GU

Question 1

Testicular torsion is most common at what age?

Answer 1

Adolescence 12- 16 yrs

Question 2

Torsion of hydatid of Morgagni is AKA? Common age of presentation

Answer 2

AKA torsion of testicular appendage
Usually pre pubertal males

Note: blue dot sign - tender nodule with blue discoloration on the upper pole of the testis

Question 3

Blue dot sign is seen in what pathology?

Answer 3

Torsion of testicular appendage

Question 4

Torsion of testicular appendage require surgical intervention T/F

Answer 4

F - if diagnosis is clear not indication for surgery, symptoms should resolve w/in 48 hrs

Question 5

Management of a hydrocele?

Answer 5

If < 2 yrs reassurance only, 95% will resolve by 2 yrs old

If > 2 yrs old ligation of processus vaginalis

Question 6

Mgmt of priapism?

Answer 6

Mgmt is different for ischaemic vs non ischaemic
Ischaemic is painful and non ischaemic is not

Ischaemic is an emergency - needs surgery consult. Tc ice pack, oral analgesia and cavernous aspiration if there for > 4 hrs

Question 7

What is the only absolute medical indication for circumcision?

Answer 7

BXO (balantitis xerotica obliterans)

Note: as 10% of cases will have narrowing of urethra and hence urethral calibration is also indicated.
Other relative indications: recurrent paraphimosis, posterior urethral valves or high grade VUR (due to abnormal tract/increase risk UTIs)

Question 8

Balantitis xerotica obliterans vs phimosis

Answer 8

BXO - thickened non retractile foreskin, it does not evert and is scarred. Leads to a pin hole opening

Phimosis: non retractile foreskin, mild erythema, ballooning of foreskin on micturition and white debris

Question 9

What is the mgmt of phimosis in a baby?

Answer 9

Reassurance; foreskin in only retractable in 1% of babies at birth; only 1% of 16 yrs old will have a foreskin that is non retractable

Question 10

Presence of pus cell in the urine of a pt who has recently been started on a new medication.

Answer 10

Acute interstitial nephritis

Common meds: beta lactams, sulphonamides, rifampicin, ethambutol, erythromycin

Question 11

What is the mgmt of a chronic ovarian cyst > 5cm?

Answer 11

Ovary sparing cystectomy

At 5cm or greater there is a risk of torsion

Question 12

According to NICE guidelines in a child over 3 yrs old what is the appropriate duration of treatment with oral abx for cystitis?

Answer 12

3 days

NB: pyelonephritis is 7-10 days

Question 13

In hypospadias where does the urethra open?

Answer 13

Ventrally just before the glans

Other features: a chordee (tilt ventrally) and hooded foreskin
Note: epispadias is much less common and is an opening on the dorsal side

Question 14

What is the mgmt of the lack of a palpable testis?

Answer 14

Normal up until 6 months

After 6 months should have a diagnostic laparoscopy and possibly the first stage if orchidopexy.

NB: no form of imaging is reliable enough to determine whether a testes is present or not

Question 15

Vesicoureteric reflux is most accurately diagnosed by a DMSA scan T/F

Answer 15

F - DMSA scan is the best investigation to look for renal scars
Micturating cystography is used for diagnosis

Question 16

Most vu reflux spon resolves the age of 3 yrs T/F

Answer 16

F - most resolves by 5 yrs

Question 17

Of children who present to the hospital with a UTI about what % have VUR?

Answer 17

30 - 40%

Question 18

Umbilicus draining in a infant, differentiate patent vitellointestinal remnant from urachal sinus

Answer 18

Patent vitellointestinal remnant - more likely to drain pus or intestinal contents
Patent urachal sinus - as is bladder, more likely to drain clear

Do USS to investigate these

Question 19

Causes of secondary hyperoxaluria?

Answer 19

Overall it is due to fat malabs –> short gut, Crohns. CF and pancreatitis

Can lead to oxalate stones

Question 20

In a patient with a UTI and a large renal stone what is the most likely type of stone?

Answer 20

Struvite (mix of Mg, ammonium, phos and ca due to proteus)

Can cause a large stag horn calculus and renal impairment

Question 21

Are uric acid stones radio opaque or lucent?

Answer 21

Lucent

Note: radio opaque = ca, struvite and cystine stones

Question 22

In a patient with grade V VUR when is surgery indicated?

Answer 22

1. Anyone > 5 yrs old
2. 1-5 years old if bilateral (even if no scarring)
3. 1-5 years old with scarring

Note: if unilateral and no scarring in 1-5 yr old no surgery, only antibiotic prophylaxis

Question 23

Features of an atypical UTI

Answer 23

Poor urine flow
Abdo and/or bladder mass
Positive culture of non- E coli organism
Raised Cr
Signs of sepsis
Failure to respond to appropriate antibiotic treatment within 48hrs

Note: according to NICE guidelines any children with any feature of atypical UTI need ultrasound

Question 24

What is the definition of recurrent UTIs

Answer 24

3 or more lower UTIs
OR 2 or more of UTIs of which at least one is upper

Note: prophylactic antibiotics rec for recurrent UTIs

Question 25

When a patient is having a MCUG for VUR work up what preperation need to be undertaken before hand?

Answer 25

Patient should be started on prophylactic orally for 3 days with the MCUG being done on the 2nd day

Question 26

What is the incidence of hypospadias?

Answer 26

1 in 300 live male births

Question 27

How does detrusor instability typically present?

Answer 27

Urge incontinence , due to spon contraction of the bladder muscle

Question 28

Clinical presentation of ureterocele?

Answer 28

1. Recurrent cystitis
2. Renal outflow obstruction which can lead to renal failure

Note: can also have no symptoms

Question 29

Hydrocoele vs varicocoele

Answer 29

Hydrocoele - acute onset, can be post traumatic, transilluminates

Varicocoele - chronic onset, “bag of worms” consistency