Pediatric Vomiting Practice Quiz (24 questions)

1. Which feature distinguishes true vomiting from regurgitation?

A. True vomiting forcefully ejects stomach or esophageal contents, while regurgitation is effortless or nearly effortless.

B. True vomiting occurs without nausea, while regurgitation requires nausea and retching.

C. True vomiting is effortless return of food, while regurgitation is accompanied by retching.

D. True vomiting involves rechewing food, while regurgitation is forceful ejection of stomach contents.

Answer: (A)

Explanation

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.

2. A child has infrequent episodes of vomiting but becomes acutely ill and vomits forcefully more than four times per hour during an episode. Which pattern best fits?

A. Cyclic recurrent vomiting, which generally involves low-intensity episodes in children who are not acutely ill.

B. Chronic recurrent vomiting, which generally involves low-intensity episodes in children who are not acutely ill.

C. Cyclic recurrent vomiting, which involves infrequent but acutely severe episodes.

D. Chronic recurrent vomiting, which involves infrequent episodes with acute severity.

Answer: (C)

Explanation

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.

3. When beginning an evaluation of vomiting, which approach best covers the initial assessment?

A. Review abdominal, respiratory, and neurologic symptoms, then focus on imaging before asking about diet or medications.

B. Ask about diet and medications, then assess abdominal symptoms while deferring respiratory and neurologic review.

C. Identify the vomiting pattern, review abdominal, respiratory, and neurologic symptoms, and ask about diet and medications.

D. Identify the vomiting pattern, review abdominal and neurologic symptoms, and ask about hydration and family history.

Answer: (C)

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.

4. A patient with acute vomiting also has findings consistent with an acute abdomen. What is the appropriate immediate action?

A. Begin outpatient observation and reassess after symptoms settle.

B. Arrange immediate surgical consultation.

C. Request neurologic consultation before considering surgical evaluation.

D. Start dietary modification and schedule routine follow-up.

Answer: (B)

Explanation

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.

5. Which combination of findings is characteristic of an acute abdomen?

A. Nonbilious vomiting, voluntary abdominal tensing, and pain relieved by movement.

B. Bilious vomiting, involuntary guarding, rebound tenderness, and a rigid abdomen.

C. Progressive headache, early-morning vomiting, and an abnormal funduscopic examination.

D. Nausea, normal bowel sounds, and mild tenderness without pain on movement.

Answer: (B)

Explanation

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.

6. A child has progressive headaches and vomiting on waking, with no nausea and an abnormal funduscopic examination. What condition do these findings suggest?

A. A congenital intestinal obstruction.

B. An acute abdominal process.

C. Cyclic recurrent vomiting.

D. Increased intracranial pressure.

Answer: (D)

Explanation

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.

7. What is a volvulus?

A. A congenital intestinal abnormality that may predispose the bowel to twisting on the mesentery.

B. Twisting of the bowel on the mesentery, generally associated with congenital intestinal malrotation.

C. A narrowing of the intestinal lumen caused by a congenital mucosal web.

D. A postoperative adhesion that tethers bowel and causes intermittent obstruction.

Answer: (B)

Explanation

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.

8. Which presentation is typical of many cases of intestinal malrotation that appear in the newborn period?

A. Progressive headaches with early-morning vomiting and an abnormal funduscopic examination.

B. Partial obstruction presenting later with nonbilious vomiting and mild symptoms.

C. Volvulus with bilious vomiting and severe clinical toxicity.

D. Intermittent vomiting over years without severe neonatal illness.

Answer: (C)

Explanation

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.

9. A newborn has an acute congenital intestinal obstruction. Which group consists entirely of congenital obstructive lesions?

A. Esophageal stenosis, volvulus, duodenal webs, and annular pancreas.

B. Inflammatory bowel disease, mucosal disease, annular pancreas, and volvulus.

C. Mucosal disease, annular pancreas, postoperative adhesions, and esophageal stenosis.

D. Postoperative adhesions, volvulus, inflammatory bowel disease, and duodenal webs.

Answer: (A)

Explanation

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.

10. What anatomical arrangement causes superior mesenteric artery syndrome?

A. The stomach is compressed between the liver and the anterior abdominal wall.

B. The duodenum is compressed between the anterior superior mesenteric artery and the posterior aorta.

C. The jejunum is compressed between the pancreas and the superior mesenteric vein.

D. The duodenum is compressed between the posterior superior mesenteric artery and the anterior aorta.

Answer: (B)

Explanation

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.

11. A patient with superior mesenteric artery syndrome has bilious vomiting and epigastric pain. Which position may relieve the symptoms?

A. Lying supine with the legs extended

B. Lying prone or bringing the knees toward the chest

C. Lying on the side with the knees extended

D. Sitting upright with the trunk leaning backward

Answer: (B)

Explanation

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.

12. In a child with rotavirus infection, which symptom sequence is commonly observed?

A. Vomiting begins one to two days before diarrhea.

B. Vomiting and diarrhea generally begin at the same time.

C. Vomiting begins after the diarrhea has resolved.

D. Diarrhea begins one to two days before vomiting.

Answer: (A)

Explanation

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.

13. Which pattern is most characteristic of pyloric stenosis in a young infant?

A. Intermittent vomiting and diarrhea following a febrile illness

B. Progressive, often projectile nonbilious vomiting in the first weeks of life

C. Sudden bilious vomiting with abdominal pain in the first days of life

D. Chronic nausea with morning coughing and nasal congestion

Answer: (B)

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.

14. A child with unexplained vomiting develops altered mental status and abnormal breathing. What cause should these findings raise concern for?

A. Ingestion of a toxic drug or poison

B. Ureteropelvic junction obstruction causing hydronephrosis

C. A sinus infection causing postnasal drip

D. A routine viral illness causing gastrointestinal symptoms

Answer: (A)

Explanation

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.

15. Which presentation is typical of ureteropelvic junction obstruction in an older child?

A. Persistent lower abdominal pain with vomiting and consistently abnormal urinalysis

B. Early-morning vomiting after coughing, accompanied by congestion and postnasal drip

C. Acute bilious vomiting with epigastric pain relieved by a knee-chest position

D. Intermittent abdominal or flank pain, often with vomiting, despite a potentially normal examination or urinalysis

Answer: (D)

Explanation

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.

16. Which timing pattern is consistent with inborn errors of metabolism that cause vomiting?

A. They typically begin in infancy and remain limited to brief episodes after meals.

B. They generally begin only during acute illness and resolve when the stress ends.

C. Most present in the newborn period, while some emerge later after food introduction or during stress or illness.

D. Most first appear after food introduction, while newborn presentation is uncommon.

Answer: (C)

Explanation

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.

17. Which combination of findings can accompany vomiting caused by a metabolic disorder?

A. Low blood glucose with normal neurologic function and a family history of motion sickness

B. Dehydration, isolated abdominal pain, and a family history of uncomplicated infections

C. Respiratory alkalosis, preserved mental function, and a family history of seasonal allergies

D. Acidosis, mental deterioration, or coma, with a family history that may include neonatal deaths

Answer: (D)

Explanation

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.

18. A child with vomiting has neurologic symptoms and an unusual odor on the breath. What evaluation should be considered?

A. A metabolic workup

B. An assessment limited to urinary obstruction

C. A workup focused on acute gastroenteritis

D. An evaluation focused on sinus drainage

Answer: (A)

Explanation

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.

19. An infant has effortless regurgitation after feeding and sometimes arches the back during episodes. Which condition best fits this pattern?

A. Forceful vomiting caused by an acute mechanical obstruction

B. Paralytic ileus causing persistent gastric contents to accumulate

C. Gastroesophageal reflux, which can be associated with arching in Sandifer syndrome

D. Peptic ulcer disease presenting with meal-related epigastric pain

Answer: (C)

Explanation

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.

20. A child is suspected of having gastroesophageal reflux, but has no apnea or other life-threatening symptoms. Which approach may help diagnostically?

A. Try an H₂ blocker or proton pump inhibitor and assess the response

B. Diagnose peptic ulcer disease based on response to liquid antacids

C. Order additional apnea-focused studies before considering reflux treatment

D. Use antibody testing to determine whether reflux is causing the symptoms

Answer: (A)

Explanation

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.

21. A young child has nonspecific abdominal symptoms, occasional nighttime awakening, and gastrointestinal bleeding. Which condition can produce this range of findings?

A. Infant gastroesophageal reflux, typically presenting as effortless regurgitation

B. Peptic ulcer disease, including gastritis, duodenitis, or gastric and duodenal ulcers

C. Gastric stasis resulting from medication or electrolyte disturbance

D. Food hypersensitivity, commonly involving cow’s milk or soy protein

Answer: (B)

Explanation

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.

22. An infant repeatedly vomits after consuming cow’s milk protein, and an immune-mediated food reaction is being considered. Which explanation fits this possibility?

A. Food hypersensitivity, including non-IgE syndromes or an IgE-mediated food allergy

B. Pseudo-obstruction, a chronic intermittent ileus associated with neuropathy or myopathy

C. Paralytic ileus, which may follow surgery or result from medication effects

D. Psychogenic vomiting, diagnosed before evaluating potential organic causes

Answer: (A)

Explanation

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.

23. After surgery, a patient develops markedly slowed gastric emptying and signs of intestinal paralysis. Which cause-and-effect relationship is consistent with these findings?

A. Surgery can lead to gastric stasis or paralytic ileus

B. Psychogenic stress can establish vomiting without excluding organic causes

C. Neuropathy can produce a chronic intermittent pseudo-obstruction with family history

D. Food introduction can lead to hereditary fructose intolerance or celiac disease

Answer: (A)

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.

24. A patient’s vomiting is suspected to have a psychogenic cause. What must happen before that diagnosis is made?

A. A specific food must be shown to trigger an immune reaction

B. Organic causes of the vomiting must be ruled out

C. A family history of chronic intermittent ileus must be established

D. A history of surgery must be confirmed as the underlying cause

Answer: (B)

Explanation

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.