genito-urinary

Question 1

Symptoms of balanitis

Answer 1

• redness and itchiness of glans penis
• often assoc with non-retractile foreskin (preputial adhesions)
• dysuria
• urethral discharge

Question 2

What are the causes of balanitis

Answer 2

allergy
chlamydia
gonnorhea
syphillus

Question 3

What is the management of balanitis

Answer 3

1% hydrocortisone cream for 1-2 weeks
miconidazole cream if confirmed candida
clean penis with luke warm water
Avoid soaps and bubble baths

Question 4

What happens if you have chronic balanitis

Answer 4

Balanitis xerotic obliterans

Question 5

What are the indications for circumcision following balanitis

Answer 5

recurrent infection
lichen sclerosis
persistent phimosis

Question 6

Which commensal organism that can cause balanitis doesn’t always need treating

Answer 6

group B strep

Question 7

When should you refer a child with balanitis

Answer 7

• uncertainty with dianogsis
• persistent or recurrent balanitis which is not responding to management
• suspected lichen sclerosus and/or persistent phimosis — refer to a paediatric urologist or surgeon for consideration of circumcision.

Question 8

What is phimosis

Answer 8

non-retractile foreskin

natural separation occurs around 5YO

Question 9

What is the most common congenital defect of the penis

Answer 9

hypospadius

Question 10

What is hypospadius

Answer 10

• urethral meatus on the ventral aspect of the penis or scrotum, dorsal winged prepuce (foreskin), and ventral curvature of the penis (chordee)
• foreskin incompletly formed ventrally

Question 11

Which children with hypospadius should be referred to surgeons

Answer 11

all of them!!!

Question 12

What other congenital anomalies can hypospadius be associated with

Answer 12

• inguinal hernia
• cryptorchidism,
• other abnormalities of the renal tract.

Question 13

What is the management of hypospadius

Answer 13

Surgery ~1YO by urologist/plastic surgeon

- do not have child circumcised pre-operatively as can be used as a graft if needed

Question 14

What are the main complications of surgery to corret hypospadius

Answer 14

• fistula
• stenosis
• dehiscence

Question 15

What is a uretorecele

Answer 15

abnormal outpouch of the ureter into the bladder
predisposes children to recurrent UTIs
Can cause obstruction

Question 16

What does the presence of absolute incontinence suggest

Answer 16

structural anomaly

Question 17

What is a duplex kidney with ectopic ureter

Answer 17

2 ureters are coming from one kidney. In an ectopic, one ureter sits below the neck of the bladder leading to lack of control of micturition

Question 18

What is vesicoureteric reflux

Answer 18

abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladde

Question 19

What is the investigation of choice to look for vesicoureteric reflux

Answer 19

micturating cystography - is invasive and requires catheterisation

Question 20

What is DMSA scintigraphy

Answer 20

• gold standard for detecting renal parenchymal defects
• uses technetium
• isotope is concentrated in the proximal renal tubules; its distribution correlates with functioning renal tissue

Question 21

WHat is tortid hydatid of Morgagni

Answer 21

torsion of the appendix teste - presents with upper pole testicular pain

Question 22

What are the featurs of tortid hydatid of Morgagni

Answer 22

• upper pole testicular pain
• present cremasteric reflex
• blue dot sign
• absence of nausea and vomiting

Question 23

What is the management of tortid hydatid of Morgagni

Answer 23

• analgesia
• scrotal support
• bed rest
• usually 5-10 days
• surgery if ongoing pain/doubt of diagnoses

Question 24

What is idiopathic scrotal oedema

Answer 24

• self limiting
• scrotal swelling and erythema
• no epidydimal or teste involvement
• <10YO
• resolves 3-10 days

Question 25

What is the triad of nephrotic syndrome

Answer 25

oedema heavy proteinurea >1g/m/day hypoalbuminaemia

Question 26

What investigations should you do if qureying nephrotic syndrome

Answer 26

- urine dip - electrolytes and albumin - protein-createnine ratio rarely done in children

Question 27

What is the role of protien:creatine ratio in nephrotic syndrome

Answer 27

quantifies the amount of protein in urine

Question 28

what would be considered typical findings in a child with nephrotic syndrome

Answer 28

- 1 - 10 years - normal BP - normal renal function - no macroscopic haematuria

Question 29

do you need to do a renal biopsy in a child with clinic triad of nephrotic syndrome

Answer 29

No - if fit triad, treat with steroids, those who respond in 4 weeks are 90% likely to have minimal change disease

Question 30

Who gets a renal biopsy in minimal change disease

Answer 30

atypical features - <1 - macroscopic haematuria - high BP - abnormal renal function

Question 31

what is the most likely histology in typical nephrotic syndrome in children

Answer 31

minimal change

Question 32

what is the most likely histology in atypical nephrotic syndrome in children

Answer 32

focal segmental glomerulonephritis

Question 33

Non-pathological causes of proteinuria

Answer 33

- transient proteinurea - fever induced - exercise induced - UTI - postural proteinurea

Question 34

Pathological causes of proteinuria

Answer 34

- nephrotic syndrome - glomerulonephritis - CKD - tubular interstitial disease

Question 35

What are the main complications of nephrotic syndrome in children

Answer 35

- hypovolaemia! may look overloaded but intravascularly deplete - infection - thromboembolism

Question 36

Signs of intravascular depletion

Answer 36

- cool peripheries - increased core-peripheral temp gap (>2 degrees) - tachycardia

Question 37

Why are you at risk of thromboembolism with nephrotic syndrome

Answer 37

- reduced levels of anti-thrombin 3 as its being lost in urine - this creates a pro-thrombotic state

Question 38

where is the most common sites of clot formation in a child with nephrotic syndrome

Answer 38

- renal blood vessels | - sagittal sinus venous system

Question 39

how does renal vessel thrombosis present

Answer 39

- macroscopic haematuria | - abdo pain

Question 40

How does sagittal venous sinus thrombosis present

Answer 40

- worsening unremitting head ache | - opthalmic issues

Question 41

What is the management of thromboembolism

Answer 41

- urgent imaging - renal US vs CT head | - anti-coagulation

Question 42

Risk factors of sagital venous sinus thrombosis in children

Answer 42

- Pro-coagulant - Sickle cell anemia - Chronic hemolytic anemia - Beta-thalassemia major - Heart disease. - Iron deficiency - Certain infections - Dehydration - Head injury - For newborns, a mother who had certain infections or a history of infertility

Question 43

Causes of haematuria

Answer 43

- UTI - glomerulonephritis - UT stones - trauma - renal tract injury - PCKD - Renal vein thrombosis - Arteritis - Haematological disorder - drugs - cyclophosphamide - exercise induced - fictitious

Question 44

post infectious causes of glomerulonephritis

Answer 44

- bacterial - streptococcal/staphylococcalaureus/mycoplasma/pneumoniae salmonella - viral: herpes/EBV/varicella/CMV - fungi:candida, aspergillus - parasitic:toxoplasma, malaria, schistosomiasis

Question 45

Non-infectious causes of glomerulonephritis

Answer 45

- membraneoproliferative glomerulonephritis - Iga nephropathy - Subacute bacterial endocarditis - Alports syndrome - Systemic disease - SLE