Coeliac Disease and Cow’s Milk Protein Allergy in Children

What this deck covers

Coeliac Disease and Cow’s Milk Protein Allergy in 18 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 18 cases, in order

1. Miserable since the first cereals
2. The blood test that comes first
3. A normal result that cannot be trusted
4. Do not take the bread away yet
5. When the scope can be skipped
6. What the samples show
7. Who to test when nothing hurts
8. An itchy rash on both elbows
9. Iron that never worked
10. Still unwell on the new diet
11. Hives within minutes of the first bottle
12. Blood in the nappy of a thriving baby
13. Which milk to try next
14. Pale and floppy two hours after rice
15. Going back to milk
16. The bean that is not the answer
17. Swapping one animal for another
18. Wind and water, no rash

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: Cow’s milk protein allergy of the delayed type, Faecal elastase and a three-day stool fat collection, The sample was taken too early in the illness, Arrange genetic testing instead, Proceed to endoscopy with duodenal biopsies, Eosinophils packed into the lining in large numbers, A child with type 1 diabetes and no gut symptoms, Chronic spontaneous urticaria, Blood loss from a Meckel diverticulum, Add a course of oral steroid to settle the lining, Food protein induced enterocolitis syndrome, Change him to an extensively hydrolysed formula, A soya-based infant formula, A rapid bolus of intravenous fluid.

Clinical pearls from this deck

• Ask when cereals started. Symptoms that predate them are not this diagnosis.
• An antibody result without a total level beside it cannot be interpreted.
• Read the total IgA before you read the antibody. It decides whether the antibody means anything.
• Never test a child who has already stopped eating gluten. Put it back first.
• The second sample is not a repeat of the first. It is there to catch a swapped tube.
• Include the bulb. In a small number of children it is the only place the change is seen.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all Gastroenterology Board Questions case decks · pediatric reference values.