Renal and Urology

Question 1

Children under 6 months with a UTI require what scan

Answer 1

USS within 6 weeks

Question 2

Children under 6 months with atypical or recurrent UTIs require which scans

Answer 2

USS during illness
DMSA 6 months later
MCUG

Question 3

Does a 7 month old child require a USS following a UTI

Answer 3

No unless recurrent or atypical

Question 4

What do all children with recurrent UTI need?

Answer 4

DMSA scan 4-6 months after infection

USS within 6 weeks

Question 5

What children with atypical or recurrent UTI need a MCUG

Answer 5

Under 6 months

Question 6

Features that make a UTI aytipical

Answer 6

Non E Coli
Sepsis
Poor urine flow/ abdominal mass
Raised creatine
Failure to respond to treatment within 48 hours

Question 7

Definition of a recurrent UTI (2)

Answer 7

2 or more (if one systemic)

3 or more (if none systemic)

Question 8

A diagnosis can be made for acute pyelonephritis if either two are present:

Answer 8

Temperature greater than 38C

Loin pain or tenderness

Question 9

Why are nitrites present in UTI dipstick

Answer 9

Gram negative bacteria (e coli) break down nitrates -> nitrites

Question 10

What should all children under 3 months with a fever have

Answer 10

IV antibiotics

Septic screen - cultures, bloods, lactate, LP

Question 11

What do children with aytipical UTIs require

Answer 11

All need an USS during infection

<6 months: DMSA and MCUG
6 months - 3 years: DMSA

Question 12

What is a DMSA used to identify

Answer 12

How well the kidneys are working and if there is any scaring

Question 13

What is a MCUG used to diagnosed.

What is MCUG full name

Answer 13

VUR

Micturating cystourethrogram

Question 14

Management of VUR (4)

Answer 14

Avoid constipation
Frequent urination
Prophylactic ABX
Surgery

Question 15

Why is vulvovaginitis most common in children 3-10

Answer 15

Post puberty, oestrogen helps keep skin healthy and resistant to infection

Question 16

Urine dipstick result for vulvovaginitis

Answer 16

Leukocytes but no nitrites

Question 17

Risk factors for vulvovaginitis

Answer 17

3-10 years, wet nappies, chemicals, tight clothing, poor hygiene, constipation, threadworms, pressure (horse riding), heavily chlorinated pools

Question 18

What 2 other conditions do patients with vulvovaginitis usually have a history of (misdiagnosed)

Answer 18

Thrush and UTIs

Question 19

Management of vulvovaginitis

Answer 19

Mainly supportive:

Avoid chemicals, emollients, loose clothing, good hygiene

Oestrogen cream may help

Question 20

Triad of nephrotic syndrome

Answer 20

Low serum albumin
High urine protein
Oedema

Question 21

Other than low serum albumin, high urine protein and oedema what 3 other features are common in this syndrome

Answer 21

Nephrotic syndrome

Raised lipid profile
HTN
Hypercoaguable

Question 22

Most common cause of nephrotic syndrome in children

Answer 22

Minimal change disease

Secondary to renal disease or secondary to systemic illness: HSP, DM, infections

Question 23

Management of minimal change disease

Answer 23

Steroids

Low salt diet

Question 24

What causes 90% of nephrotic syndrome

Answer 24

Minimal change disease

Question 25

Nephritis definition

Answer 25

Inflammation of the kidneys which causes haematuria, reduced GFR and proteinuria (although less than nephrotic)

Question 26

Two most common causes of nephritic syndrome in kids

Answer 26

``` Post-streptococcal glomerulonephritis IgA nephrophathy (Bergers disease) ```

Question 27

What infection is Post-streptococcal glomerulonephritis possible after What blood test to confirm

Answer 27

Tonsilitis Throat swab for anti-streptolysin antibodies

Question 28

What is anti-streptolysin antibodies used to determine

Answer 28

Severity and immune response to recent streptococcus infection Used for post-strep glomerulenphitis and RF

Question 29

What is IgA nephropathy (Bergers disease) And what condition is it linked to

Answer 29

IgA depostis in kideny cause inflammation Henoch-Schonlein pupura (IgA vasculitis)

Question 30

What is management for Bergers disease

Answer 30

Steroids and immunosuppressant medications to slow progression

Question 31

What toxin causes HUS

Answer 31

Shiga

Question 32

HUS triad

Answer 32

Haemolytic anaemia AKI Thrombocytopenia

Question 33

What bacteria produces the Shiga toxin

Answer 33

e coli 0157 and shigella

Question 34

What increases the risk of developing HUS

Answer 34

Antibiotics and anti-motility agents like loperamide

Question 35

is HUS dangerous?

Answer 35

10% of kids die Low threshold for dialysis

Question 36

How to manage HUS

Answer 36

Dialysis Anti-HTN Fluid balance Blood transfusions

Question 37

What is enuresis

Answer 37

Bed wetting

Question 38

When should children be dry by day and by night

Answer 38

2 at day | 3-4 at night

Question 39

Common and important condition to rule out in enuresis

Answer 39

Constipation UTI, learning disability, CP

Question 40

5 causes of secondary enuresis (wetting bed that had previously been dry)

Answer 40

UTI, constipation, T1DM, new psychological problems, maltreatment

Question 41

Common pharmacological management of enuresis

Answer 41

Desmopressin (ADH) given at bedtime to reduce fluid in bladder

Question 42

What is Imipramine used for

Answer 42

TCA used for enuresis Unsure how it works but believes to relax bladder

Question 43

Why type of incontinence is oxybutinin used for

Answer 43

Overactive bladder causing urge incontinence Anticholinergic medication

Question 44

Two types of PKD

Answer 44

AR - presents in kids with oligohydramnios | AD - presents in later life

Question 45

What is Potter syndrome and what condition normally causes it

Answer 45

Lack of amniotic fluid (oligohydramnios) causes dysmorphic features such as low set ears, flat nasal bridge. Also causes pulmonary hypoplasia. Will need dialysis and most will have end stage renal failure by adulthood. ARPKD

Question 46

What is a Wilms tumour

Answer 46

Nephroblastoma

Question 47

What should be ruled out in all children under 5 with an abdominal mass

Answer 47

Wilms tumour

Question 48

Diagnosis of Wilms tumour

Answer 48

US | Core biopsy

Question 49

Management of Wilms tumour

Answer 49

Nephrectomy

Question 50

Where is the issue in children with posterior urethral valve

Answer 50

Proximal end of urethra Only occurs in newborn boys

Question 51

How may a posterior urethral valve be diagnosed prenatally

Answer 51

Hydronephrosis Oligohydramnios -> underdeveloped fetal lungs (pulmonary hypoplasia) -> resp failure

Question 52

5 RF for undescended testicles

Answer 52

FH, low birth weight, SGA, premature, smoking in pregnancy

Question 53

How long to watch and wait in undescended testicles in newborns?

Answer 53

3-6 months -> seen by surgeon | Orchidoplexy -? 6-12 months

Question 54

Age of hypospadias treatment

Answer 54

3-4 months

Question 55

Where is fluid in hydrocele

Answer 55

Tinica vaginalis

Question 56

What is the developmental origins of the tunica vaginalis

Answer 56

Connected with peritoneal cavity So if not separated will allow fluid from peritoneal cavity to drain

Question 57

Difference between the 2 types of hydrocele

Answer 57

Simple - fluid trapped in tunica vaginallis (not connected to abdo) Communicating - connected to peritoneal cavity via processus vaginalis

Question 58

Key examination finding of hydrocele

Answer 58

Transilluminates with light (whole testicle will brighten up like a bulb)

Question 59

How to manage a simple hydrocele

Answer 59

Will resolve within 2 years without needing any surgery

Question 60

How is a communicating hydrocele managed

Answer 60

Ligate the connection between peritoneal cavity and hydrocele (soon but not urgent)