Gastroenterology – Set 3

What this deck covers

Gastroenterology – Set 3 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 paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Toddler with coryza and loose stools
2. Bloody stools after a barbecue
3. Screaming bouts, limp in between
4. Listing the likely culprits
5. Choosing the sign to trust
6. Limp and flank pain with fever
7. Low bicarbonate, high chloride
8. Sent home, back worse with a lump
9. Doughy skin and a high-pitched cry
10. Umbilical ache that moved
11. Father wants two prescriptions
12. Third bout at the age of five
13. Painless maroon stools in a toddler
14. Groin bulge when he cries
15. Mother reassured by clean nappies
16. First scan inconclusive
17. Drowsy toddler, many watery stools
18. Waiting for theatre, thirsty
19. Milk or meals while unwell?
20. Stable girl with a matted lump
21. Hands on a quiet abdomen
22. What the tube feed is made of
23. Air enema being planned
24. Timing a groin operation
25. Febrile teenager with rebound
26. Mother asks for a quicker cure
27. Navel bulge when she cries
28. Dry lips at 20 months
29. Tracking down the bleeding point
30. Walled pocket beside the caecum
31. Missed jabs, then a flood of stool
32. Pale and quiet between bouts
33. Hard to wake, cold mottled legs
34. Bedside test for a low position
35. Father asks what made it likely
36. Round white spot on the film
37. Hard, tender groin lump
38. After fluids and antibiotics
39. Setting the pace of correction
40. Rigid belly after two boluses
41. Father asks why it happened
42. Transfused girl, source now found
43. Every drink returned, tube refused
44. Green vomit after a kidney operation
45. Hungry after a night of fluids
46. Parents ask when surgery comes
47. Pale, puffy and little urine
48. What the probe should find
49. Heading home after the drip
50. Pink again after a bolus

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Acute bacterial pyelonephritis, Vibrio cholerae, Yersinia, Salmonella, norovirus, Lactic acid from poor tissue perfusion, Ovarian torsion, Juvenile colonic polyp, Rapid non-contrast MRI of the abdomen, Stop milk and food; give clear fluids for 24 hours, Na 90, K 20, glucose 111 mmol; 311 mOsm/L, 200 mL, plus 100 mL after each watery stool, Daily probiotic drops from birth, Right-sided pain on pressing the left iliac fossa, Emergency herniotomy without delay, Repeat imaging in 24 hours before deciding, If it persists beyond about 4 to 5 years.

Clinical pearls from this deck

• Diarrhoea is the discriminator: fever with vomiting but little diarrhoea should prompt a urine test.
• Pink burger, petting farm, blood without fever: think of the organism that leads to kidney failure.
• A baby who is pale and limp between bouts of screaming is not colicky: think of telescoping bowel.
• Colon invaders bleed; small-bowel secretors pour water.
• Press, count and look at the breathing: capillary refill, skin turgor and deep breathing beat dry lips.
• A limp and a flexed hip in a febrile child with flank pain can be the appendix, not the hip or the kidney.

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 case decks · pediatric reference values.