Pediatric

Question 1

Gastroesophageal Reflux (GER)

Answer 1

GER=return of gastric contents into the esophagus THIS IS A NORMAL PROCESS
GER becomes ‘Spitting up” or vomiting when refluxed material passes out of the mouth
½ of of infants 0-3 months of age vomit at least once a day
2/3 of those 4-6 months do as well
No special treatment is required as infants will grow out of this by 2 years of age

Question 2

Gastroesophageal Reflux Disease (GERD)

Answer 2

Occurs in a small percentage of normal infants but more commonly seen in infants with disabilities
May present as failure to thrive (FTT)
May be esophageal symptoms or respiratory symptoms such as cough, pneumonia, and apnea spells
Only symptom may be irritability
Diagnosis of GERD is difficult as there is no absolute test

Question 3

Genetic Association

Answer 3

An association is a group of anomalies that occur more frequently together than would be expected by chance alone but that do not have a predictable pattern of recognition and/or a suspected unified underlying etiology.
VACTERL association

Question 4

VACTERL association

Answer 4

vertebral- butterfly vertebrae, hemi-vertebrae
anal
cardiac- VSD, ASD, PDA
tracheo-esophageal
renal- solitary kidney, horseshoe kidney)

limb

Question 5

associated urologic malformations with imperforate anus

Answer 5

vesicoureteral reflux
hydronephrosis
unilateral renal agenesis
unilateral renal ectopia
renal hypoplasia
duplication of bladder
crossed ectopy with fusion
posterior urethral valve
duplication of pyelocalyseal system
ureteropelvic junction stenosis
bladder exstrophy

Question 6

genital malformations with imperforate anus

Answer 6

male- cryptorchidism
hypospadiasis
scrotal bifida
penile bifida
epispadias

female- vaginal agenesis
duplication of uterus
bicornated uterus

Question 7

Hypochloremic Metabolic Alkalosis- 5 main major causes

Answer 7

Loss of hydrogen ions -

• Vomiting or nasogastric suction
• Primary mineralocorticoid excess

Renal Hydrogen Loss -

• Primary mineralocorticoid excess
• Loop or thiazide diuretics
• Posthypercapnic alkalosis
• Hypercalcemia and the milk-alkali syndrome

Shift of hydrogen ions into intracellular space -
- Hypokalemia.

Alkalotic agents -
- Alkalotic agents in excess, such as bicarbonate or antacids.

Contraction alkalosis -

• Due to loss of water in the extracellular space from diuretic use.
• Sweat losses in cystic fibrosis
• Villous adenoma or factitious diarrhea

Question 8

The pathogenesis hyperchloremic metabolic alkalosis occurs via 2 mechanisms:

Answer 8

1) Increased plasma bicarbonate concentration due to hydrogen loss in the urine or gastrointestinal tract, hydrogen movement into the cells, the administration of bicarbonate, or volume contraction.
2) A decrease in net renal bicarbonate excretion (or the rise in the net reabsorption) through the kidney.

Question 9

The rise in the net reabsorption of bicarbonate through the kidney occurs through 3 mechanisms:

Answer 9

Decreased circulating volume.

2) Chloride depletion and hypochloremia 
3) Hypokalemia.

Question 10

Pyloric Stenosis

Answer 10

Incidence ranges from 0.1-1.0% of the population and seems to be rising
Male predominance of 4:1
Seems to have a multifactorial genetic component
Cause is unknown but infant and maternal exposure to erythromycin has been identified
Diagnosis can be made by palpation of the pyloric olive or ultrasound