CLIPP 31: 5 y/o female with puffy eyes

Question 1

List 3 causes of conjunctivitis

Answer 1

Infection
Allergy
Chemical Irritation

Question 2

Are children <6 more likely to have bacterial or viral conjuctivitis?

Answer 2

Bacterial

Question 3

is bacterial or viral conjunctivitis more likely to be associated with purulent drainage/eye crusting over?

Answer 3

Bacterial

Question 4

Most common pathogens in periorbital cellulitis?

Answer 4

Most often caused today by pneumococci, Moraxella catarrhalis, or non-typeable Haemophilus influenzae

Question 5

4 top differential diagnosis for fatigue, periorbital edema and increased abdominal girth

Answer 5

Acute glomerulonephritis
CHF
Hepatic failure
Nephrotic syndrome

Question 6

Periorbital edema is an early sign of what?

Answer 6

Hypoalbuminemia

Question 7

Why are mildly enlarged tonsils normal in children aged 4-6?

Answer 7

Because peak growth of lymphoid tissue occurs at 4 to 6 years of age, and because of frequent viral upper respiratory infections in children of this age, it is very common to see mildly enlarged tonsils

Question 8

In addition to hematuria, what is an additional common finding seen in pts with acute glomerulonephritis?

Answer 8

HTN

Question 9

Lipid findings in hypoalbuminemia?

Answer 9

Hyperlipidemia

Question 10

Most common nephrotic syndrome in children?

Answer 10

Minimal change disease

Accounts for >90% of children < 10

Question 11

Management of minimal change disease?

Answer 11

Corticosteroids
Sodium restriction to 1500-2000mg/day

During edema accumulation, the patient usually excretes less than 5 mEq of sodium per day. A diet of 50 mEq per day will result in the net gain of a kilogram of body water every 3 days. Current guidelines recommend sodium restriction to a level of 1500-2000 mg daily

Question 12

What indicates a need for a renal biopsy in someone with minimal change disease?

Answer 12

Steroid resistant patients

Question 13

What are the 4 most common infectious complications from nephrotic syndrome?

Answer 13

Spontaneous peritonitis (usually strep pneumo)
Pneumonia
Cellulitis
Urinary Tract Infection

Question 14

when in remission, what prophylaxis should patients with minimal change disease/nephrotic syndrome receive?

Answer 14

Polyvalent pneumococcal vaccine
Two doses of varicella vaccine (if not already immunized)
An annual influenza vaccine

Question 15

How are compliments affected in PSGN?

Answer 15

C3 is low