CGRN Pediatric Gastroenterology 2 — Questions and Answers
Question 1: Which finding is most concerning for eosinophilic esophagitis (EoE) in a school-age child?
- Intermittent watery diarrhea
- Recurrent food impaction and dysphagia (Correct answer)
- Rectal prolapse
- Painless jaundice
Correct answer: Recurrent food impaction and dysphagia
EoE presents with food impaction and dysphagia in children and adolescents due to eosinophilic infiltration causing esophageal remodeling.
Question 2: In pediatric Crohn's disease, which complication is more common than in adult-onset disease?
- Colorectal cancer
- Growth failure and delayed puberty (Correct answer)
- Primary sclerosing cholangitis
- Pyoderma gangrenosum
Correct answer: Growth failure and delayed puberty
Chronic inflammation and corticosteroid use in pediatric Crohn's disease impairs growth hormone axis, leading to growth failure and delayed puberty.
Question 3: Which is the first-line treatment for H. pylori eradication in pediatric patients according to NASPGHAN guidelines?
- Amoxicillin monotherapy for 14 days
- Triple therapy: PPI + amoxicillin + clarithromycin or metronidazole (Correct answer)
- Bismuth quadruple therapy only
- Sequential therapy is never used in pediatrics
Correct answer: Triple therapy: PPI + amoxicillin + clarithromycin or metronidazole
NASPGHAN recommends PPI-based triple therapy (PPI + amoxicillin + clarithromycin or metronidazole) as first-line H. pylori eradication in children.
Question 4: A nurse is preparing a 7-year-old for upper endoscopy. Which age-appropriate preparation strategy is most effective?
- Withhold all information to avoid increasing anxiety
- Use play therapy and age-appropriate explanation of the procedure (Correct answer)
- Administer anxiolytics without explanation
- Involve parents but exclude the child from education
Correct answer: Use play therapy and age-appropriate explanation of the procedure
Age-appropriate preparation using play therapy and simple explanations reduces procedural anxiety and improves cooperation in school-age children.
Question 5: Which type of rectal bleeding pattern in an infant most suggests allergic proctocolitis?
- Large-volume bright red blood with shock
- Small amounts of blood-streaked mucus in a well-appearing, breastfed infant (Correct answer)
- Black tarry stools
- Bloody diarrhea with fever and dehydration
Correct answer: Small amounts of blood-streaked mucus in a well-appearing, breastfed infant
Allergic proctocolitis presents with blood-streaked mucus in a well-appearing infant, most commonly due to cow's milk protein allergy transmitted through breast milk.
Question 6: Which electrolyte abnormality is characteristic of bilious vomiting from a high intestinal obstruction in a neonate?
- Metabolic acidosis with hyperkalemia
- Metabolic alkalosis with hypokalemia and hypochloremia (Correct answer)
- Hypernatremia with normal pH
- Respiratory acidosis
Correct answer: Metabolic alkalosis with hypokalemia and hypochloremia
Loss of acidic gastric and intestinal secretions through bilious vomiting causes metabolic alkalosis with hypokalemia and hypochloremia.
CGRN Pediatric Gastroenterology 2
Which finding is most concerning for eosinophilic esophagitis (EoE) in a school-age child?