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Flashcards in Random Peds Questions Deck (186)
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1
Q

Which condition uses the rule of 3’s: more than 3 hours, more than 3 days per week, for more than 3 months?

A

Colic

2
Q

What is the criteria for a child to have enuresis?

A

Child over 5 years old

2 times per week

For 3 weeks

3
Q

What is the most common cause of encopresis?

A

Constipation

4
Q

What is the definition of failure to thrive (FTT)?

A

Weight less than 5th percentile on multiple occasions

OR

Weight deceleration that crosses two major percentile lines

5
Q

What is the most common primary nephrotic syndrome and between what ages does it occur?

A

Minimal Change Nephrotic Syndrome

Occurs between ages 1-8

6
Q

What is the leading cause of hypertension in children (according to the lecture)?

A

Vesicoureteral Reflux

7
Q

What is the test of choice for vesicoureteral reflux?

A

Voiding Cystourethrogram (VCUG)

8
Q

What specific gravity is required for a 1+ protein on dipstick to be considering proteinuria and what if it is higher than that?

A

Specific gravity of < 1.015

If higher than this… needs to be 2+ protein.

9
Q

What conditions should imaging be done for a child with a UTI?

A

Child with 1st UTI before age 5

Febrile UTI

Recurring UTI

Male with UTI

10
Q

What is heme-positive urine caused by and what do each of these indicate?

A

Hemaglobinuria = presence of hemoglobin free from red blood cells – caused by hemolytic anemia

Myoglobinuria – caused be skeletal muscle injury (ex. rhabdomyolysis)

11
Q

A child comes in with his foreskin trapped behind his glans penis. What is the condition and how is it treated?

A

Paraphimosis

This is a MEDICAL EMERGENCY.

Treatment = emergent circumcision

12
Q
  1. What is the treatment for voiding dysfunction?
  2. At what age is pharmacological therapy avoided until?
  3. At age 7, what can we use?
A

1. Reassurance is key!

2. Pharmacological therapy is avoided until age 7!

  1. Desmopressin Acetate (synthetic analog of antidiuretic hormone) and Imipramine (tricyclic antidepressant)
13
Q

Do we circumsize a child who was diagnosed with hypospadias?

A

No - foreskin is needed because it may be used in surgical repair.

14
Q

What pediatric orthopedic condition is more common in females?

What physical exam tests would you administer?

A

Developmental Dysplasia of the Hip

Administer Barlow’s test (dislocation test) and Ortolani test (relocation test)

15
Q

What sign is seen on x-ray for a child with idiopathic osteonecrosis of the femoral head?

A

Well first - this is Legg-Calve-Perthes Disease

Sign on x-ray = cresent sign

16
Q

What is the most common adolescent hip disorder?

A

Slipped Capital Femoral Epiphysis

17
Q

I say “obese 10-year-old girl with hip pain and a limp”. You say….

A

Slipped Capital Femoral Epiphysis

18
Q

What is the most common cause of “toeing in”?

A

Internal tibial torsion

19
Q

What is the most common cause of “toeing in” after age 3?

A

Femoral Anteversion

20
Q

What othopedic disorder has point tenderness at tibial tubercle?

A

Osgood-Schlatter’s Disease

21
Q

What is the most common cause of scliosis?

A

Idiopathic (roughly 65% of the time)

22
Q

What is the diagnostic test of scoliosis?

A

Adam’s forward bend test

23
Q

At an angle greater than ___, surgical intervention is needed to treat scoliosis.

A

50 degrees

24
Q

What is unilateral contraction of the sternocleidomastoid muscle?

A

Torticolis

25
Q

What is the most common type of Salter-Harris Fracture?

A

Type II (75%) - transverse through physis into the metaphysis

26
Q

What orthopedic disorder is characterised by blue sclera and decreased hearing?

A

Osteogenesis Imperfecta

27
Q

What condition is known as the 100 day cough and requires treatment of everyone in the family?

A

Pertussis

28
Q

What are the 3 stages of pertussis?

A

Catarrhal stage: 1-2 weeks - URI symptoms, fever, cough, runny nose – when child is MOST CONTAGIOUS

Paroxysmal Stage: 1-6 weeks, “post-tussive vomiting, inspiratory whoop”

Convalescent Stage: recovery 2-3 weeks - cough lessens

29
Q

A child comes into urgent care with a barking cough and inspiratory stridor.

1. Identify the disorder

2. Name the causative agent

3. Name the hallmark finding on x-ray

A
  1. Croup
  2. Parainfluenza
  3. “Steeple sign” on chest x-ray
30
Q

What is the medical condition that has fallen in incidence due to the HiB vaccination and what would you see on x-ray?

A

Epiglottis

“Thumb sign”

31
Q

Is epiglottis a medical emergency?

A

Duh

32
Q

A patient presents with fatty, greasy, white stools and recurrent respiratory infections. What test would you order to confirm your diagnosis and what disease are you testing for?

A

Sweat chloride test - Why? Because this disorder is an abnormality in the Cystic Fibrosis Transmembrane Conductance Regulator (a chloride channel)

This is obviously cystic fibrosis.

33
Q

What non-asthmatic medication could be beneficial to tr in a child who has asthma and why?

A

Trial of PPI’s since asthma and GERD are commonly connected!

34
Q

What types of foreign bodies in the nose are you concerned with and why?

A

Batteries and Magnets

Can cause septal perforation

35
Q

When would you see a “ground glass appearance” on chest x-ray and what are these patients lacking?

A

This is hyaline membrane disease - these patients are lacking surfactant.

36
Q

What is the most common craniofacial anomaly in children?

A

Cleft lip/palate

37
Q

What is the passage of gastric contents into the esophagus causing troublesome symptoms or complications?

A

GERD

38
Q

What is the passage of gastric contents into the esophagus, but is a normal physiologic process in infants and children - does not cause symptoms, esophageal injury or complications and resolves by 18 months?

A

GER (Gastroesophageal Reflux)

39
Q

Define a tracheoesophageal fistula and esophageal atresia.

A

A congenital anomaly of the respiratory tract causing a connection of the esophagus to the trachea and the development of a false pouch (esophageal atresia) instead of an esophagus.

40
Q

How are tracheoesophageal fistulas and esophageal atresias diagnosed?

A

Inability to pass a NG tube into the stomach

Definitive test = upper GI series with endoscopy for direct visualization

41
Q

An infant comes in who is projectile vomiting after being fed but remains hungry. What would you expect to find on an upper GI series and on physical exam?

A

Upper GI series = string sign

Physical exam = olive shaped mass felt in RUQ

42
Q

An abdominal x-ray shows a “double bubble sign”. What is causing this sign?

A

Ladd bands have caused a volvulus, which is showing air in the duodenum and stomach only

43
Q

What GI pediatric disorder presents with sudden onset of bilious vomiting (green vomit)?

A

Volvulus

44
Q

What condition would present with currant jelly stool and a bulls eye or target sign?

A

Intussusception

45
Q

What GI pediatric disorder causes children to draw legs/knees towards their abdomen?

A

Intussusception

46
Q

What disease involves the absence of ganglion cells in the distal rectum and colon?

What sign would be present on DRE?

A

Hirschsprungs Disease

On DRE… “squirt sign”

47
Q

What disease presents with failure to pass meconium (first stool) within the first 72 hours of life?

A

Hirschsprungs disease

48
Q

What is the most common congenital anomaly of the small intestines?

A

Meckel’s Diverticulum

49
Q

What GI disorder has the buzz word “vitelline duct”?

A

Meckel’s Diverticulum

50
Q

What disorder is characterized by the rule of two’s?

A

Meckel’s Diverticulum

Occurs in 2% of the population, male to female ratio is 2:1, within 2 feet of the ileoceccal valve, can be 2 inches long, usually present before age 2

51
Q

What is the most common condition in children requiring emergency abdominal surgery?

A

Appendicitis

52
Q

What happens when a child has an imperforate anus?

A

They’re full of shit.

HA. That sucks.

53
Q

What is the imaging of choice for appendicitis?

A

CT

54
Q

What type is hernia is most common in children?

Which type is most dangerous?

A

Most common = umbilical

Most dangerous = diaphragmatic

55
Q

What is the diagnostic test for lactose intolerance in children?

A

Lactose breath hydrogen test

56
Q

What suture is most commonly affected by craniosynostosis?

A

Saggital

57
Q

What is Hering’s Law and what disorder is it for?

A

Agonist muscles in both eyes receive equal innervation to ensure coordinated movements (eg, as right eye abducts, the left eye will adduct)

Strabismus

58
Q

What often presents with unilateral purulent nasal drainage, epistaxis, nasal obstruction and mouth breathing?

A

Nasal foreign body

59
Q

A child presents after a possible untreated ear infection. When you look at him, you immediately notice that one of his ears is “sticking out”. What condition do you immediately need to consider?

A

Mastoiditis

60
Q

What is a pseduocyst of minor salivary gland origin?

What is a pseudocyst of the sublingual glands and submandibular glands?

A

Salivary gland origin = mucoceles

sublingual and submandibular gland origin = ranulas

61
Q

What is a huge sign of child abuse?

A

Any bruise in an infant less than 6 months old

62
Q

What is the most frequent diagnosis in sick children in the US?

A

Otitis Media

63
Q

Who needs treatment for otitis media?

Who can be observed?

A

Treatment = children less than 2 years old and older children with bilateral disease or otorrhea

Observation = children older than 2 years with minimal symptoms and unilateral disease

64
Q

Do we treat otitis media with effusion with antibiotics?

A

Negative - this is a plumbing problem

Time is the only remedy

65
Q

What is the first line treatment for otitis media?

A

HD Amoxicillin

66
Q

Is sinusitis more commonly caused by a virus or bacteria?

A

Virus

67
Q

What is commonly caused by Group A Coxsackie virus?

A

Hand, Foot and Mouth Disease

68
Q

What is one of the first symptoms of hand, foot and mouth disease?

A

Refusal to feed due to oral sores

69
Q

What physical exam finding would you expect to see in a child with erythema infectiosum?

A

Slapped cheek appearance

70
Q

A child presents to your office with a 4-day history of high fiver that finally stopped last night. The child now has a diffuse maculopapular rash. What do you think is going on with them?

A

Roseola - Exanthem subitum

71
Q

What is the causative agent of fifth’s disease?

A

Parvovirus B-19

72
Q

What condition can cause a potential life-threatening formation of a pseudomembrane in the posterior pharynx?

A

Diphtheria

73
Q

What is the worldwide 5th leading cause of death in children under 5?

A

Measles

74
Q

A child presents to your office with a 5-day history of a high fever as well as a strawberry tongue. What is the most likely diagnosis?

A

Kawaskai’s Disease

75
Q

Why should we all boycott monday’s exams and just sleep?

A

Mumps

76
Q

What is the most common congenital heart disease?

A

Ventricular Septal Defect (VSD)

77
Q

What physical exam finding would you expect upon auscultation of a patient with an atrial septal defect?

A

Widely split S2 through inspiration and expiration

Grade II-III midsystolic crescendo-decresendo murmur

78
Q

What is the most common anatomic type of atrial septal defect?

A

Ostium secundum - defect in the mid septum at the fossa ovalis (80%)

79
Q

What cardiac disorder has a loud (Grade III-IV) harsh crescrendo-decrescendo murmur heard at the upper LSB radiating towards clavicles and is louder with inspiration?

A

Pulmonic stenosis

80
Q

For managing pulmonic stenosis, valvuloplasty is always indicated for gradient > ____.

A

75mm

81
Q

What condition would you expect to find a continuous “machinery murmur” and how it is treated?

A

Patent ductus arteriosus

Indomethacin

82
Q

What do ventricular septal defect, atrial septal defect and patent ducut arteriosus have in common?

A

Left to right shunting

83
Q

What condition would you expect to find a difference of more than 10mmHg between the upper and lower extremities?

A

Coarctation of the aorta

84
Q

What is the diagnostic imaging for coarctation of the aorta?

A

Cardiac MRI/MRA and CT

85
Q

What condition causes a right to left shunt?

A

Tetralogy of Fallot

86
Q

What disease is treated with high dose aspirin and puts children at risk for coronary artery aneurysms?

A

Kawasaki’s Disease

87
Q

What is the most common nutritional deficiency in children?

A

Iron deficiency

88
Q

What is the most common malignancy in children?

A

Leukemia - 33%

89
Q

What is the most common abdominal tumor in children?

A

Wilms tumor

90
Q

What type of juvenile rheumatoid arthritis involves a quotidian fever pattern with a rash?

A

Systemic arthritis

91
Q

What type of pediatric rheumatic condition presents with Kobner’s phenomenon?

A

Systemic arthritis

92
Q

Identify the difference between persistent and extended oligoarthritis.

A

Persistent = no other joint involvement after the first 6 months

Extended = four or less joints over the first 6 months and then increases in number over time

93
Q

What is highly indicative of psoriatric arthritis?

A

Arthritis in a single DIP

94
Q

What is the most common vasculitis in children and how does it most commonly present?

A

Henoch Sholien Purpura

Rash = most common presentation

95
Q

What condition involves a deletion in chromosome 22 causing low PTH and Ca levels?

A

DiGeorge syndrome

96
Q

What disorder involves a female phenotype with an XY genotype?

A

Androgen insensitivity

97
Q

Define cephalohematoma.

A

Blood between the periosteum and the bone due to difficult labor or delivery with suction or forceps

Does not cross suture lines

98
Q

What condition is caused by a brachial plexus injury during birth?

A

Erb palsy

99
Q

Why is it dangerous for cat ladies to become pregnant?

A

Toxoplasmosis Gondii

100
Q

What are the 3 components of the atopic traid?

A

Asthma

Atopic dermatitis

Allergic rhinitis

101
Q

What is the most common allergic disorder and what are some physical exam findings you would see?

A

Allergic rhinoconjunctitivitis

Physical exam = allergic shiners, allergic salute, cobblestoning of the posterior pharynx

102
Q

What are the most common causes of anaphylaxis in the following age groups:

  1. Children
  2. Adults
  3. Elderly
A

Children = food

Adults = venom

Elderly = medications

103
Q

Which immunologic disease requires daily prophylactic antibiotics and antifungal agents?

A

Chronic Granulomatous disease

104
Q

What is the most common neurologic disorder of infants and young children?

A

Febrile seizures

105
Q

What is considered an abnormal head size?

A

2 standard deviations above or below normal

106
Q

What is the most common cause of persisting proteinuria in children?

A

Orthostatic proteinuria

107
Q

What are the signs and symptoms associated with primary nephrotic syndrome in children?

A

Facial and lower extremity edema

Progresses to generalized and aggressive edema

108
Q

How do you treat minimal change disease?

A

Corticosteroids

109
Q

Which type of primary nephrotic syndrome can lead to end stage renal disease?

A

Focal segmental glomerulosclerosis

110
Q

The following is diagnostic criteria for which disorder:

  1. 3-4+ proteinuria on dipstock
  2. Over 150mg on 24 hour urine
  3. Increased serum creatinine
A

Primary nephrotic syndrome

111
Q

Treatment for primary nephrotic syndrome. Fill in the blank.

If the child is between the ages of __ and __: no biopsy needed - just treat

If the child is less than ___ or older than ___: biopsy needeed prior to treatment

A

If the child is between the ages of 1 and 8 : no biopsy needed - just treat

If the child is less than 1 or older than 8 : biopsy needeed prior to treatment

112
Q

The following triad is for which genitourinary disorder in children?

1. fever

2. rash - maculopapular/urticarial

3. Arthralgia with steady increasing creatinine

*No hematuria or proteinuria*

A

Acute tubulointerstitial nephritis

113
Q

What presents with persisting hematuria and proteinuria that lacks any other explanation?

A

Membranous glomerulopathy

114
Q

What is the most common cause of acute renal failure, typically in children under 4 years old?

A

Hemolytic-uremic syndrome

115
Q

What is the triad for hemolytic uremic syndrome?

A

Hemolytic anemia

Uremia

Thrombocytopenia

116
Q

What disorder is preceded by an acute GI illness in 80% of children?

A

Hemolytic-uremic syndrome

117
Q

I say helmet and burr cells on peripheral blood smear.

You say…

A

Hemolytic-uremic syndrome

118
Q

When do we start screening for hypertension in children?

A

Age 3

119
Q

What is pediatric hypertension defined as?

A

Systolic and diastolic blood pressure over the 95th percentile for weight, height, age and gender.

120
Q

At what age does toileting start?

At what age are most children dry through the night?

A

Toileting starts around age 2-3

Most kids are dry through the night by age 5

121
Q

When does the anterior fontanelle close?

A

10-24 months

122
Q

When does the posterior fontanelle close?

A

By 2 months

123
Q

What is the most common form of strabismus?

A

Pseudostrabismus

124
Q

During the midsummer, a child presents to your office with his mother. She mentions her son has had a fever, sore throat, and is refusing to eat. You do an oral exam and notice diffuse oral lesions.

  1. What is your diagnosis?
  2. What is the most common causative agent?
A

1. Herpangina

2. Coxsackie A virus

125
Q

A child presents to your office with a fever and is refusing to eat according to his mother. You also notice the child has tender lesions on his hands, feet and buttocks.

What diagnosis should climb to the top of your differential?

A

Hand, foot and mouth disease

126
Q

What is the causative agent of roseola?

A

Herpes virus 6

127
Q

What is the most common cause of impetigo?

A

Staph aureus

Then, group A streptococcus

128
Q

How do you treat impetigo?

A

Topical mupirocin

If severe - Dicloxicillin

129
Q

What is the most common causative agent for epiglottis?

A

Haemophilis Influenzae B

130
Q

I say… drooling and tripoding in a 5 year old.

You say…

A

Epiglottis

131
Q

Treatment for epiglottis. Go.

A

Ceftriaxone (Rocephin)

Anti-pyretics for fever

Secure airway

IV steroids

132
Q

Is streptococcus pharyngitis caused by Group A or Group B streptococcus?

A

Group A

133
Q

What is the DOC for treating streptococcus pharyngitis?

A

Penicillin

134
Q

What is a manifestation of streptococcus pharyngitis if left untreated for 2-4 weeks?

A

Rheumatic fever

Symptoms:

  1. Migratory athritis
  2. Pancarditis/valvitis
  3. CNS involvement
  4. Erythema marginatum
  5. Subcutaneous nodules
135
Q

Symptoms include hot potato voice, drooling, trismus, ipsilateral ear pain.

1. What is the diagnosis?

2. How do we treat it?

A

1. Peritonsillar abscess

2. Drainage + oral Augmentin or Clindamycin

136
Q

What is the leading cause of blindness in children?

A

Uveitis

137
Q

Also known as “still’s disease”

Arthralgia of the knees, ankles and wrists most commonly

Quotidian fever pattern

Macular salmon rash with Kobner phenomenon

A

Systemic juvenile idiopathic arthritis

138
Q

What disorder causes arthritis of 1-2 joints but quickly progressives to 5 or more joints over a 6 month course?

A

Polyarthritic juvenile idiopathic arthritis

139
Q

What is the most common subtype of juvenile idiopathic arthritis representing roughly 50% of cases?

A

Oligoarthritis

140
Q

What is the diagnostic criteria for Henoch Shoilen Purpura?

A

Need 2 out of the 4:

  1. Purpura
  2. Bowel angina
  3. Biopsy
  4. Pediatrics group
141
Q

What is the most common cause of excessive growth hormone?

A

Pituitary adenoma

142
Q

What is the definitive treatment for Grave’s disease (hyperthyroidism)?

A

Radioactive iodine

143
Q

What are some complications of hyperparathyroidism?

Dig deep in those brains.

A
  1. Pathologic fractures
  2. Urinary calcium stones
  3. CNS changes (if calcium rises too rapidly)
  4. Renal failure
144
Q

What is the hallmark finding of hypoparathyroidism?

A

Low ionized calcium

145
Q

I say Chvostek and Trousseau sign. You say…

A

Hypoparathyroidism

146
Q

What has a URI prodrome with cough, coryza, and conjunctivitis.

It also causes Koplik spots in the mouth and a brick red rash starting at the hairline and progressing head to toe - sparing palms and soles.

A

Measles

147
Q

What is the causative agent for measles?

A

Paramyxovirus

148
Q

What disease is caused by the togavirus?

A

Rubella

149
Q

3 day pink maculopapular rash

Posterior cervical and posterior auricular lymphadenopathy

Forcheimer spots

A

Rubella

150
Q

Is the infection from congenital rubella syndrome chronic or acute?

A

Chronic

151
Q

Low grade fever

Fatigue, headache

Parotitis within 2 days of prodromal symptoms

A

Mumps

152
Q

Dew drops on a rose petal

A

Varicella zoster

153
Q

Describe the progression of the rash associated with varicella zoster.

A

Begins on the face and trunk and spreads to extremities.

154
Q

Which of the following is not caused by the paramyxovirus?

A) Measles

B) Fifth’s Disease

C) Mumps

D) Respiratory Syncytial Virus

A

B) Fifth’s Disease - Parvovirus B19

155
Q

What disease starts as a URI then progresses to fever, expiratory wheeze that is junky sounding, nasal flaring, grunting, retractions, low O2 sat?

A

Bronchiolitis

156
Q

Do we treat bronchiolitis with steroids and antibiotics?

A

Hell to da no.

Treatment = nasal suctioning and hydration.

157
Q

What can we give infants with pulmonary dysplagia, premature birth or congenital heart disease to prevent bronchiolitis?

A

Palivizumab

158
Q

What is the causative agent of croup?

A

Parainfluenza virus 1

159
Q

What are some hallmark findings for croup?

A

Steeple sign” on x-ray

Barking, seal cough

Inspiratory stridor

Coughing at night especially when laying down

Respiratory distress (retractions, low O2 sat)

160
Q

How do we treat mild croup?

How about moderate - severe croup?

A

Mild = Dexamethasone

Moderate/Severe = oxygen, racemic epi, consider hospital admission

161
Q

What has asymmetric skin folds?

A

Developmental Dysplagia of the hip

162
Q

What do you perform at 6 weeks gestation if the fetus is female and breech?

A

An ultrasound is check for developmental dysplagia

163
Q

What is the treatment for Legg-Calve-Perthes Disease?

A

Observation - femoral head can revascularize in 12-18 months

Limit vigorous activity

Crutches

NSAIDs

164
Q

What is the treatment for Slipped-Capital-Femoral Epiphysis?

A

Surgical fixation

Single screw into the epiphysis

165
Q

What is a normal foot angle?

A

0-30 degrees

166
Q

What causes pes planus (flat feet)?

A

External tibial torsion

167
Q

What is medial rotation of forefoot that is present at birth and occurs at the TMT joint?

A

Metatarsus adductus

168
Q

What is a congenital deformity of the foot causing plantar flexion of the ankle, adduction of the heel and high arches?

This is also known as “club foot”

A

Talipes Equinovarus

169
Q

What is the treatment for talipes equinovarus?

A

Immediate casting before hospital discharge

Serial casting every 1-2 weeks

Surgery after 4 months of treatment

170
Q

Scoliosis: lateral curvature of the spine over ____ degrees.

A

10 degrees

171
Q

What angle do you measure on the x-ray for scoliosis?

A

Cobb angle

172
Q

Treatment for scolisos.

If over __ to ___ % = brace

If over ___% = surgery

A

If over 20 to 40 % = brace

If over 50 % = surgery

173
Q

What is the treatment for nursemaid elbow?

A

Opposite of MOI.

Pressure on the radial head with forced flexion and supination.

174
Q

How many doses in the MMR vaccine?

When are they given?

A

2 doses!

1st: 12-15 months
2nd: 4-6 years

175
Q

What are the 3 most common diseases seen in schools?

A

Influenza

Pertussis

Varicella

176
Q

What is the best diagnostic study for influenza?

A

PCR

177
Q

What is the best way to prevent influenza?

A

Influenza vaccine!

Get it between august/september

178
Q

These are signs of _____ _____.

Tachycardia, retractions (intercostal and sternal), nasal flaring, grunting, head bobbing, abdominal breathing, tripod position.

A

Respiratory distress

179
Q

DOC for pneumonia?

2nd line?

A

DOC = Amoxicillin

2nd line = Macrolide

180
Q

What is the leading cause of death in a <1 year old infant?

A

Sudden infant death syndrome

181
Q

How do you treat hyaline membrane disease?

A

Corticosteroids - induces formation of surfactant in fetal lungs

Or give surfactant

182
Q

What are some ways to evaluate for dehydration in a child with diarrhea?

A

Urinary frequency

Skin turgor

Mucous membranes

183
Q

What is the treatment for volvulus?

A

Immediate surgery

184
Q

How do you diagnose Meckel’s Diverticulum?

A

Meckel scan (nuclear medicine)

185
Q

Diarrhea, steatorrhea, weight loss, vitamin deficiency

Herpetic dermatitis

A

Celiac Disease

186
Q

Abdominal pain, bloating, flatulence, diarrhea

1. Disorder?

2. How to diagnose?

3. Treatment?

A

Lactose Intolerance

Lactose hydrogen breath test

Don’t eat lactose ya dumb dumb