PEDS GU

Question 1

Most common agent of UTI

Answer 1

E. coli

Question 2

UTI DDx for kids under 1 yr

Answer 2

<1 yr of age: Anatomic abnormalities, VUR, Uncircumcised male infants

20% of febrile male infants

Question 3

UTI DDx for kids over 1 yr

Answer 3

> 1 year of age: UTIs seen more in otherwise healthy children → usually girls

Peaks seen in infancy, toilet training, and at onset sexual activity

Question 4

What is the most common serious bacterial infection in fever without a focus in kids less than 24 months

Answer 4

Pyelonephritis

Question 5

UTI dx recommendations

Answer 5

AAP recs: catheterization 2-24mo

Clean catch if toilet trained

Perineal bags for urine collection prone to contamination → not recommended for UA or urine culture

Question 6

What is the gold standard dx for UTI

Answer 6

Urine Culture (UC)
Gold standard

Necessary for CONFIRMATION and appropriate therapy

Question 7

Bacteria or pyuria in UA & ≥ 50,000 CFU/mL of single pathogen on urine culture, in symptomatic child =

Answer 7

UTI

Question 8

Sensitivity and specificity of Leukocyte esterase and Nitrite for UTI.

Answer 8

70% sensitivity & 99% specificity for UTI

Question 9

ABX approach to UTI

Answer 9

Oral antibiotics:
>6 months of age, not ill-appearing, but positive urine culture
-Amoxicilin 
-TMP/SMX
-Nitrofurantoin 

Parenteral (IV) antibiotics:

• Toxic/dehydrated-appearing, not tolerating PO
• Ceftriaxone!

Duration parenteral antibiotics:
Neonate: 10-14 days
Older children: 7-14 days

Question 10

What is the w/u for recurrent UTI

Answer 10

If recurrent UTI: VCUG → vesicoureteral reflux evaluation

Question 11

If a child is under 1 year of age or no toilet trained with a uti what is the 1st step

Answer 11

Renal/Bladder US → 1st UTI in infants or non-toilet trained children

Question 12

50% of males w/ VUR present with

Answer 12

50% of males with posterior urethral valves

Question 13

What is the treatment for a Grade I or II VUR

Answer 13

Grade I & II VUR will likely resolve w/out surgery regardless of age or if unilateral or bilateral

Still refer to nephrologist

Question 14

Tx for Grade III or higher VUR

Answer 14

Grade III younger age at diagnosis and unilateral higher rate of spontaneous resolution

Nephrology consult

Question 15

What is the onset of PCKD

Autosomal recessive

Answer 15

Kidney failure usually early childhood (prenatal can be seen)

Question 16

What is the syndrome most often assoc with Horshoe Kidney

Answer 16

Turner

Question 17

A young male pt presents with Small, “blue dot” on top of scrotum
Small swelling on upper pole of testicle

Think

Answer 17

Appendiceal torsion

Question 18

What is the chance of saving the testicle in torsion

Answer 18

Detorsion & fixation of testis

If performed w/in 4-6 hrs of torsion → >90% chance of testicular salvage

Question 19

Complications of cryptorchidism

Answer 19

Testicular cancer (5 times normal)
Infertility (in adulthood)

Question 20

What is the time frame to refer cryptorchidism to urology

Answer 20

If still undescended at 6 months, refer to Urology

Question 21

Non communicating hydrocele that persists at 18 month =

Answer 21

Urology referral

Question 22

W/u for communicating hydrocele

Answer 22

Smallest in the AM, enlarges during the day

Persists

Urology referral for surgical correction

Associated w/ inguinal hernia

Question 23

10% of hypospadias pts will present with

Answer 23

Undescended testes

Question 24

MGMT for hypospadias

Answer 24

Urology → surgical correction

Before 18 mos old, ideal age is 6-12mo

NO circumcision !
(foreskin may be needed for repair)

Question 25

Define enuresis

Answer 25

Definition: urinary incontinence in a child who is adequately mature to have achieved continence

Question 26

Primary vs secondary enuresis

Answer 26

Primary: incontinence in a child who has never achieved dryness Secondary: incontinence in a child who has been dry for at least 6 mos

Question 27

What is the W/u for primary vs secondary enuresis

Answer 27

Primary nocturnal enuresis: Often a family hx of enuresis and least likely to have identifiable cause Secondary diurnal & secondary nocturnal enuresis: More likely organic etiology (i.e., UTI, DM/polyuria/polydipsia, diabetes insipidus, chronic constipation)

Question 28

A pt with a negative UA and culture for enuresis should get what additional w/u

Answer 28

Consider renal ultrasound and/or VCUG based on primary vs secondary and diurnal +/- nocturnal Postive findings would be UTI, DM, and renal Dz

Question 29

No clinical response w/in 2 days of antimicrobial therapy initiation for UTI →

Answer 29

re-evaluate, repeat urine culture, & undergo prompt imaging—look for abscess, new growth

Question 30

MC cause of VUR

Answer 30

Causes: Most common: congenital ureterovesical junction (UVJ) incompetence -UVJ matures through early childhood Cystitis or acquired bladder obstruction → bladder outlet obstruction → increased intravesicular pressure

Question 31

Medical therapy for VUR (In general)

Answer 31

Timed voiding, regular fecal elimination, increased fluid intake, prompt assessment and treatment of UTIs Better with VUR grades I and II And surgery Referal to urology

Question 32

Difference between autosomal dominant and recessive PKD

Answer 32

Dominant: adults onset Recessive: early childhood

Question 33

Autosomal recessive PKD

Answer 33

Marked bilateral renal enlargement Bilteral palpable flank masses, pulmonary hypoplasia, Kidney failure usually early childhood (prenatal can be seen) Hepatic fibrosis → portal HTN Bile duct ectasia & biliary dysgenesis Flank masses, hepatomegaly, pneumothorax, proteinuria, hematuria

Question 34

What separates Epidiymo-orchitis and Testicular torsion

Answer 34

Absent or positve prehns sign Torsion will be absent

Question 35

A pt presents with Primary Diurnal and Nocturnal enuresis Think

Answer 35

Neurodevelopmental condition | Bladder function problem

Question 36

A pt presents with secondary Diurnal and Nocturnal enuresis | Think

Answer 36

UTI | Diabetes mellitus or diabetes insipidus

Question 37

Rx options for enuresis

Answer 37

Desmopressin :decreases urinary production & safe in enuresis treatment (90% relapse when discontinued) -Camp, overnight stays at friend’s house Rarely, imipramine & tricyclic antidepressants -Nephrology consult warranted