Paeds renal and urology

Question 1

What are a better indication of UTI between nitrites and leukocytes? What single finding would not merit treatment?

Answer 1

• Nitrities
• UTI treatment should not be commenced if only leukocytes are present

Question 2

What’s the most common causative organism of UTIs?

Answer 2

E coli

Question 3

What’s the most common causative organism of UTIs in boys?

Answer 3

Proteus mirabilis

Question 4

What is the immediate management of children <3 months with a fever?

Answer 4

• Immediate IV antibiotics
• Septic screen

Question 5

What is the management of UTI in systemically unwell children?

Answer 5

7-10 days oral abx

Question 6

What is the management of UTI in systemically well children?

Answer 6

3 days oral abx

Question 7

What factors indicate a child with a UTI should be followed up

Answer 7

• If < 3 months old
• If were systemically unwell with UTI
• If suffer with recurrent UTIs

Question 8

What Ix do atypical UTIs warrant?

Answer 8

• USS renal tract
• Micturating cyctourecthrogram
• DMSA scan

Question 9

What can micturating cystourethrograms diagnose?

Answer 9

Vesicle-ureteric reflux

Question 10

What age group is nephrotic syndrome most common?

Answer 10

2-5 years

Question 11

What triad is seen in nephrotic syndrome

Answer 11

• Low serum albumin
• Proteinuria
• Oedema

Question 12

What’s the most common cause of nephrotic syndrome in children?

Answer 12

Minimal change disease

Question 13

What’s the most common cause of nephrotic syndrome in children?

Answer 13

Minimal change disease

Question 14

What is the management of first episode of nephrotic syndrome?

Answer 14

• 60mg/kg prednisolone for 4 weeks
• 40mg/kg prednisolone on alternate days for 4 weeks

Question 15

When do you get frothy urine?

Answer 15

Nephrotic syndrome

Question 16

What happens in nephrotic syndrome?

Answer 16

The basement membrane of the glomerulus become highly permeable to protein

Question 17

What is nephritis?

Answer 17

Inflammation within the nephrons of the kidneys

Question 18

What are the 2 most common causes of nephritis?

Answer 18

• Post strep glomerulonephritis
• IgA nephropathy

Question 19

What are 4 features of nephritis?

Answer 19

1. Haematuria
2. Proteinuria
3. AKI (impaired GFR, rising CR)
4. Salt and water retention (HTN, oedema)

Question 20

Management of nephritis?

Answer 20

Supportive, manage underlying cause

Question 21

What is nocturnal enuresis?

Answer 21

Bed wetting

Question 22

What is secondary nocturnal enuresis?

Answer 22

Where a child being wetting the bed when they have been dry for at least 6 months

Question 23

What is primary nocturnal enuresis?

Answer 23

When a child has never been consistently dry at night

Question 24

What type of nocturnal enuresis is more associated with underlying illness?

Answer 24

Secondary nocturnal enuresis

Question 25

What is haemolytic uraemic syndrome?

Answer 25

When there is thrombosis in small blood vessels throughout the body

Question 26

What usually triggers haemolytic uraemic syndrome?

Answer 26

Shiga toxin

Question 27

What triad is seen in haemolytic uraemic syndrome

Answer 27

- Haemolytic anaemia - AKI - Thrombocytopenia

Question 28

What is the typical disease course of haemolytic uraemic syndrome?

Answer 28

Symptoms that start 5 days after brief gastroenteritis

Question 29

How serious is haemolytic uraemic syndrome? What's the management?

Answer 29

- Its a medical emergency (10% mortality) - Supportive management under experienced paediatricans

Question 30

What is hypospadias?

Answer 30

When the urethral meatus is abnormally displaced to the ventral side of the penis.

Question 31

What is epispadias?

Answer 31

Where the meatus is displaced to the dorsal side (top) of the penis

Question 32

Rx of hypospadias?

Answer 32

- Mild cases may not require treatment - Surgery after 3/4 months

Question 33

What antibiotic is indicated in children with a UTI who are unwell or <3 months?

Answer 33

IV cefuroxine

Question 34

What features are suggestive of an atypical UTI?

Answer 34

- Seriously ill - Poor urine flow - Mass - Raised Cr - Septicaemia - Failure to respond to treatment in 48hrs - Non E.Coli organisms

Question 35

What is classes as recurrent UTI?

Answer 35

- 2 or more upper UTI/pyelonephritis - 1 ep of ^^^ plus 1 or more ep of lower UTI - 3 ep or more of lower UTI

Question 36

When would a child <6 months with a UTI have... 1. MCUG 2. DMSA 3. USS (within 6 weeks)

Answer 36

1. If atypical/recurrent 2. If atypical/recurrent 3. Anyone <6 months with UTI will have USS post infection

Question 37

Children with an atypical presentation of nephrotic syndrome are less likely to have minimal change disease. What 5 factors indicate atypical nephrotic syndrome?

Answer 37

- <1 or >11 years old - Raised creatinine - Visible haematuria - Raised BP - Family history

Question 38

Give 5 complications of nephrotic syndrome

Answer 38

- Hypercholesterolaemia - Thrombosis - Increased risk of infection - Hypovolaemia - Relapses

Question 39

What's the most common cause of nephrotic syndrome in children?

Answer 39

Minimal change disease

Question 40

What's the management of minimal change disease?

Answer 40

Prednisolone

Question 41

How long are steroids given for in the management of nephrotic syndrome? What is the Rx of steroid resistant nephrotic syndrome?

Answer 41

- Given for 4 weeks and gradually weaned for the next 8 weeks - ACE inhibitors and immunosuppressants e.g. cyclosporine/tacrolimus/rituximab

Question 42

What are the 2 most common causes of nephritis in children?

Answer 42

- Post-streptococcal glomerulonephritis - IgA nephropathy

Question 43

What is IgA nephropathy also known as

Answer 43

Berger's disease

Question 44

What will a biopsy show in IgA nephropathy?

Answer 44

IgA deposits and glomerular mesangial proliferation

Question 45

When and following what does... 1. IgA nephropathy present 2. Post-strep glomerulonephritis present

Answer 45

1. Days following infection 2. Weeks after sore throat

Question 46

What triad is seen in HUS?

Answer 46

- AKI - Microangiopathic haemolytic anaemia - Thrombocytopenia

Question 47

What are 2 tests for testicular torsion?

Answer 47

- Prehn's sign - elevation of testes does NOT improve pain - Cremasteric reflex - negative (testes don't move)

Question 48

Which abdominal tumour doesn't cross the midline and which does?

Answer 48

- Wilms tumour doesn't cross the midline - Neuroblastoma does

Question 49

What 2 urinary tests are raised in neuroblastoma?

Answer 49

- Urinary vanillylmandelic acid (VMA) - Urinary homovanillic acid (HVA)