1/ Primary Care Case of the Week 2
Each week I’d like to share a case for #MedStudents to continue developing their clinical reasoning, even though not on clinical placement at present.
All cases are factitious, but inspired by those seen in #PrimaryCare
#MedEd #MedTwitter
2/ 3yo young girl presents to the clinic with her mum with one week of puffy eyes. Her mum initially thought she hadn’t been sleeping enough, but it seems to be worsening.
🤷🏻♀️What’s your list of differential diagnoses?
🤷🏽♂️What you would like to know on history & exam?
3/ Acute Post-Streptococcal Glomerulonephritis (APSGN)
👉🏽Inflammatory disease of kidneys
👉🏻Occurs 2-3 weeks after group A streptococcus throat or skin infection
👉🏽Need both clinical & laboratory evidence to diagnose
👉🏿Increased risk of Chronic Kidney Disease in later life
4/ Case Definition of APSGN
🔴Clinical evidence 2+ of:
👉🏽Facial/ peripheral oedema
👉🏻Moderate haematuria on dipstick
👉🏿Hypertension
🔴Laboratory evidence:
👉🏿Microscopic haematuria +
👉🏽Evidence of recent strep infection (ASOT, Anti-DNase B, throat/skin swab) +
👉🏻Reduced C3
5/ APSGN Management:
💉Treat the group A streptococcus with IM benzathine penicillin
💊Treat the elevated blood pressure with antihypertensives
☎️Notify public health & paediatrician
👋🏼Contact tracing
🏠Family, household & close contacts also need IM benzathine penicillin!
6/ What about managing an APSGN Outbreak?!
💁🏽Community education is VITAL
💁🏻♂️Engage local health workers (they know the community the best!)
💁🏼♀️Screen ALL children 1-17yrs
💁🏾♂️Treat sore throats, skin sores & scabies
7/ Thanks to everyone who contributed! 🙌🏾🙌🏻🙌🏽
@drbeecee @JaqHughes @KarenDwyer12 @SwastiThinks @am_baker
#Medstudents & #JuniorDocs can read more about APSGN more here:
🤩digitallibrary.health.nt.gov.au/prodjspui/bits…
🤩kams.org.au/wp-content/upl…
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