Pediatric (EOR): Gastrointestinal/Nutritional System
(Smarty PANCE) Questions With Complete Solutions
What is the first-line medication for pediatric GERD?
H2 receptor antagonists (ranitidine - now withdrawn,
famotidine) or PPIs (omeprazole, lansoprazole) for proven
GERD
What diagnostic tests are used for pediatric GERD?
Upper GI series (r/o anatomic abnormalities), pH probe (gold
standard), upper endoscopy (if complications suspected)
What is the most common cause of acute viral hepatitis in
children?
Hepatitis A virus (HAV) - fecal-oral transmission, common in
daycare settings
What are the classic symptoms of acute hepatitis in children?
Jaundice, dark urine, pale stools, hepatomegaly, abdominal pain,
fatigue; children often asymptomatic (especially HAV)
How is Hepatitis A transmitted and prevented?
Fecal-oral transmission; Prevention: HAV vaccine at 12-23
months (2-dose series), good hand hygiene
What hepatitis viruses cause chronic infection?
Hepatitis B and Hepatitis C - can lead to cirrhosis and
hepatocellular carcinoma
How is vertical transmission of Hepatitis B prevented?
,HBIG + HBV vaccine within 12 hours of birth to infants of
HBsAg-positive mothers
What laboratory findings are seen in acute hepatitis?
Markedly elevated AST/ALT (>1000 U/L), elevated bilirubin
(direct and indirect), prolonged PT/INR if severe
What is the treatment for acute Hepatitis A in children?
Supportive care only - self-limited infection; post-exposure
prophylaxis with HAV vaccine or immune globulin within 2
weeks
What chronic hepatitis requires treatment in children?
Chronic Hepatitis B (antiviral therapy if active disease) and
Hepatitis C (direct-acting antivirals - cure rate >95%)
What is Hirschsprung disease?
Congenital absence of ganglion cells in distal colon
(aganglionosis) leading to functional obstruction
What is the most common location of aganglionosis in
Hirschsprung?
Rectosigmoid region (80% of cases); can extend proximally in
severe cases (total colonic aganglionosis rare)
What is the classic presentation of Hirschsprung in newborns?
Failure to pass meconium within 48 hours of birth (90% of
cases), abdominal distention, bilious vomiting
What is the presentation of Hirschsprung in older
infants/children?
, Chronic constipation since birth, failure to thrive, abdominal
distention, explosive stools after rectal exam
What is the most serious complication of Hirschsprung disease?
Hirschsprung-associated enterocolitis (HAEC) - life-threatening
with fever, explosive diarrhea, sepsis; high mortality if untreated
What is the gold standard diagnostic test for Hirschsprung?
Rectal suction biopsy showing absence of ganglion cells and
hypertrophied nerve fibers
What contrast enema finding suggests Hirschsprung?
Transition zone between dilated proximal colon and narrow
distal aganglionic segment; delayed evacuation of contrast at 24
hours
What is the definitive treatment for Hirschsprung disease?
Surgical resection of aganglionic segment with pull-through
procedure (Swenson, Duhamel, or Soave procedure)
What is the incidence of inguinal hernias in premature vs term
infants?
Premature infants: 13-30% incidence; Term infants: 1-5%
incidence; male predominance 6:1
What is the most common type of pediatric inguinal hernia?
Indirect inguinal hernia due to patent processus vaginalis (95-
97% of cases)
What is the classic presentation of pediatric inguinal hernia?
(Smarty PANCE) Questions With Complete Solutions
What is the first-line medication for pediatric GERD?
H2 receptor antagonists (ranitidine - now withdrawn,
famotidine) or PPIs (omeprazole, lansoprazole) for proven
GERD
What diagnostic tests are used for pediatric GERD?
Upper GI series (r/o anatomic abnormalities), pH probe (gold
standard), upper endoscopy (if complications suspected)
What is the most common cause of acute viral hepatitis in
children?
Hepatitis A virus (HAV) - fecal-oral transmission, common in
daycare settings
What are the classic symptoms of acute hepatitis in children?
Jaundice, dark urine, pale stools, hepatomegaly, abdominal pain,
fatigue; children often asymptomatic (especially HAV)
How is Hepatitis A transmitted and prevented?
Fecal-oral transmission; Prevention: HAV vaccine at 12-23
months (2-dose series), good hand hygiene
What hepatitis viruses cause chronic infection?
Hepatitis B and Hepatitis C - can lead to cirrhosis and
hepatocellular carcinoma
How is vertical transmission of Hepatitis B prevented?
,HBIG + HBV vaccine within 12 hours of birth to infants of
HBsAg-positive mothers
What laboratory findings are seen in acute hepatitis?
Markedly elevated AST/ALT (>1000 U/L), elevated bilirubin
(direct and indirect), prolonged PT/INR if severe
What is the treatment for acute Hepatitis A in children?
Supportive care only - self-limited infection; post-exposure
prophylaxis with HAV vaccine or immune globulin within 2
weeks
What chronic hepatitis requires treatment in children?
Chronic Hepatitis B (antiviral therapy if active disease) and
Hepatitis C (direct-acting antivirals - cure rate >95%)
What is Hirschsprung disease?
Congenital absence of ganglion cells in distal colon
(aganglionosis) leading to functional obstruction
What is the most common location of aganglionosis in
Hirschsprung?
Rectosigmoid region (80% of cases); can extend proximally in
severe cases (total colonic aganglionosis rare)
What is the classic presentation of Hirschsprung in newborns?
Failure to pass meconium within 48 hours of birth (90% of
cases), abdominal distention, bilious vomiting
What is the presentation of Hirschsprung in older
infants/children?
, Chronic constipation since birth, failure to thrive, abdominal
distention, explosive stools after rectal exam
What is the most serious complication of Hirschsprung disease?
Hirschsprung-associated enterocolitis (HAEC) - life-threatening
with fever, explosive diarrhea, sepsis; high mortality if untreated
What is the gold standard diagnostic test for Hirschsprung?
Rectal suction biopsy showing absence of ganglion cells and
hypertrophied nerve fibers
What contrast enema finding suggests Hirschsprung?
Transition zone between dilated proximal colon and narrow
distal aganglionic segment; delayed evacuation of contrast at 24
hours
What is the definitive treatment for Hirschsprung disease?
Surgical resection of aganglionic segment with pull-through
procedure (Swenson, Duhamel, or Soave procedure)
What is the incidence of inguinal hernias in premature vs term
infants?
Premature infants: 13-30% incidence; Term infants: 1-5%
incidence; male predominance 6:1
What is the most common type of pediatric inguinal hernia?
Indirect inguinal hernia due to patent processus vaginalis (95-
97% of cases)
What is the classic presentation of pediatric inguinal hernia?
