Dysphagia in Children

What this deck covers

Dysphagia in Children 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. Steak stuck after a year of careful chewing
2. What to do once the bolus is out
3. Starting with the least burden
4. Where the drug has to land
5. Taking six away, adding them back
6. The baby who will not take lumps
7. Eight years without treatment
8. Telling two swallowing problems apart
9. Water as hard to swallow as bread
10. Confirming what contrast suggested
11. What the pressure trace shows
12. The repair that should last
13. Dry eyes and a stiff gullet
14. When theatre is not an option
15. A double ring on the chest film
16. Eight weeks after the drain cleaner
17. Coughing at every meal
18. Noisy breathing that eases on stretching

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: A peptic stricture from long-standing acid reflux, Arrange a barium swallow to measure the narrowing, Swallowed topical budesonide for twelve weeks, Subcutaneous dupilumab every two weeks, Arrange endoscopy with biopsies from two levels, Vomiting that occurs shortly after meals, Eosinophilic inflammation of the gullet, Twenty-four hour acid and impedance monitoring, Long-acting nitrate taken before every meal, Long-standing untreated coeliac disease, Injection of botulinum toxin into the sphincter, Observe her for six hours and repeat the radiograph, Scar tissue has contracted and narrowed the gullet, Pressure measurement of the gullet.

Clinical pearls from this deck

• Ask how the child eats, not whether swallowing hurts. The adaptations are the history.
• A normal-looking gullet with a suggestive history still needs biopsies from two levels.
• A response to acid suppression no longer excludes the diagnosis. It is treatment.
• Swallowed, not inhaled, and nothing to eat or drink for half an hour afterwards.
• Skin and blood allergy tests do not find the food. Only reintroduction and biopsy do.
• A baby who refuses lumps but drains a bottle is telling you where the problem is.

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.