Urology Questions Flashcards
What is the most common bacterial cause of urinary tract infections in children?**
- A) Klebsiella
- B) Streptococcus
- C) Pseudomonas
- D) E. coli
D) E. coli
- Explanation: E. coli is responsible for 75% to 90% of UTIs in children, making it the most common causative agent.
*In the management of UTI, which of the following is typically used as first-line treatment?**
- A) Amoxicillin
- B) Ciprofloxacin
- C) Bactrim (trimethoprim-sulfamethoxazole)
- D) Metronidazole
C) Bactrim (trimethoprim-sulfamethoxazole)
- Explanation: Bactrim, along with Macrodantin (nitrofurantoin) and Keflex (cephalexin), is commonly used as first-line treatment for UTIs in children.
What imaging is recommended after completing UTI treatment for a child who had confirmed bacteriuria and fever?**
- A) CT urogram
- B) Renal and bladder ultrasound
- C) MRI abdomen
- D) Simple abdominal X-ray
B) Renal and bladder ultrasound
- Explanation: A renal and bladder ultrasound is advised to check for anatomical abnormalities after completing UTI treatment, especially in cases with fever.
What is the recommended course of action for a child with recurrent UTIs and associated vesicoureteral reflux (VUR)?**
- A) Observation only
- B) Long-term antibiotic prophylaxis
- C) Immediate surgical intervention
- D) Change in diet and physical activity
B) Long-term antibiotic prophylaxis
- Explanation: To prevent further UTIs in children with VUR, long-term antibiotic prophylaxis for 6 to 12 months is recommended.
When is referral to a pediatric urologist indicated in the context of childhood UTIs?**
- A) After a single episode of uncomplicated cystitis
- B) After every febrile UTI with positive culture
- C) Only if symptoms persist despite multiple courses of antibiotics
- D) After initial empirical treatment without urine culture evidence
B) After every febrile UTI with positive culture
- Explanation: Even a single febrile UTI with positive urine culture necessitates evaluation by a pediatric urologist to rule out underlying issues and determine further management.
Amy is a 5-month-old female initially presenting to the pediatric clinic with a 2-day history of fever. Her temperature has ranged between 101°F and 102°F. She appears irritable but is feeding well. There is no history of vomiting, diarrhea, or respiratory symptoms. Her past medical history is unremarkable, and she has been meeting her developmental milestones. Amy’s vaccination status is up to date.
Physical Examination:
- Vitals: Temp: 101.5°F, HR: 140 bpm, RR: 30 bpm
- She has no overt signs of upper respiratory tract infection.
- Abdominal examination reveals mild tenderness in the suprapubic area without any palpable mass.
- The rest of the physical examination is normal.
Initial Investigations:
A urine sample is obtained through catheterization. Urinalysis shows:
- Leukocyte esterase: Positive
- Nitrites: Positive
- White blood cells: >50 per HPF
- Bacterial count is significant.
The urine culture grows: E. coli, sensitive to trimethoprim-sulfamethoxazole (Bactrim) and nitrofurantoin (Macrodantin).
Amy is admitted to the hospital and started on IV antibiotics due to her age and febrile status, with the plan to switch to oral antibiotics after clinical improvement.
During the hospital stay, she is referred for a renal and bladder ultrasound, which comes back normal. She is discharged on Bactrim for a total of 10 days of antibiotic therapy.
Questions:
-
What factors in Amy’s case indicate the need for IV antibiotics initially?
- A) Her age
- B) Significant bacteriuria and fever
- C) Laboratory confirmation of E. coli
- D) All of the above
Answer:** D) All of the above
- Explanation: IV antibiotics are often indicated in young infants (especially under 6 months), particularly when there are signs of systemic involvement such as fever and significant bacteriuria.
Why was a renal and bladder ultrasound performed in this case?**
- A) To identify anatomical abnormalities or dilation
- B) To look for urinary stones
- C) To evaluate bladder wall thickness
- D) To guide antibiotic selection
A) To identify anatomical abnormalities or dilation
- Explanation: A renal and bladder ultrasound is used to detect any underlying anatomical issues, such as hydronephrosis, that might predispose Amy to recurrent UTIs.
What additional management might be considered if Amy’s UTI recurs with vesicoureteral reflux suspected?**
- A) Considering surgery immediately
- B) Increasing hydration without any other measures
- C) Long-term low-dose prophylactic antibiotics
- D) Repeating the same treatment as the initial episode
C) Long-term low-dose prophylactic antibiotics
- Explanation: If vesicoureteral reflux is present, a common management approach is to use prophylactic antibiotics to prevent recurrent infections and further renal damage.
What advice should be given to Amy’s parents to reduce the risk of future UTIs?**
- A) Maintain good hydration and regular voiding patterns
- B) Focus only on dietary modifications
- C) Avoid visits to crowded places
- D) Use aspirin for fever management
A) Maintain good hydration and regular voiding patterns
- Explanation: Ensuring good hydration and regular bowel and bladder habits can reduce the risk of UTIs by facilitating flush-through of the urinary system.
What is Vesicoureteral Reflux (VUR)?**
- A) Infection of the kidneys
- B) Regurgitation of urine from the bladder into the ureters
- C) Blockage of the ureters
- D) Swelling of the bladder
Answer:** B) Regurgitation of urine from the bladder into the ureters
- Explanation: VUR is a condition where urine flows backwards from the bladder into the ureters and possibly the kidneys.
Why is VUR significant in pediatric patients?**
- A) It causes immediate kidney failure.
- B) It leads to the exposure of the kidneys to infected urine, increasing the risk of pyelonephritis.
- C) It permanently stops urine production.
- D) It only affects bladder size.
Answer:** B) It leads to the exposure of the kidneys to infected urine, increasing the risk of pyelonephritis.
- Explanation: VUR can result in recurrent UTIs and, if infected urine reaches the kidneys, it can cause pyelonephritis.
What is a characteristic of Grade III VUR?**
- A) Urine does not reach the renal pelvis.
- B) Urine reaches up to the renal pelvis without any dilation.
- C) Mild to moderate dilation of the renal pelvis occurs.
- D) Severe hydronephrosis is evident.
Answer:** C) Mild to moderate dilation of the renal pelvis occurs.
- Explanation: Grade III VUR is characterized by reflux that reaches the renal pelvis with mild or moderate dilation.
What management strategy is commonly used for patients with VUR to prevent further complications?**
- A) Immediate surgical intervention for all cases
- B) Prophylactic antibiotic therapy
- C) Ignoring urinary symptoms until adulthood
- D) Dialysis before any treatment
B) Prophylactic antibiotic therapy
- Explanation: Prophylactic antibiotics might be used to prevent recurrent urinary tract infections in patients with VUR, thus protecting the kidneys.
For pediatric patients with VUR, what additional measures should be taken into consideration besides antibiotics?**
- A) Treating concurrent constipation or dysfunctional voiding habits
- B) Avoiding any liquid intake throughout the day
- C) Encouraging holding in urine for long periods
- D) Using high doses of painkillers as needed
*Answer:** A) Treating concurrent constipation or dysfunctional voiding habits
- Explanation: Treating constipation and voiding dysfunctions are crucial in managing VUR as these conditions can contribute to urinary stasis and reflux.
Which diagnostic test is often repeated in patients with VUR after a year to evaluate the condition?**
- A) Magnetic Resonance Imaging (MRI)
- B) Voiding Cystourethrogram (VCUG)
- C) Electrocardiogram (ECG)
- D) Complete Blood Count (CBC)
Answer:** B) Voiding Cystourethrogram (VCUG)
- Explanation: A VCUG is a key diagnostic tool to evaluate and monitor VUR by observing how urine moves through the urinary tract during urination.
