Renal/Urinary

Question 1

What might be the cause of a child who is constantly damp?

Answer 1

ectopic ureter –> picked up on CT

Question 2

Abdo exam revealed distended bladder, child is also noted to have strange gait. What could be the cause?

Answer 2

Neuropathic bladder

Question 3

First investigation in child with enuresis?

Answer 3

Urine dip - check for glucose, protein & signs infection

Question 4

Criteria for nocturnal enuresis?

Answer 4

> 5y, at least twice weekly

Question 5

Recommended Mx nocturnal enuresis in 5y/o?

Answer 5

Positive reinforcement, star charts etc. Rule out other potential causes?

Question 6

Potential causes of secondary enuresis?

Answer 6

Emotional upset (most common), UTI, diabetes,

Question 7

Most common cause UTIs in children? What would suggest an abnormal urinary tract?

Answer 7

E coli (gram -ve) 85% cases.
Infection from pseudomonas = abnormality suspected

Question 8

Signs of potential pyelonephritis?

Answer 8

Bacteruria, fever >38˚C or loin pain

Question 9

What suggests atypical UTI?

Answer 9

abnormal U&Es, seriously unwell, abdominal mass, no response to Abx in 48h, non- E coli, poor urine flow

Question 10

What investigations would you do for an atypical UTI?

Answer 10

USS, poss DMSA, MCUG

Question 11

6m old child presents with general lethargy and a fever of 37.4˚C. On dipstick you find +ve leucocytes & nitrites. What would be appropriate Tx?

Answer 11

Features of lower UTI/cystitis. Tx with 3d oral Abx, either cephalosporin or co-amoxiclav

Question 12

Tx of 2m old child with UTI?

Answer 12

Admit to hosp, IV Abx, investigate

Question 13

When must you test a child’s urine?

Answer 13

Any child with unexplained fever >38˚C

Question 14

Tx of 4y/o child with urinary symptoms whose urine dipstick showed +ve leukocytes, -ve nitrites?

Answer 14

Child has clinical Sx even though no bacteria. Tx as if has UTI - 3d oral Abx, e.g trimethoprim. Send sample to lab for MC&S

Question 15

+ve what on urine dipstick suggests UTI and should lead to initiation of treatment?

Answer 15

+ve nitrites (bacteruria)

Question 16

What is the triad of HUS?

Answer 16

Acute renal F
Microangiopathic haemolytic anaemia
Thrombocytopenia

Question 17

Child has come in following 5 day Hx nausea and vomiting and bloody diarrhoea, and has since been deteriorating. Blood film shows low Hb and schistocytes… Dx?

Answer 17

HUS - blood film = Microangiopathic haemolytic anaemia.

Question 18

What might you see in blood tests of nephrotic syndrome?

Answer 18

Low plasma albumin

Question 19

Most common type of nephrotic syndrome?

Answer 19

steroid sensitive –> Tx with prednisone if needed

Question 20

Difference between nephrotic & nephritic syndrome?

Answer 20

Nephrotic = proteinuria
Nephritic = haematuria

Question 21

Potential cause of a child with a raised BP and positive blood and protein on urine dipstick?

Answer 21

Glomerulonephritis. Inflammation of glomeruli leads to decreased UO & volume overload –> HTN and oedema

Question 22

Mx of hypospadias?

Answer 22

Surgery before 2y