Urology

Question 1

What are the presenting features of a UTI in children or infants?

Answer 1

fever
lethargy
irritable
vomiting
poor feeding
urinary frequency
incontinence
dysuria

Question 2

What are the clinical features that allow for a diagnosis of acute pyelonephritis to be made?

Answer 2

temp > 38
loin pain

Question 3

What are the Abx used for children under 3 months with a fever?

Answer 3

IV ceftriaxone
(+ septic screen, consider LP)

Question 4

What are the Abx used for children over 3 months of age who are otherwise well with symptoms of a UTI?

Answer 4

Trimethoprim
Nitrofurantoin
Cefalexin
Amoxicillin

Question 5

What are the ultrasound rules for children?

Answer 5

Under 6 months (first UTI) - abdominal USS within 6 weeks
Children with recurrent UTI - abdominal USS within 6 weeks
Children with atypical UTI - abdominal USS during illness

Question 6

What is the purpose of a DMSA scan?

Answer 6

= Dimercaptosuccincic acid scan of kidneys
4-6 months after illness to assess for damage from recurrent / atypical UTI

Question 7

How is vesicle-ureteric reflux diagnosed?

Answer 7

Micturating cystourethrogram (MCUG)

Question 8

How is vesico-urethreic reflux managed?

Answer 8

Avoid constipation
Avoid delayed micturition
Prophylactic Abx
Surgical input (paediatric urology)

Question 9

What is a MCUG and what are the indications for one?

Answer 9

= micturating cystourethrogram
investigation of atypical / recurrent UTI in children under 6 months
Fx of vesico-ureteric reflux, dilation of ureter on USS, poor urinary flow

Question 10

What is the management of volvovaginitis?

Answer 10

Avoid soap and chemicals
Avoid perfume or antiseptics
Toilet hygiene
Keep area dry
Use emollients e.g. sudacrem
Loose cotton clothing
Treat constipation / worms
Avoid activities that exacerbate problem

Question 11

What is the triad of clinical features of nephrotic syndrome?

Answer 11

Oedema
Hypoalbuminaemia
Proteinuria

Question 12

What is the most common cause of nephrotic syndrome in children?

Answer 12

Minimal change disease (90%)
Intrinsic causes: FSG, membranoproliferazive glomerulonephritis
Systemic causes: Henoch Schonlein purpura, Diabetes, Infection

Question 13

What is the diagnostic features of Minimal change disease?

Answer 13

Renal biopsy: no abnormalities
Urinalysis: small molecular weight proteins, hyaline casts

Question 14

What is the management of Minimal change disease?

Answer 14

Corticosteroids

Question 15

What is the management of nephrotic syndrome in children?

Answer 15

High dose steroids
Low salt diet
Diuretics (oedema)
Albumin infusions
Abx prophylaxis (in sev cases)

Question 16

What are the complications associated with nephrotic syndrome in children?

Answer 16

Hypocolaemia
Thrombosis
Infection
Acute / chronic renal failure
Relapse (steroid dependant / resistant)

Question 17

What are the most common causes of nephritis in children?

Answer 17

Post-streptococcal glomerulonephritis
IgA nephropathy (Berger’s disease)

Question 18

What are the features of post-streptococcal glomerulonephritis?

Answer 18

Recent tonsillitis infection (streptococcus) e.g. +ve throat swab / anti-streptolysin Ab titres on blood test

Question 19

What is the management for post-streptococcal glomerulonephritis?

Answer 19

Supportive
OR
Antihypertensives + diuretics (if complications e.g hypertension / oedema)

Question 20

What is the management of IgA nephropathy?

Answer 20

Supportive management
Immunosuppressant medications e.g. steroids / cyclophosphamide

Question 21

What is haemolytic uraemic syndrome?

Answer 21

Thrombosis in small blood vessels in body
Typically triggered by bacterial toxin (shiga toxin from E coli / shigella)

Question 22

What are the features of haemolytic uraemic syndrome?

Answer 22

Haemolytic anaemia
AKI
Thrombocytopenia

Question 23

What is the presentation of haemolytic uraemic syndrome?

Answer 23

v urine output
haematuria
abdo pain
lethargy
confusion
oedema
HTN
bruising

Question 24

What is the management of haemolytic uraemic syndrome?

Answer 24

= medical emergency
Supportive management
- ref to paed renal unit for renal dialysis
- antiHTN
- fluid balance
- blood transfusions

Question 25

What are the causes of primary nocturnal enuresis?

Answer 25

Variation in normal development
Overactive bladder
Fluid intake
Failure to wake
Psychological distress
Secondary cause: chronic constipation, UTI, LD, Cerebral palsy

Question 26

What is the management of primary nocturnal enuresis?

Answer 26

Reassurance + encouragement / positive enforcement
v fluid intake
Treat secondary causes: chronic constipations
Enuresis alarms
Pharmacological treatment

Question 27

What are the causes of secondary nocturnal enuresis?

Answer 27

UTI
Constipation
T1DM
Psychological problems + maltreatment

Question 28

What is the definition of secondary nocturnal enuresis?

Answer 28

Child wetting bed after previously having been dry for at least 6 months

Question 29

What are the pharmacological management options for enuresis?

Answer 29

Desmopressin (analogue of ADH > v vol of fluid produced by kidneys) for nocturnal enuresis
Oxybutinin (anticholinergic) for urge incontinence
Imipramine (tricyclic antidepressant) ? MOA - relax bladder / lighten sleep

Question 30

What are the symptoms of hypernatraemic dehydration?

Answer 30

Full OF SALT
Flushing
Oedema
Fever
Seizures
Agitation
Low urine output
Thirst

Question 31

What are the symptoms of hyponatraemic dehydration?

Answer 31

SALT LOSS
Stupor
Anorexia (+ N&V)
Limp tone
Tendon reflexes reduced
Lethargy
Orthostatic hypotension
Seizures
Stomach cramps