Urology

Question 1

Newborn with prenatal ultrasound (US) positive for hydronephrosis (>10mm AP diameter of the renal pelvis. What is the next best step?

Answer 1

Renal US after 48h of life

Question 2

What is the best test to confirm the diagnosis of urinary tract infection (UTI)

Answer 2

Urine culture

Question 3

A one-year-old child presents with the first febrile UTI.What is the appropriate imaging study?

Answer 3

Renal-bladder US (RBUS)

Question 4

What is the gold standard test for the diagnosis of anatomical details of the renal system and degree of reflux?

Answer 4

Voiding cystourethrography (VCUG). It should not be routinely performed in children after a first febrile UTI

Question 5

What are the indications of VCUG?

Answer 5

Findings on RBUS that suggest the presence of high-grade vesicoureteral reflux or the recurrence of febrile UTIs

Question 6

What is the main difference between cystitis and acute pyelonephritis?

Answer 6

Presence of fever and urine infection is highly suggestive of pyelonephritis

Question 7

Prevalent cause of recurrent UTIs in children

Answer 7

Constipation

Question 8

Child with an indwelling catheter and a urine dipstick analysis negative for nitrites

Answer 8

Enterococcal UTI

Question 9

Empiric antibiotics in patients suspected of having an enterococcal UTI

Answer 9

Combination of ampicillin or amoxicillin and, third-generation cephalosporin or aminoglycoside

Question 10

A 4-year-old boy with weak urine stream, failure to thrive, recurrent UTIs, enuresis. The renal US is positive for bilateral hydronephrosis. What is the best test to establish the diagnosis?

Answer 10

VCUG for the possibility of a posterior urethral valve

Question 11

A 4-year-old female with a history of chronic constipation presenting with vaginal bleeding and urethral mass

Answer 11

Female urethral prolapse

Question 12

A 6-year-old female with persistently damp underwear (day and night)

Answer 12

Ectopic ureter

Question 13

A 7-year-old uncircumcised boy with penile pain, swollen foreskin O/E: head of the penis is enlarged and congested with a collar of edematous foreskin. A constricting band of retracted foreskin is noted past the head of the penis. What is the best treatment?

Answer 13

Emergent reduction of the foreskin to its anatomical position. May apply compression, sugar, pin-pricks to decrease the edema

Question 14

What are the most common anatomical contraindications of circumcision?

Answer 14

Hypospadias with incomplete foreskin, epispadias, ambiguous genitalia

Question 15

An uncircumcised 3-year-old boy presents with a nonpainful, white, mobile mass just distal to the corona of the boy’s penis

Answer 15

Reassurance (normal smegma)

Question 16

Full-term male newborn presents with right undescended testis. The remainder of the physical examination is unremarkable. What is the next best step?

Answer 16

Referral to a surgeon if the testis remains undescended at 6months of age

Question 17

A 15-year-old boy presents with a painless, solid, firm, irregular mass in the left testicle

Answer 17

Testicular cancer until proven otherwise

Question 18

A 12-year-old boy presents with sudden onset of testicular pain, vomiting, the right testicle is swollen, tender, absent cremasteric reflex

Answer 18

Testicular torsion

Question 19

Patient presents with testicular torsion

Answer 19

Immediate urology consult (the testicular US should not delay the consultation)

Question 20

A 12-year-old boy presents with pain, tenderness, and swelling in the upper pole of the right testicle. O/E: bluish dot is visible through the scrotum

Answer 20

Torsion of the testicular appendage

Question 21

A 12-year-old boy presents with soft non-tender fullness within the left hemiscrotum, homogenous glow without internal shadows on transillumination; testes are palpable posteriorly

Answer 21

Hydrocele

Question 22

An 18-year-old male presents with a left-sided mass that feels like a bag of worms; the left testicle is smaller than normal; the mass increases in size with Valsalva maneuver

Answer 22

Varicocele

Question 23

Adolescent male is complaining about a mobile nodule noted above the testis; the mass does not increase with Valsalva

Answer 23

Spermatocele

Question 24

A sexually active adolescent male presents with testicular pain that improves with testicular elevation; he has dysuria and fever. The cremasteric reflex is intact

Answer 24

Epididymitis

Question 25

A 10-year-old boy with a sudden onset of right flank colicky abdominal pain, nausea, vomiting, frequent urination. Physical examination is normal. The urine test is positive for 20 RBCs. The renal US shows 3mm stone in the right ureter

Answer 25

Pain medicine, aggressive hydration (most stones smaller than 5mm pass spontaneously in children)

Question 26

A 10-year-old boy presents with blood in urine and difficulty voiding after blunt trauma to the genital area. O/E: there is a drop of blood on the meatus

Answer 26

Urethral injury (best study is retrograde urethrography)