Clinical Teaching Y4

Question 1

If there is a kidney problem in kids what must you always check?

Answer 1

BP

Question 2

What is the typical presentation of post-streptococcal glomerulonephritis in kids?

Answer 2

Presents 7-21d after group A strep infection (pharyngitis/impetigo) with gross haematuria, oedema, HTN, malaise, anorexia, abdominal pain

Question 3

What initial investigations should you do in someone with suspected post-strep GN?

Answer 3

Dipstick - proteinuria, RBC casts
Bloods - urea & Cr high, C3 low
Serum ASO titre

Question 4

What does protein in the urine indicate?

Answer 4

Kidney damage until proven otherwise

Question 5

What is the most common cause of painless haematuria in kids?

Answer 5

Post-strep GN

Question 6

How do you treat post-strep GN?

Answer 6

Sodium restriction, diuretics, antihypertensives, penicillin for 10d

Question 7

What is the prognosis of post-strep GN?

Answer 7

Very good

Question 8

Why do you get coca cola urine in post-strep GN?

Answer 8

Blood coming from kidneys and is haemolysed by time it reaches toilet

Question 9

What things might make you suspected neurofibromatosis?

Answer 9

Café au lait spots

Short stature

Question 10

What should a hairy growth over the spine indicate?

Answer 10

Spinal abnormality may be present underneath

Question 11

With neurological examination what are two key things you should always look at?

Answer 11

Spine and skin

Question 12

When should we worry about strawberry haemangiomas?

Answer 12

Only if they are other sensory areas (e.g. eyes, mouth, nose)
May cause torrential bleeding if exposed to a lot of friction
If forms yellow crust may be infected with impetigo

Question 13

What is the course of a strawberry haemangioma?

Answer 13

Get bigger over first year of life and then fade (usually gone by 5Y)

Question 14

How do we treat strawberry haemangiomas?

Answer 14

Propranolol can reduce the size (but only use when problematic)
Removal and skin graft
Laser treatment

Question 15

What are the side effects of propranolol?

Answer 15

Hypotension, can mask hypoglycaemia, bradycardia

Question 16

What are cavernous haemangiomas?

Answer 16

Capillary malformations under the skin that can run dee[ into body tissues

Question 17

What haematological abnormality can cavernous haemangiomas cause?

Answer 17

Thrombocytopenia

Question 18

How do you pick up cavernous haemangiomas?

Answer 18

Doppler as not always obvious to naked eye

Question 19

Port wine stain over eye can cause what dangerous condition?

Answer 19

Glaucoma

Question 20

Cradle cap might be the first sign of?

Answer 20

Atopy

Question 21

What is an important differential for milia in newborns?

Answer 21

HSV (can cause v. serious neurological damage)

Question 22

What is the commonest cause of delayed bladder control?

Answer 22

FH

Question 23

What two things are really important to find out in taking an enuresis history?

Answer 23

1. day time or night time wetting or both?

2. secondary or primary enuresis

Question 24

Which of night time and day time bladder control takes longest to achieve?

Answer 24

Night time (takes to about 7, day time is at about 5)

Question 25

Define primary enuresis

Answer 25

Never been dry | Never been dry longer than 6m

Question 26

What is primary enuresis most likely to be?

Answer 26

Structural problem

Question 27

What is secondary enuresis most likely to be?

Answer 27

A problem outside of the renal tract, e.g. behavioural, abuse, tumour on kidney or UTI

Question 28

Define enuresis

Answer 28

Continued bedwetting past 6y in boys, 5y in girls

Question 29

What tests should you do in enuresis?

Answer 29

Renal USS to check for abnormalities, e.g. duplex kidneys MAG3, MCUG, DSMA UTI testing Diabetes testing

Question 30

Urgency/frequency in children with enuresis may indicate what? What may help these children?

Answer 30

Overactive bladder | Oxybutinin (anticholingeric)

Question 31

What are some common causes of daytime wetting?

Answer 31

``` Overactive bladder (detrusor overactivity) Constipation ```

Question 32

How do you manage daytime wetting?

Answer 32

Advice re increasing drinking (stretch bladder wall --> contraction & strengthening) Advice re double voiding to prevent post-void dribbling Anticholingerics

Question 33

Why can't you do a DMSA until 3-4 months after a UTI?

Answer 33

After UTI get temporary scarring and want to wait 3-4m to see if what permanent scarring exists

Question 34

What can permanent renal scarring lead to?

Answer 34

HTN and renal failure

Question 35

What screening is offered to those with renal scarring?

Answer 35

Annual USS and dipstick for proteinuria

Question 36

What kinds of urine samples can you take in paediatrics?

Answer 36

From best to least favoured: - Clean catch - Catheter urine - Suprapubic aspiration

Question 37

What is the most common presentation of UTI in kids?

Answer 37

Non-specific | From collapse, septicaemia --> V&D, FFT, colic, PUO

Question 38

What tests can be used to see VUR?

Answer 38

MAG3 (no catheter req.) | MCUG (catheter req.)

Question 39

What are the grades of VUR?

Answer 39

1. Incomplete filling of upper urinary tract without dilatation 2. Complete filling with or without slight dilatation 3. Ballooned calyces 4. Megaureter 5. Megaureter & hydronephrosis

Question 40

How do you treat UTI in <3m?

Answer 40

IV amoxicillin & gentamicin | OR IV cephalosporin and ampicillin to cover listeria

Question 41

How do you treat uncomplicated UTI in >3m?

Answer 41

Trimethoprim 3d (or amoxicillin/co-amoxiclav/nitrofurantoin) Avoid constipation, drink plenty of fluids, encourage full voiding

Question 42

How do you empirically treat pyelonephritis in children?

Answer 42

Gentamicin

Question 43

How do you treat enuresis?

Answer 43

1. Enuresis alarm | 2. Desmopressin can be used for short term relief from night time wetting