Paeds placement

Question 1

Describe HSP.

What immunoglobulin is it associated with

Answer 1

Small vessel vasculitis

IgA

Question 2

What does it often precede

Answer 2

URTI

Question 3

Clinical Features

4 Headings

Answer 3

Rash: Erythamotous macula rash on buttocks, lower legs & ulcer side of arm.

• In boys can be testicular rash, D.D torsion
• Think gravity dependant

Arthritis - Affects large joints: knee, ankles, elbows

GI: colicky pain & malaena + haematemisis, intuessusception, perforation

Renal: haematuria & proteinuria present in 50%

Question 4

Complications

Answer 4

IgA nephropathy (nephrotic)

• Worse prognosis if older patient
• Can present with proteinuria, haemutria

1% can develop end-stage kidney failure

Question 5

Investigations for HSP

Answer 5

• Serum IgA
• Urinalysis
• FBC (increased platelets)
• U&Es
• ESR
• US +

Question 6

Diagnosis

Answer 6

Clinical diagnosis

Question 7

Management

Answer 7

Supportive Rx

NSAIDs for arthritic symptoms
Corticosteroids for arthritis
Steroids + azathiprine for renal (need referral urology)

For kidney assessment:
Urine input & output charts
Daily weighs
US +- biopsy

Question 8

Prognosis

Answer 8

1/4 reoccur
↓ 3 milder
Depends on level of renal impairment

Question 9

In a vomiting history, what symptoms can you think of that would point to a diagnosis.

Answer 9

Large amounts of feed in Hx in thriving baby who seems hungry -> overfeeding
Projectile vomit: P.S.
Bile stained vomit: intestinal obstruction (atresia or malrotation, intussesception (older child)): NG tube to aspirate stomach + stop feed + upper GI contrast
Diarrhoea: gastroenteritis
Fever: infection (UTI, otitis media, meningitis)
Cough fits + turning blue: whooping cough
Down’s or cerebral palsy: GORD

Question 10

Examination of vomiting child

Answer 10

• Dehydration (frontenlles, crying, mucus membranes)
• Look for & feel for pyloric mass
• Abdo distension?
• Papilloedmea - ↑ ICP
• Meningitis signs