Gastroenterology – Set 4

What this deck covers

Gastroenterology – Set 4 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. Pellets every third day
2. Climbing-frame fall, team leader asks
3. Still full after two weeks
4. Blood-streaked mucus, content baby
5. Painless blood, a cherry-red lump
6. Could a nerve problem explain it
7. Lap belt and blood on the glove
8. Blood on the paper, pain at stool
9. First day, swelling, no meconium
10. Soiled pants and huge stools
11. Hamartomas on investigation
12. Desk-toy balls in the stomach
13. Puffy eyelids on a new bottle
14. Handlebar blow and back pain
15. Soiling plus daytime wetting
16. Parents notice anal lumps
17. Green vomit, live pink worm
18. Freckled lips and colicky attacks
19. Hives and wheeze within minutes
20. Once a week, soiled pants
21. Steady after one bolus
22. Tense swelling in cerebral palsy
23. Free gas in a boy on steroids
24. Handlebar bruise, duct spared
25. Swollen and silent after diarrhoea
26. Swollen ankles and a prolapsing lump
27. Why laxatives rather than a cream
28. Vomiting after the first bottle
29. Oral plan failed after three weeks
30. Bright red after normal stools
31. Blocked bowel by age band
32. Refuses the first-choice drink
33. Toddler cries at every hard stool
34. Toddler who mouths everything
35. Which daily medicine now
36. Parents ask about the outlook
37. Steroids, ibuprofen and sudden pain
38. Grey, mottled after yoghurt
39. Oral and rectal routes both failed
40. Horse kick to the upper belly
41. Eczema and arching with bottles
42. Swollen lumps, pus at the anus
43. Grandmother suggests an old oil
44. Retching with nothing coming up
45. Beyond the medicine each day
46. Early fullness weeks after a fall
47. Green vomiting after spinal surgery
48. Parents plan for the future
49. One removed, nothing else seen
50. How long to keep going

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Abdominal radiograph to confirm faecal loading, Stop breastfeeding and start amino acid formula, Bowel or mesenteric injury, Overflow from functional constipation, Food protein-induced allergic proctocolitis, A single small tag at 6 o’clock, Extensively hydrolysed casein formula, A double bubble with no gas further down, Ileocolic intussusception, IgE-mediated anaphylaxis to milk, Sigmoid volvulus, Batteries swallowed; small coins inhaled, Barium meal and follow-through, Magnetic resonance cholangiopancreatography.

Clinical pearls from this deck

• No red flags, no tests: treat and review.
• Look for the blood in C; feel the whole abdomen in the secondary survey.
• Two weeks of macrogol and still full: add a stimulant.
• Treat the mother’s diet, not the baby’s feed.
• Painless blood at the end of a normal stool in a school child: a polyp.
• Trouble from birth suggests Hirschsprung disease; trouble from the potty is functional.

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.