XII. Gastrointestinal disorders
2002 Self-Assessment Exercise —
XII. Gastrointestinal disorders
[Return to Category List]
Questions
Question 13. Answer.
A 3-year-old child is brought to the emergency department with a fever of 103.1°F (39.5°C)
and diarrhea of acute onset. The stool is guaiac-positive and contains leukocytes. There is no
history of foreign travel, and the child has not received antibiotics recently.
Of the following, the organism that is MOST likely to be isolated from this child's stool is:
A. Clostridium difficile
B. Giardia lamblia
C. rotavirus
D. Salmonella enteritidis
E. Vibrio cholerae
Question 35. Answer.
A healthy 8-month-old infant is brought to your office for a routine health supervision visit.
On physical examination, the edge of the liver is palpable 2.0 cm below the right costal
border and has a span of 5 cm.
Of the following, the MOST appropriate evaluation for this infant is:
A. consultation with a gastroenterologist
B. hepatic ultrasonography
C. laboratory testing for hepatitis
D. repeat examination in 2 weeks to assess liver size
E. routine health supervision visit at 1 year of age
Question 61. Answer.
A 16-year-old girl comes to your office for evaluation of abdominal pain that started 3 days
ago and is associated with vomiting. Physical examination reveals icterus, but no
hepatomegaly.
Of the following, the study that is MOST definitive in establishing the cause of this girl's
symptoms is:
,A. abdominal radiography
B. abdominal ultrasonography
C. measurement of aspartate aminotransferase
D. measurement of serum lipase
E. upper gastrointestinal radiographic series
Question 84. Answer.
You are evaluating a 12-year-old boy who has ulcerative colitis for fatigue, weight loss, and
jaundice. The ulcerative colitis has been in remission while he has been receiving 5-amino
salicylate therapy.
Of the following, the MOST likely cause of this child's symptoms is:
A. cholelithiasis
B. fatty infiltration of the liver
C. hepatic abscess
D. hepatitis B infection
E. sclerosing cholangitis
Question 107. Answer.
A mother brings in her 2-month-old child, explaining that the infant was having bloody
diarrhea and abdominal distension while receiving milk-based formula. Her brother-in law,
who is a physician, tested the child and diagnosed milk protein intolerance. She asks you
what therapy should be started for this intolerance.
Of the following, the BEST treatment for milk protein intolerance is to:
A. administer allergy immunotherapy for milk protein
B. allow only small amounts of milk products
C. completely avoid all milk products for 1 to 2 years
D. make no dietary changes
E. only allow milk proteins that have been cooked
Question 137. Answer.
The mother of a 10-month-old boy, who has been diagnosed as having mild mental
retardation, reports that he frequently regurgitates food that he then chews and reswallows.
Prior to the regurgitation, he contracts his abdominal muscles aggressively. This action seems
to have a calming effect.
,Of the following, the MOST likely cause of this behavior is:
A. achalasia
B. gastric outlet obstruction
C. gastroesophageal reflux
D. rumination syndrome
E. Sandifer syndrome
Question 162. Answer.
A 14-year-old adolescent is brought to the emergency department for evaluation of
hematochezia. Physical examination reveals pallor, tachycardia, and hypotension, but no
hepatosplenomegaly or abdominal tenderness.
After obtaining laboratory tests, the MOST appropriate next step in management is:
A. abdominal ultrasonography
B. emergent colonoscopy
C. Meckel scan
D. placement of a nasogastric tube
E. upper gastrointestinal radiographic series
Question 185. Answer.
A healthy 15-month-old male infant is brought to your office for evaluation of diarrhea. His
growth, weight gain, activity, and appetite have been normal. The first stool of the day
appears normal, but they become increasingly loose and frequent as the day progresses.
Of the following, your BEST advice to the mother is to:
A. avoid fiber-containing foods
B. initiate the intake of balanced electrolyte solutions
C. limit the intake of fluids and fruit juice
D. restrict the intake of fatty foods
E. substitute lactose-free for other dairy products
Question 208. Answer.
A 3-year-old child has a history of abdominal distension and rectal prolapse. Rectal
examination reveals decreased anal tone and stool at the anal verge. Abdominal radiography
shows a distended large intestine and stool in the distal colon and rectum.
, Of the following, the MOST likely cause of this child's symptoms is:
A. cystic fibrosis
B. functional constipation
C. Hirschsprung disease
D. hypothyroidism
E. intestinal pseudo-obstruction
Question 234. Answer.
A 15-year-old boy comes to your office for evaluation of vomiting. He explains that the
episodes occur every 3 months and last 48 hours. The emesis initially contains food particles,
but soon becomes bilious. After 24 hours of vomiting, he becomes dehydrated and requires
administration of intravenous fluids in the emergency department. Between the episodes, he
is asymptomatic.
Of the following, the MOST likely etiology of this vomiting is:
A. cyclic vomiting
B. food allergy
C. giardiasis
D. gluten sensitivity
E. recurrent viral gastroenteritis
Question 255. Answer.
A 3-month-old male infant is jaundiced and febrile. He underwent a Kasai procedure for
biliary atresia 1 month ago. Laboratory tests reveal a white blood cell count of 15,300/cu mm
(15.3 x 109/L), a total bilirubin concentration of 7.0 mg/dL (119.7 mcmol/L), and a direct
bilirubin of 3.5 mg/dL (59.9 mcmol/L).
Of the following, the MOST likely cause of his symptoms is:
A. ascending cholangitis
B. biliary obstruction
C. Caroli disease
D. infectious hepatitis
E. sclerosing cholangitis
Answers
2002 Self-Assessment Exercise —
XII. Gastrointestinal disorders
[Return to Category List]
Questions
Question 13. Answer.
A 3-year-old child is brought to the emergency department with a fever of 103.1°F (39.5°C)
and diarrhea of acute onset. The stool is guaiac-positive and contains leukocytes. There is no
history of foreign travel, and the child has not received antibiotics recently.
Of the following, the organism that is MOST likely to be isolated from this child's stool is:
A. Clostridium difficile
B. Giardia lamblia
C. rotavirus
D. Salmonella enteritidis
E. Vibrio cholerae
Question 35. Answer.
A healthy 8-month-old infant is brought to your office for a routine health supervision visit.
On physical examination, the edge of the liver is palpable 2.0 cm below the right costal
border and has a span of 5 cm.
Of the following, the MOST appropriate evaluation for this infant is:
A. consultation with a gastroenterologist
B. hepatic ultrasonography
C. laboratory testing for hepatitis
D. repeat examination in 2 weeks to assess liver size
E. routine health supervision visit at 1 year of age
Question 61. Answer.
A 16-year-old girl comes to your office for evaluation of abdominal pain that started 3 days
ago and is associated with vomiting. Physical examination reveals icterus, but no
hepatomegaly.
Of the following, the study that is MOST definitive in establishing the cause of this girl's
symptoms is:
,A. abdominal radiography
B. abdominal ultrasonography
C. measurement of aspartate aminotransferase
D. measurement of serum lipase
E. upper gastrointestinal radiographic series
Question 84. Answer.
You are evaluating a 12-year-old boy who has ulcerative colitis for fatigue, weight loss, and
jaundice. The ulcerative colitis has been in remission while he has been receiving 5-amino
salicylate therapy.
Of the following, the MOST likely cause of this child's symptoms is:
A. cholelithiasis
B. fatty infiltration of the liver
C. hepatic abscess
D. hepatitis B infection
E. sclerosing cholangitis
Question 107. Answer.
A mother brings in her 2-month-old child, explaining that the infant was having bloody
diarrhea and abdominal distension while receiving milk-based formula. Her brother-in law,
who is a physician, tested the child and diagnosed milk protein intolerance. She asks you
what therapy should be started for this intolerance.
Of the following, the BEST treatment for milk protein intolerance is to:
A. administer allergy immunotherapy for milk protein
B. allow only small amounts of milk products
C. completely avoid all milk products for 1 to 2 years
D. make no dietary changes
E. only allow milk proteins that have been cooked
Question 137. Answer.
The mother of a 10-month-old boy, who has been diagnosed as having mild mental
retardation, reports that he frequently regurgitates food that he then chews and reswallows.
Prior to the regurgitation, he contracts his abdominal muscles aggressively. This action seems
to have a calming effect.
,Of the following, the MOST likely cause of this behavior is:
A. achalasia
B. gastric outlet obstruction
C. gastroesophageal reflux
D. rumination syndrome
E. Sandifer syndrome
Question 162. Answer.
A 14-year-old adolescent is brought to the emergency department for evaluation of
hematochezia. Physical examination reveals pallor, tachycardia, and hypotension, but no
hepatosplenomegaly or abdominal tenderness.
After obtaining laboratory tests, the MOST appropriate next step in management is:
A. abdominal ultrasonography
B. emergent colonoscopy
C. Meckel scan
D. placement of a nasogastric tube
E. upper gastrointestinal radiographic series
Question 185. Answer.
A healthy 15-month-old male infant is brought to your office for evaluation of diarrhea. His
growth, weight gain, activity, and appetite have been normal. The first stool of the day
appears normal, but they become increasingly loose and frequent as the day progresses.
Of the following, your BEST advice to the mother is to:
A. avoid fiber-containing foods
B. initiate the intake of balanced electrolyte solutions
C. limit the intake of fluids and fruit juice
D. restrict the intake of fatty foods
E. substitute lactose-free for other dairy products
Question 208. Answer.
A 3-year-old child has a history of abdominal distension and rectal prolapse. Rectal
examination reveals decreased anal tone and stool at the anal verge. Abdominal radiography
shows a distended large intestine and stool in the distal colon and rectum.
, Of the following, the MOST likely cause of this child's symptoms is:
A. cystic fibrosis
B. functional constipation
C. Hirschsprung disease
D. hypothyroidism
E. intestinal pseudo-obstruction
Question 234. Answer.
A 15-year-old boy comes to your office for evaluation of vomiting. He explains that the
episodes occur every 3 months and last 48 hours. The emesis initially contains food particles,
but soon becomes bilious. After 24 hours of vomiting, he becomes dehydrated and requires
administration of intravenous fluids in the emergency department. Between the episodes, he
is asymptomatic.
Of the following, the MOST likely etiology of this vomiting is:
A. cyclic vomiting
B. food allergy
C. giardiasis
D. gluten sensitivity
E. recurrent viral gastroenteritis
Question 255. Answer.
A 3-month-old male infant is jaundiced and febrile. He underwent a Kasai procedure for
biliary atresia 1 month ago. Laboratory tests reveal a white blood cell count of 15,300/cu mm
(15.3 x 109/L), a total bilirubin concentration of 7.0 mg/dL (119.7 mcmol/L), and a direct
bilirubin of 3.5 mg/dL (59.9 mcmol/L).
Of the following, the MOST likely cause of his symptoms is:
A. ascending cholangitis
B. biliary obstruction
C. Caroli disease
D. infectious hepatitis
E. sclerosing cholangitis
Answers
