Pediatric Urology

Question 1

• *** You are seeing a child referred by their pediatrician who has microscopic hematuria and no protein. The parents are distraught, but you tell them: (TEST QUESTION)
  a. their child likely has a Wilm’s tumor
  b. their child needs a CAT scan
  c. their child has a less than 1% chance of having a malignancy.
  d. the child needs no further workup
  e. a source for the microscopic hematuria is always found.

Answer 1

c. their child has a less than 1% chance of having a malignancy.

Question 2

• *** A child presents with right flank pain and vomiting that lasts 4 hours and goes away as the child falls asleep. This is happening with greater frequency. You obtain a renal bladder ultrasound that shows mild right hydronephrosis. The nuclear scan shows no obstruction. The child continues to have symptoms. You tell the family: (TEST QUESTION)
  a. They are making this up
  b. The tests were all normal so it must be a GI problem.
  c. The child is seeking attention.
  d. The child needs to be imaged at the time they are in pain no matter what the hour.
  e. The child needs a CAT scan to look for other causes of pain.

Answer 2

d. The child needs to be imaged at the time they are in pain no matter what the hour.

Question 3

• *** You are called to evaluate a female neonate with a palpable abdominal mass. The abdominal ultrasound is most likely to show: (TEST QUESTION)
  a. A Wilm’s tumor
  b. Neuroblastoma
  c. A rhabdomyosarcoma
  d. A massive UPJ obstruction
  e. A distended bladder

Answer 3

d. A massive UPJ obstruction

Question 4

• *** You are called to evaluate a newborn male with a normal phallus and bilateral undescended testicles that cannot be palpated. You tell the ICU staff who calls you: (TEST QUESTION)
  a. Not to worry we don’t do anything about this for 6 months anyway.
  b. Send them to urology clinic in a month.
  c. Call me after you get the karyotype back.
  d. Go ahead and circumcise the baby.
  e. I’ll be down as soon as I can. Do NOT discharge the baby until we make sure there is no uterus on the pelvic ultrasound.

Answer 4

e. I’ll be down as soon as I can. Do NOT discharge the baby until we make sure there is no uterus on the pelvic ultrasound.

Question 5

• *** A pediatrician calls you about a 14 y/o female with Down’s syndrome who is trached and vented, has a g-tube in place, and has undergone an aortic valve replacement. She had a febrile UTI, and he inquires about imaging her. You would advise: (TEST QUESTION)
  a. The guidelines say you don’t do anything until the 2nd UTI.
  b. She does not need a VCUG.
  c. She needs an ultrasound.
  d. She needs a VCUG.
  e. She needs an ultrasound and a VCUG.

Answer 5

e. She needs an ultrasound and a VCUG.

Question 6

• *** You are evaluating a 10 y/o boy who cannot control his bladder or bowel. He has also had a recent UTI. A urinary flow rate shows a diminished flow rate. Your next step would be: (TEST QUESTION)
  a. Treat his constipation.
  b. Get a VCUG to rule out posterior valves.
  c. Start him in biofeedback.
  d. Send him home with a voiding calendar.
  e. Send him to the psychiatrist for a behavioral disorder.

Answer 6

b. Get a VCUG to rule out posterior valves.

Question 7

• *** You are seeing an 8 y/o girl for intermittent day and night wetting. On physical examination you notice that she has a deviation of her gluteal cleft, and she has a hair tuft at the top of the cleft. What diagnosis should you consider and what test should be ordered next? (TEST QUESTION)
  a. Ectopic ureter and ultrasound
  b. reflux and a VCUG
  c. tethered cord and lumbar spinal MRI
  d. constipation and a KUB
  e. sphincteric insufficiency and urodynamics

Answer 7

c. tethered cord and lumbar spinal MRI

Question 8

• *** You are called to evaluate a 12 y/o boy with right scrotal pain that has lasted 8 hours. He is vomiting as you enter the room to examine him. The right testes is high riding, and very tender to touch. There is no cremasteric reflex on exam. Your next move will be: (TEST QUESTION)
  a. To take him to the operating room to detorse the testes.
  b. Prescribe motrin
  c. Wait for an ultrasound
  d. Order tumor markers.
  e. Observe him in the ER.

Answer 8

a. To take him to the operating room to detorse the testes.