Renal & Genito-urinary

Question 1

Presentation of UTI in infant

Answer 1

Fever 
• Vomiting 
• Lethargy or irritability 
• Poor feeding/ faltering growth 
• Jaundice 
• Septicaemia 
• Offensive urine 
• Febrile seizure  (>6 months

Question 2

Presentation of UTI in children

Answer 2

• Dysuria, frequency and urgency
• Abdominal pain or loin tenderness
• Fever with or without rigors (exaggerated shivering)
• Lethargy and anorexia
• Vomiting, diarrhoea
• Haematuria
• Offensive/cloudy urine
• Febrile seizure
• Recurrence of enuresis

Question 3

Vesicoureter reflux

Answer 3

developmental anomaly of the vesicoureteric junctions. The ureters are displaced laterally and enter directly into the bladder rather than at an angle, with a shortened or absent intramural course.

Question 4

Tx for UTI

Answer 4

<3 months refer to hospital immediately
>3 months and Upper UTI/Pyelonephritis give trimethoprim oral for 7 days
>3 months and lower UTI/cystitis given trimethprim or nitrofurantion for 3 days

Question 5

Clincal signs and symptoms of pyelonephritis

Answer 5

bacteriuria and fever ≥38° C or bacteriuria

Question 6

Acute renal colic

Answer 6

acute and severe loin pain caused by a urinary stone obstructing the flow of urine

Question 7

Tx for aute renal colic

Answer 7

Pain: IM diclofenac
Nausea metoclopramide IM

ADMIT IF:
The person is in shock or has fever or other signs of systemic infection.
The person is at increased risk of acute kidney injury, for example if there is a solitary or transplanted kidney, pre-existing chronic kidney disease, or bilateral obstructing stones are suspected.
The person is pregnant.

Question 8

Symptoms of nephtrotic syndrome

Answer 8

periorbital oedema (particularly on waking) which is often the earliest sign
• scrotal or vulval, leg, and ankle oedema (Fig. 19.16)
• ascites
• breathlessness due to pleural effusions and abdominal distension
• infection such as peritonitis, septic arthritis, or sepsis due to loss of protective immunoglobulins in the urine.

Question 9

steroid sensitive nephrotic syndrome

Answer 9

age between 1–10 years 
• no macroscopic haematuria 
• normal blood pressure 
• normal complement levels 
• normal renal function.

Question 10

Tx of nephrotic syndrome

Answer 10

Oral steroid (prednisolone-60mg/m3 per day)
ween steroids should have protein free urine by day 11

Question 11

Causes of acute nephritis

Answer 11

Post-infectious (including streptococcus)
• Vasculitis (Henoch–Schönlein purpura or, rarely, SLE (systemic lupus erythematosus), Wegener granulomatosis, microscopic polyarteritis, polyarteritis nodosa)
• IgA nephropathy and mesangiocapillary glomerulonephritis
• Antiglomerular basement membrane disease (Goodpasture syndrome) – very rare

Question 12

Balanitis

Answer 12

inflammation of the glans penis w/wo involving the foreskin

Question 13

Balanitis tx

Answer 13

Clean penis daily with lukewarm water
non specific/irritant dermatitis: topical hydrocortisone 1% cream or ointment once a day for 14 days or till symptoms resolve

Candidal balanitis: an imidazole cream

Question 14

Testicular torsion

Answer 14

Sudden onset pain in grown or lower abdomen
Redness and swelling
Treat within onset of symptoms to lower risk of testicular loss
Undescended testis at increased risk of torsion

Question 15

Hydrocele

Answer 15

same anatomy as inguinal hernia but processus vaginalis cannot open as wide. Often asymptomatic

Question 16

Hypospadias

Answer 16

Urethral meatus variable in position-mostly distal shaft
Ventral curvature of the shaft of the penis
hooded appearance of foreskin

Question 17

Tx for enuresis

Answer 17

Star chart
Enuresis alarm
Desmopressin (short term relief)

Question 18

Haemolytic uraemic syndrome (HUS)

Answer 18

Triad of acute renal failure, haemolytic anaemia, and thrombocytopenia.
Commonly secondary to GI infection with E.Coli 0157:H7
Follows prodrome of bloody diarrhoea

Question 19

Treatment of HUS

Answer 19

Dialysis

Monoclonal anti-terminal, complement antibody eculizumab