Case Studies

Question 1

is it important to calculate feed volumes per feed and per kg per day?

Answer 1

yes

Question 2

what is the management for milk protein intolerance ?

Answer 2

trial of hydrolysed feed
milk free advice for weaning
may need thickeners/acid suppression

Question 3

what are the two hydrolysed feeds?

Answer 3

nutramigen

aptimil pepti 1

Question 4

state some signs that would show if a baby was well?

Answer 4

pink colour 
active 
feeding 
crying 
babbling 
development 
stools
urine

Question 5

state some signs that would show if a baby was unwell?

Answer 5

pale colour 
less active 
poor feeding 
crying 
airway noises (stridor, wheeze) 
poor weight gain 
rash, spots, bruises

Question 6

4 weeks old otherwise healthy baby. Good weight gain (180g/w), breast fed, presents with streaks of fresh blood in stool for last 4 days.
No fever. General and abdominal examination is normal.
what is a differential diagnosis ?

Answer 6

cows milk protein allergy
(CMPA)
infection
constipation

Question 7

what are some important questions to ask about streaks of blood in the stool?

Answer 7

change in stool frequency
straining, pain, vomiting
Fhx of atopy
clarify weight gain

Question 8

what is the management of CMPA?

Answer 8

stool culture
material milk avoidance (milk protein from mother can pass into the breast milk)
mother will need Ca/Vit D supplements

Question 9

state some possible Fhx atopy

Answer 9

allergies
asthma
eczema
hayfever

Question 10

what is the prognosis of CMPA?

Answer 10

most children have grown out of it by 1 year

Question 11

is CMPA IgE mediated ?

Answer 11

no

Question 12

state some IgE mediated food allergies?

Answer 12

egg, nuts, pulses, fish, grains, milk

Question 13

state some symptoms of food allergy ?

Answer 13

vomiting, pain, diarrhoea
urticaria, angioedema, pruritis
wheeze, cough, stridor

Question 14

what test is used for IgE mediated food allergy?

Answer 14

none

Question 15

does IgE mediated or non mediated allergies symptoms last longer?

Answer 15

non IgE mediated may last for many days whereas IgE mediated only last 12 hours

Question 16

state some symptoms of CMPA?

Answer 16

vomiting, diarrhoea, abdo pain, reflux, poor feeding, FTT, eczema \

Question 17

state what food should be used in a milk challenge at home?

Answer 17

baked milk in biscuit/pancake 
cooked milk in custard
yogurt
cheese
milk

Question 18

3y old boy referred for poor weight gain and loose, pale stools (1 year, 3-4 times/day), flatus. Picky eater, all normal diet, miserable, term, formula fed, tried milk free diet. No significant past illness or family history
Examination; Pale, less sub cutaneous fat, muscle wasting, distended abdomen
what is the possible diagnosis?

Answer 18

coeliac disease

Question 19

what are the tests done for coeliac disease?

Answer 19

stool screen (faecal elestase, electrolytes)
anti-tissue transglutaminase
anti-endomysial
duodenal biopsy
bloods - FBC, Fe status, CRP, LFTs, Vit D status

Question 20

what is the treatment of coeliac disease ?

Answer 20

gluten free diet

Question 21

A 6y old boy presents with 12m of abdominal pain. He passes stools 1/week with occasional blood. He is on the 98th weight centile and 50th height centile.
Examination shows small soft masses in the LLQ
what is a diagnosis ?

Answer 21

chronic constipation

Question 22

state the constipation cycle ?

Answer 22

constipation -> large hard stool -> pain or anal fissure -> withholding of stool

Question 23

what is a complication chronic constipation ?

Answer 23

faecal incontinence

Question 24

what is the management of faecal incontinence ?

Answer 24

stool softener 
increase fluid intake 
increase fibre intake 
reduce milk and sweets 
praise and star charts

Question 25

A 10 week old boy presents with 4 weeks of frequent post feed effortless vomits and distress (back arching and pulling up knees). Examination showed a soft abdomen with no palpable masses. what is a possible diagnosis?

Answer 25

gastro-oesophageal reflux

Question 26

what questions should be asked about gastro-oesophageal reflux?

Answer 26

colour of vomit (bilious?) volume, blood feeding position, type, volume weight gain, development, cough

Question 27

what is the management of GORD?

Answer 27

feeding advice - routines and volume | medical treatment - feed thickeners, PPI, milk free feeding

Question 28

is GORD common?

Answer 28

yes

Question 29

what colour is bile?

Answer 29

green

Question 30

is bilious vomiting serious?

Answer 30

yes

Question 31

state some causes of the bilious vomiting ?

Answer 31

malrotation intussusception ileus (sepsis?) crohns disease

Question 32

what is the management of bilious vomiting ?

Answer 32

urgent surgical opinion IV access and fluids NG tube Abdo X ray

Question 33

A 9 month old girl presents with 48h of increasing wheeze and respiratory effort and a 4d history of mild runny nose and cough. Examination shows bilateral wheeze and crackles. She has sub-costal recession, a pink throat and red ears. Resp rate 60, Sats 93% and temp 37.9o what is the diagnosis ?

Answer 33

bronchiolitis

Question 34

are any medications that can help bronchiolitis ?

Answer 34

no | - self limiting

Question 35

on what day do the symptoms of bronchiolitis peak?

Answer 35

4-5days

Question 36

state some symptoms of bronchiolitis ?

Answer 36

nasal stuffiness tachypnoea poor feeding

Question 37

An 18m boy presents with a 4 hour history of barking cough and noisy breathing having been well the day before Examination shows a runny nose, loud stridor, tracheal tug sub-costal recession, well perfused peripheries and temp of 37.8o what is the diagnosis?

Answer 37

croup

Question 38

state the symptoms of pneumonia?

Answer 38

``` fever >38.5 SOB cough grunting wheeze ```

Question 39

what 1st and 2nd line antibiotics should be used for pneumonia?

Answer 39

amoxicillin | macrolide