UROLOGY

Question 1

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

Answer 1

Renal US after 48 h of life

Question 2

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

Answer 2

Urine culture

Question 3

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

Answer 3

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

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 are the indications of VCUG?

Answer 4

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

Question 5

What is the main difference between cystitis and acute pyelonephritis?

Answer 5

Presence of fever and urine infection is highly
suggestive of pyelonephritis

Question 6

Prevalent cause of recurrent UTIs in children

Answer 6

Constipation

Question 7

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

Answer 7

Enterococcal UTI

Question 8

Empiric antibiotics in patients suspected of having an enterococcal UTI

Answer 8

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

Question 9

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

Answer 9

Female urethral prolapse

Question 9

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 9

VCUG for the possibility of a posterior urethral
valve

Question 10

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

Answer 10

Ectopic ureter

Question 11

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 11

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

Question 12

What are the most common anatomical
contraindications of circumcision?

Answer 12

Hypospadias with incomplete foreskin,
epispadias, ambiguous genitalia

Question 13

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

Answer 13

Reassurance (normal smegma)

Question 14

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

Answer 14

Testicular cancer until proven otherwise

Question 15

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

Answer 15

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

Question 16

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

Answer 16

Testicular torsion

Question 17

Patient presents with testicular torsion

Answer 17

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

Question 18

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 18

Torsion of the testicular appendage

Question 19

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 19

Hydrocele

Question 20

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 20

Varicocele

Question 21

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

Answer 21

Spermatocele

Question 22

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 3 mm stone in the right ureter

Answer 22

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

Question 23

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 23

Epididymitis

Question 24

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 24

Urethral injury (best study is retrograde
urethrography)