Q 1:
A 6-year-old boy has complained of periumbilical abdominal pain for the past 2 months. He has a
history of mild constipation that his mother has managed successfully by increasing juice and
fruits in his diet. The mother is frustrated because the boy has been sent home from school
frequently due to complaints of pain. She reports that he is being evaluated for dyslexia. The
pain occasionally occurs on weekends and school vacation breaks.
Of the following, the MOST likely diagnosis is
A. chronic constipation with fecal impaction
B. factitious abdominal pain
C. Helicobacter pylori gastritis
D. recurrent (functional) abdominal pain syndrome
E. school phobia
Answer
D
The symptoms exhibited by the child described in the vignette are most consistent with
recurrent (functional) abdominal pain. The mother states that she has managed the child’s mild
constipation successfully, and there is no history of encopresis to suggest fecal impaction.
School phobia is less likely because the pain also occurs on weekends and school holidays.
Although Helicobacter pylori gastritis is a possibility in children who have epigastric abdominal
pain, those affected often have associated nausea and vomiting.
------------------
Q 2
A 12-year-old girl who has Crohn disease has had poor appetite and chronic diarrhea despite
her medical treatment. In evaluating her nutritional state, you document a low plasma zinc
concentration and initiate zinc supplementation.
Of the following, a TRUE statement about zinc supplementation is that it
A. decreases serum alkaline phosphatase values
B. impairs wound healing
C. inhibits the absorption of dietary copper
D. should be given with dairy products
E. usually decreases appetite
Answer
C
Both copper and zinc are absorbed from the intestine. Zinc-containing foods include beef,
cheese, and legumes (beans and nuts). Copper-containing foods include liver, fish, and
legumes. Both zinc and iron can interfere with intestinal copper absorption. Therefore, if a zinc
supplement is given to a patient who has chronic malnutrition, the patient should be monitored for
potential copper deficiency. Zinc absorption can be impaired if zinc is given at the same time as
dairy products. Patients who have zinc deficiency often have impaired wound healing, reduced
alkaline phosphatase activity, and impaired taste that may affect appetite, all of which should
improve after zinc supplementation.
Answer
D
The symptoms exhibited by the child described in the vignette are most consistent with
recurrent (functional) abdominal pain. The mother states that she has managed the child’s mild
constipation successfully, and there is no history of encopresis to suggest fecal impaction.
School phobia is less likely because the pain also occurs on weekends and school holidays.
Although Helicobacter pylori gastritis is a possibility in children who have epigastric abdominal
pain, those affected often have associated nausea and vomiting.
------------------
Q 2
A 12-year-old girl who has Crohn disease has had poor appetite and chronic diarrhea despite
her medical treatment. In evaluating her nutritional state, you document a low plasma zinc
concentration and initiate zinc supplementation.
Of the following, a TRUE statement about zinc supplementation is that it
A. decreases serum alkaline phosphatase values
B. impairs wound healing
C. inhibits the absorption of dietary copper
D. should be given with dairy products
E. usually decreases appetite
Answer
C
Both copper and zinc are absorbed from the intestine. Zinc-containing foods include beef,
cheese, and legumes (beans and nuts). Copper-containing foods include liver, fish, and
legumes. Both zinc and iron can interfere with intestinal copper absorption. Therefore, if a zinc
supplement is given to a patient who has chronic malnutrition, the patient should be monitored for
potential copper deficiency. Zinc absorption can be impaired if zinc is given at the same time as
dairy products. Patients who have zinc deficiency often have impaired wound healing, reduced
alkaline phosphatase activity, and impaired taste that may affect appetite, all of which should
improve after zinc supplementation.
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