Gastroenterology – Set 8

What this deck covers

Gastroenterology – Set 8 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. Jaundice, aching joints, vitiligo
2. Bleeding gums in acute hepatitis
3. Slurred speech and falling grades
4. Why the abdomen fills with fluid
5. Yellow infant with bruised shins
6. A chelator and its companion
7. Obese diabetic teenager, raised ALT
8. Why one blood test is not enough
9. Big spleen after a neonatal line
10. Aunt with a positive AMA
11. Farm child, right upper fullness
12. Confused after chickenpox, no jaundice
13. Negative viral screen, high protein
14. Febrile, yellow transplant child
15. Same swollen ankles as grandfather
16. Cupful of blood after a Kasai
17. Which risk drives liver scarring
18. Tired teenager with a high IgG
19. Feeling well and off to university
20. Large spleen, low platelets
21. Planning care for a liver cyst
22. INR unchanged after vitamin K
23. Colitis, itching and beaded ducts
24. Repeated fevers years after a graft
25. Borderline results, one gene variant
26. Yellow boy, clubbed fingers
27. AST surge after the gym
28. Stable after transfusion, scope soon
29. Biopsy done, starting therapy
30. Normal liver tests despite varices
31. Well brother with both gene variants
32. Jaundiced baby who will not settle
33. Cysts within a cyst on a sheep farm
34. GGT stays high despite remission
35. Four days of double-dose syrup
36. Grandmother asks about gallstones
37. Should this liver be sampled
38. Sodium falls as the swelling grows
39. Second drug after the bleed stops
40. Fever and rib pain after dysentery
41. Grandfather’s joint-pain tablets
42. Canal swimmer with a huge spleen
43. Well little sister, affected brother
44. Yellow and itchy after sinusitis
45. Two bleeds and a patent left branch
46. When to call the transplant centre
47. ALT stays up, cold and constipated
48. Acid-base puzzle in a failing liver
49. Fibrin plug and red wale marks
50. Fever that outlasts the neutropenia

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Alpha-1 antitrypsin deficiency, Peritoneal inflammation with protein-rich exudate, Chronic hepatitis B virus infection, Unlikely: it is almost only an adult disease, IgG, ANA, anti-smooth-muscle, anti-LKM1, About 10 to 11 g/dL, Until her urine copper has normalised, Consumption of factors by intravascular clotting, Brain MRI with diffusion imaging, Tranexamic acid infusion, Observation with yearly liver tests, Magnetic resonance cholangiography, If the diagnosis is unclear or fibrosis likely, Metronidazole, then a luminal agent.

Clinical pearls from this deck

• Negative viral screen plus a high globulin in a jaundiced child: think of autoimmune hepatitis.
• In acute hepatitis the INR tells you how the liver works; the ALT tells you how hurt it is.
• Neurological Wilson disease without Kayser-Fleischer rings is rare enough to question the diagnosis.
• Ascites in cirrhosis: pressure, protein and a sodium-hungry kidney.
• Jaundice plus spontaneous bruising in an ill infant is liver failure until the INR proves otherwise.
• Penicillamine always comes with pyridoxine.

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.