Random Mix

Question 1

What investigations would you do in a patient presenting with DKA?

Answer 1

Blood Glucose
Blood Ketones
U&Es to look for dehydration
ABG to look for metabolic acidosis
Urine glucose and ketones
ECG for T wave changes of hypokalaemia

Question 2

Why should dehydration be corrected slowly in children with DKA.

Answer 2

They have an increased risk of cerebral oedema

Question 3

What three things should be given to treat DKA?

Answer 3

IV Fluids
IV Insulin (glucose once

Question 4

Why are UTI’s in childhood significant?

Answer 4

Up to half may have a structural abnormality of their urinary tract
Pyelonephritis may damage the growing kidney by forming a scar, predisposing to hypertension (10%) and chronic renal failure if the scarring is bilateral

Question 5

How do UTIs present in infants? How does this impact treatment?

Answer 5

NON-SPECIFIC
fever, vomiting, lethargy, poor feeding, jaundice, offensive urine, febrile convulsions
This means that a urine sample should be taken in EVERY infant who presents with an unexplained fever

Question 6

How might UTI’s present in older children?

Answer 6

Dysuria and frequency, haematuria, offensive, cloudyy urine, recurrence of eneuresis, abdo pain/loin tenderness, fever, D&V, febrile convulsions

Question 7

What predisposes children to getting UTIs?

Answer 7

Renal or urinary tract abnormality
Incomplete bladder emptying
Vesicoureteric reflex.

Question 8

Describe the vesicoureteric reflex

Answer 8

Developmental abnormality at the vesicoureteric junctions
Ureters are displaced laterally and enter directly into the bladder rather than at an angle
Predisposes to reflux, severe urinary reflux can reach the kidneys (intra-renal reflux)

Question 9

Why is intra-renal reflux important in terms of infection?

Answer 9

Incomplete voiding - predisposes to infection
IRR - kidneys may become infected with bugs
IRR - scarring of kidneys leading to hypertension and chronic renal failure in later life.

Question 10

Describe what a MCUG scan does and what a DMSA scan does.

Answer 10

MCUG - catheter test, to look for VUR or obstruction

DMSA - dye ingested, uptake by kidneys, looks for renal scarring.

Question 11

What advice can you give to children and parents about ways to reduce UTIs at home?

Answer 11

Drink plenty of fluids
Regular Voiding
Double Micturition
Good Perineal Hygiene

Question 12

If you do find renal scarring on DMSA scan, what would be do about it?

Answer 12

Consider low dose antibiotic prophylaxis to prevent future UTIs
Monitor blood pressure, renal growth and function regularly