Rosh Pediatrics Practice Exam

An 8-year-old boy experiences stomach pain after meals heavy in milk. What is the most appropriate intervention for his suspected condition?

1. Gluten-restricted diet

2. Lactose-restricted diet

3. Loperamide prior to every meal

4. Rifaximin

The correct answer is: Lactose-restricted diet

The suspected condition based on the provided information is likely lactose intolerance, which is common in children and can lead to symptoms such as stomach pain after consuming dairy products. Implementing a lactose-restricted diet is the most appropriate intervention, as it directly addresses the root cause of the symptoms. In children with lactose intolerance, the body lacks sufficient levels of lactase, the enzyme needed to properly digest lactose, the sugar found in milk and dairy products. When lactose is ingested without adequate lactase, it can result in gastrointestinal symptoms such as abdominal pain, bloating, and diarrhea after meals high in dairy. By restricting lactose from the diet, the child can avoid these symptoms and improve his overall comfort and wellbeing. This dietary change can also be supplemented by lactase enzyme supplements that allow some tolerance to lactose if the child still wishes to consume small amounts of dairy. Choosing alternative interventions, such as a gluten-restricted diet, would not be appropriate unless there was clear evidence of celiac disease or wheat allergy, neither of which are suggested by the symptoms described. Loperamide is an anti-diarrheal medication that manages symptoms rather than addressing the cause of lactose-induced discomfort. Rifaximin, an antibiotic, is typically used for specific intestinal bacterial over