Nephrology and Urology – Set 5

What this deck covers

Nephrology and Urology – Set 5 in 50 board-style clinical cases with worked explanations. Each case gives you a clinical vignette, four options, the correct answer, and an explanation of why each of the other three is wrong, with the guideline or textbook it follows named on the answer.

Board-style teaching questions for paediatricians and trainees preparing for paediatric board, MRCPCH and licensing examinations. Written from published guidelines and standard paediatric textbooks, with the source named on every answer.

The 50 cases, in order

1. Feverish infant, cleanest specimen
2. Dilated left kidney found before birth
3. Newborn boy who only dribbles urine
4. Measuring how a dilated kidney drains
5. Planning the late isotope scan
6. Is urine passing back up?
7. Before the first antibiotic dose
8. Chances of outgrowing the problem
9. Schoolgirl with new daytime wetting
10. More fevers and a new scar
11. Positive bag urine in a baby
12. Likely organism in a newborn
13. Baby boy with a dribbling stream
14. Bacteria found in a well girl’s urine
15. What a catheter culture must show
16. Scans after a first febrile infection
17. Fever, a sore side and dark urine
18. Who needs a catheter contrast study?
19. Infection behind a blocked ureter
20. When to add a voiding study
21. Preventing a second infection
22. Clinic checks for a scarred kidney
23. Proving the cause of a weak dribble
24. Definitive care once he is stable
25. First drug for a girl with dysuria
26. Wet at 7 after valve ablation
27. A high reading in a crying toddler
28. When to do an infant’s cystogram
29. Still febrile on day 3 of treatment
30. Kidney outlook after valve ablation
31. What an ultrasound can tell us
32. Which of four needs the surgeon?
33. A fourth bladder infection in a year
34. Repeated infections and a slow bowel
35. Two positive squares on a dipstick
36. A boy who drinks 4 litres a day
37. Sore loins without a high fever
38. Choosing the route of an antibiotic
39. A toddler’s third febrile infection
40. Still stinging on day 2 of treatment
41. Teenager with headaches, small kidneys
42. When a dilated kidney needs surgery
43. Too small for the instrument
44. A bladder that will not empty
45. Strong esterase but no nitrite
46. An isotope scan in the first days
47. Afebrile after 36 hours on a drip
48. A drug to avoid in a jaundiced baby
49. First infection at 3 months of age
50. Who needs the late isotope scan?

Diagnoses and management options tested

Across the fifty cases you are asked to choose between options such as: Suprapubic bladder aspiration, Intravenous urogram, A micturating cystourethrogram, Continuing the same plan for a further 2 years, Pelviureteric junction obstruction, Subureteric bulking injection alone, A repeat micturating cystourethrogram every year, Oral trimethoprim for 3 days, Now, while febrile, without changing antibiotics, The presence and grade of vesicoureteric reflux, Treatment-dose co-amoxiclav every day for 6 months, Intravenous ceftriaxone, as both loins are tender, Change to oral nitrofurantoin for 3 days, Cutaneous vesicostomy.

Clinical pearls from this deck

• When treatment cannot wait in an infant, the specimen must be one that can be trusted.
• A one-sided dilated pelvis above a normal ureter and bladder localises the block to the top of the ureter.
• A rising creatinine behind a full bladder is treated with a tube before anything else.
• By 3 months of age she is old enough for a dynamic study of drainage.
• A cortical defect is only a scar if it is still there months after the infection.
• To see urine going the wrong way, the contrast has to start in the bladder.

Work through the deck once for recognition, then again a week later to test yourself — each question gives the answer and explains why every other option fails.

More from this system: all nephrology and urology case decks · pediatric reference values.