Genitourinary/Renal

Question 0

In MCUG fleuroscopy or plain film X-ray?

Answer 0

Fluoroscopy

Question 1

In micturating cystourethography (MCUG) where does the dye go?

Answer 1

Into the bladder through a urethral catheter

Question 2

What is MCUG used to diagnose?

Answer 2

Vesicoureteric reflux

Question 3

What is the triad of signs of nephrotic syndrome?

Answer 3

Proteinuria
Hypoalbuminaemia
Oedema
(High triglycerides)

Question 4

What 2 drugs can be used short term in nocturnal enuresis?

Answer 4

Desmopressin- antidiuretic

Oxybutynin - anticholinergic, reduces detrusor muscle instability

Question 5

Name some causes of nocturnal enuresis?

Answer 5

Stress
UTI
Constipation
Diabetes
Neurogenic bladder 
Structural abnormality

Question 6

What is haemolytic uraemic syndrome associated with?

Answer 6

Gastroenteritis caused by ecoli 0157:H7

Or occasionally shigella

Question 7

What is the triad of haemolytic uraemic syndrome?

Answer 7

acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia

Question 8

What is the history might indicate the child has developed HUS?

Answer 8

Not passing urine

Question 9

What is the most common cause of AKI in children?

Answer 9

Hypovolaemia

Question 10

What is the treatment for HUS?

Answer 10

Intensive support involving dialysis

Question 11

What are the complications of HUS

Answer 11

Encephalopathy
Hypertension
Chronic renal failure
Future proteinuria

Question 12

In nephrotic syndrome what is the urine creatinine to protein ratio?

Answer 12

It is high

Question 13

What is the treatment of nephrotic syndrome? How long does this have to be carried out for?

Answer 13

Corticosteroid therapy for approx 8 weeks -slowly ween down.

Fluid restriction, regular weight measurements, low salt diet

Penicillin prophylaxis until protein uria has stopped

Question 14

A child with nephrotic syndrome low urinary sodium and high packed cell volume.. What is happening?

What is the treatment?

Answer 14

They are hypovolaemic
At risk of thrombosis and shock

IV albumin 4.5%

Question 15

What is another word for haematocrit?

Answer 15

Packed cell volume

Question 16

How do you decide whether proteinuria is likely to be transient of not?

Answer 16

24 h urine catch
Or
Protein/creatinine ratio - should not be higher than 20

Question 17

What is a common benign cause of proteinuria?

Answer 17

Orthostatic proteinuria

Question 18

What is the most common cause of haematuria in children?

Answer 18

UTI

Question 19

Name some other causes of haematuria..

Answer 19

UTI
Post strep glomerulonephritis 
Trauma
Poly cystic kidneys 
HSP
Stone/ tumour
Sickle cell

Question 20

What investigations would you do in haematuria?

Answer 20

Urine microscopy and culture
Protein and calcium excretion
USS
bloods - U&E, FBC, clotting

Question 21

As well as urine dip what else is it important to measure in HSP?

Answer 21

Blood pressure

Question 22

What is the physiology behind nephrotic syndrome?

Answer 22

Increase capillary wall permeability in the glomerulus which allows protein to leak through

Question 23

Why might someone with nephrotic syndrome have an increased risk of infection?

Answer 23

Because immunoglobulin are lost in the urine

Avoid live vaccines and chicken pox

Question 24

What does C3 complement do in nephrotic syndrome?

Answer 24

It will be normal | Is decreased in some glomerulonephritis

Question 25

In those with steroid resistant nephrotic syndrome (10%) what is the management?

Answer 25

Renal biopsy Cyclophosphamide

Question 26

What is paraphimosis?

Answer 26

Where the foreskin is trapped in retracted position due to swollen glans

Question 27

What advise can you give for vulvovaginitis?

Answer 27

More frequent bathing No soap Loose fitting underwear

Question 28

What is the physiology behind vesicouriteric reflux?

Answer 28

Ureters are abnormally short and straight where they insert into wall of bladder so they are not properly occluded when bladder contracts

Question 29

What is the treatment for VUR?

Answer 29

surveillance monitoring Prophylactic antibiotics Surgery in 50% if renal function deteriorates or breakthrough infections

Question 30

When would you do USS in child with a UTI?

Answer 30

If they are under 6 months Or have atypical UTI Or recurrent UTI

Question 31

What is the definition of recurrent UTI in children?

Answer 31

Over 2 upper tract infections | Or over three lower tract

Question 32

In torsion of the testes how quickly can irreversible infarction occur?

Answer 32

6-12 hours but tortion should be relieved in 4 hours

Question 33

What is actually twisted in testicular tortion?

Answer 33

The spermatic cord

Question 34

What age is teaticular tortion more common?

Answer 34

Adolescents

Question 35

Where is tender in testicular tortion compared to tortion of the hydatid morgagni?

Answer 35

The actual testicle is painful, in hydatid, the pain is more in the upper pole

Question 36

If there is a blue dot visible on the scrotum when it is transilluminated what is this suggestive of?

Answer 36

Tortion of the hydatid morgagni

Question 37

IS the cremaster reflex preserved in tortion of the hydatid morgagni?

Answer 37

Yes

Question 38

How is testicular tortion treated?

Answer 38

Surgically by manually in twisting the testicle and bilateral fixation to tunica vaginalis

Question 39

Epididmitis and tortion both present with a painful swollen testicle and potential nausea, how do you differentiate?

Answer 39

Prehns sign- when tenderness is relieved by lifting the testicle suggests epididimitis