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Leeds MBCHB Year 4 Peads > Renal and Urology > Flashcards

Renal and Urology Flashcards

1
Q

Children under 6 months with a UTI require what scan

A

USS within 6 weeks

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2
Q

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

A

USS during illness
DMSA 6 months later
MCUG

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3
Q

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

A

No unless recurrent or atypical

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4
Q

What do all children with recurrent UTI need?

A

DMSA scan 4-6 months after infection

USS within 6 weeks

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5
Q

What children with atypical or recurrent UTI need a MCUG

A

Under 6 months

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6
Q

Features that make a UTI aytipical

A 
Non E Coli
Sepsis
Poor urine flow/ abdominal mass
Raised creatine
Failure to respond to treatment within 48 hours
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7
Q

Definition of a recurrent UTI (2)

A

2 or more (if one systemic)

3 or more (if none systemic)

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8
Q

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

A

Temperature greater than 38C

Loin pain or tenderness

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9
Q

Why are nitrites present in UTI dipstick

A

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

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10
Q

What should all children under 3 months with a fever have

A

IV antibiotics

Septic screen - cultures, bloods, lactate, LP

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11
Q

What do children with aytipical UTIs require

A

All need an USS during infection

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

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12
Q

What is a DMSA used to identify

A

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

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13
Q

What is a MCUG used to diagnosed.

What is MCUG full name

A

VUR

Micturating cystourethrogram

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14
Q

Management of VUR (4)

A

Avoid constipation
Frequent urination
Prophylactic ABX
Surgery

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15
Q

Why is vulvovaginitis most common in children 3-10

A

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

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16
Q

Urine dipstick result for vulvovaginitis

A

Leukocytes but no nitrites

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17
Q

Risk factors for vulvovaginitis

A

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

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18
Q

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

A

Thrush and UTIs

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19
Q

Management of vulvovaginitis

A

Mainly supportive:

Avoid chemicals, emollients, loose clothing, good hygiene

Oestrogen cream may help

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20
Q

Triad of nephrotic syndrome

A

Low serum albumin
High urine protein
Oedema

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21
Q

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

A

Nephrotic syndrome

Raised lipid profile
HTN
Hypercoaguable

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22
Q

Most common cause of nephrotic syndrome in children

A

Minimal change disease

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

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23
Q

Management of minimal change disease

A

Steroids

Low salt diet

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24
Q

What causes 90% of nephrotic syndrome

A

Minimal change disease

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25
Q

Nephritis definition

A

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

26
Q

Two most common causes of nephritic syndrome in kids

A 
Post-streptococcal glomerulonephritis
IgA nephrophathy (Bergers disease)
27
Q

What infection is Post-streptococcal glomerulonephritis possible after

What blood test to confirm

A

Tonsilitis

Throat swab for anti-streptolysin antibodies

28
Q

What is anti-streptolysin antibodies used to determine

A

Severity and immune response to recent streptococcus infection

Used for post-strep glomerulenphitis and RF

29
Q

What is IgA nephropathy (Bergers disease)

And what condition is it linked to

A

IgA depostis in kideny cause inflammation

Henoch-Schonlein pupura (IgA vasculitis)

30
Q

What is management for Bergers disease

A

Steroids and immunosuppressant medications to slow progression

31
Q

What toxin causes HUS

A

Shiga

32
Q

HUS triad

A

Haemolytic anaemia
AKI
Thrombocytopenia

33
Q

What bacteria produces the Shiga toxin

A

e coli 0157 and shigella

34
Q

What increases the risk of developing HUS

A

Antibiotics and anti-motility agents like loperamide

35
Q

is HUS dangerous?

A

10% of kids die

Low threshold for dialysis

36
Q

How to manage HUS

A

Dialysis
Anti-HTN
Fluid balance
Blood transfusions

37
Q

What is enuresis

A

Bed wetting

38
Q

When should children be dry by day and by night

A

2 at day

3-4 at night

39
Q

Common and important condition to rule out in enuresis

A

Constipation

UTI, learning disability, CP

40
Q

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

A

UTI, constipation, T1DM, new psychological problems, maltreatment

41
Q

Common pharmacological management of enuresis

A

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

42
Q

What is Imipramine used for

A

TCA used for enuresis

Unsure how it works but believes to relax bladder

43
Q

Why type of incontinence is oxybutinin used for

A

Overactive bladder causing urge incontinence

Anticholinergic medication

44
Q

Two types of PKD

A

AR - presents in kids with oligohydramnios

AD - presents in later life

45
Q

What is Potter syndrome and what condition normally causes it

A

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

46
Q

What is a Wilms tumour

A

Nephroblastoma

47
Q

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

A

Wilms tumour

48
Q

Diagnosis of Wilms tumour

A

US

Core biopsy

49
Q

Management of Wilms tumour

A

Nephrectomy

50
Q

Where is the issue in children with posterior urethral valve

A

Proximal end of urethra

Only occurs in newborn boys

51
Q

How may a posterior urethral valve be diagnosed prenatally

A

Hydronephrosis

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

52
Q

5 RF for undescended testicles

A

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

53
Q

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

A

3-6 months -> seen by surgeon

Orchidoplexy -? 6-12 months

54
Q

Age of hypospadias treatment

A

3-4 months

55
Q

Where is fluid in hydrocele

A

Tinica vaginalis

56
Q

What is the developmental origins of the tunica vaginalis

A

Connected with peritoneal cavity

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

57
Q

Difference between the 2 types of hydrocele

A

Simple - fluid trapped in tunica vaginallis (not connected to abdo)

Communicating - connected to peritoneal cavity via processus vaginalis

58
Q

Key examination finding of hydrocele

A

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

59
Q

How to manage a simple hydrocele

A

Will resolve within 2 years without needing any surgery

60
Q

How is a communicating hydrocele managed

A

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

Leeds MBCHB Year 4 Peads (21 decks)

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