen. What is the most appropriate next step in management:

A a. Plain abdomen x-ray erect B b. IV normal saline C c. Nasogastric tube suction D d. Allof the above.

35. Complications of gastroenteritis include all, except:

A a. Dehydration. B b. Ascites C c. Lactose intolerance. D d. Malnutrition

36. Which is true about acidosis following severe gastroenteritis:

A a. Acidosis is more common than alkalosis B b. Acidosis is especially noticed when diarrhoea is severe C c. Metabolic acidosis is associated with increased rate and depth of respiration D d. All the above.

37. A mother complained that her 2-month old boy is not putting on weight because he has persistent projectile vomiting that follows each meal. On examination, there was an olive like mass on palpating his upper abdomen. What is your diagnosis?

A a. Umbilical hernia B b. Congenital pyloric stenosis C c. Rumination. D d. None of the above.

38. What investigation do you recommend?

A a. Abdominal ultrasound. B b. Endoscopy C c. Barium enema. D d. None of the above.

39. Causes of non-infective diarrhea include all except:

A a. Hypothyroidism B b. Hirschsprung’s disease C c. Malabsorption D d. Dietary errors

40. Which of the following maybe a pre-renal cause for acute renal failure:

A a. Bladder stones B b. Gastroenteritis C c. Immune thrombocytopenic purpura D d. Glomerulonephritis.

41. The commonest electrolyte and acid/base disturbance in acute diarrhea include all the following, except:

A a. Hyponatremia B b. Hypokalemia C c. Acidosis. D d. Alkalosis

42. All the following are expected in hypertonic dehydration, except:

A a. Moist tongue B b. Serum sodium above 150 mEq/L C c. Water loss more than sodium loss D d. Water shifts from IC compartment to ECcompartment

43. Watery diarrhea is caused by all except:

A a. Campylobacter B b. Giardiasis C c. Cholera D d. Rotavirus

44. Causes of hypokalemia include:

A a. Diarrhea B b. Vomiting C c. Inhaled salbutamol D d. Allof the above.

45. Minimal fluid requirement of a 6-month-old infant with mild diarrhea is:

A a. 50mUkg. B b. 75mUkg C c. 150mUkg D d. 300mUkg

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