CGRN Pediatric Gastroenterology 1 — Questions and Answers
Question 1: Which finding differentiates pyloric stenosis from GERD in a 4-week-old infant?
- Projectile non-bilious vomiting after feeding (Correct answer)
- Bilious vomiting with abdominal distension
- Bloody mucousy stools
- Watery diarrhea after feeding
Correct answer: Projectile non-bilious vomiting after feeding
Pyloric stenosis presents with forceful, projectile, non-bilious vomiting due to gastric outlet obstruction, typically at 2–8 weeks of age.
Question 2: Which pediatric GI condition is characterized by absence of ganglion cells in the distal colon?
- Intussusception
- Hirschsprung disease (Correct answer)
- Meckel's diverticulum
- Celiac disease
Correct answer: Hirschsprung disease
Hirschsprung disease results from failure of neural crest cell migration, leaving a segment of colon without enteric ganglion cells and unable to relax.
Question 3: The classic triad of intussusception in a toddler includes colicky abdominal pain, vomiting, and which other finding?
- Watery diarrhea
- Currant-jelly stools (Correct answer)
- Bilious emesis
- High fever above 40°C
Correct answer: Currant-jelly stools
Currant-jelly stools result from mucosal ischemia and sloughing caused by the invaginated bowel obstructing blood supply.
Question 4: An infant with necrotizing enterocolitis (NEC) on X-ray will most likely show which finding?
- Intraluminal air-fluid levels only
- Pneumatosis intestinalis (Correct answer)
- Calcified meconium
- Dilated stomach with no distal gas
Correct answer: Pneumatosis intestinalis
Pneumatosis intestinalis — air within the bowel wall — is the pathognomonic radiographic finding of necrotizing enterocolitis.
Question 5: Which condition should be ruled out first in a child presenting with painless rectal bleeding and a Meckel's scan?
- Hemorrhoids
- Meckel's diverticulum with ectopic gastric mucosa (Correct answer)
- Anal fissure
- Juvenile polyp
Correct answer: Meckel's diverticulum with ectopic gastric mucosa
Meckel's diverticulum with ectopic gastric mucosa secretes acid that ulcerates adjacent ileum, causing painless rectal bleeding detectable by technetium-99m scan.
Question 6: At what age should the CGRN nurse anticipate that pediatric colonoscopy requires general anesthesia rather than conscious sedation?
- All pediatric patients regardless of age require general anesthesia
- Typically children under 12 years require general anesthesia or deep sedation (Correct answer)
- Only neonates require general anesthesia
- Age is not a factor; weight is the only determinant
Correct answer: Typically children under 12 years require general anesthesia or deep sedation
Children under 12 years typically require deep sedation or general anesthesia for colonoscopy due to inability to cooperate and higher anxiety compared to adults.
CGRN Pediatric Gastroenterology 1
Which finding differentiates pyloric stenosis from GERD in a 4-week-old infant?