Professional Practice II

Urine is showing the presenting illness, other tests than is done to support.

Vital signs should always be done first before any invasive procedures.

D. Integration of care provided by all professionals (FALSE)

Medical history consists of hospital or GP treatment
surgery or any anaesthetic problems

MI / IHD / CVA / TIA / ep / asth / TB / liver / pu / DM / rhF / bp

medications and allergies, any side effects, previous medical therapies

Gastroesophageal reflux disease is extremely common in infancy and may present with [non-bilious] vomiting after feeding, irritability, arching of the back and feeding problems. Further investigation may be required if the infant presents with failure to thrive, blood in the vomitus, recurrent cough, pneumonia or persistent symptoms. Management may include a trial of prevacid, frequent smaller feeds and positional changes.

BIG NOTE: IgA nephropathy is actually much more common in males, but I noticed that after writing the question. It has a widely variable clinical course, but in an otherwise healthy patient (normotensive) with isolated hematuria, it's usually quite benign. I think the most sensible thing to do would be monitoring his risk factors (BP, proteinuria) for progression to renal failure.

CRP and ESR are markers of systemic inflammation, pointing to some sort of inflammatory process. Crohn's usually (50% of the time) affects the terminal ileum and cecum, found in the RLQ, and classically presents with symptoms like bloody diarrhea, pain and weight loss.

Vitamin K is administered to all newborns to prevent the development of hemorrhagic disease of the newborn (HDN). Newborns are deficient vitamin K due to low stores at birth, low levels in breast milk and poor placental transfer. Most standard commercial infant formulas contain supplemental vitamin K therefore HDN is primarily a problem of exclusively breast fed infants.

Please see article on HDN: http://www.emedicine.com/ped/TOPIC966.HTM

Pain that radiates "from loin to groin" is a classic presentation for renal colic. Nausea and vomiting are almost always present because the kidney shares autonomic innervation with the gastrointestinal tract. The abdomen is typically soft with mild tenderness on the affected side, and ileus may occur in protracted cases. Signs of peritonitis are rare.

Urinary extravasation is inconsequential.

Remember these key points about renal colic:
1. presents as intense pain radiating from loin to groin with nausea and vomiting
2. diagnosed by CT scan
3. management is usually outpatient oral hydration and pain control until the stone passes spontaneously
4. admission indications include: compromised renal function, inability to tolerate outpatient management, evidence of infection

Idiopathic is the primary cause of osteoarthritis of the hip.

Stones less than 5 mm in diameter will pass spontaneously 75% of the time. Therefore, this patient can be managed on an outpatient basis with oral hydration, oral pain control, and urine straining. Retrieval of the stone or stone fragments allows for analysis that can guide future preventative measures.

Admission criteria include: inability to tolerate oral hydration or pain control, evidence of infection, renal failure, or solitary kidney.

To promote primary health care

Unenhanced CT is the preferred imaging modality, since essentially all stones show up on CT. IV pyelogram allows visualization of the degree of obstruction, but it is time consuming and requires contrast that cannot be administered until it is established that the patient does not have pre-existing renal failure (thus the creatinine).

An elevated leukocyte count may suggest urinary tract infection, which necessitates more aggressive intervention or admission. Urine pH may help determine the type of stone (acidic pH suggests uric acid stone, alkaline pH suggests infective or struvite stone). Gross or microhematuria is often seen.