Gastroenterology Prometric Style Questions – 50 Cases with Answers

What this deck covers

Gastroenterology – Prometric Style Questions, Set 1 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for board, MRCPCH and Prometric examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. No meconium for two days
2. Vomiting that shoots across the room
3. Ten days of forceful vomiting
4. Skip lesions in a boy who stopped growing
5. Ten bloody stools and a swollen belly
6. Jaundice with a positive surface antigen
7. Two bubbles and nothing beyond
8. A rash on elbows, knees and buttocks
9. Mother already stopped the bread
10. Stools that stop when he fasts
11. Vomiting blood with a cold periphery
12. Fever, rigors and yellow eyes
13. Food that will not go down
14. Pain that eases leaning forward
15. Confused after the chickenpox
16. Green vomit and a twisting sign
17. Blood at the end of the stool
18. Heavy painless bleeding, all tests normal
19. Screaming in waves, quiet between
20. Pain that moved to the right
21. Two days of watery stools
22. Soiling that parents think is deliberate
23. Constipation with a hairy patch
24. Milk back after every feed
25. Arching and refusing food
26. Diarrhoea years after the resection
27. Still yellow at six weeks
28. Tremor with abnormal liver tests
29. Four months of jaundice and itching
30. Itching worse than the jaundice
31. Yellow only when he is run down
32. Jaundice after the family trip
33. Picking a drug for the long haul
34. Meat stuck in the gullet twice
35. A swallowed disc in the gullet
36. Night pain that food relieves
37. Why some strains cause ulcers
38. A big spleen and normal liver tests
39. Clubbed fingers and a swollen belly
40. Diarrhoea that started before birth
41. Swollen but no protein in the urine
42. Belly pain during chemotherapy
43. A bulge that comes with crying
44. Bubbling at the mouth after birth
45. Pain that eases after the toilet
46. A mass after a week of pain
47. Blood in a thriving baby’s nappy
48. A discharging opening beside the anus
49. Vomiting green after an old operation
50. A preterm belly that turned shiny

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Rectal suction biopsy, Oral mesalazine at a maintenance dose, Jejunal atresia, Inflammatory exudation across an ulcerated mucosa, Oesophageal manometry, Immediate laparotomy, Infantile colic with a coincidental gastroenteritis, Referral for behavioural therapy and a star chart, Barium swallow and meal with a follow through, Autoimmune hepatitis with a coincidental tremor, A rise in the conjugated fraction on fasting, Peptic stricture from long-standing reflux, The cytotoxin-associated gene product, Urinary sodium concentration on a spot sample.

Clinical pearls from this deck

• Ask when meconium was first passed. Beyond 48 hours in a term baby, think Hirschsprung until a histology report says otherwise.
• A vomiting baby who is furious for the next feed is obstructed, not septic.
• Acid urine in an alkalotic baby is not a laboratory error; it is the kidney choosing volume over pH.
• In an adult you reach for steroids; in a growing child you reach for the feed first.
• Stop the loperamide before you order the film; the drug given to settle the diarrhoea is often what dilated the colon.
• The core immunoglobulin M is the clock. Positive means recent; negative with a persisting surface antigen means this has been going on a long time.

This deck is open to everyone with no sign-in. Work through it once for recognition, then again a week later to test yourself.

More from this system: all gastroenterology case decks · pediatric reference values.