Brainscape's Knowledge GenomeTM

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


See full index

3a > Paeds renal > Flashcards

Paeds renal Flashcards

1
Q

How might a baby (<3 mnths) present with a UTI?

A
  • Fever
  • Lethargy
  • Irritability
  • Vomiting
  • Poor feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs and symptoms of a UTI in older children (verbal and > 3 yrs)

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

What is the first line examination in a UTI

A

-Clean catch urine dip

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

What is the diagnosis based on urine dip outcome

A
  • Under 3mnths : needs MCS
  • 3 mnths to 3 years : LE +ve or nitrite +ve = treat as UTI
  • > 3 yrs : le +ve and nitrite +ve = UTI. If nitrite +ve but le -ve, treat as UTI and send MCS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the most common UTI cause in children.

A
  • E.coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How should all children under 3 mnths old with a fever be managed and in the case of suspected UTI ?

A
  • Admit + IV antibiotics (cefuroxime)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When is an USS done in a child with a UTI?

A
  • All children under 6mnths with their first UTI
  • Children with recurrent UTI’s
  • Children with atypical UTI’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is a DMSA scan done in a child with a UTI

A
  • 4 to 6 mnths after the illness to assess for kidney scarring in recurrent or atypical UTI’s
  • Patches of scarred kidney will not take up the injected material
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When is a micturating cystourethrogram (MCUG) done in a child with a UTI?

A
  • To assess for vesico-ureteric reflux when the urine has a tendency to flow from the bladder back into the ureters
  • Done to assess atypical or recurrent UTI’s in children <6mnths
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is a MCUG done?

A
  • A child is catherised and contrast is injected into the bladder.
  • X-rays are then taken to determine whether the contrast refluxes into the ureters
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When would a diagnosis of acute pyelonephirits be given in a child?

A
  • Temp of greater than 38 degrees or loin pain / tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define enuresis, nocturnal enuresis and diurnal enuresis

A
  • Enuresis : involuntary urination
  • Nocturnal enuresis : bed wetting
  • Diurnal enuresis : inability to control bladder functioning during the day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is primary nocturnal enuresis

A
  • Where a child has never managed to be consistently dry at night
  • Usually caused by a variation on normal development and there will often be Fx of delayed dry nights.
  • Requires reassurance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give 4 other causes of primary nocturnal enuresis

A
  • Overactive bladder
  • Fluid intake -> fizzy drinks, juice and caffeine before bed
  • Failure to wake
  • Psychological distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Give 4 secondary causes of primary nocturnal enuresis

A
  • Chronic constipation
  • UTI
  • Learning disability
  • Cerebral palsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is primary nocturnal enuresis managed ?

A
  • Determine cause using 2 wk diary
  • If <5, reassure will likely resolve
  • Lifestyle changes : reduce fluids at night, pass urine before bed
  • Encourage and + reinforcement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is secondary nocturnal enuresis ?

A

-When a child begins wetting the bed when they have been previously dry for at least 6 mnths

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

Give 5 causes of secondary nocturnal enuresis

A
  • UTI
  • Constipation
  • T1DM
  • New psychosocial problems
  • Maltreatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give 2 kinds of diurnal enuresis

A
  • Urge : overactive bladder than gives little warning before emptying
  • Stress : leakage of urine during physical exertion, coughing or laughing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Give 3 types of medication that can be used for nocturnal enuresis

A
  • Desmopressin - taken at bed time to reduce the volume of urine production by the kidney
  • Oxybutin - anticholinergic medication reducing contractility of the bladder in an overactive bladder causing urge incontinence
  • Imipramine - tricyclic antidepressant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the triad of nephrotic disease ?

A
  • Low serum albumin
  • High protein on dipstick (>3)
  • Oedema
22
Q

Give 3 other features that occur in pts with nephrotic syndrome

A
  • Deranged lipid profile -> high cholesterol, triglycerides and low density lipoproteins
  • High BP
  • Hyper-coagulability with increased tendency to form blood clots
23
Q

What is nephrotic syndrome ?

A

-When the basement membrane in the glomerulus becomes highly permeable to protein, allowing protein to leak from the blood into the urine.

24
Q

When is nephrotic syndrome most common in children and what is the most common cause

A
  • Aged 2-5
  • Minimal chnaged disease
25
Q

Give 5 secondary causes of nephrotic syndrome

A
  • Intrinsic kidney disease : focal segmental glomerulosclerosis and membranoproliferative glomerulonephritis
  • Systemic illness : henoch schonlein purpura, DM, infection (HIV, hepatitis and malaria)
26
Q

How will minimal change disease likely present ?

A
  • 2 to 5 year old
  • Generalised oedema : facial swelling, hands and feet
  • Frothy urine
  • Pallor
  • Proteinuria
  • Low albumin
27
Q

What is seen on urinalysis in minimal change disease ?

A
  • Small molecular weight proteins
  • Hyaline casts
28
Q

How is nephrotic syndrome managed ?

A
  • Admit
  • Prednislone (60mg/m2/day) for 4wks and then 40mg/m2/every other day for 28 days
  • Low salt diet
  • Diuretics for oedema
  • Albumin infusions if severe hypoalbuminaemia
29
Q

What is used to treat minimal change disease in steroid resistant children ?

A
  • ACE inhibitors
  • Immunosuppressants (cyclosporine, tacrolimus, rituximab)
30
Q

Give 5 complications of minimal change disease

A
  • Hypovolaemia : occurs as fluid leaks from the intravascular to the interstitial space causing oedema and low BP
  • Thrombosis
  • Infection
  • Acute or chronic renal failure
  • Relapse
31
Q

What are the 3 characteristics of nephritis

A
  • Haematuria
  • Proteinuria : less than in nephrotic syndrome
  • Reduction in kidney functione
32
Q

How is UTI in >3mnths managed if very unwell

A

Admit + IV cefuroxime

33
Q

How is a UTI managed if over 3 mnths and not very unwell

A
  • 1st line = oral trimethoprim or nitrofurantoin
34
Q

How is pyelonephritis in an >3mnth managed

A
  • If very unwell : admit + IV cefuroxime
  • No very unwell : oral cefalexin or co-amoxiclav
35
Q

what is defined as recurrent UTI

A
  • 2 upper UTI
  • 1 upper UTI + 1 lower UTI
  • 3 lower UTI
36
Q

define atypical UTI

A
  • Seriously ill
  • Poor urine flow
  • Abdo or bladder mass
  • raised creatinine
  • Septicaemia
  • Failure to respond to tx within 48 hrs
  • Infection with non e.coli
37
Q

what imaging will a child under 6 mnths with a UTI need and when

A
  • USS during acute infection if no response in 48 hrs, atypical or recurrent UTI
  • USS within 6 wks of infection if they respond to abx within 48 hrs and UTI is not atypical or recurrent
  • DMSA 4-6 mnths later if recurrent or atypical
  • MCUG if recurrent or atypical
38
Q

what abx / vaccines are given in nephrotic syndrome

A
  • Oral penicillin V to oedematous / ascitic pts to protect against pneumococcal infection
  • Pneumococcal polysaccharide vaccine
  • Varicella vaccine
39
Q

What is hypospadias?

A
  • > Congenital abnormality : ventral urethral meatus, hooded prepuce and chordee (curvature) in more severe forms
  • > management with surgery at 12 mnths, cicrumcision is CI
40
Q

What is the common triad in HUS

A
  • Haemolytic anaemia - normocytic anaemia
  • Acute kidney injury
  • Thrombocytopenia
41
Q

What is the most common cause of HUS

A

-> Shiga toxin produced by e.coli 0157

42
Q

How would HUS present ?

A
  • Brief gastroenteritis caused by E.coli : bloody diarhoea
  • Acute kidney injury : reduced urine output, haematuria
  • Thrombocytopenia : brusing
  • Abdo pain, lethargy and irritability, confusion, oedema, HTN
43
Q

What investigations are done in HUS

A
  • FBC : normocytic anaemia, thrombocytopenia, fragmented blood film (shistocytes and helmet cells)
  • U&E : AKI
  • Stool culture : PCR for shiga toxins
44
Q

How would HUS present

A
  • 18 mnth
  • Recent Hx of bloody diarrhoea
  • Bloods : AKI and thrombocytopenia
45
Q

Give 2 conditions associated with hypospadias

A
  • Cryptotchidism
  • Inguinal hernia
45
Q

Give 2 conditions associated with hypospadias

A
  • Cryptotchidism
  • Inguinal hernia
46
Q

Give 3 ways VUR can present

A
  1. Antenatal period : hydronephrosis on USS
  2. Recurrent childhood UTI
  3. Reflux nephropathy -> chronic pyelonephritis secondary to VUR
47
Q

What is a complication of chronic pyelonephritis caused by VUR

A

-Increased renin causing HTN

48
Q

What are the 5 grades of VUR

A
  • I : reflex into ureter only
  • II : reflux into renal pelvis
  • III : mild/moderate dilation of ureter, renal pelvis and calyces
  • IV : dilation of renal pelvis, calyces with moderate ureteral tortuosity
  • V : gross dilation of the ureter, pelvis, calyces with urethreal tortuosity
49
Q

Focal segmental glomerulosclerosis : causes, Ix, management

A
  • Cause of nephrotic syndrome and CKD in young adults.
  • Cause : idiopathic, HIV, heroin, alport’s, sickle cell
  • Ix : renal biopsy
  • Manage : steroids +/- immunsuppressants
50
Q
A

3a (45 decks)

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