Pediatrics Flash Cards - Case 31 - Nephrotic

Question 1

Children of which age group are more likely have bacterial than viral conjunctivitis?

Answer 1

Children younger than 6 are more likely to have a bacterial than a viral infection.

Question 2

Physical exam findings c/w allergic rhinitis?

Answer 2

allergic shiners (dark circles under eyes), Dennie’s lines (extra crease below eyelid), allergic “salute” (nasal crease), and cobblestoning of the conjunctiva (fine bumps on the conjunctival mucosa)

Question 3

Most likely organism causing periorbital cellulitis in kiddos?

Answer 3

pneumococci, Moraxella catarrhalis, or non-typable Haemophilus influenzae (Formerly Hib pre-vaccine)

Question 4

AT what age do the sinuses develop?

Answer 4

ethmoid and the maxillary sinuses: present at birth. sphenoid sinuses: usu pneumatized by 5 yrs; frontal sinuses appear at age 7 to 8 years but not completely developed til late teens

Question 5

What is considered cut-off for fever w/ oral thermometer?

Answer 5

38°C

Question 6

Drugs commonly implicated in serum(-like) sickness?

Answer 6

Cefaclor, Penicillins, Trimethoprim-sulfamethoxazole

Question 7

What is the prot:cr ratio and how do you interpret it?

Answer 7

urine protein (mg/dL) / urine creatinine (mg/dL) = urine protein:creatinine ratio: < 0.2 is normal in children older than 2 years (< 0.5 is normal in 6- to 24-month-olds); > 1.0 is in a suspicious range for nephrotic syndrome; > 2.5 is diagnostic for nephrotic syndrome

Question 8

Urine dip protein levels that warrant further w/u?

Answer 8

30 mg/dL (1+) on 2 randoms one week apart w/ SG < 1.015; or 100 mg/dL (2+) w/ SG > 1.015.

Question 9

C3 and C4 levels in post-strep GN?

Answer 9

Low C3

Question 10

normal serum K+ for a child?

Answer 10

3.4-4.7 mEq/L (just a smidge under adult 3.5-5.0)

Question 11

Mechanisms behind venous thrombosis in nephrotic patients?

Answer 11

1) urinary loss of antithrombin III, others; 2) Destabilization of platelets by hyperlipidemia; 3) ↑ fibrinogen levels, and 4) ↑ viscosity d/t ↑ Hct (esp if diuretics are used w/o albumin replacement)

Question 12

Treatment for primary nephrotic syndrome?

Answer 12

Steroid and sodium restriction (max 1500-2000 mg/day)

Question 13

MD response to clinically sig fever in nephrotic syndrome kiddo?

Answer 13

admit

Question 14

Tram-track appearance of the glomerular basement membrane and subendothelial immune complex deposition

Answer 14

MPGN (Membranoproliferative glomerulonephritis)

Question 15

Enlarged, hypercellular glomeruli with neutrophil invasion

Answer 15

PSGN

Question 16

Mostly normal glomeruli and mesangial proliferation but with areas of juxtamedullar glomeruli showing segmental scarring in one or more lobules

Answer 16

focal segmental glomerulonephritis (FSGS)