Past Year SAQ Flashcards
List 4 important investigations with expected findings to diagnose nephrotic syndrome
- FBC -> Note for raised TWC (indicating infection)
- Serum cholesterol -> Increased
- Liver function tests -> Serum albumin LOW
- Urinalysis -> Proteinuria
- Quantitative urinary protein excretion
-> Urine protein:creatinine ratio (>200mg/mmol)
-> 24 hour urine protein (>1g/m2/day) - Renal profile -> AKI
2Y child brought to pediatric clinic with generalized edema and scrotal swelling. He voids frothy urine.
State the probable diagnosis and the pathophysiology of this condition.
Probable diagnosis: Nephrotic Syndrome
Principle of treatment for nephrotic syndrome
Management of edematous state
1. Bed rest -> Usually not required
2. Corticosteroid
3. Diet
4. Antibiotic
5. Fluid status
6. Fluid restriction -> Not recommended unless in edematous state
7. Diuretics
8. Human albumin
9. Chart monitoring
Treat the complications
1. Hypovolemia -> Infuse salt poor albumin at 0.5 - 1.0g/kg/dose over 1 hour
2. Primary peritonitis -> Parenteral penicillin and a 3rd generation cephalosporin
3. Thrombosis -> Detailed investigations and adequate treatment with anticoagulation needed
Complication of nephrotic syndrome
- Hypovolemia
- Thrombosis
- Infection
- Hypercholesterolemia
- Renal failure
List 4 parameters/clinical features to assess the severity of bronchial asthma
- Daily symptoms
- Daily nocturnal symptoms
- Exacerbation affecting sleep and activity frequently
- PEFR or FEV1 <60%
- Exercise or activity induced asthma
State 3 different types of drugs used to treat asthma in children with mode of action and side effects of drugs
- Beta 2 agonist (SALBUTAMOL/TERBUTALINE)
- MOA: Stimulate B2 receptor -> Activate adenylate cyclase via G protein and increase cAMP to increase PKA -> Bronchodilation
- ADR: Headache, palpitations, tachycardia, fine tremor, hypokalemia - Corticosteroid (PREDNISOLONE)
- MOA: Restrain clonal proliferation of T helper cells -> Decrease formation of cytokines
- Inhibit release of mediators from mast cells and reduce edema and inflammation
- ADR: Impaired growth, adrenal suppression and altered bone metabolism - Anti-leukotriene (MONTELUKAST)
- MOA: LTB4 is a potent chemoattractant for neutrophils and eosinophils
ADR: Headache, dyspepsia, Zileuton - liver toxicity - Anti-muscarinic agent (IPRATROPIUM BROMIDE)
- MOA: Competitively antagonize acetylcholine (Ach) binding to muscarinic receptors (M3) -> Reduce CGMP and cause bronchodilation and reduction of mediators’ release
- ADR: Dry mouth, constipation, urinary retention and unpleasant bitter taste
Describe the management of the above child with moderate severity of acute asthma
- Treat the patient with NEBULIZED SALBUTAMOL or MDI salbutamol with a spacer (4-6 puffs if < 6 years and 8-12 puffs if > 6 years)
- ORAL PREDNISOLONE for 1 mg/kg/day for 3 to 5 days.
- Review after 20 minutes and if no improvement treat him as moderate
A teenage mother gave birth to a baby at the gestational age of 32 weeks. The birth weight of the baby is 1.5 kg
State the probable diagnosis of the above baby
Preterm Low birth weight baby
State the antenatal treatment that can improve respiratory problems after delivery
- Dexamethasone 4 doses of 6mg given IM 12 hours apart or
- Betamethasone 2 doses of 12mg given IM 24 hours apart
A 9-month-old infant is brought to the pediatric clinic with a history of cyanosis while crying. On clinical examination, the infant has early clubbing of fingers and an ejection systolic murmur at LLSB. The probable diagnosis is Tetralogy of Fallot.
Classify congenital heart disease.
State the chest X ray and ECG findings in TOF
- Chest X-ray -> BOOT-SHAPED HEART and OLIGEMIC LUNG FIELDS
- ECG – right ventricular hypertrophy (upright T waves in V1 and pure R waves with no S wave, right axis deviation and tall P wave
Describe the management of hyper cyanotic spell in TOF
- Treat as a medical emergency
- Knee chest/ squatting position for the baby – the baby is on the mother’s shoulders with knees tucked up underneath
- Administer 100% oxygen
- Give parenteral morphine 0.1-0.2 mg/kg
- If all fails, give IV propranolol, volume expanders (crystalloids or colloids), IV sodium bicarbonate and heavy sedation, intubation and mechanical ventilation
- Emergency Blalock Taussig shunt
State the palliative and corrective treatment of TOF
Blalock Taussig shunt is the treatment of choice for TOF
A mother with gestational diabetes gave birth to a baby weighing 4kg. The baby started to have convulsions 2 hours after delivery. The blood glucose checked for the baby is 1.2 mmol/L
State the probable diagnosis
Hypoglycemia
State the immediate treatment to control the convulsions for the hypoglycemic infant
IV bolus 10% dextrose 2-3 ml/kg bolus and IV dextrose 10% drip at 60-90 ml/kg/day
List 4 problems/anomalies that hypoglycemic baby may develop
- Macrosomia
- Intrauterine growth restriction
- Respiratory distress syndrome
- Polycythemia
Describe the reason why the baby got low blood glucose level
- Growth-restricted and preterm infants have poor glycogen stores
- Whereas the infants of a diabetic mother have sufficient glycogen stores, but hyperplasia of the islet cells in the pancreas causes high insulin levels
A 7-year-old boy attends pediatric clinic with purpuric rashes on both upper and lower limbs and buttocks. On clinical examination, he has ankle pain and a tender abdomen
State the probable diagnosis
HENOCH SCHOLEIN PURPURA
List 4 important investigations for HSP
- Urinalysis –> hematuria and proteinuria
- Platelet count -> normal or elevated
- WBC -> normal or elevated
- IgA level -> elevated
- BUN/Creatinine -> elevated
State 2 serious complications and treatment for one of them
- Intussusception
- Ileus
- Protein-losing enteropathy
The treatment of intussusception is hydrostatic reduction with saline under ultrasound guidance
A 40-year-old mother who is pregnant for 10 weeks, has a 2-year-old child with Down Syndrome. She is afraid the baby may have the same abnormalities.
Describe 3 antenatal tests to diagnose Downs Syndrome
- Triple test
- Nuchal translucency test
- Amniocentesis
List 4 system-wise major problems that Down Syndrome children may develop
CVS
1. Congenital heart disease -> AVSD
GIT
1. Duodenal atresia
2. Pyloric stenosis
3. Tracheoesophageal fistula
4. Anorectal malformation
CNS
1. Congenital cataract
2. Glaucoma
3. Hearing impairment
4. Visual impairment
Endocrine
1. Hypothyroidism
2. Hypogonadism
Describe 3 important differences between Down syndrome and Turner syndrome
A newborn male weighing 3kg, is referred to the neonatal unit because he is found to be jaundiced at 18 hours of life. He was born by spontaneous vertex delivery at term following an uneventful pregnancy. He has been exclusively breastfed at 2-hour intervals. On examination, there is mild pallor but no cyanosis but edema. His skin is yellow to the nipples and no rashes detected. No abnormalities are detected in the respiratory, cardiovascular, abdomen, musculoskeletal, and central nervous system.
State any additional information needed to obtain from his mother to help determine the cause of his jaundice
Her blood group and RH status.
Based on the findings given, state the 2 most likely causes of jaundice in this baby. List 2 reasons
- ABO incompatibility
- RH incompatibility
- G6PD deficiency
Describe 2 investigations and treatment for this newborn baby
Investigation:
1. Total serum bilirubin
2. Direct COOMBS test
3. Peripheral blood film
Treatment:
1. Phototherapy
A previously well 4-year-old boy presents with a 5-day history of generalized edema and frothy urine. On examination, he has periorbital, ankle, and gross scrotal edema. Examination of his chest reveals dullness on percussion and reduced breath sound in the right lower hemithorax on auscultation. The abdomen is slightly distended and shifting dullness is positive.
State the most likely diagnosis based on the above history and physical examination.
NEPHROTIC SYNDROME
State the probable cause of his chest findings (dullness and reduced breath sounds in the right lower hemithorax) in a nephrotic syndrome patient
PLEURAL EFFUSION
While staying in the hospital, a nephrotic syndrome child develops a sudden onset of severe abdominal pain. State 2 possible causes of his abdominal pain
- Spontaneous bacterial peritonitis
- Hypovolemia
Describe the management of a nephrotic syndrome patient
Management of edematous state
1. Bed rest -> Usually not required
2. Corticosteroid
3. Diet
4. Antibiotic
5. Fluid status
6. Fluid restriction -> Not recommended unless in edematous state
7. Diuretics
8. Human albumin
9. Chart monitoring
Treat the complications
1. Hypovolemia -> Infuse salt-poor albumin at 0.5 - 1.0g/kg/dose over 1 hour
2. Primary peritonitis -> Parenteral penicillin and a 3rd generation cephalosporin
3. Thrombosis -> Detailed investigations and adequate treatment with anticoagulation needed
Treatment of hypovolemia is
- Infuse salt-poor albumin at 0.5 to 1.0 g/kg dose over one hour.
- Assess daily by weight
- If severe, treat with IV 20% albumin infusion with furosemide*
*sunflower contradicts peads protocol
Treatment of spontaneous bacterial peritonitis is parenteral penicillin and third-generation cephalosporin
A 10-month-old girl is brought to the clinic because of loose motion on and off for three days. Her mother complained that these symptoms occurred at least once a month after the introduction of complementary feeding three months ago and that she was not gaining weight during these 3 months.
On examination, she appears well except for mild pallor and slightly thin brown hair. Her weight is 5.5 kg (below the 3rd percentile for his age), height is on the 10th centile and head circumference is on 10th percentile. No abnormalities are detected in her respiratory, cardiovascular, abdomen, or central nervous system.
State the information to be gathered from her mother to help determine the underlying cause.
- Mothers exposure to teratogen and infection
- Any history of chronic illness in the family
List the possible causes of poor weight gain and recurrent loose motion in this girl
Describe the management plan for this girl
Investigation for the cause:
1. Full blood count, LFT, RFT, Urine FEME, Karyotyping
Treatment:
- Correction of the underlying etiology if possible
- Enteral or parenteral feeding, follow up patient and monitor growth charts
An 18-month-old child with a history of birth asphyxia is referred to the clinic because of delayed walking. On examination of his both lower limbs, he has hypertonia, hyperreflexia, and positive Babinski sign on both sides. His upper limbs are otherwise normal
State the type of motor neuron lesion and the area of the brain involved
State the probable diagnosis
UMN lesion at pre-central motor cortex
Probable diagnosis: Cerebral palsy