5yo w/ puffy eyes

Question 1

Allergic Conjunctivitis eye discharge characteristic

Answer 1

ropey and mucoid

Question 2

Viral and bacterial conjunctivitis tend to

Answer 2

usual starts unilaterally then moves bilaterally.

Question 3

Other sxs w/ periorbital swelling associated with URI

Answer 3

nasal congestion, cough pharyngitis

Question 4

Other sxs w/ periorbital swelling associated with seasonal allergies

Answer 4

itchy eyes

mucoid discharge

sneezing, itchy nose,, CLEAR nasal secretions

dark circles under eyes

Extra crease below lower eyelid (Dennie’s line)

fine bumps on conjuncitival mucosa

Question 5

Other sxs w/ periorbital swelling associated with periorbital cellulitis

Answer 5

unilateral, usually red

local insect bite, trauma, infection

can also extend from other site of infection like sinusitis

usually from pneumococci, Moraxella, non-typeable Hib

Question 6

How do you asses for signs of heart failure in a child

Answer 6

S4 gallop (overload of the LV–>CHF) ALWAYS PATHOLOGIC

S3 can be normal

Question 7

Minimal change disease is divided up into 3 groups. How do you delineate these groups?

Answer 7

1 steroid responsive

2 relapsing/steroid-dependent

3 steroid-resistant

Question 8

What is the treatment for primary nephrotic syndrome

Answer 8

corticosteroids

Sodium Restriction

Combo IV furosemide and Albumin for symptomatic edema

Question 9

What are some common infections assoc w/ nephrotic syndrome

Answer 9

Spontaneous peritonitis (fever, minimal findings MCC Strep pneumo)

Pneumonia
Cellulitis
UTI

Question 10

When in remission from nephrotic syndrome what should they receive to prevent infection?

Answer 10

Polyvalent Pneumococcal vaccine

2 doses of varicella

Annual flu vaccine

Question 11

Ddx for fatigue, periorbital edema, increasing abdominal girth

Answer 11

Acute glomerulonephritis

CHF

Hepatic Failure (almost always jaundiced also)

Nephrotic Syndrome

Question 12

labs to order for generalized edema in setting of hypoalbuminemia

Answer 12

Lytes, BUN/Creta

AST/ALT/cholesterol/albumin/TGs

C3 and C4 complement levels

Streptozyme

Question 13

Treatment of nephrotic syndrome

Answer 13

Corticosteroids

Sodium Restrict 1500-2000

Question 14

What sxs would warrant addition of IV furosemide and Albumin in tx of generalized edema w/ c/o nephrotic syndrome

Answer 14

dyspnea
scrotal edema (compromising testicular perfusion)

Question 15

indications for renal biopsy w/ nephrotic syndrome

Answer 15

hematuria, htn, increased creat, children >10yo if dx not drug reaction related or postinfectious GN

Question 16

Post streptococcal glomerulonephritis associated w/ what lab findings in relation to ANA, Anti-streptolysin O, C3,

Answer 16

ANA negative (you wouldn’t obtain this anyway)

High ASO titers

Low C3, will return to nml levels 6-8 weeks after presentation.

Timely tx of strep throat won’t necessarily prevent development of PSGN but will prevent rheumatic fever

Question 17

What causes 85% cases of nephrotic syndrome in kids aged 1-10 years old?

Answer 17

Minimal change disease: normal glomeruli on Light microscopy

Question 18

glomerulonephritis presents w/ signs of generalized edema and

Answer 18

gross hematuria(tea colored urine)