Urogenital

Question 1

Vesicoureteric reflux

Answer 1

Abnormal back flow of urine from the bladder into the ureter and kidney.

Presentation:

• Quite common in kids with recurrent UTIs
• Might be seen antenatally - hydronephrosis
• Chronic pyelonephritis/renal scarring

Investigation:

• Micturating cystourethrogram

Management:

• May self-resolving - monitor and give antibiotics for infections
• Surgical repair

Question 2

Acute post-streptococcal glomerulonephritis

Answer 2

Presentation:

• Haematuria 1-2 after throat infection

Investigation:

• Urine dip - haematuria, may have proteinuria
• Throat swab - strep
• Anstreptolysin O tirtre

Management:

• Penicillin V to get rid of strep
• Monitor fluid balance

Question 3

Nephrotic syndrome

Answer 3

Presentation:

• Oedema - eyelids and legs esp in morning
• May have had a recent URTI

Investigation:

• Urinalysis - high protein
• Bloods - low albumin, high triglyceride and cholesterol
• Most common cause is minimal change disease - no need for biopsy

Management:

• Fluid restrict, low salt diet
• Prednisolone

Question 4

Things to exclude before dx of primary nocturnal enuresis

Answer 4

UTI
Diabetes
Sexual abuse

Question 5

Management of primary nocturnal enuresis

Answer 5

Reward charts
Enuresis alarm
Desmopressin - for short term things e.g. sleepovers

Question 6

Management of undescended testes

Answer 6

If unilateral - referral from 3 months
If bilateral - review within 24hrs as might need endo or genetic investigation

Staying undescended increases risk of testicular cancer, torsion and infertility

Question 7

Testicular torsion

Answer 7

Presentation:

• Sudden acute pain
• Nausea, vomiting
• Swelling of testicle
• Absent cremasteric reflex
• Lifting testicle causes pain to worsen

Investigation:

• It’s an emergency - don’t waste time - immediate surgical exploration

Management:

• Surgery

Question 8

UTIs in kids

Answer 8

Presentation:

• More common in girls
• Abdo pain, irritability, fever
• Dysuria, urgency
• Poor feeding

Investigations:

• Clean catch urine sample

Management:

• If younger than 3 months - immediate referral to paeds
• If 3 months plus - consider admission if high UTI and give co-amox. If low uti - give normal antibiotics e.g. trimethoprim, nitrofurantoin