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Paediatrics for Finals > Urinary > Flashcards

Urinary Flashcards

1
Q

How is a urine sample in children collected?

A

Ideally clean catch but can use urine collection pads

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2
Q

What is the management of UTI’s in

a) <3 months
b) LUTI
c) UUTI

A

a) urgently admit
b) 3 days of trimethoprim or nitrofurantoin
c) Most need admitting but can do 7-10 days of oral co-amoxiclav or ceftriaxone

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3
Q

What should be done if a child is experiencing recurrent UTIs?

A

Imaging of the genitourinary system often with USS

May need antibiotic prophylaxis

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4
Q

Describe the process leading to renal failure in VUR

A

Ureters enter the bladder at a more perpendicular angle leading to an inadequate PUJ. Urine can reflux back up the system leading to progressive dilation.

Frequent UTIs due to this abnormal flow leads to renal scarring and eventually failure

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5
Q

How would you investigate VUR in

a) <2 y/o
b) >2 y/o
c) suspected renal scarring

A

<2 y/o = micturating cystourethogram (need to catheterise)

> 2 y/o = indirect cystogram

scarring = DSMA

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6
Q

How is VUR managed?

A

Prophylactic antibiotics until 2 y/o

If not self-resolved by 2 then surgical

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7
Q

What happens in testicular torsion?

A

The spermatic cord twists on its mesentery within the tunica vaginalis leading to necrosis

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8
Q

What are the signs and symptoms of testicular torsion?

A

Severe, unilateral scrotal pain
Radiates to groin and abdomen
Vomiting

Testis is retracted up
Negative Phren’s
Absent cremateric reflex

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9
Q

If you were to investigate testicular torsion, what would you do?

A

Doppler USS

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10
Q

What is the management of testicular torsion?

A

bilateral orchidoplexy

May need orchidectomy if necrosed and non-viable

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11
Q

When is bed wetting considered abnormal?

A

> 5 in girls

>6 in boys

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12
Q

What would you want to rule out/ investigated in a child wetting the bed?

A 
UTI
Diabetes
Constipation 
Renal failure
Abuse
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13
Q

What is the stepwise management of enuresis?

A
  1. reassurance, no caffeine, rewards for using toilet before bed
  2. Enuresis alarm for 1 month
  3. Desmopressin for 1 month
  4. Specialists for anti-cholinergics and tricyclics
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14
Q

At what age should you refer a child with undescended testis?

A

3 months so that they are investigated etc and ready to have surgery by 1

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15
Q

What are the complications of undescended testis?

A

Infertility
Testicular cancer
Psychological impact
Torsion

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16
Q

How are undescended testis managed

a) if it’s palpable
b) if it’s not palpable
c) it’s bilateral

A

a) orchidopexy
b) laparotomy to find the testis and then orchidopexy
c) Refer to genetics

17
Q

What are some differentials for childhood haematuria?

A 
V: sickle cell, coagulation disorder
I: UTI
T: prolonged exercise, stones
A: HSP, glomerulonephritis 
M:
I: PCKD
N: Wilm's tumour

Fabricated induced illness, child abuse

18
Q

What is Henoch-Schonlein Purpura?

A

IgA mediated autoimmune hypersensitivity vasculitis

19
Q

What are the signs and symptoms of HSP?

A

Abdominal pain and bloody diarrhoea
Rash: purpuric on back of legs and ulnar arm
Joint: painful, swollen ankles and knees
Renal: haematuria and proteinuria

20
Q

What are some complications of HSP?

A 
Renal failure
Intussusception 
Arthritis 
Testicular pain
Pancreatitis
21
Q

Which nephrotic syndrome is most commonly seen in children? What are some secondary causes of nephrotic syndrome?

A

Minimal change disease

SLE, HPS, Alport, NSAIDs, leukaemia and lymphoma

22
Q

How does nephrotic syndrome present?

A

Periorbital swelling
Frothy urine
Fatigue, weakness, anorexia

23
Q

What is the management of nephrotic syndrome?

A
  1. Steroids

2. Ciclosporin

24
Q

What are some complications of nephrotic syndrome?

A

Thrombotic events
Hyperlipidaemia
Infections

25
Q

Compare IgA nephritis and post-streptococcal glomerulonephritis

A

IgA:

  • 1-2 days post-URTI
  • macroscopic haematuria

Post-strep:

  • 1-2 weeks post-URTI
  • low complement
  • oedema, haematuria, proteinuria, HTN
26
Q

What organism typically causes haemolytic uraemic syndrome?

A

E.coli

27
Q

What are the signs, symptoms and blood results seen in HUS?

A

History of bloody diarrhoea, appear pale, reduced urine output

  • Haemolytic anaemia
  • Thrombocytopenia
  • AKI
28
Q

What are the signs and symptoms of Wilms tumour?

A

Palpable abdominal mass
Painless haematuria
Flank pain
Anorexia and fever

Paediatrics for Finals (11 decks)

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