peds44

Question 1

repletion phase for hyponatremic or isonatremic dehydration

Answer 1

replace fluids over 24 hours

Question 2

repletion phase for hypernatremic dehydration

Answer 2

replace more slowly over 48 hours to minimize risk of cerebral edema

Question 3

oral rehydration salt salotions

Answer 3

balanced mixtures of glucose and electrolytes (since glu co-transport still works in secretroy diarhhea, whereas other pways of Na absorption are impaired)

Question 4

when is ORT inapprop

Answer 4

severe life-threatening dehydration, paralytic ileus, or GI obstruction, patients with extremely fast stool losses or repeated severe emesis losses

Question 5

microscopic hematuria

Answer 5

greater than 6 RBCs per HPF, detected on 3 or more consec samples

Question 6

urinary dipstick for hamturia

Answer 6

detects hemoglobin or myoglobin in the urine

Question 7

false neg on urine dipstick for hematuria

Answer 7

vit C ingestion

Question 8

RBC casts

Answer 8

glomerular bleeding (acute or active glomerulonephritis)

Question 9

dymorphic RBCs

Answer 9

originating in the glomerulus, ofetn have blebs

Question 10

RBCs that look normal

Answer 10

originate in the lower urinary tract

Question 11

large numbers of RBCs (esp in the presence of dysuria)

Answer 11

may indicate acute hemorrhagic cystitis (due to bacterial or viral infection or chemotherapeutic agents like cyclophosphamide)

Question 12

proteinuria

Answer 12

more than 100 mg/m2/day

Question 13

how to screen for proteinuria

Answer 13

urine dipstick; it detects albumin

Question 14

false pos on urine dipstick for protein

Answer 14

if urine is very concentrated (sg>1.025) or alkaline (pH > y) or If patient received certain meds (peniccilin, aspirin, oral hypoglycemic agents)

Question 15

false neg on urine dipstcik for protein

Answer 15

if the urine is very dilute

Question 16

most accurate way to detect proteinuria

Answer 16

24 hour protein collection ; normal Is less than 100 mg/m2

Question 17

random spot urine

Answer 17

protein to creatinine ratio; early morning sample is ideal;

Question 18

normal urine TP/CR for 6-24 months

Answer 18

<0.5

Question 19

normal urine TP/CR for > 2 years is <0.2

Answer 19

right

Question 20

benign transient proteinuria

Answer 20

may be associated with vigorous exercise, fever, dehydration, and CHF

Question 21

wht if dipstick is pos for blood but no rbcs on microscopic U/A

Answer 21

hemoglobinuria or myoglobinura

Question 22

RBC casts

Answer 22

glomerulonephritis; if no casts, can be glomerular or lower urinary source

Question 23

examples of tubular proteinuria

Answer 23

interstitial nephritis, ischemic renal injury (ATN), and tubular damage due to nephrotoxic drugs

Question 24

marker for tubular proteinuria (as opposed to glomberular)

Answer 24

urinary B2 microglobulin

Question 25

glucosuria and aminoaciduria

Answer 25

accompany tubular proteinuria

Question 26

nephritic syndrome

Answer 26

gross hematuria, htn, fluid overload from renal insuff

Question 27

most common form of acute glomerulonephritis in school aged kids

Answer 27

psotstrep glomerulonephritis; but rare before age 2

Question 28

when does post strep glomerulonephritis develop relative to infection

Answer 28

8-14 days after infection of skin or pharynx with group A beta hemolytic strep

Question 29

low serum complement (C3)

Answer 29

transient in post-strep GN

Question 30

prognosis of post strep GN

Answer 30

usually normalizes in 6-8 weeks; severe renal failure is rare

Question 31

diagnosis of poststrep GN

Answer 31

ASO titer, ADB titer

Question 32

bx in post-strep gn?

Answer 32

not typically indicated but if you were to do it, youd see mesangial cell proliferation

Question 33

does antibiotic tx of strep reduce the risk of post strep GN?

Answer 33

no, but it does reduce the risk of rheumatic fever

Question 34

bergers diseaes

Answer 34

aka IgA nephopathy

Question 35

most common type of chronc glomerulonephritis world wide

Answer 35

bergers disease

Question 36

when does bergers disease usually present?

Answer 36

second or third decade of life

Question 37

bergers diseae more common in what races?

Answer 37

asia, australian, and in native americans; rare in african american

Question 38

clinical features of bergers

Answer 38

recurrent bouts of hematuria assoc with resp infections

Question 39

diagnosis of iga nephropathy (bergers)

Answer 39

renal biopsy shows mesangial prolif and incr mesangial matrix

Question 40

treatment for iga nephropathy

Answer 40

mainly supportive; meds only recommended for patients with associated pathologic proteinuria or renal insuff

Question 41

henoch-schonlein purpura nephritis

Answer 41

igA mediated vasculitis with palpable purpura on the butt and thigh, abdominal pain, arthritis and hematuria

Question 42

prognosis

Answer 42

in majority of patients, the renal featurs of HSP are self-limited with recovery in 3 months; 1 to 5% develop chronic renal failure

Question 43

membranoproliferative glomerulonephritis

Answer 43

mesangial hypercellularity and thickened glomerular basement membrane

Question 44

prognosis for membranoproliferative glomerulonephritis

Answer 44

variable, but most patients ultimately develop end stage renal disease

Question 45

managmeent of membranoproliferative glomerulonephritis

Answer 45

some patients repsond to steroids; ace inhib may slow progression

Question 46

membraneous nephropahty

Answer 46

more common in young kids; heavy proteinuria and often progresses to renal insuff

Question 47

most common cause of nephrotic syndrome in the US

Answer 47

membraneous nephopathy

Question 48

nephrotic syndrome characterisitics

Answer 48

heavy proteinuria (>50 mg/kg/day), hypoalbuminemia, hypercholesterolemia, and edema

Question 49

when does nephrotic syndrome present?

Answer 49

2/3 present before 5 years

Question 50

types of nephrotic syndrome

Answer 50

primary (most common), NS that results from other primary glomerular diseases; NS that results from systemic diseases

Question 51

most common cause of primary NS

Answer 51

minimal change disease

Question 52

systemic diseases that can cause NS

Answer 52

SLE and HSP