QuestionSBA
QuestionChoice
The patient is most likely presenting with haemolytic uraemic syndrome (HUS). This is caused by a toxin, usually produced by E. coli 0157, which is most often associated with undercooked meat and petting farms. The toxin causes endothelial damage and thrombus formation in the renal arteries. It presents with the triad of microangiopathic haemolytic anaemia, thrombocytopenia, and acute kidney injury. Blood tests typically show haemolytic anaemia, with raised creatinine & urea, and low platelets. Schistocytes and reticulocytes may be seen on blood film. HUS is most often managed conservatively with supportive measures.
10006771
a
Haemolytic uraemic syndrome
QuestionChoice
ITP involves immune-mediated platelet destruction resulting in easy bruising (purpura) and bleeding, typically following a recent infection. ITP would show an isolated thrombocytopenia, but with normal red blood cell morphology. It is more common in children but is not associated specifically with E.coli-0157. There is no sign that the patient is experiencing widespread bruising.
10006775
e
Immune thrombocytopenic purpura
QuestionChoice
This would also present with fever, anaemia, thrombocytopenia, and evidence of renal impairment. The presence of schistocytes on blood film may also be seen. It does not present with bloody diarrhoea or vomiting and is not associated with food. TTP is caused by genetic or acquired ADAMST-13 deficiency, resulting in inhibition of von Willebrand factor. Neurological symptoms are also seen in TTP.
10006774
d
Thrombotic thrombocytopenic purpura
QuestionChoice
Nephritic syndrome presents with haematuria and proteinuria (<2g). It may also present with oliguria and oedema. It may follow an infection and is more common in children, but it is an unlikely cause in this case as it is more associated with URTI's than gastroenteritis, so would not explain the diarrhoea and vomiting or blood film.
10006773
c
Nephritic syndrome
QuestionChoice
Although the patient likely did suffer a bout of gastroenteritis (E.coli) which may have led to the development of HUS, a simple gastroenteritis infection is unlikely to cause this patient's presentation on its own. Gastroenteritis may present with bloody diarrhoea for example with salmonella poisoning which is usually transmitted from undercooked chicken. The presence of schistocytes, deranged blood tests and signs of AKI rule out gastroenteritis as the cause.
10006772
b
Gastroenteritis
Concept
Chapter
2693
4540
Haemolytic uraemic syndrome
Topic
142
Nephrology
13901
A 10-year-old boy presents to A&E with a three-day history of severe abdominal pain, vomiting, and diarrhoea which has been bloody for the past two days. The patient takes no regular medications and has no significant past medical history. He attended a barbeque at a friend's house five days previously. The patient has a temperature of 37.8 degrees. Blood tests show the following:
Hb 98, Creatinine 140, Urea 11, Platelets 32. A urine dipstick demonstrates proteinuria.
A blood film shows the presence of schistocytes and reticulocytes.
Which of the following is the most likely cause for his presentation?
a