Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Stage 3 > Paediatrics: Nephrology/Rheumatology > Flashcards

Paediatrics: Nephrology/Rheumatology Flashcards

1
Q

What are causes of proteinuria in children?

A

1) Orthostatic proteinuria
2) Transient proteinuria
3) Nephrotic syndrome - minimal change disease
4) Type 1 diabetes - poorly controlled diabetes can result in diabetic glomerulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the clinical features of orthostatic proteinuria

A

1) Commonest cause of proteinuria in children
2) Generally benign + requires no active management
3) Typically presents in adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the clinical features of transient proteinuria?

A

1) Children will often be found to have proteinuria incidentally when being investigated
2) Commonest causes = concurrent infections or recent seizure
3) Benign and usually self limiting, with the proteinuria receding as the precipitant is treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What condition do you presume in a child aged 1-8 years with 3+ proteinuria on dipstick?

A

Nephrotic syndrome - minimal change disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you manage minimal change disease (treat empirically in any child with nephrotic syndrome)?

A

1) Start empirical steroids (prednisolone)
2) Second line = other immunosuppressive agents e.g. ciclosporin
3) Fluid restriction + reduced salt intake
4) Human albumin and furosemide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you limit progression of type 1 diabetes related proteinuria?

A

Good control of diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you manage proteinuria in a child?

A

1) Send at least two separate urine samples for protein:creatinine ratios with one sample being an early morning sample
2) All patients should have their BP measured at rest to ensure they aren’t hypertensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you definitively diagnose minimal change disease?

A

Electron microscopy findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the features of nephrotic syndrome/minimal change disease?

A

Proteinuria (> 3 g/L), frothy urine + peripheral oedema + hypertension + preceding URTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the complications of minimal change disease?

A

1) Spontaneous peritonitis
2) Thrombosis
3) Renal damage
4) Increased risk of infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the prognosis of minimal change disease?

A

1) ⅓ resolve and never have another episode
2) ⅓ have a further relapses requiring steroid treatment
3) ⅓ are steroid/immunosuppression dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common cause of chronic joint pain in children?

A

Juvenile idiopathic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is juvenile idiopathic arthritis (JIA)?

A

An umbrella term for a range of arthritides affecting children and young people where the cause is not clear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is juvenile idiopathic arthritis diagnosed?

A

1) Clinical diagnosis of exclusion for children < 16 years old who have persistent joint swelling > 6 weeks - exclude infections, malignancy, lupus
2) Different types = polyarthritis, oligoarthritis and systemic forms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does juvenile idiopathic arthritis present?

A

Systemic signs followed by joint pain/swelling/tenderness > 6 weeks
1) Fevers
2) Malaise
3) Salmon pink rash e.g. on legs
4) Weight loss/anorexia
5) Lymphadenopathy
6) Uveitis
7) Joint involvement can be in one or multiple joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is juvenile idiopathic arthritis managed?

A

1) Chronic disease requiring MDT input from paediatricians, physiotherapy, orthopaedics, OT and ophthalmology
2) Psychological support to help coming to terms with using walking aids so early on in life - can be extremely debilitating
3) NSAIDs - symptom control only
4) Steroids - intra-articular or oral
5) Steroid-sparing agents e.g. methotrexate or biologics e.g. TNF-a inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are complications of juvenile idiopathic arthritis?

A

1) Flexion contractures - requiring physio and splints
2) Joint destruction - requiring prostheses at young ages
3) Growth failure - from steroids and chronic disease
4) Anterior uveitis - causing visual impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does Osgood-Schlatter disease present?

A

Swelling + tenderness over tibial tuberosity in athletic teenagers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is chondromalacia patellae?

A

A condition caused by softening of the cartilage of the patella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does chondromalacia patellae present?

A

Teenage girls - anterior knee pain when walking up and down stairs and rising after prolonged sitting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does Henoch-Schonlein purpura (HSP) present?

A

1) Joint pain
2) Palpable and purpuric rash
3) Haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is transient synovitis?

A

Benign cause of limp in children from inflammation of the synovial lining/membrane of the hip joint

23
Q

In which children does transient synovitis occur?

A

Most common in children aged 3-11 and twice as common in boys

24
Q

How does transient synovitis present?

A

1) Preceding viral URTI 1-2 weeks before onset of pain and limp
2) Acute onset non-weight bearing limp - crying child that refuses to walk
3) Hip pain or referred knee pain - more mild than septic arthritis
4) Examination - no erythema/oedema, joint mildly tender to palpation, internal rotation limited by pain, no obvious abnormalities in hip or knee
4) ± low-grade fever

25
Q

What are two causes of acute onset limp where the child avoids bearing weight and presents with a fever?

A

1) Transient synovitis (‘irritable hip’ as an inflammatory reaction after a viral infection)
2) Septic arthritis (septic has higher fever and more severe pain - bacterial infection of joint)

26
Q

How do you investigate suspected transient synovitis especially to try and rule out septic arthritis?

A

1) Blood tests - raised WCC and inflammatory markers may point more towards septic arthritis but may be normal or raised in either condition
2) Joint ultrasound/X rays - may show effusion or be normal in either conditions
3) Joint aspirate under ultrasound guidance + blood cultures - if history, examination, bloods and XR do not give a clear diagnosis or if high index of clinical suspicion for septic arthritis

27
Q

How do you definitively differentiate between transient synovitis and septic arthritis?

A

Joint aspirate MC&S - bacteria within the joint space confirms septic arthritis

28
Q

How do you manage transient synovitis?

A

Supportive treatment - transient synovitis generally resolves in around 7 days with minimal risk of long term damage to the joint

29
Q

Which non-infectious condition can present with limp in children?

A

Acute leukaemias (uncontrolled proliferation of WBCs) - would also have systemic symptoms

30
Q

What is a cause of acute limp in obese teenagers?

A

Slipped capital (displacement of the) femoral epiphysis

31
Q

What is a potential cause of bilateral limp in children?

A

Duchenne muscular dystrophy (genetic defect in dystrophin) - presents with chronic muscle weakness and wasting

32
Q

What is Henoch-Schonlein Purpura (HSP)?

A

Small vessel vasculitis characterised by IgA deposition - the most common small vessel vasculitis in children

33
Q

Which age children are typically affected by HSP?

A

3-5 years old

34
Q

How does HSP present?

A

1) Purpura or petechiae on the buttocks and lower limbs
2) Abdominal pain
3) Arthralgia
4) Nephritis (haematuria +/- proteinuria)
5) May be pyrexial
6) HSP is commonly preceded by a viral upper respiratory tract infection

35
Q

How is HSP managed?

A

1) NSAIDs for analgesia and their anti-inflammatory effect
2) Antihypertensives may be needed to control blood pressure
3) After an episode of HSP, children should have regular urine dips for 12 months to check for renal impairment
4) Supportive management bc often resolves spontaneously

36
Q

What is the prognosis of HSP?

A

1) The majority of cases of HSP recover completely
2) ⅓ of patients have a second episode of HSP
3) Long-term renal impairment occurs in about 1/5 patients with significant proteinuria

37
Q

What is the nephro feature of HSP?

A

It is associated with nephrotic and nephritic syndromes, as well as a rapidly progressive glomerulonephritis, due to glomerular IgA deposition

38
Q

What is the key triad in HSP?

A

Joint pain + abdo pain + palpable purpura

39
Q

When might steroids be needed in HSP?

A

1) Severe renal involvement e.g. rapidly progressive, crescentic glomerulonephritis, or persistent nephrotic syndrome
2) Intractable symptoms not responding to analgesia

40
Q

How is the rash different in HSP and ITP?

A

In ITP the purpuric rash is not typically palpable whereas in HSP it is palpable

41
Q

What is immune/idiopathic thrombocytopenic purpura (ITP)?

A

An autoimmune disease of unknown cause resulting in an isolated low platelet count and a tendency to bruise/bleed - children may develop ITP post-virally and recovery often occurs spontaneously

42
Q

What is a complication of HSP?

A

Renal failure

43
Q

Who is affected by ITP and how?

A

1) Children - self-limiting disease following viral infection
2) Adults - chronic relapsing disease

44
Q

What is prognosis of ITP?

A

85% of cases spontaneously remit in 3-6 months so a watch and wait approach is generally advised

45
Q

What investigations do you do in ITP?

A

1) FBC
2) Blood film
3) ± bone marrow (only required if atypical findings on blood film/FBC)
4) ± further tests to exclude other differential diagnoses (e.g. aplastic anaemia, leukaemia, thrombocytic thrombocytopenic purpura)

46
Q

Which two investigations are always done in ITP?

A

FBC + blood film

47
Q

How do you manage ITP?

A

1) Watch and wait + safetynetting to avoid bleeding risks
2) Platelet transfusions/IVIG should be avoided in the absence of active life-threatening bleeding, persistent bleeding refractory to treatment or those requiring surgery
3) Steroids are used in persistent cases - to raise platelet count if needs to be raised acutely (no need in the absence of clinically significant bleeding)
4) Splenectomy may be considered in refractory cases

48
Q

What is the first line treatment of ITP without clinically significant bleeding?

A

Watch and observe - safetynetting advice to avoid contact sports, blood-thinning medications and to monitor for signs of worsening bleeding

49
Q

How does ITP present?

A

1) Low platelets and associated bleeding - e.g. recurrent nose bleeds
2) Palpable, non-blanching red spots on limbs
3) History of recent viral illness

50
Q

What would you see on blood film of ITP?

A

Normal sized platelets, no clumping seen

51
Q

What would you see on FBC and clotting screen in ITP?

A

Low platelets (everything else normal)

52
Q

Which test is used to diagnose/rule out autoimmune haemolytic anaemia?

A

Direct antiglobulin test (DAT) - would be positive

53
Q

What is Evan’s syndrome?

A

ITP + autoimmune haemolytic anaemia

Stage 3 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions