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Vomiting in Children - An ED Approach.

Total questions: 22

Worksheet time: 8mins

Name
Class
Date
1.

Which of the following is a surgical emergency in a vomiting child?

a)

Bilious (green) vomiting

b)

Non-bilious vomiting with diarrhoea

c)

Vomiting after eating dairy/gluten

d)

Vomiting that resolves with ondansetron

2.

What is the most likely cause of projectile vomiting in a 6-week-old male?

a)

Gastroenteritis

b)

Appendicitis

c)

Pyloric Stenosis

d)

Diabetic Ketoacidosis

3.

True or False: Vomiting without diarrhoea is reassuring?

a)

TRUE

b)

FALSE

4.

Which of the following is NOT a red flag for vomiting in children?

a)

Watery diarrhoea with vomiting

b)

Bilious vomiting

c)

Vomiting with altered consciousness

d)

Projectile vomiting in an infant

5.

What is the first-line treatment for mild dehydration in gastroenteritis?

a)

Intravenous Fluids

b)

Ondansetron

c)

Nil by mouth

d)

Oral rehydration solution (ORS)

6.

Which investigation is MOST appropriate for suspected intussusception?

a)

CT Abdomen

b)

Abdomen Ultrasound

c)

Contrast / Gas Enema

d)

Stool MCS

7.

A 4-year-old has green vomit, abdominal distension, and lethargy. What should you do FIRST?

a)

Start IV fluids and escalate to surgery

b)

Give oral ondansetron and observe

c)

Trial of Fluids. Likely Discharge

d)

Paracetamol / Supportive Cares and observe

8.

Which statement about ondansetron in kids is TRUE?

a)

It cures the underlying cause

b)

It helps reduce vomiting and admissions

c)

It should be avoided in gastroenteritis

d)

It replaces the need for rehydration

9.

Which of the following is an example of functional vomiting?

a)

Vomiting due to intussusception

b)

Bilious vomiting in neonate

c)

Vomiting with fever and lethargy

d)

Cyclical vomiting syndrome

10.

Acute infectious gastroenteritis in children is most commonly caused by:

a)

Viruses

b)

Bacteria

c)

Parasite

d)

Fungi

11.

Hypernatraemia in infants with gastroenteritis is most often caused by?:

a)

IV fluid overload

b)

Overuse of oral rehydration solution

c)

Concentrated formula or home-made fluids

d)

Sweat loss

12.

Which of the following is NOT a red flag in gastroenteritis according to QPEC?

a)

High-grade fever in >3 months old

b)

Bilious vomiting

c)

Severe lethargy

d)

Localised abdominal pain

13.

A risk factor for dehydration in gastroenteritis is:

a)

Mild fever ~ 37.5'

b)

Vomiting without fever

c)

Age >5yrs

d)

≥5 loose stools in 24 hours

14.

For children >2 years with clinical dehydration, which route is preferred?

a)

Subcutaneous fluid rehydration (0.9% saline)

b)

IV fluids (0.9% saline + 5% glucose)

c)

Nil by mouth

d)

Trial of fluids (10mL/kg over 60 minutes)

15.

Rapid rehydration volume over 4 hours is calculated as:

a)

20 mL/kg

b)

50 mL/kg

c)

100 mL/kg

d)

10 mL/kg

16.

To prevent spread of viral gastro in childcare, children should be excluded for:

a)

Completion of 5 day antibiotic course

b)

24–48 hours after symptoms stop

c)

One week minimum

d)

Until cessation of vomiting

17.

A 3-week-old male presents to ED with forceful, non-bilious vomiting after every feed for 3 days. He is hungry after vomiting and has lost weight. On exam, he appears slightly dehydrated. A small olive-shaped mass is palpated in the epigastric region. WHAT IS THE MOST LIKELY DIAGNOSIS?

a)

Gastro-oesophageal reflux disease

b)

Pyloric stenosis

c)

Hirschsprung disease

d)

Intussusception

18.

A 2-month-old presents with sudden onset bilious vomiting, abdominal distension, and lethargy. Mum reports one episode of dark, bloody stool ("currant jelly"). The child is tachycardic with a distended abdomen. WHAT IS THE NEXT MOST APPROPRIATE STEP?

a)

Oral rehydration and discharge

b)

Immediate surgical referral

c)

Trial of ondansetron

d)

Abdominal X-ray and stool culture

19.

A 2-year-old girl presents with vomiting and watery diarrhoea for 24 hours. She is alert, has mild dry lips, and her cap refill is <2 sec. She hasn’t kept down much fluid today. No blood in stool. WHAT IS THE MOST APPROPRIATE NEXT STEP?

a)

IV fluids immediately

b)

Antidiarrhoeal and antiemetic medications

c)

Trial of oral rehydration solution

d)

Discharge with safety netting advice + supportive cares

20.

A 13-year-old boy presents with vomiting, abdominal pain, and increasing drowsiness over 6 hours. He is tachypnoeic with fruity-smelling breath. BGL is 18.6 mmol/L. WHAT IS THE LIKELY DIAGNOSIS?

a)

Viral gastroenteritis

b)

Appendicitis

c)

Sepsis

d)

Diabetic ketoacidosis (DKA)

21.

A 4-year-old presents with recurrent episodes of vomiting every few weeks, lasting 24–48 hours. No associated fever, diarrhoea, or abdominal tenderness. Child is well between episodes. WHAT IS THE MOST LIKELY DIAGNOSIS?

a)

Functional constipation

b)

Gastroenteritis

c)

Cyclical vomiting syndrome

d)

Appendicitis

22.

A 7-year-old boy presents with early morning vomiting, worsening headache, and blurred vision. Parents report he’s been more irritable and has had difficulty at school. On examination, he is bradycardic with elevated blood pressure and shows papilloedema on fundoscopy. WHAT IS THE MOST LIKELY UNDERLYING CAUSE OF HIS VOMITING?

a)

Migraine

b)

Viral Gastroenteritis

c)

Raised intracranial pressure

d)

Motion sickness