Pediatric Vomiting Practice Quiz (24 questions)

Explanation

Initial evaluation includes identifying the vomiting pattern, reviewing abdominal, respiratory, and neurologic symptoms, and asking about diet and medication use. Hydration and family history may be relevant clinically, but they do not replace the specified initial assessment.

Explanation

Gastric stasis and paralytic ileus may follow surgery, as well as arise from other causes such as neuropathy, drugs, or electrolyte disturbances. Pseudo-obstruction is also associated with neuropathy, but it is described as a rare chronic disorder of intermittent ileus rather than a postoperative effect in this unit.

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With rotavirus, vomiting often precedes diarrhea by one to two days. The sequence in which diarrhea comes first is the documented confusion, not the typical pattern.

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Volvulus is the twisting of bowel on the mesentery and generally occurs in the context of congenital intestinal malrotation. Malrotation is the congenital abnormality itself, not the twisting event.

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True vomiting is a forceful ejection and often involves nausea and retching, whereas regurgitation is effortless or nearly effortless. Rechewing food characterizes rumination, not regurgitation in general.

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In this syndrome, the superior mesenteric artery lies anterior to the duodenum and the aorta lies posterior to it, producing transient obstruction. Compression of the stomach between the liver and abdominal wall describes a different anatomical relationship.

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Metabolic disorders may produce vomiting episodes with acidosis, mental deterioration, and coma, and relevant family history may include neonatal deaths or unexplained developmental and growth problems. A family history of seasonal allergies does not reflect the concerning inherited pattern described.

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Mental status changes together with abnormal respirations may indicate ingestion of a toxic drug or poison. Sinusitis can contribute to vomiting, but it does not account for this warning combination.

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Food hypersensitivity can cause vomiting and commonly involves cow’s milk or soy protein; both non-IgE conditions and IgE-mediated food allergy are possible. Psychogenic vomiting is not the appropriate explanation before organic causes have been ruled out.

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Bilious vomiting, involuntary guarding, rebound tenderness, and abdominal rigidity are among the signs of an acute abdomen. Progressive headache and an abnormal funduscopic examination instead suggest increased intracranial pressure.

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Psychogenic vomiting should be diagnosed only after organic causes have been ruled out. A food trigger or surgical history may point toward an organic explanation, but neither is a prerequisite for considering psychogenic vomiting.

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Esophageal stenosis, volvulus, duodenal webs, and annular pancreas are congenital obstructive lesions, which usually present acutely in newborns but may present later with partial obstruction. Postoperative adhesions and inflammatory or mucosal disease are acquired causes rather than congenital lesions.

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Acute vomiting in the context of an acute abdomen requires immediate surgical consultation. Outpatient observation is not an appropriate substitute when an acute abdomen is present.

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Early-morning vomiting, progressive headaches, absence of nausea, and an abnormal funduscopic examination are findings suggestive of increased intracranial pressure. An acute abdominal process is suggested by abdominal signs such as tenderness, guarding, or rigidity.

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Many newborns with intestinal malrotation present with volvulus, bilious vomiting, and severe clinical toxicity. Intermittent vomiting years later is another possible presentation, but it does not describe the common severe neonatal pattern.

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Peptic ulcer disease can cause nocturnal awakening, gastrointestinal bleeding, meal-related symptoms, or nonspecific symptoms, especially in young children. Gastroesophageal reflux can cause regurgitation, but it does not account as directly for the ulcer-related symptom range described.

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Infant gastroesophageal reflux commonly appears as near-effortless regurgitation and may include arching associated with Sandifer syndrome. True vomiting is characterized by forceful ejection, rather than effortless regurgitation.

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A prone or knee-chest position may relieve symptoms by changing the anatomical relationship involved in the obstruction. Lying supine with the legs extended is not the position associated with symptom relief.

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Cyclic recurrent vomiting is characterized by infrequent episodes that can be acutely severe, with forceful vomiting more than four to six times per hour. Chronic recurrent vomiting is generally lower intensity, and affected children are usually not acutely ill.

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Older children with ureteropelvic junction obstruction often have intermittent abdominal or flank pain with vomiting, while examination and urinalysis may be normal or show a mass or hematuria. Early-morning vomiting with congestion and postnasal drip instead suggests a sinus-related cause.

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Most inborn errors of metabolism present early in the newborn period, but some cause later chronic or cyclic vomiting after certain foods are introduced or during stress or illness. The claim that newborn presentation is uncommon reverses the typical timing.

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Vomiting accompanied by neurologic symptoms or unusual odors from the breath, urine, or ear wax warrants consideration of a metabolic workup. An evaluation limited to sinus drainage would not address these metabolic warning signs.

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In suspected reflux without life-threatening symptoms such as apnea, a trial of an H₂ blocker or proton pump inhibitor may be diagnostic. Apnea often prompts additional study rather than relying on an acid-suppression trial alone.

Explanation

Pyloric stenosis typically appears in the first few weeks of life with progressive, often projectile, nonbilious vomiting; poor weight gain or later coffee-ground emesis may also occur. Bilious vomiting suggests a different obstructive pattern.