Case Files Pediatrics, Fourth Edition (LANGE Case Files) by Sanders Mark Jason & Toy Eugene & Yetman Robert & Hormann Mark & Lahoti Sheela & McNeese Margaret & Geltemeyer Abby M

Author:Sanders, Mark Jason & Toy, Eugene & Yetman, Robert & Hormann, Mark & Lahoti, Sheela & McNeese, Margaret & Geltemeyer, Abby M. [Sanders, Mark Jason]
Language: eng
Format: epub
Publisher: McGraw-Hill
Published: 2012-08-30T00:00:00+00:00

COMPREHENSION QUESTIONS

29.1 A 16-year-old adolescent boy complains of intermittent cola-colored urine of several years’ duration, usually when he has a “cold.” He is otherwise well and has no medical complaints. When the dark-colored urine is present, he has no dysuria. None of his family members has similar complaints or renal disease. On physical examination he is normotensive and appears healthy. Which of the following is the most likely cause of his intermittent hematuria?

A. Acute poststreptococcal glomerulonephritis

B. Henoch-Schönlein purpura nephritis

C. IgA nephropathy

D. Recurrent kidney stones

E. Rapidly progressive glomerulonephritis

29.2 The parents of a healthy 12-year-old girl bring her to you for a physical examination required for summer camp. They have no complaints, and the girl denies any problems. Her last menses was normal 2 weeks prior. The camp requires a urine screen. To your surprise, the clean-catch urine screen has significant hematuria. Red cell casts are noted. You tell the findings to the parents, and they respond that “everyone on dad’s side of the family has blood in their urine and they are all doing well.” The family history is negative for deafness and for renal failure. Microscopy of renal tissue from this patient or from her father will most likely reveal which of the following?

A. Endothelial cell swelling and fibrin in the subendothelial space

B. Immune complex deposition in the mesangium

C. Large numbers of crescentic glomeruli

D. Renal cell carcinoma

E. Thinning of the basement membrane

29.3 A 17-year-old adolescent female has joint tenderness for 2 months; the pain has affected her summer job as a lifeguard. In the morning, she awakens with bilateral knee pain and swelling, and right hand pain. The pain eases during the day but never completely resolves. Nonsteroidal anti-inflammatory drugs help slightly. She also wants a good “face cream” because “her job has worsened her acne.” On physical examination you notice facial erythema on the cheeks and nasolabial folds. She has several oral ulcers that she calls cold sores and bilateral knee effusions, and her right distal interphalangeal joints on her hand are swollen and tender. Her liver is palpable 3 cm below the costal margin. She has microscopic hematuria and proteinuria. Which of the following is the most likely cause of this young woman’s arthritis?

A. Juvenile rheumatoid arthritis

B. Lyme disease

C. Osteoarthritis

D. Postinfectious arthritis

E. Systemic lupus erythematosus

29.4 You are not surprised to see one of your most challenging patients, a 16-year-old adolescent girl who has been seen several times per week over the last 2 months complaining of cough, occasional hemoptysis, malaise, and intermittent low-grade fever. Thus far you have identified a microcytic, hypochromic anemia for which she has been taking iron (without response) and migratory patchy infiltrates on chest radiograph that seem unaffected by antibiotic treatment. She has no tuberculosis (TB) exposure risks, and her TB skin test was negative. Today she also complains of facial edema and tea-colored urine. You suddenly realize her symptoms can be grouped as which of the following syndromes?

A. Alport syndrome

B. Denys-Drash syndrome

C. Goodpasture syndrome

D. Hemolytic-uremic syndrome

E. Nephrotic syndrome