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NBME p2ck_form8 Answers

step2ck_form8/Block 4/Question#10 (1.1 difficulty score)
A 5-year-old girl is brought to the physician ...
Poststreptococcal glomerulonephritis🔍

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submitted by step_prep2(17),
  • Young child who had strep throat 2 weeks ago who presents with periorbital edema, gross hematuria, proteinuria and RBC casts (consistent with glomerulonephritis), most consistent with post-strep glomerulonephritis
  • Both IgA and PSGN can lead to gross hematuria associated with an upper URI, with differences being (1) Acute PSGN: Seen 2-4 weeks after infection of pharynx or skin, Seen in children (often age 6-10), leads to low complement levels, patient will have subepithelial immune complex humps (2) IgA nephropathy: Seen concurrently with respiratory or GI infection, more common in young adult men (age 20-30), complement levels unaffected, patient will have IgA-based deposits in mesangium
  • Key idea: Treating strep throat will reduce risk of rheumatic fever, but does not reduce risk of post-strep glomerulonephritis

submitted by letsdothis(3),

Anyone else get thrown off by the laboratory abnormalities (hyponatremia, hyperkalemia, hyperchloremia, metabolic acidosis)?