Acute gastroenteritis and infectious diarrhoea — formative SAQs

SAQ 1 — The toddler with watery diarrhoea (10 marks, 15 minutes)

An 18-month-old boy has two days of frequent watery, non-bloody diarrhoea and vomiting. He is restless and irritable, his eyes look sunken, his mucous membranes are dry, his skin pinch is slow and his capillary refill is prolonged, but he is alert and his peripheries are warm. His nappies have been drier than usual. [1]

a) Using recognised clinical signs, what grade of dehydration does this child have, and which signs support your grade? (3 marks) [3] [4]

b) Describe your rehydration plan, including the type of fluid, the route, the volume and the timeframe, and what you would do if he refuses to drink. (4 marks) [8] [1]

c) Beyond rehydration, outline the feeding advice and the adjunct treatment you would give, and one thing you would specifically avoid. (3 marks) [5] [1]

SAQ 2 — The child with bloody diarrhoea (10 marks, 15 minutes)

A 4-year-old girl has three days of diarrhoea that is now bloody and mixed with mucus, with fever and crampy abdominal pain. She is drinking and only mildly dehydrated. Her mother asks whether she needs antibiotics. [11]

a) What organisms cause bloody diarrhoea in a child, and how does this change your assessment compared with watery diarrhoea? (3 marks) [11] [1]

b) Explain your approach to antibiotics in this child, and the specific reason you would be cautious. (4 marks) [1] [11]

c) What complication of Shiga-toxin Escherichia coli must you watch for, and what would you monitor to detect it? (3 marks) [11] [1]