NR602
FINAL EXAM
STUDY GUIDE PEDIATRIC GASTROINTESTINAL & GENITOURINARY
LATEST UPDATE 2026
✓ This study guide provides a comprehensive review of pediatric
gastrointestinal and genitourinary conditions commonly tested
in NR602. It covers key clinical presentations, assessment
findings, diagnostic criteria, management strategies,
pharmacologic treatments, differential diagnoses, and patient
education. Emphasis is placed on early recognition, evidence-
based interventions, and family-centered care to improve
pediatric outcomes.
MBOFFIN
,Know for each condition: Pharmacologic management, physical assessment findings,
differential diagnoses, patient education and recommended follow-up, and clinical
decision-making using evidence-based guidelines
Literature: Lee, D., Starr, N. B., Brady, M. A., Gaylord, N. M., Driessnack, M., C Duderstadt,
K. (2020). Burns' pediatric primary care (7th ed.). Elsevier.
Week Five: Pediatric Gastrointestinal, Genitourinary, and
Endocrine/Metabolic Conditions
Chapter 40: Gastrointestinal Disorders
Chapter 41: Genitourinary Disorders
Chapter 45: Endocrine and Metabolic Disorders, pp. 952–964
Gastrointestinal
Dehydration
• Key clinical assessment
o Mild: thirsty, normal mentation, ±slightly dry mucosa, minimal tachycardia.
o Moderate: tachycardia, dry mucous membranes, decreased tears,
decreased urine output, delayed capillary refill (2–3 s).
o Severe: lethargy/irritability, very delayed cap refill (>3 s), hypotension, poor
peripheral pulses, anuria.
o Physical exam findings: weight loss (if known), sunken fontanel (infants),
decreased skin turgor, dry mucosa, decreased tears/urine.
• Pharmacologic / fluid management
o First-line: Oral Rehydration Therapy (ORT) for mild–moderate dehydration
(ORS like Pedialyte). Replace deficits with age/weight-based volumes:
▪ Offer young children 20 ml/kg per hour
▪ Offer older children 100 mL of ORS every 5 minutes
▪ Combine with IV therapy as needed
▪ Reassess after 4 hours; repeat if needed
▪ Avoid juice, soft drinks, and sports drinks
o Severe dehydration / shock: Isotonic IV bolus (lactated ringers, normal saline
if LR not available) repeated as needed guided by perfusion and mental
status; obtain labs concurrently.
▪ Under 1 year:
• 30 ml/kg over the first hour
• 70 ml/kg for the following 6 hours
, • 100 ml/kg from 6 to 24 hours.
▪ Over 1 year:
• 30 ml/kg over the first 30 minutes
• 70 ml/kg for the following 3 hours.
▪ Reassess every 15 to 30 minutes
• Differential diagnoses
o Sepsis, diabetic ketoacidosis (DKA), adrenal crisis, intestinal obstruction,
metabolic disorders.
• Patient education C follow-up
o Teach ORS dosing, avoid undiluted juice/ soda; encourage small frequent
sips if vomiting. Red flags: persistent lethargy, decreased urine, poor oral
intake — return immediately. Follow up within 24–48 hours if not improving.
• Clinical decision-making (evidence-based)
o Use clinical dehydration severity (history + exam) to choose ORT vs IV fluids.
Attempt ORT for most non-shocked children; escalate to IV if shock, inability
to tolerate ORS, or persistent severe dehydration.
Colic (signs and symptoms, treatment recommendations)
• Presentation / assessment
o Paroxysmal inconsolable crying in otherwise healthy infant, often starting in
first weeks and peaking ~6 weeks; rule of “Wessel’s”: cry >3 hours/day, >3
days/week, >3 weeks. Crying often in evenings, with drawing up legs.
Examine for feeding, stooling pattern, growth, red flags (vomiting, fever, poor
weight gain).
• Management (non-pharmacologic first)
o Parent education C reassurance: normal self-limited condition; techniques
like soothing, swaddling, movement, white noise, parental coping strategies,
structured support.
, o Pharmacologic: limited role. If suspected cow’s milk protein intolerance and
history supports, consider trial of maternal elimination (breastfeeding) or
hydrolyzed formula; simethicone and probiotics have mixed evidence; use
cautiously and recognize limited benefit.
• Differential diagnoses
o GERD, milk protein allergy, infection, intestinal obstruction, intussusception
(if pain severe/intermittent), neurologic/behavioral issues.
• Patient education C follow-up
o Reassure that colic typically improves by 3–4 months. Provide resources for
parental support and safety (avoid shaking), return promptly for poor weight
gain, vomiting, fever, or abnormal exam. Follow up within 1–2 weeks if
ongoing concerns.
• Clinical decision-making
o Prioritize red-flag exclusion (growth, exam). Try nonpharmacologic
interventions first; consider limited trials of dietary change if history suggests
allergy. Document support/referral for parental mental health if stress is
high.
Appendicitis
• Presentation / assessment
o Periumbilical pain migrating to RLQ (McBurney point), anorexia,
nausea/vomiting, fever, guarding, rebound. In young kids, presentation may
be atypical with diffuse pain, lethargy. Consider appendicitis in any child
with persistent abdominal pain.
o Physical exam findings
▪ RLQ tenderness, guarding, rebound, Rovsing sign, psoas/obturator
signs (variable in kids). Fever and leukocytosis support but are not
definitive.
o Labs / imaging
▪ CBC (WBC), CRP can support suspicion. Ultrasound is recommended
first-line imaging in children due to no radiation; CT if US inconclusive
or high clinical suspicion and US not diagnostic. Use clinical scoring
(PAS, Alvarado) to stratify risk but not to replace clinical judgment.
• Pharmacologic / surgical management
o Definitive: appendectomy for non-perforated and perforated cases (timing
individualized; some evidence supports not delaying appendectomy >24 h if
needed). Preoperative IV fluids, analgesia, and antibiotics for perforated or
complicated cases. Perioperative antibiotics per local surgical guidelines.
FINAL EXAM
STUDY GUIDE PEDIATRIC GASTROINTESTINAL & GENITOURINARY
LATEST UPDATE 2026
✓ This study guide provides a comprehensive review of pediatric
gastrointestinal and genitourinary conditions commonly tested
in NR602. It covers key clinical presentations, assessment
findings, diagnostic criteria, management strategies,
pharmacologic treatments, differential diagnoses, and patient
education. Emphasis is placed on early recognition, evidence-
based interventions, and family-centered care to improve
pediatric outcomes.
MBOFFIN
,Know for each condition: Pharmacologic management, physical assessment findings,
differential diagnoses, patient education and recommended follow-up, and clinical
decision-making using evidence-based guidelines
Literature: Lee, D., Starr, N. B., Brady, M. A., Gaylord, N. M., Driessnack, M., C Duderstadt,
K. (2020). Burns' pediatric primary care (7th ed.). Elsevier.
Week Five: Pediatric Gastrointestinal, Genitourinary, and
Endocrine/Metabolic Conditions
Chapter 40: Gastrointestinal Disorders
Chapter 41: Genitourinary Disorders
Chapter 45: Endocrine and Metabolic Disorders, pp. 952–964
Gastrointestinal
Dehydration
• Key clinical assessment
o Mild: thirsty, normal mentation, ±slightly dry mucosa, minimal tachycardia.
o Moderate: tachycardia, dry mucous membranes, decreased tears,
decreased urine output, delayed capillary refill (2–3 s).
o Severe: lethargy/irritability, very delayed cap refill (>3 s), hypotension, poor
peripheral pulses, anuria.
o Physical exam findings: weight loss (if known), sunken fontanel (infants),
decreased skin turgor, dry mucosa, decreased tears/urine.
• Pharmacologic / fluid management
o First-line: Oral Rehydration Therapy (ORT) for mild–moderate dehydration
(ORS like Pedialyte). Replace deficits with age/weight-based volumes:
▪ Offer young children 20 ml/kg per hour
▪ Offer older children 100 mL of ORS every 5 minutes
▪ Combine with IV therapy as needed
▪ Reassess after 4 hours; repeat if needed
▪ Avoid juice, soft drinks, and sports drinks
o Severe dehydration / shock: Isotonic IV bolus (lactated ringers, normal saline
if LR not available) repeated as needed guided by perfusion and mental
status; obtain labs concurrently.
▪ Under 1 year:
• 30 ml/kg over the first hour
• 70 ml/kg for the following 6 hours
, • 100 ml/kg from 6 to 24 hours.
▪ Over 1 year:
• 30 ml/kg over the first 30 minutes
• 70 ml/kg for the following 3 hours.
▪ Reassess every 15 to 30 minutes
• Differential diagnoses
o Sepsis, diabetic ketoacidosis (DKA), adrenal crisis, intestinal obstruction,
metabolic disorders.
• Patient education C follow-up
o Teach ORS dosing, avoid undiluted juice/ soda; encourage small frequent
sips if vomiting. Red flags: persistent lethargy, decreased urine, poor oral
intake — return immediately. Follow up within 24–48 hours if not improving.
• Clinical decision-making (evidence-based)
o Use clinical dehydration severity (history + exam) to choose ORT vs IV fluids.
Attempt ORT for most non-shocked children; escalate to IV if shock, inability
to tolerate ORS, or persistent severe dehydration.
Colic (signs and symptoms, treatment recommendations)
• Presentation / assessment
o Paroxysmal inconsolable crying in otherwise healthy infant, often starting in
first weeks and peaking ~6 weeks; rule of “Wessel’s”: cry >3 hours/day, >3
days/week, >3 weeks. Crying often in evenings, with drawing up legs.
Examine for feeding, stooling pattern, growth, red flags (vomiting, fever, poor
weight gain).
• Management (non-pharmacologic first)
o Parent education C reassurance: normal self-limited condition; techniques
like soothing, swaddling, movement, white noise, parental coping strategies,
structured support.
, o Pharmacologic: limited role. If suspected cow’s milk protein intolerance and
history supports, consider trial of maternal elimination (breastfeeding) or
hydrolyzed formula; simethicone and probiotics have mixed evidence; use
cautiously and recognize limited benefit.
• Differential diagnoses
o GERD, milk protein allergy, infection, intestinal obstruction, intussusception
(if pain severe/intermittent), neurologic/behavioral issues.
• Patient education C follow-up
o Reassure that colic typically improves by 3–4 months. Provide resources for
parental support and safety (avoid shaking), return promptly for poor weight
gain, vomiting, fever, or abnormal exam. Follow up within 1–2 weeks if
ongoing concerns.
• Clinical decision-making
o Prioritize red-flag exclusion (growth, exam). Try nonpharmacologic
interventions first; consider limited trials of dietary change if history suggests
allergy. Document support/referral for parental mental health if stress is
high.
Appendicitis
• Presentation / assessment
o Periumbilical pain migrating to RLQ (McBurney point), anorexia,
nausea/vomiting, fever, guarding, rebound. In young kids, presentation may
be atypical with diffuse pain, lethargy. Consider appendicitis in any child
with persistent abdominal pain.
o Physical exam findings
▪ RLQ tenderness, guarding, rebound, Rovsing sign, psoas/obturator
signs (variable in kids). Fever and leukocytosis support but are not
definitive.
o Labs / imaging
▪ CBC (WBC), CRP can support suspicion. Ultrasound is recommended
first-line imaging in children due to no radiation; CT if US inconclusive
or high clinical suspicion and US not diagnostic. Use clinical scoring
(PAS, Alvarado) to stratify risk but not to replace clinical judgment.
• Pharmacologic / surgical management
o Definitive: appendectomy for non-perforated and perforated cases (timing
individualized; some evidence supports not delaying appendectomy >24 h if
needed). Preoperative IV fluids, analgesia, and antibiotics for perforated or
complicated cases. Perioperative antibiotics per local surgical guidelines.
