Renal/Urinary

Question 1

At what age are children usually dry by day?

Answer 1

2 years

Question 2

At what age are children usually dry by night?

Answer 2

3 years

Question 3

What proportion of children are dry by day and night by age 4?

Answer 3

75%

Question 4

How is enuresis managed in under 5s?

Answer 4

Reassurance and lifestyle modification to help avoid enuresis. NO PUNISHMENT OR EMBARRASSMENT FOR WET NIGHTS - counterproductive.
Star chart reward system for dry nights.

Question 5

How is enuresis managed in over 5s?

Answer 5

Reassurance and lifestyle modification to help avoid enuresis. NO PUNISHMENT OR EMBARRASSMENT FOR WET NIGHTS - counterproductive.
Enuresis alarm is first line in combination with star chart reward system.
Desmopressin may be added if no success, can also be offered for short overnight stays elsewhere e.g. sleepover, school trip.
Consult specialist before beginning oxybutynin.

Question 6

What is the most common (90%) causative organism in UTI in children?

Answer 6

E. coli

Question 7

Which organism is more common in boys with UTI and predisposes to phosphate stone formation?

Answer 7

Proteus

Question 8

UTI due to which organism may suggest structural abnoramlity in the urinary tract?

Answer 8

Pseudomonas

Question 9

What features make a UTI atypical?

Answer 9

Serious illness.
Poor urine flow.
Abdominal or bladder mass.
Raised creatinine.
Sepsis.
Failure to respond to treatment with suitable antibiotics within 48 hours.
Infection with non-E. coli organisms.

Question 10

What is classed as recurrent UTIs?

Answer 10

2+ episodes of upper UTI
OR 
1 of UTI plus 1+ episode(s) of lower UTI 
OR
3+ episodes of lower UTI

Question 11

What results on urine dipstick should prompt you to regard the problem as UTI and to start antibiotics and send a urine sample for MC+S?

Answer 11

Positive nitrites and positive leukocytes

Positive nitrites and negative leukocytes

Question 12

How should you proceed if the urine dipstick results show negative nitrites but positive leukocytes?

Answer 12

Only start antibiotics if clinical suspicion of UTI. Send sample for MC+S

Question 13

What investigations should a child under 6 months with a typical UTI get?

Answer 13

USS

Question 14

What investigations should a child under 6 months with an atypical UTI get?

Answer 14

USS, MCUG, DMSA

Question 15

What investigations should a child aged 6 months - 3 years with an atypical UTI get?

Answer 15

USS and DMSA

Question 16

What investigations should a child over 3 years with an atypical UTI get?

Answer 16

USS (and DMSA if recurrent)

Question 17

What can MCUG identify?

Answer 17

Urethral abnormalities and vesico-ureteric reflux

Question 18

What can DMSA identify?

Answer 18

Identifies areas of renal scarring and differential renal function

Question 19

How is UTI managed in children under 3 months and those over 3 months?

Answer 19

Under 3 months: Admit. iv cefotaxime until temp has settled, then switch to oral Abx
Over 3 months with UUTI: IV/PO Abx for 7-10 days
Over 3 months with LUTI: PO Abx for 3 days

Question 20

What forms the triad in Haemolytic Uraemic Syndrome?

Answer 20

Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia

Question 21

Which age group does HUS tend to affect?

Answer 21

Infants and toddlers.

Question 22

What causes HUS?

Answer 22

Typical HUS is secondary to GI infection with E. coli O157 through contact with farm animals or uncooked beef.

Question 23

How may HUS present?

Answer 23

Diarrhoea turning bloody after 1-3 days. Abdominal pain. N+V. Absence of fever. The E. coli toxin localises to the renal endothelial cells where it causes intravascular thrombogenesis, damaging RBCs (anaemia) hence the acute renal failure.

Question 24

What are the features of nephrotic syndrome?

Answer 24

Heavy proteinuria causing hypoalbuminaemia, accompanied by oedema and hyperlipidaemia

Question 25

What is the commonest cause of nephrotic syndrome in children?

Answer 25

Minimal change glomerular disease

Question 26

What is the main management of minimal change disease in children?

Answer 26

Corticosteroids (e.g. prednisolone) for 6+ weeks

Fluid restriction and low salt diet

Question 27

How may glomerulnephritis present?

Answer 27

Onset of illness 2-3 weeks after pharyngitis (commonly strep throat). Cola-coloured urine (raised RBCs, WBCs and proteins). Facial oedema. Abdominal or loin pain. Raised BP. Oliguria initially then diuresis. Haematuria and proteinuria gradually subside over the next year.

Question 28

Where does the urethra most commonly open in hypospadias?

Answer 28

On or adjacent to glans penis (ventral surface)

Question 29

How are hypospadias managed?

Answer 29

Correctional surgery before 2 years. Must not be circumcised as foreskin used for reconstruction.