Prep 2 Flashcards
Why are there muddy brown casts in the urine in ATN?
because in acute tubular necrosis tubular cells necrose, and as part of the process red cells leak into the tubule as a response to the injury… and so then these dead tubular cells with hemoglobin look a muddy brown color
Muddy brown casts and epithelial casts, mild pyruia and mild proteinuria think
ATN
Is the urine concentrated or dilute in ATN?
dilute
and you are also losing lots of sodium in the urine
the kidenys basically just stop doing their job
Treatment for ATN
Supportive
Type of casts seen in acute glomerulopnephritis
red blood cell casts
along with hematuria, microscopic or gross
What is BP like in acute glomerulonephritis?
high. you get hypertensive.
The cause of acute interstitial nephritis is usually blank. And the associated symptoms you get with it are….
caused by an allergic reaction to a drug
will get associated fever, rash, and eosinophilia
Urine eosinophils think
acute interstitial nephritis
UA in acute instertitial nephritis
will show…
white cells
red cells
a little protein
and EOSINOPHILS
hemolytic anemia, thrombocytopenia and renal failure =
HUS
How to remove an aspirated foreign body
rigid bronch
A very very thin teen gymnast female has a low free T4, but normal TSH. What does she have?
euthyroid sick syndrome in the setting of being in a negative energy balance state and way, way too thin
Define primary amenorrhea
= no period by age 15
What is euthyroid sick syndrome?
It’s a physiologic adaptation to conserve energy when living in a negative energy balance state
you will have a normal TSH but low free T4
Blank is a condition where serum levels of free T4 are low in patients who have nonthyroidal systemic illness but who are actually euthyroid.
Euthyroid sick syndrome
Delayed puberty in girls is defined as
lack of breast development by age 13
Permanent hypoigonadotropic hypogonadism + anosmia =
Kallman syndrome
Hypergonadotropic hypogonadism is the result of
primary gonadal failure
Name some causes of hypergonadotropic hypogonadism
Turner syndrome (streak, dysfunctional ovaries)
Gonad injury for radiation or chemo
Klinefelter syndrome
Define delayed puberty in boys:
lack of testicular growth to 4 mL (2.5 cm in length) by age 14
Name some causes of hypogonadotropic hypogonadism
eating disorder
excessive exercise
systemic illness
Name the 4 categories of delayed puberty:
normal variant constitutional delay
hypogonadotropic hypogonadism
hypergonadotropic hypogonadism
Are x-rays good at picking up femoral neck stress fractures?
NO
Femoral neck stress fracture is a can’t miss diagnosis, but x-ray will usually be normal so you need an MRI
Who usually gets femoral neck stress fractures
teenage girls who do running sports
How to diagnose a femoral neck stress fracture
MRI
The danger of missing a femoral neck stress fracture
If the patient keeps walking on it, can progress to a complete hip fracture
What type of injury should be considered in all female athletes with groin pain?
femoral neck stress fracture
Initial management for teens where you suspect a possible femoral neck stress fracture:
crutches (do NOT bare weight)
MRI
if it’s a lateral stress fracture, will need surgery
if medial, will need prolonged non weigh bearing and gradual return to normal walking and sports as long as remains pain free
When should healthy children start having their blood pressure checked, and how often should it be checked?
at each annual WCC starting at age 3
Who should have blood pressure screenings start before age 3?
obese children
ALL congenital heart disease (even if fully repaired)
SGA babies
VLBW babies
ANYONE who had an umbilical line
complicated nicu course
sickle cell disease
renal disease or FH
prematurity LESS than 32 weeks
Blank is characterized by infrequent, brief focal motor seizures that occur predominantly during sleep
benign rolandic epilepsy
What is benign rolandic epilepsy?
= a common childhood epilepsy where kids get focal seizures (often during sleep) that involve facial twitching, speech arrest, hypersalivation, and face/arm clonic movements. Kids will actually have preserved consciousness and remember these seizures.
some kids with BRE also will have generalized tonic clonic seizures
usually outgrow by age 16
EEG in benign rolandic epilepsy will show
biphasic independent bilateral centrotemporal spikes, often during light sleep
normal background
Juvenile myoclonic epilepsy is characterized by this triad of symptoms:
- myoclonic seizures in early morning
- generalized tonic clonic seizures
- absence seizures
persists into adulthood
What is a myoclonic seizure?
= brief, shock like jerks of a muscle or group of muscles
Panayiotopoulous syndrome
= a childhood focal epilepsy syndrome that presents between ages 1-4
these toddlers/young kids will get infrequent autonomic seizures (for ex, ictal vomiting, cyanosis, pallor….) while awake. seizures can be long and can evolve into status.
kids usually outgrow.
Panayiotopoulous syndrome
= a childhood focal epilepsy syndrome that presents between ages 1-4
these toddlers/young kids will get infrequent autonomic seizures (for ex, ictal vomiting, cyanosis, pallor….) while awake. seizures can be long and can evolve into status.
kids usually outgrow.
Most common sites for pedi IO:
proximal tibia (go slightly medial)
distal femur
Who usually gets an RPA? (retropharyngeal abscess)
kids ages 2-4 who have just had a URI
What will a lateral neck radiograph show in a kid with an RPA?
edema of the prevertebral soft tissues
(basically edema right behind the pharynx – hence the name retro pharyngeal abscess)
RPAs are usually polymicrobial, however the PREDOMINANT pathogens are…..
strep pyogenes (group A strep)
staph aureus
and respiratory anerobic bacteria, like peptostreptococcus, fusobacterium, and prevotella
ok so mainly remember: GAS and staph aureus
Name 3 bugs that do NOT cause RPAs:
strep pneumo
pseudomonas
morexlla
these bugs do lots of other things, but they do NOT cause RPAs
Major 2 bugs that cause RPAs
GAS and staph aureus
Precautions for mumps should be airborne, droplet or contact?
droplet
Name the 4 disease/bugs that required airborne precautions:
covid obviously
TB
measles
varicella
Precautions needed for neisseria meningitidis
droplet
how is mumps spread
respiratory droplets
Marked hypotonia and poor suck and swallow in the first few days of life in a term neonate think
Prader-Wili syndrome
There is a neonate in the NICU with multiple anomalies but they are not suggestive of any one specific genetic syndrome. In this case, the best first line genetic test to do is:
a CMA to look for deletions or duplications anywhere across all of the chromosomes
(CMA = chromosomal microarray)
What is a chromosomal microarray?
= a genetic test with high resolution that will look for “copy number changes” (aka either duplications or deletions) across the entire genome
FISH
= fluorescent in situ hybridization
this genetic test is good for when you suspect a specific genetic disorder, such as 22q11.2 deletion syndrome (DiGeorge syndrome)
rapid turn around time of 48 hours
basically uses fluorescence to detect the presence or absence of a specific region of the genome
so you have to know what you are looking for
The recommended first-line test for multiple congenital anomalies not suggestive of a specific syndrome is
CMA (chromosomal microarray)
this is also the recommended first line genetic test for autism and unexplained, non-syndromic developmental delay
What test will look for deletions or duplications anywhere along the entire genome?
a chromosomal microarray
How doe a CMA (chromosomal microarray) work?
the patient’s DNA is put onto a microchip and the computer analysis is used to compare the patient’s genetic material to that of a reference sample
(there is more to it but this is the basic idea – this his how theoretically any and all deletions or duplications that a patient might have can be picked up)
Best genetic test to order first when evaluating a child with intellectual disability of unclear cause
chromosomal microarray
Genetic tests that can be used to diagnose Williams Syndrome (which is caused by a 7q11.23 deletion)
either a chromosomal microarray (which would detect deletions or duplications anywhere)
or FISH using a probe targeted to 7q11.23 if you have a very strong clinical suspicion
Can a chromosomal microarray detect a balanced translocation?
no
Is whole exome sequencing ever first line?
no
Turn around time for whole exome sequencing
3-4 months
yikes that is a longg time
How does whole exome sequencing work?
the test sequences protein-coding regions of all genes to identify disease-causing change in the proband
Proband
= first person with a genetic condition in a family
or the person serving as the starting point
Fascination with water think
Angelman syndrome
MECP2 mutation causes this x-linked syndrome
Rett syndrome
According to PREP, should a 6 mo intubated bronchiolitic be fed via NG tube or NJ tube?
NJ due to “risk of aspiration”
OK PREP sure.
