MCN 548 CH 34 EXAM QUESTIONS AND
CORRECT ANSWERS
age 5 and once during adolescence - ANSWER A complete UA should be done when?
3 - ANSWER HTN is renal in origin in children; BP must be done at every recommended
visit beginning at age _____.
Kidneys - ANSWER Filter, clear, reabsorb.
Secrete substances essential to the body's metabolism
1.5 - 3ml/kg/hr - ANSWER Normal urine excretion
Kidneys
Ureters - ANSWER Upper urinary tract
Urethra
Bladder
Meatus - ANSWER Lower urinary tract
FTT - ANSWER o Can be associated with UTI
o Renal tubular acidosis
o Chronic renal failure
Unusual weight gain - ANSWER May be associated with nephrotic syndrome or acute
renal failure
BP - ANSWER elevated with nephritis and nephrotic syndrome
UA characteristics - ANSWER o Color
o Clarity
o Odor
o Specific gravity
o Osmolarity
Specific gravity - ANSWER o Measure of hydration and renal concentration ability
o Varies from 1.003 to 1.030
,o Greater than 1.020 = concentrated
intact erythrocytes - ANSWER Spotty changes on dipstick
free Hgb or myoglobin - ANSWER Uniform changes in color on dipstick
WBC in the urine and warrants further investigation - ANSWER Leukocyte esterase on
dipstick
Nitrite - ANSWER Indirect measurement of bacteria in the urine
Common urinary pathogens contain enzymes the reduce nitrate to nitrite
Urine must be in the bladder x 4 hours to show accurate results
Leuk esterase and nitrite dipsticks - ANSWER These are not reliable in children < 3
years old; therefore a negative dipstick does not r/o a UTI
Urine culture - ANSWER Should be done on any pt positive for leuk esterase or nitrites, if
child has symptoms, if child has high fever without source, or if risk criteria is met.
nitrates and leukocyte esterase - ANSWER Combination of These is highly predictive for
a positive urine culture.
urine culture - ANSWER Gold standard for UTI diagnosis
urine culture - ANSWER can be done by standard culture methods or by dipslide
incubated overnight
UTI - ANSWER Dipslides with > 100,000 colony forming units
N. gonorrhoeae and chlamydia trachomatis - ANSWER Either urethral swabs or vaginal
swabs are accurate for culture for diagnosing
Insert swab 1-2 cm into the urethral opening with a slow gentle twisting action on
removal.
o If urine test is available, the specimen should be between 10-20 mL of the first catch of
urine with no cleansing of the perineum or penis.
24 hour urine - ANSWER Determines calcium excretion, calcium-creatinine ratio, and
quantification of protein
Serum or BUN - ANSWER estimates urea concentration in serum or blood and is a
measure of toxic metabolites that can cause uremic syndrome.
Serum creatinine in combination with creatinine clearance - ANSWER Used to estimate
the glomerular filtration rate or kidney function.
Serum procalcitonin of > 0.5 mg/mL - ANSWER is an accurate and reliable biological
marker for renal involvement during a febrile UTI, pyelonephritis, and renal scarring
, May be useful in dx of UTI
Voiding urosonography (VS) - ANSWER Detects and grades vesicoureteral reflux and
has been shown to be superior to VCUG
Dimercaptosuccinic acid scanning (DMSA) - ANSWER o Most sensitive tool for detecting
acute pyelo and renal scarring - should be considered in young children with febrile UTI
o High sensitivity for detecting VUR
Voiding cystourethrogram (VCUG) - ANSWER o Only indicated if there is an abnormal
DMSA scan and VS, or if there is recurrent infection.
o Gold standard for diagnosing vesicouretal reflux (VUR) and should be done as soon as
the urine is sterile.
Asymptomatic bacterirua
Cystitis
Pyleonephritis - ANSWER There are three kinds of UTI in children:
Asymptomatic bacterirua - ANSWER • Bacteria in the urine without other symptoms
• Benign and DOES NOT cause renal injury
Cystitis - ANSWER Infection of the bladder that produces lower tract symptoms
• DOES NOT cause fever or renal injury
Pyleonephritis - ANSWER • Most severe type of UTI
Pyleonephritis - ANSWER • Involves renal parenchyma or kidneys
• Potential for irreversible renal damage to occur
, Pyleonephritis - ANSWER Signs:
o Fever, irritability, vomiting in an infant
o Urinary symptoms associated with fever, bacteriuria, vomiting, renal tenderness
Complicated UTI - ANSWER Defined as
o UTI with a fever, toxicity, and dehydration
o Or a UTI occurring in a child younger than 3-6 months
UTI - ANSWER •First occurrence
•Recurrent
•Chronic
Recurrent - ANSWER UTI within 2 weeks with the same organism or any reinfection with
a different organism
Chronic - ANSWER UTI ongoing, unresolved, often caused by a structural abnormality
or resistant organism
E. coli - ANSWER Most common cause of UTI is
Cranberry juice - ANSWER helps prevent adherence of e. coli to the urethra
more common in neonates - ANSWER UTI secondary to group B strep
ascending
(Colonization oF the urethral area and ascends the urinary tract) - ANSWER Most UTIs
are thought to be
CORRECT ANSWERS
age 5 and once during adolescence - ANSWER A complete UA should be done when?
3 - ANSWER HTN is renal in origin in children; BP must be done at every recommended
visit beginning at age _____.
Kidneys - ANSWER Filter, clear, reabsorb.
Secrete substances essential to the body's metabolism
1.5 - 3ml/kg/hr - ANSWER Normal urine excretion
Kidneys
Ureters - ANSWER Upper urinary tract
Urethra
Bladder
Meatus - ANSWER Lower urinary tract
FTT - ANSWER o Can be associated with UTI
o Renal tubular acidosis
o Chronic renal failure
Unusual weight gain - ANSWER May be associated with nephrotic syndrome or acute
renal failure
BP - ANSWER elevated with nephritis and nephrotic syndrome
UA characteristics - ANSWER o Color
o Clarity
o Odor
o Specific gravity
o Osmolarity
Specific gravity - ANSWER o Measure of hydration and renal concentration ability
o Varies from 1.003 to 1.030
,o Greater than 1.020 = concentrated
intact erythrocytes - ANSWER Spotty changes on dipstick
free Hgb or myoglobin - ANSWER Uniform changes in color on dipstick
WBC in the urine and warrants further investigation - ANSWER Leukocyte esterase on
dipstick
Nitrite - ANSWER Indirect measurement of bacteria in the urine
Common urinary pathogens contain enzymes the reduce nitrate to nitrite
Urine must be in the bladder x 4 hours to show accurate results
Leuk esterase and nitrite dipsticks - ANSWER These are not reliable in children < 3
years old; therefore a negative dipstick does not r/o a UTI
Urine culture - ANSWER Should be done on any pt positive for leuk esterase or nitrites, if
child has symptoms, if child has high fever without source, or if risk criteria is met.
nitrates and leukocyte esterase - ANSWER Combination of These is highly predictive for
a positive urine culture.
urine culture - ANSWER Gold standard for UTI diagnosis
urine culture - ANSWER can be done by standard culture methods or by dipslide
incubated overnight
UTI - ANSWER Dipslides with > 100,000 colony forming units
N. gonorrhoeae and chlamydia trachomatis - ANSWER Either urethral swabs or vaginal
swabs are accurate for culture for diagnosing
Insert swab 1-2 cm into the urethral opening with a slow gentle twisting action on
removal.
o If urine test is available, the specimen should be between 10-20 mL of the first catch of
urine with no cleansing of the perineum or penis.
24 hour urine - ANSWER Determines calcium excretion, calcium-creatinine ratio, and
quantification of protein
Serum or BUN - ANSWER estimates urea concentration in serum or blood and is a
measure of toxic metabolites that can cause uremic syndrome.
Serum creatinine in combination with creatinine clearance - ANSWER Used to estimate
the glomerular filtration rate or kidney function.
Serum procalcitonin of > 0.5 mg/mL - ANSWER is an accurate and reliable biological
marker for renal involvement during a febrile UTI, pyelonephritis, and renal scarring
, May be useful in dx of UTI
Voiding urosonography (VS) - ANSWER Detects and grades vesicoureteral reflux and
has been shown to be superior to VCUG
Dimercaptosuccinic acid scanning (DMSA) - ANSWER o Most sensitive tool for detecting
acute pyelo and renal scarring - should be considered in young children with febrile UTI
o High sensitivity for detecting VUR
Voiding cystourethrogram (VCUG) - ANSWER o Only indicated if there is an abnormal
DMSA scan and VS, or if there is recurrent infection.
o Gold standard for diagnosing vesicouretal reflux (VUR) and should be done as soon as
the urine is sterile.
Asymptomatic bacterirua
Cystitis
Pyleonephritis - ANSWER There are three kinds of UTI in children:
Asymptomatic bacterirua - ANSWER • Bacteria in the urine without other symptoms
• Benign and DOES NOT cause renal injury
Cystitis - ANSWER Infection of the bladder that produces lower tract symptoms
• DOES NOT cause fever or renal injury
Pyleonephritis - ANSWER • Most severe type of UTI
Pyleonephritis - ANSWER • Involves renal parenchyma or kidneys
• Potential for irreversible renal damage to occur
, Pyleonephritis - ANSWER Signs:
o Fever, irritability, vomiting in an infant
o Urinary symptoms associated with fever, bacteriuria, vomiting, renal tenderness
Complicated UTI - ANSWER Defined as
o UTI with a fever, toxicity, and dehydration
o Or a UTI occurring in a child younger than 3-6 months
UTI - ANSWER •First occurrence
•Recurrent
•Chronic
Recurrent - ANSWER UTI within 2 weeks with the same organism or any reinfection with
a different organism
Chronic - ANSWER UTI ongoing, unresolved, often caused by a structural abnormality
or resistant organism
E. coli - ANSWER Most common cause of UTI is
Cranberry juice - ANSWER helps prevent adherence of e. coli to the urethra
more common in neonates - ANSWER UTI secondary to group B strep
ascending
(Colonization oF the urethral area and ascends the urinary tract) - ANSWER Most UTIs
are thought to be
