General revision Flashcards
(228 cards)
1
Q
S3 heart sound can be d/t
A
normal: pregnancy/young people
path: LV failure
2
Q
S4 heart sound d/t
A
severe LV hypertrophy and aortic stenosis
3
Q
petichial rash + unwell infant ddx
A
meningococcal
dengue fever
4
Q
petichial rash + well infant ddx
A
enteroviral infection
rubella
EBV
HSP
5
Q
macular and/or papular + unwell infant ddx
A
early meningococcal
travel history for rare causes
6
Q
macular and/or papular + well infant ddx
A
measles erythema infectosum (fifth disease) from human parvovirus B19 roseola infantum from herpes adenoviral infection EBV
7
Q
diffuse erythematous rash + unwell infant ddx
A
TSS - toxic shock syndrome
invasive group A streptococcal infection
scarlet fever
Kawasaki disease
8
Q
diffuse erythematous rash + well infant ddx
A
staphylococcal slapped cheek syndrome
enteroviral infection
9
Q
vesicular/bullous rash in an infant ddx
A
varicella zoster
herpes simplex
staphylococcal infection
10
Q
What are the 6 diseases/exanthems of childhood?
A
- Measles (morbillivirus)
- Scarlet fever (strep. pyogenes)
- Rubella (rubivirus)
- Filatow-Dukes’ disease (controversial)
- Erythema infectiosum (parvovirus B19)
- Roseola infantum (HHV-6 and HHV-7)
11
Q
what is the pathogen which causes erythema infectiosum?
A
parvovirus B19
12
Q
varicella zoster vaccine type
A
live attenuated
13
Q
XXY = which chromosomal syndrome?
A
Klinefelter
14
Q
What syndrome has 45 chromosomes where the missing chromosome is a sex chromosome. i.e. 45, XO
A
Turner’s syndrome
15
Q
what could cause an infant to have excess androgens
A
congenital adrenal hyperplasia
16
Q
what could indicate hypopituitarism when doing a newborn examination? why?
A
micropenis. LH and FSH regulate testosterone production in the male foetus
17
Q
What are two clinical features of Turner Syndrome?
A
Webbing of the neck
widely spaced nipples
18
Q
how do you measure the bone age of a child?
A
Xray epiphysis of left wrist and hand & compare to atlas of age and sex standards.
19
Q
Mid parental height calculation for girls
A
mums + (dad’s - 13cm) / 2 +/- 6cm
20
Q
Mid parental height calculation for boys
A
dads + (mums + 13cm) /2 +/- 7.5cm
21
Q
spondylolisthesis
A
slippage of a vertebrae (usually forward) and the spine above it relative to the vertebrae below it.
22
Q
Spondylosis
A
degenerative osteoarthritis of the joints between the centre of the spinal vertebrae and/or neural foramina
23
Q
spondylolysis
A
defect in the pars interarticularis of the vertebral arch
24
Q
4 Hs of cardiac arrest
A
Hypovolaemia
Hypothermia
Hypokalaemia/hyperkalaemia/hydrogen ions (acidosis)
Hypoxia
25
4 Ts of cardiac arrest
Tamponade
Tension Pneumothorax/Trauma
Toxins
Thromboembolism
26
Child has CD19 and CD10 positive on bloods. what have they got?
Pre-B cell ALL
27
what do you see on histo of lymphoblasts?
lacy chromatin in nucleus and minimal cytoplasm
28
Normal Hb of a newborn
150
29
Normal Hb of a 3yo
110
30
Normal Hb of an adult
130
31
Which genetic factor is a good prognostic indicator for ALL?
TEL positive
32
What can you give to patients with a factor VIII deficiency?
Cryoprecipitate (Fibrinogen blood component)
33
what is the first indicator of bone marrow failure?
thrombocytopenia. d/t lifespan of platelets is 10-14 days
34
List 3 causes of thrombocytopenia
ITP
infection (e.g. varicella zoster)
bone marrow failure
35
what is the significance of wet purpura
it is associated with serious internal haemorrhage (e.g. ICH)
36
Tx for acute ITP and wet purpura
Prednisolone (IVIG second line if pred fails)
37
Which factor is involved in Haemophilia A
Factor 8
38
Which factor is involved in Haemophilia B
Factor 9
39
Which factor is involved in Haemophilia C
Factor 11
40
Which inheritance pattern are Haemophilia A and B?
X-linked
41
What would you use in minor bleed in someone with haemophilia
Desmopressin
42
Which way is the shunt in a VSD if the baby is cyanosed and minimal heart failure signs?
R --> L
43
Which way is the shunt in a VSD if the baby has heart failure signs and minimal cyanosis
L--> R
44
What does tetralogy of fallot look like on CXR?
boot-shaped heart with upturned apex and dark lung fields
45
what arrhythmia is present in the child population?
SVT
46
Tx for acute episode of SVT in an infant/child?
Diving Seal reflex - ice cold water, immerse face.
47
Is verapamil or adenosine used for SVT tx in infants/children?
adenosine.
| Verapamil should NEVER be given (fatal)
48
What is the cause of a pulmonary branch murmur in an infant?
d/t change in amount of blood going through lungs after birth. More commonly in premature infants.
49
What is the name of the murmur in babies which is short, mid-systolic ejection murmur, low-pitched, vibratory, musical, best heard between LLSE and apex?
Still's murmur.
50
If a child is obese with a fast growth velocity what is the likely cause of their obesity?
Nutrition
51
If a child is obese with a slow growth velocity what is the likely cause of their obesity?
Hormonal/genetic
52
what are the biochemical criteria for DKA?
Venous pH
53
what bedside test would you perform for a patient with BGL >11.1mmol/L?
blood ketones on a capillary sample.
54
What clinical signs would you get for dehydration of
none
55
What clinical signs would you get for dehydration of 4-7% blood volume in paeds?
reduced skin turgor
| poor capillary return
56
What clinical signs would you get for dehydration of >7% blood volume in paeds?
poor perfusion, rapid pulse, reduced blood pressure, shock.
57
Features of BWS (Beckwith-Wiedemann Syndrome)
overgrowth, macroglossia, anterior abdominal wall defects, organomegaly, hemihypertrophy, ear lobe creases, helical pits, renal tract abnormalities
58
What developmental syndrome is most commonly associated with HH (Hyperinsulinaemic Hypoglycaemia)
BWS (Beckwith-Wiedemann Syndrome)
59
What is the most common cause of Hyperinsulinaemic hypoglycaemia?
"Dumping syndrome" after gastro-oesophageal surgery.
60
What genetic abnormality are insulinomas associated with?
MEN1 (multiple endocrine neoplasia type 1)
61
what is the most important complication of hyperinsulinaemic hypoglycaemia
hypoglycaemic brain injury (glucose and ketone production stopped by insulin so no fuel for brain)
62
at what level of BGL is insulin secretion suppressed?
4mmol/L
63
HEADSS
```
Home and Environment
Education and Employment
Activities
Drugs
Sexuality
Suicide/Depression
```
64
what are the biochemical criteria for DKA?
Venous pH
65
what blood tests should be performed on patients with newly diagnosed diabetes?
Insulin antibodies
GAD antibodies
Coeliac screen (total IgA, anti-gliadin Ab, tissue transglutaminase Ab)
Thyroid function tests (TSH, FT4)
66
ECG signs of hyperkalaemia
peaked T-waves
| Widened QRS
67
ECG signs of hypokalaemia
flattened or inverted T- waves
ST depression
wide PR interval
68
what is the BGL aim during insulin infusion in treatment of DKA?
5-12mmol/L
69
Corrected sodium for DKA
Measured Na + 0.3 (glucose - 5.5)
70
Why should patients with DKA be nursed with head up?
Risk of cerebral oedema
71
how much weight should a term neonate gain per day?
20-30g/d
72
how much is an accepted weight loss in the first week after birth?
10%
73
Normal birth weight
3.25kg
74
Normal length of a term newborn
50cm
75
Weight at 4-5months old
2 x birth weight
76
weight at 1yo
3 x birth weight
77
weight at 2yo
4 x birth weight
78
how much should an infant grow in it's 1st year
25cm
79
how much should an infant grow in it's 2nd year
12cm
80
how much should an infant grow in it's 3rd year
8cm
81
how much should an child grow between 4yo and puberty
4-7cm per year.
82
normal head circumference
35cm
83
describe the galant reflex
infant held in ventral suspension and one side of back is stroked along paravertebral line. The pelvis should move in the direction of stimulated side.
84
when does Babinski become abnormal?
after aged 2yo
85
Moro reflex, describe
infant placed semi-uprght, head supported by examiner's hand, sudden withdrawal of supported head with immediate return of support --> results in abduction and extension of the arms, opening of the hands, followed by flexion and adduction of arms.
86
what do you call the fencing reflex in a baby?
asymmetric tonic neck reflex
87
Placing reflex
dorsal surface of foot against edge of table --> infant appears to step onto table.
88
Name the reflex where you stroke the infants face and they turn towards the stimulated side?
rooting reflex
89
describe the parachute reflex
ipsilateral arm extension when a sitting infant is tilted to one side.
90
what is the name of the congenital abnormality where the end of the urethra is situated further down the shaft of the penis not at the tip.
hypospadias.
91
pathophys neuroblastoma
persisting embryonal immaturity of neural crest cells (adrenals, thoracic, abdominal ganglia)
92
marker for neuroblastoma
catecholamines (urine and blood)
93
radionuclide scan for neuroblastoma uses what labelled compound
labelled MIBG
94
bounding pulses due to a wide pulse pressure could signify what congenital abnormality
patent ductus arteriosus
95
What would cause a bounding pulse in a child/infant (3)
patent ductus arteriosus
severe aortic regurg
high cardiac output states
96
how do you choose a BP cuff size?
largest cuff which does not cover the antecubital fossa or one which covers 2/3 of the arm.
97
what could you expect to find on auscultation of an infant with atrial septal defect?
fixed splitting of the second heart sound (does not vary with inspiration or expiration)
98
What is the characteristic which makes second heart sound splitting most likely physiological and not pathological?
variation (widened splitting with inspiration)
99
what would you notice on cardiac examination of a patient with pulmonary hypertension
loud second heart sound with no definite splitting. it may be palpable at the upper left sternal border.
100
what would you expect to be the pathology if you hear an ejection click in a newborn?
bicuspid aortic valve or aortic valve stenosis
| could be pulmonary valve stenosis if heard at the left sternal edge and louder on expiration
101
what is the treatment for hepatoblastoma?
complete surgical resection of the primary +/- neoadjuvant chemo
102
how much fluid should be given in boluses for correction of intravascular depletion/hypovolaemia in children?
10-20ml/kg of 0.9% sodium chloride. Can be repeated
103
how much should maintenance fluids in unwell children be?
2/3 of maintenance rate (dependant on weight). need less because of ADH secretion.
104
what is the danger of being overaggressive in rehydration of children (especially in meningitis)
cerebral oedema
105
when should 4% dextrose 1/5 NS be given in paediatrics
never. risk of hyponatraemia from the hypotonic saline
106
how much is full maintenance in mls/day for a child weighing 3-10kg?
100 x weight
107
how much should be given for maintenance fluids per day for a child weighing 6kg?
400mls
108
how much is full maintenance fluids per day for a patient weighing 10-20kg
1000mls + 50 x (wt-10)
109
what is the most accurate way to assess the degree of dehydration in a neonate/infant?
weight loss
110
what signs would you expect for an infant with mild (3-5%) dehydration
none
111
what signs would you expect for an infant with moderate (6-9%) dehydration?
```
thirsty/irritable
slightly sunken eyes
sticky tongue
decreased tears
2-3sec cap refill
increased RR
pulse fast, still strong
hands and feet normal perfusion
```
112
what signs would you expect for an infant with severe (>10%) dehydration?
```
drowsy, floppy, limp +/- comatose
very sunken eyes
dry tongue
absent tears
slow >3 sec cap refill
fast RR
skin pinch goes back v. slowly
fast, weak pulse
cool peripheries +/- blue nail-beds
```
113
what is the difference between plasmalyte148 solution and normal saline?
plasmalyte 148 has K+ and Mg2+
114
hourly maintenance requirement in an infant/child?
4mL/kg first 10kg
2mL/kg second 10kg
1ml/kg for subsequent kg.
115
how do you calculate the fluid deficit in an infant?
%dehydration x weight (kg) x 10 = mL of fluid loss
if premorbid recent weight available then fluid loss (mLs) is equal to the weight loss in grams
116
What is Kawasaki disease?
systemic vasculitis with unknown aetiology.
117
Which nationality does Kawasaki disease most commonly affect?
Japanese and Korean
118
what is the major complication of kawasaki disease?
aneurysm of major arteries (including coronary arteries.
119
what age group does kawasaki disease most commonly affect?
6months --> 4yo
120
3yo, fever for 5 days, polymorphous rash, strawberry tongue, swollen feet, bilateral conjunctivitis, and raised CRP. What is the diagnosis?
Kawasaki disease.
121
DDx for diarrhoea/vomiting in an infant?
```
intussusception
gastroenteritis
volvulus secondary to malrotation
band from a Meckel diverticulum
duplication cyst
strangulated inguinal hernia
```
122
Which toxin is implicated in HUS?
verocytotoxin
123
what are the features of the HUS clinical triad?
microangiopathic haemolytic anaemia
thrombocytopenia
acute renal insufficiency
124
What is the treatment for pyloric stenosis?
Ramstedt's Pyloromyotomy
125
what acid base disturbance is associated with pyloric stenosis?
hypokalaemic hypochloraemic metabolic alkalosis
126
what are the two key OE findings in a pt with pyloric stenosis?
pyloric tumour/mass/olive mass
| "golf-ball waves"/peristaltic waves from L) to R)
127
2 yo infant presents with bloody diarrhoea. The CBE shows thrombocytopenia and anaemia. what 2 inv would you do next and what are the results?
blood smear: fragmented RBC and thrombocytopenia.
EUC: raised creatinine
(dx is HUS)
128
which enzyme is implicated in congenital adrenal hyperplasia
deficiency of 21-hydroxylase.
129
what are some dysmorphic features of Down Syndrome?
flat midface, flat occiput, upward slanting eyes with medial epicanthic folds, Brushfield spots in the iris, palpebrae on laughing, small down turned mouth, protruding tongue, small ears, excess nuchal skin in neonatal period.
single palmar creases, clinodactyly of the fifth digit, widened gap between first and second toes.
130
what are the three most common birth defects in patients with trisomy 21
congenital heart disease
duodenal atresia
anal atresia
131
what are some common medical problems in patients with trisomy 21
```
cataracts, strabismus
leukaemia
hypothyroidism
obesity
dental problems
OSA
atlantoaxial instability
```
132
features of an infant with trisomy 19 (Edwards syndrome)
```
low birth weight
prominent occiput
dysplastic low set ears
micrognathia (small chin)
short palpebral fissures (space between eyelids)
small mouth
clenched hand posture
prominent heels
```
133
trisomy 13
Patau syndrome
134
```
low birth weight
microcephaly with sloping forehead
scalp defects
cleft lip and palate
broad flat nose
polydactyly
```
what is the genetic abnormality?
trisomy 13 Patau
135
OE findings in Turner's
```
short stature
webbed neck
broad chest with widely spaced nipples
increased carrying angle of elbows
pigmented naevi
narrow, deep-set hyperconvex nails
idiopathic HTN
```
136
what are three medical consequences of turner's syndrome?
Failure of onset of puberty
coarctation of the aorta
renal anomalies
137
clinical features of Kleinfelter Syndrome
```
tall stature
long limbs
small testes
undescended testes
gynaecomastia
female fat distribution with age
infertility
behaviour problems
```
138
Features of triple X syndrome
```
tall stature
few dysmorphic features
IQ in normal range but lower than siblings
delayed speech and motor milestones
poor coordination
normal puberty and fertility
```
139
what genetic abnormality is implicated in fragile X syndrome?
unstable triplet repeat of DNA next to the FMR1 gene --> switches off the FMR1 gene on the X chromosome
140
what is the most common cause of acidosis in ill children?
```
lactic acidosis (metabolic acidosis)
secondary to tissue hypoxia/dehydration/shock.
```
141
causes of metabolic acidosis with increased anion gap (normochloraemic) in children?
lactic acidosis
ketoacidosis (DM, ethanol, starvation, inborn errors in metabolism of amino acids)
uraemia (renal failure)
toxins (paraldehyde, methanol, salicylate)
142
causes of metabolic acidosis with normal anion gap (hyperchloraemic) in children
intestinal losses (diarrhoea, pancreatic fistula)
renal tubular acidosis
ureteral diversion with bowel
exogenous Cl- containing compounds
dilutional (ECF expansion with bicarbonate-free isotonic solution)
mineralocorticoid deficiency
143
causes of resp acidosis in children
pneumonia/pulm oedema/interstitial fibrosis
acute airway obstruction (foreign body/aspiration/croup/epiglottitis)
thoracic cage disorders (pneumothorax, flail chest, kyphoscoliosis).
ms defects (myasthenia gravis, hypokalaemia, muscular dystrophy)
nervous (polio, GBS, botulism, tetanus)
resp centre depression (anaesthesia, narcotics, sedatives)
CF
144
Causes of metabolic alkalosis in children, chloride responsive.
```
vomiting
NGT suction
diuretics
posthypercapnic alkalosis
stool losses (laxatives, CF, villous adenoma)
massive blood transfusion
exogenous alkali administration
```
145
causes of metabolic alkalosis in children, chloride unresponsive
hyperadrenocorticoid states (Cushing's syndrome, primary hyperaldosteronism, secondary mineralocorticoidism (chewing tebacco)
hypokalaemia
Bartter's syndrome
146
causes of respiratory alkalosis
```
fever
sepsis
hypoxaemia (pneumonia, PE, atelectasis)
drugs (salicylates, xanthines, progesterone, adrenalin)
CNS disorders (tumour, CVA, trauma, infection)
psychogenetic hyperventilation
hepatic encephalopathy
mechanical ventilation
```
147
what is the most common primary acid-base disturbance in children?
respiratory alkalosis
148
what medical treatment is available for children with cerebral palsy?
baclofen (gamma-aminobutyric acid antagonist)
| botulinum toxin
149
what are some risk factors for cerebral palsy?
```
infection (CMV, group B strep, HSV)
intraventricular haemorrhage (periventricular leukomalacia)
kernicterus
stroke
brain trauma
```
150
characteristic features of a scarlet fever rash
"sandpaper" texture
| accentuation in flexural creases (Pastia lines)
151
measles clinical features
enanthem (Koplik spots)
cough
coryza
152
what bug is implicated in scarlet fever?
group A streptococcus (GAS)
153
what bug causes impetigo?
staph aureus in developed countries
Group A Beta Haemolytic Streptococcus in developing countries
s. aureus = bullous
strep = crusted, honeycomb yellow non-bullous
154
treatment for anaphylaxis
remove trigger
Oxygen 100%
adrenaline IM 0.01mL/kg (repeat 3-5minutes if symptoms persist)
fluids, adrenaline infusion if hypotensive, airway management
155
most common bacterial causes of meningitis in a neonate?
group B strep
Listeria
Klebsiella
156
Most common bacterial causes of meningitis in an infant?
Neisseria meningitides
Strep pneumoniae
Haemophilus influenzae
157
most common viral causes of meningitis in paeds?
enterovirus
adenovirus
HSV
158
gram negative diplococci in CSF. most likely pathogen?
n meningitides
159
what investigations are available for dx of duchennes muscular dystrophy
Genetic testing: dystrophin gene
Muscular biopsy: no staining of dystrophin
EMG
CK (levels 10-100x normal)
160
what would you expect to see on MRI of someone with cerebral palsy?
previous stroke
periventricular leukomalacia
cortical malformations
lesions in basal ganglia
161
how would you test for myasthenia gravis?
EMG: would show diminishing action potentials with repetitive stimulation until it becomes refractory to further stimulations.
162
what is the name of the sign in Duchennes where the child walks their hands up their legs when standing?
Gower's sign
163
what are the characteristic facial features of someone with Down's syndrome?
```
flat midface
epicanthic folds
upslanting palpebral fissures
Brushfield's spots on the iris
short neck
macroglossis
```
164
what are some deformities commonly associated with downs syndrome?
TOF
VSD/ASD/PDA
duodenal atresia
atlantoaxial instability
165
what is Todd's paralysis
Post-ictal paralysis
| Focal weakness in a part of the body after a seizure
166
how common are febrile convulsions?
2-5% of children
167
what is the risk of a sibling having a febrile convulsion?
10%
168
what is the risk of a second febrile convulsion?
30-50%
169
chance of developing epilepsy after complex febrile convulsions?
4-12%
170
What are the TORCH infections?
```
Toxoplasmosis
Other (syphilis, VZV, Parvovirus B19)
Rubella
CMV
Herpes
```
171
what are the two most common causes of nephritic syndrome in the paediatric patient?
```
IgA nephropathy (Berger's nephropathy) (common>10yo)
Post-streptococcal glomerulonephritis (mean 7yo)
```
172
what is goodpasture's disease?
anti-GBM disease.
autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure
173
complications of post-strep glomerulonephritis
```
hypertension (60%)
- hypertensive encephalopathy (10%)
AKD
Heart failure
Electrolytes: hyperkalaemia, hyperphosphataemia, hypocalcaemia
seizures
```
174
Forcheimer spots are assoc with what condition
rubella
175
complications of rubella?
```
arthritis
myocarditis
secondary bacterial infection
thrombocytopenia
pan encephalitis
```
176
when is the risk highest for congenital rubella syndrome
exposure in the first 6 weeks of pregnancy is highest.
| first trimester risk is high
177
what are the features of congenital rubella syndrome?
```
deafness
ocular - cataracts
blueberry muffin appearance
heart disease
patent ductus arteriosus
right pulmonary artery stenosis
low birthweight
psychomotor retardation
death
```
178
4 possible abdominal malignancies in a 6month old baby
neuroblastoma
nephroblastoma
hepatoblastoma
rhabdomyosarcoma
179
what investigations would do for neuroblastoma
urine catecholamines
| biopsy
180
baby born with intestines out, not in peritoneum sac
gastroschisis
181
omphalocoele vs gastroschisis
omphalocoele is covered by sheath of peritoneum, can include ovaries, liver, bladder, midline/umbilical in origin.
gastroschisis is not encased in sheath, only involves bowel, and is lateral to the midline.
182
what does gastroschisis look like on USS at 12 weeks
cauliflower lesion
183
what are the coeliac antibodies?
Tissue transglutaminase
Endomysial
Anti-gliadin
184
if someone has an elbow injury and then one day later present with a claw-like deformity with volar tilt of the hand at the wrist, what is this complication called?
Volkmann's Ischaemic Contracture
185
what is the treatment for Volkmann's ischaemic contracture?
emergency fasciotomy
186
what nerve is likely to be damaged in volkmann's ischaemic contracture?
median
187
what is the medical term for webbing of the fingers or toes? and what is the classification?
syndactyly
incomplete or comlete (to tip),
simple (skin only) or complex (skin, tendon, bone)
188
what are the clinical findings of Talipe's equinovarus?
Cavus
Adducted forefoot
Varus deformity of hindfoot
Equinus deformity of heel.
189
treatment for Talipe's Equinovarus
serial casts
achilles tenotomy if casts unsuccessful
190
treatment for undescended testes
orchidopexy at 6-12 months old
191
what is the tumour marker for colon cancer
CEA
192
what is the tumour marker for ovarian cancer
CA125
193
causative organisms for acute otitis media
strep pneumoniae
haemophilus influenzae
moraxella catarrhalis
194
what is an autoimmune cause of oesophageal strictures
eosinophilic oesophagitis
195
3 most common secondary causes of raynauds
SLE
Scleroderma
RA
196
normal range for blood creatinine
50-120 mmol/L
197
strep pyogenes type and gram
Group A strep
| gram positive
198
gram status listeria monocytogenes
gram positive
199
what bacteria causes gas gangrene
clostridium perfringens
200
best treatment for gas gangrene
debridement
201
tx of listeriosis in pregnancy
ampicillin IV + gentamicin
| if penicillin allergic then erythromycin + gent
202
E. coli gram status
gram negative
203
pseudomonas aeruginosa gram status
negative
204
moraxella catarrhalis gram status
gram -ve diplococci
205
HIB gram status
gram negative
206
bacteria involved in cat-scratch disease
bartonella henselae
207
name for sign of arching of body with neck hyperextension from tetanus or kernicterus
opisthotonus
208
ECG changes with Brugada syndrome
RBBB
| raised ST segmets in V1-3
209
autosomal dominant condition with faulty sodium channels --> sudden death from fatal arrhythmias
Brugada Syndrome
210
eponymous name for IgA nephropathy
Berger's disease
211
time of onset of IgA nephropathy
24-48 hours from onset of URTI or same time
212
time of onset of Post-strep glomerulonephritis
1-4 weeks
213
histo of renal biopsy in IgA nephropathy
mesangial IgA deposition with immunofluorescence
214
histo of renal biospy in post strep glomerulonephritis
mesangeal proliferation and neutrophil infiltration. may see crescents.
immunofluorescence shows IgG and C3.
(renal biopsy only indicated if lasts longer than 3 weeks or uncertain dx)
215
bloods in post strep glomerulonephritis
low serum levels of C3 due to activation of complement pathway --> deposition.
ASOT (antistreptolysin O titre) and anti-stre DNase B are raised in 90%
216
child presents with macroscopic haematuria, fluid overload and hypertension 2 weeks after having a sore throat. most likely ddx
post-strep glomerulonephritis
217
tx for post-strep glomerulonephritis
frusemide
fluid and salt restrict
penicillin for strep
if required, oral nifedipine or prazosin for uncontrolled HTN.
218
causes of acute nephritis in children
- post-strep glomerulonephritis
- HSP
- IgA nephropathy
- SLE
- membranoproliferative
gloerulonephritis
- vasculitis
219
IgA nephropathy presentation
recurrent episodes of macroscopic haematuria coinciding with viral infections.
220
4 immunosuppressant meds sometimes used in SLE
prednisolone
azathioprine
cyclophosphamide
mycophenolate
221
Alport Syndrome
X linked dominant
disorder of production of type IV collagen
presents c microscopic or macroscopic haematuria and proteinuria
renal failure in teenage years
222
HUS triad
microangiopathic haemolytic anaemia
thrombocytopenia
acute renal insufficiency
223
4 Hs 4 Ts
Hypovolaemia
Hypoxia
Hypothermia
Hypoglycaemia/Hyperkalaemia/H+ (acidosis)
Tension pneumothorax
Tamponade
Toxins
Thromboembolism
224
definitive tx of pyloric stenosis
Ramstedt's pyloromyotomy
225
initial tx for Crohn's
5-aminosalicylic acid (e.g. sulphasalazine)
abx (e.g. metro)
nutritional therapy
226
triad of AAA
back pain
hypotension
pulsatile abdominal mass
227
test to confirm Addisons
Short Synacthen test (synACTHen)
228
test to confirm Conns
renin-aldosterone ratio: get high aldosterone and high renin
