pediatric UTI

Question 1

2nd most common infection in children

Answer 1

UTI

Question 2

incr risk of renal scarring assc’d with which bacteria?

Answer 2

any bacteria other than E coli

Question 3

what ages are at higher risk for UTI?

Answer 3

boys younger than 1 yr

girls younger than 4 yrs

Question 4

what is a complication of UTI causing HTN, proteinuria, and renal failure

Answer 4

renal scarring

Question 5

urine sample: when to get for girls and uncircumcised boys under 2 yrs

Answer 5

when present with at least 1 risk factor

Question 6

urine sample: when to get for circumcised boys under 2 yrs

Answer 6

suprapubic tenderness or at least 2 risk factors

Question 7

urine sample: when to get for girls and uncircumcised boys > 2 yrs

Answer 7

when present with any urinary sx

Question 8

urine sample: when to get for circumcised boys > 2 yrs

Answer 8

when present with multiple urinary sx

Question 9

risk factors for UTI (7)

Answer 9

1. abd pain
2. back pain
3. fever and no other apparent source
4. ill appearing
5. suprapubic tenderness
6. fever>24 hrs
7. non-Af Am

Question 10

gold standard for UTI

Answer 10

urine culture

Question 11

what is urosepsis

Answer 11

1. toxic appearence
2. hypotension
3. poor cap refill

Question 12

when do UTI in neonates usu present

Answer 12

2nd-3rd week

Question 13

incidence of UTI in neonates is ____more in uncircumcised that circumcised

Answer 13

10x

Question 14

best method for urine culture in neonates

Answer 14

suprapubic aspiration

Question 15

most common bugs for UTI in preterm infants (2)

Answer 15

1. Coag neg Staph

2. klebsiella

Question 16

most common bugs for UTI in term infants (1)

Answer 16

E coli

Question 17

is preterm or term more likely to have hematagenous spread?

Answer 17

preterm infants more likely to have sepsis

Question 18

term infants are more likely to have____ than ______

Answer 18

pyelonephritis (ascending)» hematogenous spread

Question 19

tx of neonate UTI

Answer 19

IV ampicillin + gentamycin 10-14 days

Question 20

tx of pediatric UTI

Answer 20

3rd gen cephalosporins + aminoglycosides

Question 21

when to give oral meds

Answer 21

if age >2 months, not vomiting, family close

Question 22

how long to tx with oral meds

Answer 22

3-5 days

Question 23

f/u if failure to improve or worsening after 48 hrs

Answer 23

1. add amoxicillin
2. obtain renal and bladder U/S
3. urine culture

Question 24

when to give prophylactic Abx for recurrent UTI

Answer 24

if 3 febrile UTIs in 6 months, or 4 in 1 yr

Question 25

prophylactic tx for recurrent UTI

Answer 25

TMP-SMX or nitrofurantoin as single doses for 6 mon

Question 26

most common urologic finding in children

Answer 26

vesicourethral reflux

Question 27

vesicourethral reflux is more common in which grps (3)

Answer 27

1. white kids 2. girls 3. younger than 2 yrs

Question 28

what is the most common form of reflux

Answer 28

primary VUR

Question 29

VUR due to incompetent closure of ureterovesical jxn

Answer 29

primary VUR

Question 30

VUR due to abnormally high pressure in bladder resulting in failure of closure

Answer 30

secondary VUR

Question 31

what grade of VUR: Reflux only fills ureter without dilation

Answer 31

grade 1

Question 32

Reflux fills ureter and collecting system without dilation

Answer 32

grade 2

Question 33

Reflux fills and mildly dilates ureter and collecting system with mild blunting of calyces

Answer 33

grade 3

Question 34

Reflux fills and grossly dilates ureter and collecting system with blunting of calyces. Some tortuosity of ureter also present

Answer 34

grade 4

Question 35

Massive reflux grossly dilates collecting system. All calyces are blunted with loss of papillary impression, and intrarenal reflux may be present. There is significant ureteral dilation

Answer 35

grade 5

Question 36

test of choice for dx of VUR

Answer 36

voiding cysturethrogram (VCUG)

Question 37

when if VCUG indicated

Answer 37

1. kids with 2+ febrile UTI | 2. kids with 1 febrile UTI and other risk factors

Question 38

presents as constipation, daytime wetting, frequency and urgency

Answer 38

bladder and bowel dysfxn