Nephrology

Question 1

when should pyelonephritis be suspected

Answer 1

unexplained fever of 38°C or more, or loin pain/tenderness

Question 2

investigation for UTI

Answer 2

urine dipstick - ideal is clean catch to avoid contamination

Question 3

atypical UTI presentation in children

Answer 3

poor urine flow
abdominal or bladder mass
raised creatinine
sepsis
failure to respond to treatment within 48hrs
infection with non-e.coli organisms

Question 4

criteria for USS for UTI

Answer 4

atypical infection
recurrent UTI
first time UTI for children under 6months

Question 5

UTI clinical presentation

Answer 5

dysuria
increased frequency
increased bedwetting
foul smelling urine
darker/ cloudy urine
haematuria
abdo pain
loin/ suprapubic tenderness

Question 6

what is testicular torsion

Answer 6

twisting of the spermatic cord with rotation of the testicle

urological emergency

Question 7

examination findings of testicles in testicular torsion

Answer 7

firm swollen testicle
retracted testicle
absent cremasteric reflex
abnormal testicular lie
rotation

Question 8

USS result showing positive testicular torsion

Answer 8

whirpool sign

Question 9

management of testicular torsion

Answer 9

analgesia
orchiopexy
orchidectomy if surgery is delayed or there is necrosis

Question 10

clinical presentation of testicular torsion

Answer 10

unilateral testicular pain
abdominal pain
vomiting

Question 11

risks of undescended testes

Answer 11

higher risk of testicular torsion, infertility, testicular cancer

Question 12

management for undescended testes

Answer 12

watch and wait in newborns - should descend in first 3-6months

if not by 6months - paeds urologist

orchidopexy carried out between 6-12months

Question 13

what is nocturnal enuresis

Answer 13

involuntary bedwetting in the night
over the age of 5

Question 14

risk factors of nocturnal enuresis

Answer 14

fh
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psychological and behavioural disorders

Question 15

causes of nocturnal enuresis

Answer 15

UTI
polyuria e.g. dm
bladder dysfunction e.g. overactive bladder
sleep arousal difficulties e.g. inability to wake to noise, sensation of full bladder

Question 16

management for nocturnal enuresis without daytime symptoms

Answer 16

explain it is not the child’s fault
toilet patterns e.g. encouraged to empty bladder regularly during the day and before sleep
positive reward systems who have dry nights

Question 17

management for children aged 5yrs or older who have not responded to conservative/ lifestyle management for nocturnal enuresis

Answer 17

alarm or desmopressin

Question 18

management of primary bedwetting with daytime symptoms

Answer 18

refer to secondary care or enuresis clinic

Question 19

what is hypospadias

Answer 19

congenital condition where the urethral tabularisation is abnormally displaced on the ventral (underside ) of the penis

Question 20

classification of hypospadias

Answer 20

glanular (may be solely cosmetic)
midshaft
penoscrotal (most severe - can cause genitourinary problems)

Question 21

what conditions is hypospadias associated with

Answer 21

chordee
inguinal hernia
cryptorchidism
psychological problems

Question 22

management of hypospadias and aims

Answer 22

surgery before 2yrs of age

aims
- terminal urethral meatus so they can micturate in normal standing position
- straight erection
- normal looking penis

Question 23

what is phimosis

Answer 23

inability to retract the foreskin
this is normal before the age of 2

Question 24

cause of phimosis

Answer 24

balantis xerotica obliterans
causes inflammation and lesions (dry white thickened plaques)
as a result foreskin adheres to glans and pulling it back is painful and difficult

Question 25

clinical presentation of normal phimosis

Answer 25

end of penis may balloon when passing urine
recurrent UTI

Question 26

clinical presentation of abnormal phimosis

Answer 26

haematuria
painful erections
pain
weak urine stream
recurrent UTI

Question 27

management for phimosis

Answer 27

steroid creams or gels
personal hygiene

surgery or circumcision for persisting abnormal phimosis