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CPS Exam I > Case I > Flashcards

Case I Flashcards

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1
Q

Formula for estimating systolic blood pressure in children?

A

80 + (2 x Age)

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2
Q

Number one cause of secondary HTN in adolescents < 15 years old?

A
  • 67% of secondary HTN is from renal complications

* 11% endocrine related (hyperaldosteronism, Cushings, pheochromocytoma)

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3
Q

Strep throat accompanied with a rash, diagnosis?

A

Scarlet fever
• Slapped cheek
• Scarlatinform rash on thorax and abdomen
• Strawberry tongue

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4
Q

What symptoms would you typically have with sore throat from a viral illness (as opposed to strep infection)?

A
  • Cough
  • Hoarseness
  • Runny nose
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5
Q

Untreated strep throat infection duration?

A

2-5 days

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6
Q

Treated strep throat infection duration?

A

1-3 days

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7
Q

Possible skin sequelae of scarlet fever?

A

Desquamation 1-3 weeks after rash onset

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8
Q

How does a person get streptococcal pharyngitis?

A

Usually results from direct contact with another person with strep. pharyngitis.

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9
Q

What does Rapid Strep Test test for?

A

Detects the presence of a carbohydrate antigen by agglutination

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10
Q

Specificity of rapid strep test?

A

High specificity (95 to 98%)

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11
Q

Sensitivity of rapid strep test?

A

Low sensitivity (75 to 80%)

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12
Q

How long does throat culture typically take?

A

24-48 hours

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13
Q

How long will throat culture remain positive after GABHS infection?

A

Only 25% will remain positive a few weeks after infection

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14
Q

How long would an anti-streptolysin O test to become positive?

A

begins 1 wk, peaks 3-6 wks

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15
Q

What serologogical tests can you complete for strep infection?

A

– Anti-streptolysin (ASO) (begins 1 wk, peaks 3-6 wks)
– Anti-streptokinase (ASKase)
– Anti-nicotinamide-adenine dinucleotidase (anti-NAD)
– Anti-DNAse B antibodies (+skin) (begins 1-2 wks, peaks 6-8 wks)
– Anti-hyaluronidase (AHase)(+skin)

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16
Q

How long is a person with streptococcal pharyngitis infectious

A

Until after 24 hours of appropriate antibiotic therapy.

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17
Q

How is streptococcal pharyngitis treated?

A

• Either a single injection of penicillin
• or with a 10-day course of oral antibiotics:
penicillinV, amoxicillin, cephalosporin, macrolide or clindamycin

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18
Q

Should asymptomatic contacts of persons with streptococcal pharyngitis receive antibiotics?

A

No

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19
Q

3 non-suppurative sequelae of strep infection

A

– Rheumatic fever
– PostStreptococcal GlomeruloNephritis
– Pediatric Autoimmune Neuropsychiatric Disorder Associated with group A Streptococci (PANDAS)

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20
Q

Which of the post-streptococcal infections is treated adequately both by early and late treatment?

A

Rheumatic fever

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21
Q

Which of the post-streptococcal infections is not treated adequately both by early and late treatment?

A

Glomerulonephritis

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22
Q

What is a Still’s murmur?

A

Systolic Ejection Murmur
 in Children

Hyperdynamic blood flow over a normal pulmonic/ aortic valve

May have a high cardiac output due to: anemia, infection, thryotoxicosis, pregnancy, peripheral AV fistula, volume overload

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23
Q

Onset out rheumatic fever after streptococcal pharyngitis?

A

Develops 2-5 weeks after streptococcal pharyngitis.

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24
Q

What are the fiver major criteria for rheumatic fever diagnosis (JONES criteria–need 2 positive)?

A

Joints (migrating polyarthritis)

Obvious (heart: carditis, pericarditis, endocarditis/valvulitis)
 Nodes (subcutaneous nodules)

Erythema marginatum (skin rash)

Sydenham’s chorea (involuntary movements)

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25
What are the fiver major criteria for rheumatic fever diagnosis (JONES criteria--need 1 positive)?
``` Fever Arthralgia: Joint pain without swelling ↑ ESR/CRP Leukocytosis Heart block Previous episode of rheumatic fever or inactive heart disease ```
26
What is often the first noticeable symptom of renal disease?
Facial puffiness/periorbital edema
27
How can you differentiate hematuria from hemoglobulinuria?
Hematuria: blood on dipstick and microscope Hemoglobulinuria: blood on dipstick but NOT microscope
28
Cause of hemoglobulinuria?
Hemolytic anemia
29
Causes of hematuria?
* Infection * Kidney stones * Trauma * Tumor
30
Causes of myoglobulinura?
Rhabdomyolysis
31
In glomerulonephritis, why is it not typically considered a nephrotic syndrome?
Most don't reach the threshold of proteinuria to be classified as such
32
How do red cell casts form?
PCVT leaks red cells and protein, clumps formed in DCVT and retain shape of tubule when passed
33
Protein range for nephrotic syndrome?
> 3.5 g/day
34
Albumin range for nephrotic syndrome?
Hypoalbuminemia < 3 g/dL
35
What are the criteria for nephrotic syndrome?
* Increased glomerular permeability * Proteinuria * Hypoalbuminemia * Edema d/t DECREASED ONCOTIC PRESSURE * Hyperlipidemia and lipiduria * Typically NO HEMATURIA
36
What is the difference between nephritic syndrome and nephrotic syndrome?
Nephritic: damage due to inflammation Nephrotic: damage due to object/protein
37
What is the most common cause of nephrotic syndrome in children < 10 years of age?
Minimal change disease (idiopathic nephrotic syndrome)
38
What is minimal change disease very response to?
Steroids
39
What are symptoms of nephritic syndrome?
* hypertension * edema (oliguric renal failure) * azotemia * hematuria * red blood cell casts * pyuria (pus) * mild to moderate proteinuria < 3.5 g/day
40
What causes edema and HTN in nephritic syndrome?
Extensive inflammatory damage to glomeruli causes a fall in GFR and eventually produces uremic symptoms with salt and water retention
41
Where are most of the cases of poststreptococcal GN now reported?
97% in developing countries (India)
42
Which sex has higher rates of poststreptococcal GN?
Males
43
Besides pharyngitis, how else can someone get poststreptococcal GN?
Impetigo (but these do NOT cause rheumatic fever)
44
What is the risk of getting poststreptococcal GN after being infected with a nephritic strain of the organism?
10-15%
45
What are the complement levels assocated with PSGN?
* C3 and CH50 are low (usually seen within 2 weeks) | * C4 usually normal (alternative pathway activated)
46
If a PT has nephritis and low C3/C4, what should you suspect?
This is not poststreptococcal which only activates alternative pathway. This is activation of classical pathway. Could be lupus.
47
If a PT has nephritis and normal C3/C4 levels, what should you suspect?
Consider IgA nephropathy, Henoch-Schonlein Purpura or Goodpasture syndrome
48
What might lead to you get a renal biopsy on a patient with nephritis?
* Considering other glomerular diseases * Persistently low C3 >6 wks (? membranoproliferative GN) * Recurrent episodes hematuria (? IgA nephropathy) * Progressive increase in Creatinine
49
What is the main complication of kidney biopsy?
Bleeding
50
What is the pathology of HUS?
Thrombotic microangiopathy after bloody diarrhea caused by shiga verotoxin producing E. coli which damage glomerular vascular endothelium
51
What is the treatment for HUS?
– Supportive, observation in hospital, dialysis as needed (5-15% mortality) – Antibiotic Rx may stimulate further verotoxin production – Platelet transfusions may worsen outcome – Plasmaphersis with neurologic symptoms (reverses ongoing platelet consumption)
52
What is the prevalence of lupus nephritis in children?
Half of children with disease will get lupus nephritis
53
Who is lupus nephritis most common in?
* Women, 20-40 yrs. old | * African Americans, Latinos & Asians
54
Symptoms of lupus nephritis?
– Weight gain – High blood pressure – Darker foamier urine – Swelling around eyes, legs, ankle & fingers – More than 1⁄2 have not had other symptoms of SLE: Crescent formation – arthritis, fevers, fatigue, GI sx, HA, swollen joints , malar rash
55
What is Berger's disease?
Immune complex-mediated glomerulonephritis | defined by the presence of diffuse granular mesangial IgA deposits often associated with mesangial hypercellularity
56
What is the presentation of Berger's disease?
Recurrent macroscopic hematuria during/immediately following an URI in children (5 days vs. 10 days in PSGN) Asymptomatic microscopic hematuria in adults
57
Complement levels in Berger's disease?
Normal
58
What is Henoch-Schönlein Purpura (IgA vasculitis)?
• Systemic vasculitis w/ deposition of IgA immune complexes • Symtoms/signs: purpura 100%, arthritis 80%, abdominal pain 60%, proteinuria 50%, kidney involvement 40% nephrosis 12%
59
Complement levels in Henoch-Schönlein Purpura (IgA vasculitis)?
Normal
60
What is Anti-Glomerular Basement Membrane Disease
 | (Goodpasture Syndrome)?
Disorder in which circulating antibodies are directed mainly against the NC1 domain of the α-3 chain of type IV collagen (highly expressed in the GBM and alveoli)
61
What triggers Goodpasture Syndrome?
viral upper respiratory infection or breathing hydrocarbon solvents
62
Goodpasture presentation
Usually present with rapidly progressive glomerulonephritis: | acute renal failure, nephritic urine sediment, and non-nephrotic proteinuria
63
CXR of Goodpasture syndrome (50-60% have pulmonary involvement)?
Chest radiography shows diffuse alveolar infiltrates.
64
What will you see in the glomerulus of PSGN?
Neutrophils will invade
65
What percentage of PTs with PSGN will progress to rapidly progressive glomerulonephritis?
1%
66
What typically precedes MembranoProliferative GlomeruloNephritis (MPGN)
URI
67
Complement levels in MembranoProliferative GlomeruloNephritis (MPGN)?
Patients with MPGN continue to have persistent nephritis & hypocomplementemia beyond 4 to 6 weeks and possibly a further elevation in serum creatinine
68
Oliguria amount?
urine volume <1mL/kg/hr)
69
Anuria amount?
urine volume <50 ml
70
Indications for dialysis?
``` A acid/base refractory imbalance E electrolytes I intoxication/ingestion of substances O overload of fluids U uremia symptoms ```
71
What is the number for poison prevention
1-800-222-1222

CPS Exam I (4 decks)

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