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Paediatrics > Clinical Teaching Y4 > Flashcards

Clinical Teaching Y4 Flashcards

1
Q

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

A

BP

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

What does protein in the urine indicate?

A

Kidney damage until proven otherwise

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5
Q

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

A

Post-strep GN

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6
Q

How do you treat post-strep GN?

A

Sodium restriction, diuretics, antihypertensives, penicillin for 10d

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7
Q

What is the prognosis of post-strep GN?

A

Very good

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8
Q

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

A

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

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9
Q

What things might make you suspected neurofibromatosis?

A

Café au lait spots

Short stature

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10
Q

What should a hairy growth over the spine indicate?

A

Spinal abnormality may be present underneath

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11
Q

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

A

Spine and skin

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12
Q

When should we worry about strawberry haemangiomas?

A

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

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13
Q

What is the course of a strawberry haemangioma?

A

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

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14
Q

How do we treat strawberry haemangiomas?

A

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

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15
Q

What are the side effects of propranolol?

A

Hypotension, can mask hypoglycaemia, bradycardia

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16
Q

What are cavernous haemangiomas?

A

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

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17
Q

What haematological abnormality can cavernous haemangiomas cause?

A

Thrombocytopenia

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18
Q

How do you pick up cavernous haemangiomas?

A

Doppler as not always obvious to naked eye

19
Q

Port wine stain over eye can cause what dangerous condition?

A

Glaucoma

20
Q

Cradle cap might be the first sign of?

A

Atopy

21
Q

What is an important differential for milia in newborns?

A

HSV (can cause v. serious neurological damage)

22
Q

What is the commonest cause of delayed bladder control?

A

FH

23
Q

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

A
  1. day time or night time wetting or both?

2. secondary or primary enuresis

24
Q

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

A

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

25
Q

Define primary enuresis

A

Never been dry

Never been dry longer than 6m

26
Q

What is primary enuresis most likely to be?

A

Structural problem

27
Q

What is secondary enuresis most likely to be?

A

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

28
Q

Define enuresis

A

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

29
Q

What tests should you do in enuresis?

A

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

30
Q

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

A

Overactive bladder

Oxybutinin (anticholingeric)

31
Q

What are some common causes of daytime wetting?

A 
Overactive bladder (detrusor overactivity) 
Constipation
32
Q

How do you manage daytime wetting?

A

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

33
Q

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

A

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

34
Q

What can permanent renal scarring lead to?

A

HTN and renal failure

35
Q

What screening is offered to those with renal scarring?

A

Annual USS and dipstick for proteinuria

36
Q

What kinds of urine samples can you take in paediatrics?

A

From best to least favoured:

  • Clean catch
  • Catheter urine
  • Suprapubic aspiration
37
Q

What is the most common presentation of UTI in kids?

A

Non-specific

From collapse, septicaemia –> V&D, FFT, colic, PUO

38
Q

What tests can be used to see VUR?

A

MAG3 (no catheter req.)

MCUG (catheter req.)

39
Q

What are the grades of VUR?

A
  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
40
Q

How do you treat UTI in <3m?

A

IV amoxicillin & gentamicin

OR IV cephalosporin and ampicillin to cover listeria

41
Q

How do you treat uncomplicated UTI in >3m?

A

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

42
Q

How do you empirically treat pyelonephritis in children?

A

Gentamicin

43
Q

How do you treat enuresis?

A
  1. Enuresis alarm

2. Desmopressin can be used for short term relief from night time wetting

Paediatrics (35 decks)

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