Free Board Review Questions of the Week – Emergency Medicine Pediatric Gastrointestinal

Adam WandermanEM Questions of the Week, Pediatric EM Question of the Week, Question of the Week

Free board review questions of the week on pediatric gastrointestinal

Free Emergency Medicine Pediatric Gastrointestinal board review questions sample from Med-Challenger.

Emergency medicine pediatric gastrointestinal review questions are part of a well-rounded emergency medicine education, and is an essential component of complete patient care. Med-Challenger offers pediatric gastrointestinal review questions and everything else you need to maintain your clinical practice. More free emergency medicine pediatric sample questions can be accessed via this week’s Quick Quiz , and via free trial of Med-Challenger EM review with CME.

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This week’s case-based question:

A 1-week-old girl is brought in by her parents for evaluation of vomiting, difficulty feeding, and lethargy. The infant was born at 39 weeks of gestation, and her mother’s pregnancy was complicated by pre-eclampsia and diabetes requiring insulin. She was delivered by emergent cesarean delivery for fetal hypoxia due to a nuchal cord. She required resuscitation and 24 hours on a ventilator in the neonatal intensive care unit after birth for recurrent episodes of apnea. She was discharged home on the fourth day of life, and she has appeared to be feeding well and growing.

However, on the morning of presentation, the child has been lethargic, irritable, and unwilling to feed. She has had several episodes of large-volume emesis, the last few of which were bilious. Her parents noted dark red blood mixed with the stool in her last diaper.

On examination, the infant appears ill and lethargic. The anterior fontanelle is sunken. His vital signs are: temperature 38.3 °C (101.0 °F), heart rate 220 beats/minute, blood pressure 60/30 mm Hg, respiratory rate 50 breaths/minute, and oxygen saturation 98% on room air. Capillary refill time is 4 seconds.

Abdominal examination demonstrates distension and diffuse tenderness as well as abdominal wall cellulitis. Rebound and guarding are difficult to ascertain. No hernias are appreciable. Her diaper is filled with maroon-colored, Hemoccult positive stool.

Laboratory studies are notable for:
White blood cell count: 18,000/µL
Hemoglobin: 13.0 g/dL
Platelet count: 90,000/µL
Sodium: 131 mEq/L
Bicarbonate: 18 mEq/L
Blood urea nitrogen: 35 mg/dL
Creatinine: 1.4 mg/dL
Glucose: 210 mg/dL

Plain film of the abdomen demonstrates gastric distension, diffuse small and large bowel dilatation, pneumatosis intestinalis, and portal venous gas.

Which of the following is the most likely diagnosis?

Answer Options

malrotation with midgut volvulus
intestinal atresia
necrotizing enterocolitis
pyloric stenosis

And the answer is …

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