paed nephrology quiz.ppt - university of cape town · mephrotic syndrome post-streptococcal...

Quiz

Fifth Year Workshop 2006

RENAL

A. HAEMATURIA

Match the following urine findings with the clinical scenario provided

( Each choice may be used more than once )A

� 1. Post strep nephritis

� 2. Schistosomiasis

� 3. Renal stones

� 4. Rhabdomyolysis

� 5. Analgesic NSAIDS abuse

� 6. Acute Haemolysis

� 7. Haemolytic uraemic

syndrome

� a. RBC' s + eosinophils

� b. No RBC's; +ve for myoglobin

� c. No RBC's; +ve for haemoglobin

� d. RBCcasts, crenated RBC's

� e. RBC only

B. RICKETSMatch the following biochemical findings with theclinical scenario provided

PTH = parathyroid hormone

TRP = Tubular reabsorption of phosph

� 1. Biliary Artesia

� 2. Chronic Renal Failure

� 3. ELBW / ExPrem on breast milk

� 4. Fanconis Syndrome,

� a. ↓Calcium;

low 25-OH Vit D

� b. ↓↓ phosp ; low/N

Calcium; low TRP

� c. ↓↓Calcium, ↑phosp, ↑PTH

� d. ↓phosp, ↓Calcium ↓7Dihydroxy Vit D,

C. CASE STUDY7yr old female from Northern Transkei visiting aunt in Cape

Town. Presents with Macroscopic Haematuria

� Examination

� Well grown; BP normal; No skin lesions; No abd. masses; Dipstix 4+ blood

U/S Bladder

Q 1-3

� 1. What is the diagnosis?

� 2. Describe what you might see on microscopy

� 3. What is the best time of day to collect urine sample?

D. U/S Case

Q 1-5

The above U/S represents a form of obstructive uropathy

� 1. What is level of obstruction

� 2. Name two other sites of obstruction involving the renal tract

� 3. Which of the above three types of obstruction holds the best prognosis

� 4. How might this condition present? Suggest 3 ways

� 5. What two important considerations in this condition determine management

E. Radiological Study

� This is a study of a 3 day old boy baby who presented with bilateral renal masses and respiratory distress

Q 1-4

� 1. What is radiological study is this

� 2. What condition does it represent

� 3. What is the immediate management in a neonate

� 4. What NB symptom should specifically be asked about if considering the

diagnosis.

F.Nephritic / Nephrotic Syndrome

Complete the following two tables

“Minimal Changes”Mephrotic Syndrome

Post-StreptococcalNephritic Syndrome

BLOOD UREA/CREATININE

SERUM PROTEINS –albuminalpha-2-globulinBeta globulin

BLOOD LIPIDScholesterol phospholipids triglycerides

FBC

X-Ray chest

“Minimal Changes”Mephrotic Syndrome

Post-StreptococcalNephritic Syndrome

PRECEDING INFECTION

ASO or anti-DNase B TITRE

COMPLEMENT(total, C3)

URINE – volumehaematuriaproteinuria castsculture

G. U/S Study

� The following is a renal ultrasound of a newborn baby with a palpable abdominal mass.

Q 1-5

� 1). Describe what you see

� 2). What is this condition called.

� 3). What do you expect the renal fx of this kidney to be and how would you confirm that

� 4). Name two potential, but rear complications

� 5) What is the natural progression

H. Antihypertensives and their site of action

� Fill in the ff diagram

� List of antihypertensive

� a.Atenolol

� b.Hydrochlorothiazide

� c.Prazocin

� d.Enalapril

� e.Hydrallazine

I. Hormones and the Kidney

� 1. List 3 hormones produced by the kidney and give its function

� 2. List 3 hormones acting on kidney give their site of production and their effect.

J. Complete the following table

distinguishing cause of renal failure

Pre-Renal Intra Renal

U-Na

FeNa

Specific gravity

Urine osmolality

Urea

K. Case Study

� A 2 year old boy presents to his local clinic with pallor, lethargy and oliguria 5 days after having suffered from a diarrheal illness during which he was very feverish and passed small amounts of fresh blood in his stool.

� On examination he is noted to have peteciae.

� His blood results show the following

� Hb 5 WCC 19,7 Plts 60 INR 1.O PTT 31/30 Creatinine 248 Urea 21 K+ 5.5

� 1. What is the diagnosis

� 2. What organisms could be responsible

� 3. What tests would you do to look for haemolysis

� 4. What is the likely course of the disease?

� 5. Does he require long term follow-up; Motivate your answer.

L. Glomerular Filtration Rate

A 3 year old girl 94cm in length weight

17kg has a creatinine of 200micromols

� 1. Calculate her GFR (glomerular filtration rate)

� 2. What does this tell you about her renal function ?

� 3. What would the GFR be if her creatinine was

a) 120b) 40

� 4.Draw a graph to demonstrate the relationship between Cr and GFR Creatinine

GFR

M. HaematologyMatch the following Haematological ab(N) with the clinical conditions provided

� 1.Haemolytic uraemic syndrome

� 2.Cystinosis

� 3. CRF

� 4. Nephrotic syndrome with relapse

� 5. Post Strep Glomerulomephritis

� a) Hb 10 WCC 9 Plts 340

� b) Hb 5,4 WCC 13 Plts 400

� c) Hb 7 WCC 30,4 Plts 63

� d) Hb 6 WCC 3,7 Plts110

� e) Hb 14,2 WCC 11 Plts 690

N. Case StudySee picture below

� This pt presented with lesions on the legs and buttocks and abdominal pain

� What is the diagnosis

� Name two other symptoms associated with this condition

� Name two bed-side tests that are NB in evaluating this patient

O. Illustrative CaseThe picture below represents a syndrome

� 1. Name the syndrome

� 2. What makes up the triad

� 3. Describe what the ureters may look like

� 4. What determines the prognosis in the neonatal age.

P. HYPONATRAEMIA / HYPERNATRAEMIA 2 cases

� Case 1

� 3 months old infant,exprem presents with a 2 day

� H/O cough and fast breathing

� O/E he is pale, lethargic and in marked respiratory distress

� biochemistry :

� Sodium 110 Chl 86 Bicarb 20 Urea 2 Cr 40

� Urinary Na+ 50

� Osmalolity 210

� What is the cause of the Hyponatraemia

� Case 2

� A 10 year old mentally retarded boy was admitted with a history of increasing drowsiness. He had undergone a hemispherectomy as treatment for intractable seizures.

� Na 165 Chl 130 Urea 22 Cr 180

Glucose 9,5

� a. What is his calculated osmolality

� b. What is the presumptive diagnosis

� c. What treatment should be instituted