Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Zero to finals Paediatrics Marina > Paediatric Nephrology/Urology > Flashcards

Paediatric Nephrology/Urology Flashcards

1
Q

How do you investigate a child under 6 months with their first UTI? (Not atypical or recurrent, responds well to treatment)

A

Abdominal ultrasound within 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you investigate a child over 6 months with a recurrent UTI?

A

Abdominal ultrasound within 6 weeks

DMSA scan within 4-6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you investigate a child over 6 months with an atypical UTI?

A

Ultrasound during illness

DMSA 4-6 months after illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you investigate a child under 6 months with a recurrent UTI?

A

Ultrasound during illness

DMSA 4-6 months after illness (to look for renal scarring after an acute episode)

MCUG (to look for vesico-ureteric reflex, performed after control of the current infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

`How do you investigate a child under 6 months with an atypical UTI?

A

Ultrasound during illness

DMSA 4-6 months after illness

MCUG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is classed as an atypical UTI?

A

Seriously ill

poor urine flow

abdominal or bladder mass

raised creatinine

septicaemia

failure to respond to treatment with suitable antibiotics within 48 hours

infection with non-E. coli organisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the common complications of nephrotic syndrome (triad):

A

(triad: HIT)
* Hypercholesterolaemia; urinary albumin loss  less oncotic pressure –> hepatic cholesterol synthesis

  • Risk of infection; loss of immunoglobulin in urine–>infection risk (esp. NHS bacteria): sometimes prophylactic penicillin V
  • Risk of thrombosis; loss of AT-III in the urine –> hypercoagulable state
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the triad of nephrotic syndrome?

A

HOP: hypoalbuminaemia ,oedema, proteinuria and

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does nephrotic syndrome present in children?

A

Frothy urine

Generalised oedema - peripheral, ascites, periorbital, pulmonary

Pallor

Low serum albumin

High urine protein

Oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What blood results are seen in nephrotic syndrome?

A

Low serum albumin

Increased cholesterol and lipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the main complication of nephrotic syndrome?

A

Hypercoagulability causes increased risk of DVT and PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is minimal change disease managed?

A

Oral prednisolone

If steroid resistant -> ACEi/immunnosuppresants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the first line treatment for nocturnal enuresis after all lifestyle measures have been trialled?

A

Under 7 -> enuresis alarm

Over 7 -> desmopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which type of polycystic kidney disease presents in neonates?

A

Autosomal recessive PKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some features of polycystic kidney disease (mnemonic)?

A

MISSHAPES
-Abdominal Mass
-Infected cysts & increased BP
-Stones
-Systolic hypertension
- Haematuria
-Aneurysms (Berry)/subarachnoid haemorrhage
-Polyuria & nocturia
- Extra-renal cysts e.g. liver*(most common extrarenal manifestation) ovaries, pancreas, seminal vesicles
-Systolic murmur – due to mitral valve prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are features of autosomal recessive PKD on antenatal scans ?

A

Can be seen on antenatal scans with:

-enlargement of collecting ducts
-Oligohydramnios
-Pulmonary hypoplasia (due to oligohydramnios)
-Potter syndrome
-Congenital liver fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a Wilm’s tumour and how does it present?

A

Specific type of tumour which affects the kidney in children

Mass in abdomen (unilateral 95% cases)

Abdominal pain/flank pain

painless Haematuria

Lethargy

Weight loss

Fever/anorexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is a Wilm’s tumour diagnosed?

A

Abdominal ultrasound

Use MRI/CT to stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is a Wilm’s tumour treated?

A
  1. nephrectomy
  2. chemotherapy
  3. radiotherapy if advanced disease
  4. prognosis: good, 80% cure rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a posterior urethral valve?

A

Tissue at the proximal end of the urethra, causing obstruction of urine outflow and build up in the bladder

Leads to back flow to the kidney (Hydronephrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does a posterior urethral valve present?

A

Presents antenatally with oligohydramnios and pulmonary hypoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you manage a neonate with undescended testes?

A

Watch and wait - most will descend by 3 months

If not descended by 3 months - referral needed (used to be 6 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is hypospadias? How is it treated?

A

Congenital abnormality of the penis

Urethra is displaced towards the scrotum

Treated with corrective surgery at 12 months age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a hydrocele and how does it present? When are they normal?

A

Collection of fluid within the tunica vaginalis

Soft, smooth non-tender swelling

Transilluminates

Common in newborn males

Should absorb by 2 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How to clinically distinguish between upper UTI vs lower UTI? How is management different?

A

o Upper / pyelonephritis:
1. Bacteriuria + fever >38 degrees
2. Bacteriuria + loin pain/tenderness

o Lower / cystitis –> anything else (i.e. dysuria but NO systemic symptoms)

  • Lower UTIs are usually treated with nitrofurantoin
  • Upper UTIs are usually treated with a cephalosporino
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

children with an unexplained enlarged abdominal mass in children have paediatric review?

A

possible Wilm’s tumour - arrange paediatric review with 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what conditions are associated with Wilm’s tumour?

A
  1. Beckwith-Wiedemann syndrome
  2. as part of WAGR syndrome with Aniridia, Genitourinary malformations, mental Retardation
  3. hemihypertrophy
  4. around one-third of cases are associated with a loss-of-function mutation in the WT1 gene on chromosome 11
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

IgA nephritic syndrome vs post-strep nephritic syndrome

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

how long after group A strep infection (skin/resp) does post-strep GN happen:

A

4-6weeks

31
Q

management of post-strep GN:

A

BP control (furosemide)

32
Q

management of IgA nephropathy:

A

BP control (ACEi or ARBs) + steroids

33
Q

C3 levels in IgA GN:

A

normal

34
Q

C3 levels in post-strep GN:

A

reduced & reduced CH50)

35
Q

which protein is lost in abundance in nephritic syndrome? what does this cause?

A

-antithrombin 3
-(venous) thrombosis

36
Q

complications of nephrotic syndrome (triad, mnemonic)

A

HIT (triad):

1.Hypercholesterolaemia urinary albumin loss –>less oncotic pressure -> hepatic cholesterol synthesis

    • infection risk–> loss of immunoglobulin in urine –> infection risk (esp. NHS bacteria): sometimes prophylactic penicillin V
  2. Risk of thrombosis loss of AT-III in the urine –> hypercoagulable state
37
Q

rule of thirds in nephrotic syndrome:

A
  • 1/3 resolve and never have another episode
  • 1/3 have a further relapses requiring steroid treatment
  • 1/3 are steroid/immunosupression dependent
38
Q

clinical features of nephrotic syndrome (triad/mnemonic):

A

HOP:
1. hypoalbuminaemia (< 30 g/L).
2. oedema (usually faces, hands and feet), 3. proteinuria (> 3.5 g/24 hours)

39
Q

when do most children achieve control of bladder function by?

A

Most children get control of daytime urination by 2 years and nighttime urination by 3 – 4 years.

40
Q

most common cause of primary nocturnal enruesis:

A

The most common cause of primary nocturnal enuresis (never been dry at night) is a variation on normal development, particularly if the child is younger than 5 years. Often patients will have a family history of delayed dry nights. In this situation reassurance is important, and there is no need to jump to further investigations or management.

41
Q

what are some causes of primary nocturnal enuresis:

A
  1. Overactive bladder. Frequent small volume urination prevents the development of bladder capacity.
  2. Fluid intake prior to bedtime, particularly fizzy drinks, juice and caffeine, which can have a diuretic effect
  3. Failure to wake due to particularly deep sleep and underdeveloped bladder signals
  4. Psychological distress, for example low self esteem, too much pressure or stress at home or school
  5. Secondary causes such as chronic constipation, urinary tract infection, learning disability or cerebral palsy
42
Q

what is initial management of primary nocturnal enuresis? Next steps?

A

The initial step in management of primary nocturnal enuresis is to establish the underlying cause. It can be helpful to keep a 2 week diary of toileting, fluid intake and bedwetting episodes. This helps establish any patterns and identifies areas that may be changed, such as fluid intake before bed. It is important to take a history and examination to exclude underlying physical or psychological causes.

Management of primary nocturnal enuresis involves:

  1. Reassure parents of children under 5 years that it is likely to resolve without any treatment
  2. Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet
  3. Encouragement and positive reinforcement. Avoid blame or shame. Punishment should very much be avoided.
  4. Treat any underlying causes or exacerbating factors, such as constipation
  5. Enuresis alarms
  6. Pharmacological treatment (eg desmopressin short term ie for sleepovers)
43
Q

definition of secondary nocturnal enuresis:

A

Secondary nocturnal enuresis is where a child begins wetting the bed when they have previously been dry for at least 6 months. This is more indicative of an underlying illness than primary enuresis.

44
Q

causes of secondary nocturnal enuresis/management:

A
  1. Urinary tract infection
  2. Constipation
  3. Type 1 diabetes
  4. New psychosocial problems (e.g. stress in family or school life)
  5. Maltreatment

Always think about abuse and safeguarding, particularly with deliberate bedwetting, punishment for bedwetting (despite parental education) or unexplained secondary nocturnal enuresis.

Management of secondary nocturnal enuresis is based on treating the underlying cause. The most common and easily treatable secondary causes are urinary tract infections and constipation. Other problems may require referral to secondary care for further management.

45
Q

diurnal enuresis presentation/causes:

A

Diurnal enuresis is daytime incontinence. This occurs when the person has become dry at night but still has episodes of urinary incontinence during the day. This occurs more frequently in girls. Incontinence comes in two main types:

  1. Urge incontinence is an overactive bladder that gives little warning before emptying
  2. Stress incontinence describes leakage of urine during physical exertion, coughing or laughing.
    Other causes of diurnal enuresis include

a) Recurrent urinary tract infections
b) Psychosocial problems
c)Constipation

46
Q

how long should enuresis alarms be trialled for?

A

at least 3 months

47
Q

pharmacological treatment options for enuresis:

A

Medication for nocturnal enuresis is usually initiated by a specialist.

  1. Desmopressin is an analogue of vasopressin (also known as anti-diuretic hormone). It reduces the volume of urine produced by the kidneys. It is taken at bedtime with the intention of reducing nocturnal enuresis.
  2. Oxybutinin is an anticholinergic medication that reduces the contractility of the bladder. It can be helpful where there is an overactive bladder causing urge incontinence.
  3. Imipramine is a tricyclic antidepressant. It is not clear how it works, but it may relax the bladder and lighten sleep (like duloxetine SNRI in adults= may be offered to women if they decline surgical procedure if they have stress incontinence)
48
Q

what growth of bacteria is significant for a UTI?

A

A pure growth greater than 10⁵ is significant.

49
Q

what does isolation of proteus species imply?

A

Isolation of proteus from the urine often indicates underlying renal tract abnormalities and predisposes to renal calculi. These calculi are usually radio-opaque.

50
Q
A

The ultrasound shows dilatation of the left pelvicalyceal system and also the upper left ureter, causes are discussed later-no definite cause for obstruction is seen on this image although the distal ureter is not included.

An annotated image is shown in Figure 2:

A – renal cortex
B – renal sinus fat-bright
C – dilated renal pelvis
D – dilated upper ureter
E – dilated calyces

51
Q

what are some causes of ureteric obstruction:

A
  1. Stone
  2. Blood clot
  3. Sludge
  4. Tumour (extremely rare in children, eg Wilm’s tumour)
  5. Sloughed papilla (adolescents and adults only)

Vesico ureteric reflux which is severe and reaching the kidney can cause pelvicalyceal system dilatation.

Renal tumours can distort/compress the ureter and tumours can also slough into the ureter itself causing blockage. Acute infections per se do not cause ureteric obstruction.

52
Q

what scan diagnoses Vesico-ureteric Reflux ?

A

MCUG

53
Q

what scan checks for scarring?

A

DMSA to check for scarring (35% of VUR develop scarring)

54
Q

UTI investigations (>3 yrs)

A
55
Q

which children are more likely to get a UTI?

A

Before the age of 6 months, UTIs are more prevalent in boys. This is partly due to the increased chance of structural abnormalities within the urinary tract. Uncircumcised boys are particularly at risk, as bacteria on the foreskin are a reservoir for infection.

However, after six months of age, girls are at increased risk due to their shorter urethra and its proximity to the anus. This risk is increased again in females when they become sexually active.

56
Q

key questions in history for UTI:

A
  1. Constipation
  2. Urine flow
  3. Lower limb/back problems
  4. Antenatal renal abnormalities
  5. Family history of renal problems
  6. History of previous UTI/ fevers
57
Q

what to examine for after UTI history:

A
  1. Hypertension (complication)
  2. Poor growth
  3. Spine – for any spinal lesions
  4. Lower limb neurology
  5. Faecal masses
  6. Enlarged bladder / abdominal mass
58
Q

what 3 questions do you need to ask when considering further investigations for a UTI?

A
  1. How old is the child?
    Age is important. This may be a neonate or infant presenting with an infection as the first indicator of a possible underlying structural abnormality, such as posterior urethral valves or VUR.
  2. Is this an atypical UTI?
    80% of paediatric UTIs are secondary to E.coli infection. An infection caused by an organism other than E.coli or not responding within 48 hours of antibiotic therapy is more unusual. Equally, if a child with a UTI looks unwell, has a palpable bladder, renal impairment or poor urine flow, your index of suspicion should be raised. These are uncharacteristic signs of a urinary tract infection.
  3. Is this child having recurrent infections?
    Over 30% of children with UTIs will suffer from recurrent infections. Recurrent infections are defined as children who have two or more upper UTIs (affecting the kidneys or ureters), three lower urinary tract infections (affecting the bladder or urethra) or one upper and one lower infection at any point up until the age of 16.
59
Q

Investigations for management of UTI: (mnemonic):

A

Clear as MUD

MCUG in 4 – 6 months
Ultrasound scan acutely or within 6 weeks
DMSA in 4 – 6 months

60
Q

How is MCUG performed?

A

An MCUG is a Micturating CystoUrethroGram, which assesses for urinary reflux or obstruction.

First, a catheter is inserted, and radio-opaque contrast is administered via the catheter to fill the bladder.

X-rays are then taken during urination to see if urine is refluxing back towards the kidney.

61
Q

what does this MCUG show?

A

MCUG illustrating marked dilatation of the prostatic portion of the urethra consistent with posterior urethral valves

62
Q

How is DMSA performed?

A

A DMSA scan is used to assess the function and location of the kidneys. An isotope that emits gamma rays is attached to ‘DiMercaptoSuccinic Acid’. This is administered via an intravenous cannula and is taken up by the kidneys a few hours later. If performed acutely, it can show altered function consistent with pyelonephritis. In the UK, a DMSA scan is undertaken 4-6 months post-infection to assess for scarring.

A normal DMSA with equal isotope uptake in both kidneys.

63
Q

NICE guidelines (imaging; 3 takehome points):

A
  1. Children < 6months of age with a first typical UTI should have an ultrasound to assess for a structural cause. Consider MCUG if this is abnormal.
  2. All children with an atypical UTI, regardless of age, should have an ultrasound acutely. A DMSA is also performed if they are < 3years of age to assess renal parenchyma. Children <6 months are investigated more fully with an USS, DMSA and MCUG.
  3. All recurrent UTIs require a DMSA scan within 4-6 months to assess for scarring.
64
Q

testicular torsion vs Epididymo-orchitis

A

torsion: acute rapid onset of unilateral testicular pain, and may be associated with abdominal pain and vomiting. Sometimes abdominal pain is the only symptom in boys,

vs Epididymo-orchitis can mimic but is usually more insidious, in older patients and is associated with urinary symptoms often.

65
Q

what initial investigation will exclude epididymo-orchitis from testicular torsion?

A

Urine microscopy, culture and sensitivity (MC&S)
-. It is vital not to allow patients to wait for imaging once a possible diagnosis of testicular torsion is made

66
Q

If torsion is confirmed during scrotal exploration surgery, what is the management?

A

acute emergency:
o Urgent urological referral
o Nil by mouth, in preparation for surgery
oAnalgesia as required
oExploratory surgery ± bilateral orchiopexy ± orchidectomy ± fixation of contralateral testes
 <6hrs –> 90-100% saved; >24hrs –> 0-10% saved
 Raphe incision –> untort testes –> watch reperfusion in warm saline –> decide if orchidectomy needed
o Supportive care – analgesia, sedation, antiemetics

Bilateral orchipexy (describes the operation to surgically correct an undescended testicle, it is also used to resolve testicular torsion) is indicated (as the other side is also at risk)

-Potential orchidectomy (surgical removal of one or both testicles) should also be discussed with parents/child & included on the consent form for surgical exploration of the scrotum

67
Q

what scan is done to confirm testicular torsion?

A

A scrotal ultrasound can confirm the diagnosis. However, any investigation that will delay the patient going to theatre for treatment is not recommended. Ultrasound can show the whirlpool sign (like ovarian torsion), a spiral appearance to the spermatic cord and blood vessels.

68
Q

what are undescended testes (Cryptorchidism) a risk factor for?

A

may increase the risk for development of testicular cancer in the undescended testis and the normal descended testis

69
Q

what are some signs of testicular torsion on examination?

A

Testicular torsion is often triggered by activity, such as playing sports. Ask what the patient was doing at the time when the pain started.

It presents with an acute rapid onset of unilateral testicular pain, and may be associated with abdominal pain and vomiting. Sometimes abdominal pain is the only symptom in boys, and testicular examination to exclude torsion is essential.

Examination findings are:

  1. Firm swollen testicle
  2. Elevated (retracted) testicle: Lifting testes increases pain (in epididymitis, it relieves / Prehn’s sign)
  3. Absent cremasteric reflex
  4. Abnormal testicular lie (often horizontal)
  5. Rotation, so that epididymis is not in normal posterior position
70
Q

what are some RFs for testicular torsion:

A

undescended testes, ‘clapper bell’ testis (testes free hanging on spermatic cord)

71
Q

what testicular tumors are more common in younger patients? what markers to check?

A

teratoma=germ cell tumour (vs seminoma which has peak incidence 30-40yrs)
Biologic markers for germ cell tumours: AFP,
HCG, and LDH

72
Q

by what age is reflux nephropathy likely to have already happened?

A

by 6 months (which is why MCUG is performed in the 1st 6 months)

73
Q

what is a positive Prehn’s sign?

A

pain is relieved upon testicular elevation as seen commonly in epididymitis.

-A negative Prehn’s sign, or exacerbation of pain upon elevation of the testicle, is one of the clinical features of testicular torsion

Zero to finals Paediatrics Marina (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions