Return to Scenario ListShow Learning Points most relevant to Phase 1:

Child with generalised swelling

Clinical Discipline(s)/Organ System(s)
Genitourinary System, Paediatrics, Renal Medicine
Progress Test Topic(s)
Child health, Renal
A three year old Tongan boy is brought to clinic with periorbital swelling. His mother has noticed it over 5 days when he gets up in the morning. There is swelling around his ankles and more recently she has noted swelling of his scrotum.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy and physiology of urinary tract
   - Pathology of kidney disease
   - Microbiology of Streptococcus pyogenes and non suppurative complications of group A streptococcal infection
   - Immunopathology of post-streptococcal disease
   - Causes of end-stage renal failure
Clinical and Communication Skills 
   - Elicit a history, including ingestion history (nephrotoxins, potential allergens)
   - Differentiation of nephritic and nephrotic syndromes using history, physical examination and urinalysis
   - Recognition and management of anaphylaxis
   - Establish a relationship with the patient and family/whānau
   - Consider health literacy needs of patient and family/whānau
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Communicate with the patient and family/whānau in a way that ensures they have sufficient knowledge and understanding to be able to make informed decisions and give informed consent
   - Consideration of patient and family/whānau cultural and spiritual support needs
Hauora Māori 
   - Incidence of nephritic, nephrotic syndromes and renal disease unequally affecting Māori
   - Awareness of organ donation issues within a Māori cultural context
   - Awareness of Whānau dynamics (who is/are carers)
   - Competency in engaging in a family/whānau meeting if required
   - Impact of illness on whānau employment/income/social resources
Population Health 
   - Skin infections common in New Zealand and epidemiology of post-streptococcal nephritis
   - Dialysis and transplantation in New Zealand; access to services
Conditions to be considered relating to this scenario
nephrotic syndrome, glomerulonephritis (acute post-streptococcal GN), allergic reaction, angioedema
Less common but 'important not to miss'
other causes of hypoalbuminaemia, anaphylaxis
intestinal lymphangiectasia