UTI investigations

Question 1

Keri is a 6 year old girl has presented with a strong reddish tea-coloured urine sample after a period of unwellness, and the dipstick is strongly positive for blood. All EXCEPT ONE of the following conditions can be associated with macroscopic haematuria in children. WHICH ONE is NOT associated with macroscopic haematuria?

Question 1Select one:

a.
Adenovirus cystitis

b.
Nephroblastoma

c.
Rheumatic fever

d.
IgA nephropathy

Answer 1

Rheumatic fever

Question 2

Renal ultrasound reliably detects all of the following EXCEPT ONE. WHICH ONE? _____ 
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Question 2Select one:
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a.
Scarring of the renal cortex
​
b.
Vesico-ureteric junction obstruction
​
c.
Multicystic dysplastic kidneys
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d.
Pelvi-ureteric junction obstruction

Answer 2

Scarring of renal cortex

Question 3

A 2 month old baby boy, Adam, has been irritable and unwell, not feeding well for 24 hours. The temperature is 38.5oC and there are no specific findings on examination. His anterior fontanelle is soft and pulsatile. A bag urine shows 100 white cells, 20 epithelial cells, and a growth of mixed organisms. The white count is 18 x 109/l. WHICH ONE of the following is the MOST APPROPRIATE next investigation?

Question 3Select one:

a.
Bladder puncture

b.
DTPA renal scan

c.
Renal ultrasound

d.
Repeat bag urine

Answer 3

Bladder puncture

Question 4

A 2 month old baby boy, Adam, has been irritable and unwell, not feeding well for 24 hours. He looks unwell and his temperature is spiking at times to 39 degrees C. Full blood count shows neutrophils of 18 x 109/l. A bladder puncture shows 200 white cells and pure growth of E.coli. What is the appropriate treatment for him?

Question 4Select one:

a.
IM ceftriaxone

b.
IV Gentamicin

c.
Oral nitrofurantoin

d.
Oral cotrimoxazole

Answer 4

IV Gentamicin

Question 5

A 2 month old baby, Adam, has had two separate confirmed urinary tract infections, which required IV antibiotic therapy. An ultrasound scan during one infection showed significant bilateral renal swelling and inflammation. What following follow up investigation is indicated?

Question 5Select one:

a.
Intravenous urogram

b.
24 hr urine sodium

c.
Renal ultrasound

d.
DMSA (renal) scan

Answer 5

DMSA (renal) scan

Question 6

A 2 month old baby, Adam, has been treated for an E.coli urinary tract infection with IV bolus and rehydration fluids and 48 hours of IV gentamicin, but continues to look unwell with spiking fevers, and poor urine output. What assessment would be appropriate to perform at this stage?

Question 6Select one:

a.
Intravenous urogram and renal scintigram

b.
Plain abdominal X-ray for renal stones

c.
Lumbar puncture and blood culture

d.
Ultrasound kidneys and urinary system

Answer 6

Ultrasound kidneys and urinary system

Poor urine output

Question 7

Neroli is a 2 year old girl who has a proven urinary tract infection with a pure growth of fully-sensitive E.coli. She is well apart from dysuria. What is the first-line appropriate oral antibiotic choice?

Question 7Select one:

a.
Cefalexin

b.
Erythromycin

c.
Nitrofurantoin

d.
Co-trimoxazole

Answer 7

Co-trimoxazole

Question 8

You are about to see a child who has a definite urine infection based on a clean catch urine specimen, with increased white cells and pure growth of E.coli.

In a child with a proven urinary tract infection, in which ONE of the following situations is oral antibiotic therapy appropriate?

Question 8Select one:

a.
Child looks to be toxic

b.
Well child over 1 year old

c.
Normal newborn baby

d.
Child with bad vomiting

Answer 8

Well child over 1 year old