The Acute Metabolic Presentation – Board-Style Questions

What this deck covers

the acute metabolic presentation 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 paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 18 cases, in order

1. Two good days, then this
2. The brother who died
3. Better on the drip, worse at home
4. Working hard, chest clear
5. The specimen nobody can get twice
6. Why it cannot wait until the round
7. The day the feeds got going
8. Both at once, or one first
9. What to say in the first hour
10. How much sugar is enough
11. The sugar starts to climb
12. The bag with the fat in it
13. Peritoneal, or something faster
14. Waiting for the pharmacy
15. The call to the specialist centre
16. Putting the food back
17. The night the line came out
18. Before he goes home

Diagnoses and management options tested

Across the 18 cases you are asked to choose between options such as: The normal white cell count, which rules out bacterial illness, A strong case for a recessive disorder never identified, A second viral illness picked up during the hospital visit, As obstruction of the upper airway causing the noisy effort, The first urine he passes during this illness, frozen at once, The laboratory rejects any specimen that arrives after midnight, The weight lost in the first days masked his early symptoms, Pick the likelier of the two, as treating both blurs the picture, That an inherited chemical problem is suspected and tests are running, The strength printed on the bag rather than the rate chosen, Change to a weaker solution at the same volume, Lipid raises the ammonia in every one of these disorders, It clears far too slowly to bring a dangerous level down, Wait for the drugs, as transfer without them is unsafe.

Clinical pearls from this deck

• A well interval before collapse is not infection.
• A sibling death with no organism is a warning.
• Better on sugar and worse without it is a clue.
• Hard breathing with a clear chest: look at the blood.
• Freeze the crisis urine before the drip goes up.
• Treatment erases the evidence within a few hours.

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 genetics and metabolic case decks · pediatric reference values.