NSG6435 Final Questions and Answers Rated A

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NSG6435 Final Questions and Answers Rated A GER ✔✔uncomplicated recurrent spitting & vomiting in healthy infants that resolves spontaneously GERD ✔✔: is present when reflux causes secondary symptoms or complications GERD Test ✔✔UGI when anatomic etiologies of recurrent vomiting are considered, but should not be considered to be a test for GER and GERD pharmacotherapy ✔✔•There is no sufficient evidence to support the use of prokinetic agents for GERD Rx •Medications are usually not recommended unless pathologic GER has been demonstrated EOE ✔✔•Occurs in all ages, most frequently ♂ •Initial presentation feeding dysfunction & vague nonspecific S/S GERD -abd. pain, vomiting & regurgitation •History -Personal & FMH atopy, asthma, dysphagia, heartburn, feeding dysfunction, or food impaction -Young children- lengthy chewing, long mealtimes, washing food down w liquids & avoiding highly textured foods -Adolescents - solid food dysphagia, acute & recurrent food impactions •Suspect EoE when S/S unresponsive to Rx Most common complications: esophageal food impaction and stricture EOE treatment ✔✔-Fluticasone BID puffed in the mouth and swallow, do not rinse mouth for 30 minutes H. Pylori treatment ✔✔-: 7-10 days Amoxil + clarithromycin + PPI. Be aware of abx. resistance to biaxin, if so consider metronidazole, imidazole levofloxacin •Sequential Rx for Biaxin resistance: Amoxil + PPI x5 days, then Biaxin+Flagyl+PPI x 5 days Intussusception treatment ✔✔•Reduction should not be attempted if signs of strangulated bowel, perforation or toxicity present -surgery is required. Acute appendicitis ✔✔•Incidence of perforation high (40%) esp. younger kids (<2 y/o) -pain is poorly localized & S/S are nonspecific-high fever perforation very high Acute appendicitis PE ✔✔-Peri-umbilical pain at palpation, initially -+ McBurney's point tenderness -+ Rovsing's sign: palpation LLQ ↑ pain in RLQ -+ Psoas sign: passively extending thigh of pt. lying on side w knees extended (or flexing thigh at the hip) ↑ pain -+ Obturator sign: while child lies on back with hip & knee flexed at 90 degrees , examiner rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to move only inward. This is flexion and internal rotation of the hip. -+ Reboundness: not always reliable & very painful for child Celiac Disease, who to test? ✔✔•Screening is recommended for patients with suggestive symptoms, and also for children in groups at ↑risk for having the disease, regardless of symptoms. •***Screening of asymptomatic patients who do not have risk factors is not generally recommended. *** •North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) recommend serologic screening to be performed in children with the classic clinical features and high-risk groups, provided they are on a gluten-containing diet

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