CHAPTER 301-350

8. Which of the following strategies does NOT reduce the risk of dental caries?

A. Application of fluoride varnish semiannually

B. Drinking well water

C. Brushing teeth daily

D. Reducing juice consumption to < 4-6 oz per day

E. Application of plastic dental sealants

18. Esophageal disorders are generally due to obstruction or dysmotility. Which statement regarding these disorder types is NOT true?

A. Obstructive lesions classically produce dysphagia to solids before liquids

B. Disorders of motility usually cause difficulty with liquids before, or concurrent with, difficulty with solids

C. An esophageal web may not present until an infant begins to eat solid food

D. Dysphagia work-up typically begins with fluoroscopy

E. Manometry is used to evaluate suspected obstructive lesions

19. A 5 mo old boy was clinically diagnosed with gastroesophageal reflux at 2 mo of age. Treatment with ranitidine resolved his constant crying and even seemed to improve his spitting. His weight continues in the 50th percentile. On a follow-up visit, however, his parents report that for the past 2 wk he once again has begun frequent regurgitation, hiccups, and irritability. He is breast-fed and is given occasional supplements of cow's milk-based formula. His examination is normal. Which of the following is the most appropriate intervention?

A. Initiate milk avoidance in mother and infant (milk-free diet)

B. Fundoplication

C. Addition of metaclopramide

D. Adjustment of the dose of ranitidine

E. Change to daily antacids

24. A 6 yr old playing with his 18 mo old sibling reports that the toddler put something " shiny" in his mouth. The caregiver could not find anything in the toddler's mouth and brought him to the emergency department. The toddler has a normal exam. The most appropriate action is to:

A. Offer reassurance and discharge.

B. Obtain AP radiograph of the abdomen.

C. Obtain AP and lateral radiographs of the neck and chest and an AP radiograph of the abdomen

D. Have the child eat and drink in the emergency department; if asymptomatic, discharge

E. Proceed to urgent endoscopy

42. A 5 yr old in your practice underwent screening for celiac disease because his mother was recently diagnosed with this condition. His screening test is positive, however he is asymptomatic. Intestinal biopsy is negative. How would you classify this patient, and what are your recommendations to the mother?

A. The child has potential celiac disease and should be monitored for the development of future symptoms; a gluten-free diet is not mandatory

B. The child does not have celiac disease and requires no further testing or dietary intervention

C. The child has latent celiac disease and should start a gluten-free diet

D. The child has celiac disease and should undergo testing for associated autoimmune diseases

E. The child has silent celiac disease and should initiate gluten-free diet

43. Worldwide, infectious diarrhea is responsible for 19% of pediatric deaths. Which of the following pathogens causes the largest fraction of deaths due to gastroenteritis?

A. Clostridium difficile

B. Shigella

C. Norwalk virus

D. Rotavirus

E. Giardia lamblia

46. A 2 yr old child with profuse watery diarrhea for 2 weeks is given a trial of bowel rest (no oral feeding) and IV hydration. Continued diarrhea in this situation would be expected with what etiology?

A. Lactose intolerance

B. Celiac disease

C. Juice overconsumption

D. Secretory diarrhea

E. Osmotic diarrhea

53. A toddler undergoing toilet training had bright red blood noted on the toilet paper. On your exam, a small laceration is seen on the anus, with an adjacent skin tag. The mother reports that he grunts often while producing hard stools. The most appropriate management is:

A. Initiation of daily polyethylene glycol and increased fluid intake

B. Application of petrolatum daily to the area

C. Surgical excision and repair of the fissure

D. None of the above

58. Which statement regarding inguinal hernias in children is NOT true?

A. Over 95% of inguinal hernias in children are congenital indirect

B. One half of all inguinal hernias manifest in the 1st year of life

C. The rate of inguinal hernias in premature infants is near 30%

D. Most inguinal hernias in children are due to failure of the processus vaginalis to obliterate

E. Most congenital inguinal hernias occur on the left side

62. All of the following tests or determinations may be useful in the diagnosis of acute pancreatitis EXCEPT:

A. Serum amylase

B. Serum lipase

C. Abdominal CT

D. Serum elastase

63. A 10 yr old boy develops pancreatitis after a blow to the abdomen. During a 5-day hospitalization he is treated with intravenous fluids and analgesics and is discharged home on a low-fat diet. Four weeks later he has recurrence of abdominal pain and vomiting. The most likely diagnosis is:

A. Functional abdominal pain

B. Duodenal ulcer due to Helicobacter pylori

C. Chronic pancreatitis

D. Hemorrhagic pancreatitis

E. Pancreatic pseudocyst

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