WorksheetsUROLOGIA PEDIATRICA
Total questions: 45
Worksheet time: 45mins
Pregunta 3 – SASP 2020
. A four-year-old boy with PUV has a vesicostomy. Serum creatinine is 0.6 mg/dl. Ultrasound shows minimal hydronephrosis.Videourodynamicsshow a bladder capacity of 30 mL with a pressureof 14 cm H20 when leakage occursfrom the vesicostomy with no reflux. Undiversion is considered. The best management is resection of the posterior urethral valvesand:
A. ileal augmentation cystoplasty.
B. ileal augmentation with appendicovesicostomy.
C. bladder cyclingvia the vesicostomy.
D. primary closureof the vesicostomy.
E. autoaugmentation cystoplasty.
Pregunta 4 – SASP 2020
Patients with VHLsyndromemost frequently have:
A. renal angiomyolipoma.
B. cafe-au-lait spots.
C. glioblastomas.
D. thyroid carcinoma.
E. retina! angiomas.
Pregunta 13 – SASP 2020
. A 14-year-old girl has primary amenorrhea. She is in the 25th percentile for height and has a webbed neck. Her karyotype is 45,XO. The most likely genitourinary abnormality is:
A. renal agenesis.
B. horseshoe kidney.
C. VUR.
D. UPJ obstruction.
E. vaginal agenesis.
Pregunta 17 – SASP 2020
A four-year-old boy has renal failure . due to ~embranoprolifer~tive glomerulonephritis. He has undergone a bll~teral orchiopexy and proximal hypospadias repair asan infant. He is at greatest risk for development of:
A. gonadoblastoma.
B. NSGCT.
C. Sertoli cell tumor.
D. Wilms' tumor.
E. RCC
Pregunta 18 – SASP 2020
A six-year-old boy with left scrotal pain has a tender indurated epididymis and normal testes. Urinalysis is normal. An ultrasound shows normal testes with Doppler evidence of blood flow, an enlarged, hypervascular left epididymis, and normal kidneys. The next step is:
A. scrotal exploration.
B. radionuclide testicular sean.
C. VCUG.
D. oral antibiotic therapy.
E. NSAIDS
Pregunta 19– SASP 2020
. A three-year-old boy lost one-half of his scrotal skin after a dog attack two hours ago. His testicles, penis, and urethra are spared. The next steps are tetanus immunization, antibiotics, debridement, and:
A. split-thickness skin graft.
B. full-thickness skin graft.
C. placement of testicles in the thigh.
D. scrotal closure with drainage.
E. secondary scrotal closure.
Pregunta 33 – SASP 2020
Unilateral renal agenesis is associated with an increased incidence of:
A. ipsilateral anorchia.
B. two vessel umbilical cord.
C. ipsilateral adrenal agenesis.
D. Müllerian duct abnormalities.
E. urethral anomaly.
Pregunta 43 – SASP 2020
A five-year-old girl is wet within the first few minutes after voiding. She has mild perineal erythema. The next step is:
A. repositioning on the toilet.
B. use a timer to assure five minutes on toilet.
C. uroflow and PVR.
D. oxybutynin and timed voiding.
E. VCUG.
Pregunta 44 – SASP 2020
A six-year-old asymptomatic boy with PUV had neonatal valve ablation. He has worsening bilateral hydronephrosis and his serum creatinine has increased from 0.6 to 1.0 mg/dl over the past nine months. Videourodynamics reveal no VUR or evidence of residual valves, and filling pressures of 15 cm HiO at 220 ml and 32 cm HiO at 280mL. The next step is:
A. voiding diary.
B. antimuscarinic.
C. alpha-blocker.
D. nocturnal indwelllng catheter.
E. initiate CIC every four hours.
Pregunta 46 – SASP 2020
four-year-old girl voids normally but is continuously wet. A renal ultrasound shows normal A -appearing kidneys bilaterally. The next step is:
A. MAG-3 renal sean.
B. VCUG.
C. MRI sean.
D. Cystoscopyand vaginoscopy.
E. retrograde pyelogram.
Pregunta 49 – SASP 2020
A 13-year-old girl with spina bifida was augmented five years ago and is on CIC and antibiotic prophylaxis. She recently developed incontinence and has had two UTls. The next step is:
A. change antibiotic prophylaxis.
B. instill antibiotics into bladder during CIC.
C. observe CIC technique and obtain catheterization diary.
D. bladder ultrasound.
E. videourodynamic evaluation.
Pregunta 67 – SASP 2020
A one-year-old girl with spina bifida has new onset grade 2 hydronephrosis. VCUG demonstrates bilateral grade 4 VUR. CMG is shown. The next step is prophylactic antibiotics and:
A. observation.
B. oxybutynin.
C. CIC.
D. intradetrusor onabotulinumtoxinA.
E. bilateral ureteral reimplant.
Pregunta 75 – SASP 2020
A ten-year-old girl undergoes uncomplicated bilateral ureteral reimplantation for VUR with recurring febrile UTls. She is treated for C. difficile colitis with oral metronidazole after surgery. Two weeks later, she has fever and abdominal pain. WBC is 20,000/cu mm, and serum creatinine 1.7 mg/dl. Renal ultrasound is normal. The next step is:
A. oral vancomycin.
B. I.V. metronidazole.
C. oral vancomycin and I.V. metronidazole.
D. stool transplant.
E. rectal instillation of vancomycin.
Pregunta 79 – SASP 2020
A ten-year-old boy with bladder exstrophy underwent bladder neck reconstruction ileocystoplasty, and appendicovesicostomy two years ago. He complains of intermittent abdominal pain and hematuria. A KUB and ultrasound reveal multiple bladder calculi measuring 1-2 cm each. The best treatment is:
A. bladder irrigation.
B. SWL.
C. transurethral cystolitholapaxy.
D. percutaneous cystolithotomy.
E. convert to ileal conduit.
Pregunta 89 – SASP 2020
A 34-week gestation male fetus has worsening bilateral hydronephrosis and new bilateral ureteral dilation with normal amniotic fluid. The bladder is ful! with a wall thicknessof 5 mm. The next step is:
A. renal ultrasoundat one month after delivery.
B. renal ultrasoundand VCUGafter delivery.
C. renal sean after delivery.
D. early delivery.
E. fetal MRI sean.
Pregunta 91– SASP 2020
A four-year-old girl has recurrent UTls, urgency,frequency, and nocturnal enuresis.
Uftrasound is normal and a VCUGshows a spinning top urethra, a small capacity bfadder, and grade 2 right VUR.The next step is prophylacticantibiotics and:
A. timed voiding.
B. biofeedback.
C. antimuscarinics.
D. DDAVP.
E. endoscopiccorrection of VUR.
Pregunta 112 – SASP 2020
A ten-year-old girl with spina bífida and her father are considering surgical management of her urinary lncontinence. The process of discussing the risks and benefits of surgery with the patient and confirming the desire to proceed with surgery is known as:
A. assent.
B. consent.
C. paternalism.
D. non-maleficence.
E. statutory minor principie.
Pregunta 118 – SASP 2020
An asymptomatic two-year-old girl with resolved prenatal hydronephrosis is noted on pelvic ultrasound to have a 1 cm urachal remnant. The next step is:
A. observation.
B. VCUG.
C. antibiotics.
D. excision of urachal remnant.
E. excision of entire urachus.
Pregunta 02 – SASP 2019
A 24-year-old man has a transpubic urethroplasty in the extended lithotomy position.
Postoperatively, he has anteromedial thigh paresthesia and right lower extremity weakness. The nerve most likely injured is the:
A. femoral.
B. obturator.
C. genitofemoral.
D. sciatic.
l
E. ilioinguina
Pregunta 05 – SASP 2019
Five months after continent cutaneous diversion, a 58-year-old woman has persistent low-grade fevers, malaise, and mild abdominal discomf6rt over the diversion. Her creatinine is 1.2 mgldL, and a CT scan shows mild bilateral hydronephrosis. Urine culture is positive for E. coli. After treating the infection, the next step is:
A. urine acidification.
B. program of mechanical pouch irrigation.
C. prophylactic antibiotic administration.
D. increase size of drainage catheter.
E. pouchogram to evaluate reflux
Pregunta 13 – SASP 2019
A newborn girl has an abdominal mass. An interlabial bulging mass is also noted.
Ultrasound shows a cystic mass anterior to the rectum that does -not change with bladder catheterization. The most likely diagnosis is:
A. imperforate hymen.
B. rhabdomyosarcoma.
C. sacrococcygeal teratoma.
D. Gartner's duct cyst.
E. prolapsed ureterocele.
Pregunta 15 – SASP 2019
A two-month-old boy has a 4 cm right adrenal mass. Biopsy reveals neuroblastoma. There are metastases to the skin, liver, and bone marrow. Skeletal survey is negative. The next step is:
A. observation.
B. flank XRT.
C. multi-agent chemotherapy.
D. right adrenalectomy.
E. total body XRT and bone marrow transplant
Pregunta 30 – SASP 2019
A ten-month-old boy with a vesicostomy for posterior urethral valves develops increasing bilateral hydronephrosis and a full bladder on ultrasound. The next step
IS:
A. diuretic renogram.
B. enterocystoplasty.
C. calibrate vesicostomy.
D. VCUG.
E. bilateral cutaneous ureterostomy
Pregunta 33 – SASP 2019
A 58-year-old woman has continuous urinary incontinence.two weeks after elective robotic hysterectomy. VCUG is normal and retrograde ureterogram is shown. The next step is:
A. observation.
B. urethral catheter drainage.
C. double-J stent placement.
D. percutaneous nephrostomy.
E. ureteroneocystostomy
Pregunta 38 – SASP 2019
. A two-month-old girl with prenatal hydronephrosis is on antibiotic prophylaxis and
has a serum creatinine of 0.3 mg1dL. Bilateral hydroureteronephrosis is identified on
ultrasound and VCUG shows no VUR. MAG-3 diuretic renal scan reveals equal
function with a T 112 of 21 minutes on the right and 87 minutes on the left. The next
step is:
A. left cutaneous ureterostomy.
B. left ureteral reimplantation.
C. bilateral ureterostomy.
D. repeat ultrasound in one month.
E. MR urogram.
Pregunta 45 – SASP 2019
A four-year-old uncircumcised boy has a two-week history of foreskin swelling with urination. The retained urine under the foreskin drains slowly following completion of voiding. There is no dysuria or hematuria. Physical examination reveals mild erythema of the distal foreskin and a phimotic ring. The meatus cannot be visualized.
The next step is:
A. observation.
B. sitz baths.
C. topical steroid ointment.
D. dorsal slit.
E. circumcision.
Pregunta 48 – SASP 2019
A one-month-old girl with a history of glucose-6-phosphate dehydrogenase deficiency has a febrile UTI. Urine culture grows Enterococcus and she is treated with amoxicillin. VCUG shows bilateral grade 4 VUR. The most appropriate prophylactic antibiotic is:
A. amoxicillin.
B. amoxicillin/clavulanate K (Augmentin@).
C. trimethoprim/suIfamethoxazole.
D. nitrofurantoin.
E. cephalexin.
Pregunta 53 – SASP 2019
In penile reconstruction after amputation, microsurgical re-anastomosis of the dorsal artery and vein is most important in preventing:
A. glans atrophy.
B. urethral stricture.
C. erectile dysfunction.
D. skin loss.
E. penile numbness
Pregunta 55 – SASP 2019
A 58-year-old man has a weak urinary stream. There is no history of lower urinary tract instrumentation or trauma. Retrograde urethrogram is shown. The next step is:
A. antegrade urethrogram.
B. direct vision urethrotomy (DVIU).
C. excision and primary anastomosis.
.
D. urethroplasty with graft or flap.
E. perineal urethrostomy and two stage repair
Pregunta 56 – SASP 2019
A two-month-old boy is noted to have an asymmetrical skin dimple over his upper sacrum on a physical examination. The next step is:
A. observation.
B. spinal ultrasound:
C. VCUG.
D. spinal MRI scan.
E. urodynamic study.
Pregunta 57 – SASP 2019
A three-year-old boy with spina bifida and a neurogenic bladder has early filling
bilateral grade 2 VUR. His bladder capacity is 170 mL with low detrusor pressure.
DMSA .shows bilateral renal scars. He .is on CIC four times daily and has recurrent
febrile UTls while on prophylactic antibiotics. The next steps are to change
prophylaxis and:
A. begin dual antibiotic prophylaxis.
B. start antimuscarinic medication.
C. increase frequency of CIC.
D. vesicostomy.
E. surgical repair of VUR
Pregunta 70 – SASP 2019
A 12-year-old girl develops pelvic pain with menarche. Examination reveals a
duplicated vagina with an obstructive bulging perineal membrane which is incised
with subsequent release of trapped menses from one of the vaginal vaults. Her
periods become normal and the pain resolves. The next step is:
A. observation.
B. renal ultrasound.
C. pelvic MRI scan.
D. VCUG.
E. vaginoscopy.
Pregunta 71 – SASP 2019
. A newborn child has a normal anus, an enlarged phallus with a single opening at its base, labioscrotal fusion, and a palpable left gonad. Karyotype is 46,XX and genitogram demonstrates a low confluence of the urethra and vagina. The most likely diagnosis is:
A. exogenous androgen exposure in utero.
.
B. mixed gonadal dysgenesis.
C. partial androgen insensitivity.
D. pure gonadal dysgenesis.
E. ovotesticular disorder (true hermaphrodite)
regunta 75 – SASP 2019
A ten-year-old boy with PUV had an ileocystoplasty and appendicovesicostomy two years ago. He has several 1 cm bladder stones. The next step is:
A. SWL and bladder irrigation.
.
B. cystolithotripsy through the urethra.
C. cystolithotripsy through the appendicovesicostomy.
D. percutaneous cystolithotripsy.
E. laparoscopic cystolithotomy
Pregunta 79 – SASP 2019
A ten-year-old girl has a 1.8 cm renal pelvic stone in a horseshoe kidney with moderate hydronephrosis. The next step is:
A. SWL.
B. ureteroscopy and laser lithotripsy.
C. PCN L.
D. laparoscopic pyelolithotomy.
E. open pyelolithotomy
Pregunta 88 – SASP 2019
A five-year-old boy with a history of PUV ablation is incontinent day and night. Renal ultrasound shows normal kidneys bilaterally. VCUG shows a mildly trabeculated bladder without VUR and no urethral obstruction. PVR is 10 mL. Urinalysis is normal.
The next step is:
A. timed voiding.
B. overnight bladder drainage.
C. urodynamic study.
D. antimuscarinics.
E. desmopressin.
Pregunta 92 – SASP 2019
A 16-year-old girl has severe calf pain and paraesthesia of her foot in the recovery room following a prolonged surgery in the dorsal lithotomy position. The calf pain is exacerbated with palpation and passive dorsiflexion of her foot. She has good capillary refill and palpable pulses in her foot. The next step is:
A. Doppler ultrasound of leg.
B. EMG of leg.
C. pelvic CT scan.
D. lumbar sacral spinal MRI scan.
E. intracompartmental pressure measurement
Pregunta 96 – SASP 2019
A 16-year-old girl with a T3 spinal cord injury develops hypotension and tachycardia during PCNL for a staghorn calculus. Preoperative urine culture was negative and she was given perioperative ampicillin and gentamicin. In addition to fluid resuscitation, the next step is:
A. ensure bladder drainage.
B. stop the operation.
C. place a larger access sheath.
D. transfusion.
E. decrease irrigation flow
Pregunta 97 – SASP 2019
An eight-year-old boy with prior ileocystoplasty reports catheterizing six times daily.
Ultrasound shows new onset of bilateral moderate hydroureteronephrosis.
Videourodynamics demonstrate detrusor pressures of 10 cm Hz0 at 300 mL and 40
cm H20 at 575 mL without VUR or detrusor overactivity. The next step is:
A. increase catheterization frequency.
.
B. placement of an indwelling catheter.
C. diuretic nuclear renal scan.
D. antimuscarinics.
E. bilateral percutaneous nephrostomy tubes
Pregunta 104 – SASP 2019
A 16-year-old girl with a bladder neck reconstruction, augmentation cystoplasty, and appendicovesicostomy is unable to catheterize for 12 hours. A catheter cannot be passed via urethra or appendicovesicostomy. Ultrasound demonstrates a distended bladder. The next step is:
A. percutaneous aspiration of bladder.
.
B. cystoscopy via urethra.
C. cystoscopy via appendicovesicostomy under general anesthesia.
D. open suprapubic tube placement.
E. revision of appendicovesicostomy
Pregunta 110 – SASP 2019
A three-month-old boy had an unstented dismembered pyeloplasty. One week later, he has continued low-grade fever and modest drainage from his flank incision. Ultrasound demonstrates a large blood clot in the renal pelvis. The next step is:
A. re-evaluate in one week.
B. renal scan with Lasix.
C. placement of ureteral stent.
D. nephrostomy tube placement.
.
E. re-exploration and repair anastomotic leak
Pregunta 116 – SASP 2019
A three-year-old boy has a 12 cm solid left renal mass with a normal right kidney.
During left nephrectomy, the tumor capsule is ruptured with minimal tumor spillage,but there is a complete resection. Pathology is favorable histology WiIms' tumor with negative lymph nodes. The next step is:
A. XRT.
B. dactinomycin, vincristine, and doxoru bicin.
C. dactinomycin, vincristine, and XRT.
D. dactinomycin, vincristine, doxorubicin, and XRT.
E. cyclophosphamide, vincristine, doxorubicin, and etoposide
Pregunta 125 – SASP 2019
A 16-year-old boy with a superficial palpable extra-testicular mass in the scrotum is undergoing ultrasound evaluation. The highest resolution imaging is obtained using:
A. a linear transducer.
B. a sector transducer.
C. lower frequency.
D. higher gain.
E. pulsed wave Doppler.
Pregunta 149 – SASP 2019
The preoperative intervention most likely to decrease hospital length of stay after urinary diversion is:
A. low carbohydrate diet.
B. mechanical bowel preparation.
C. antibiotic bowel preparation.
D. p-opioid antagonist.
E. epidural placement
A 12-year-old girl has recurrent UTls. Physical examination is normal. An ultrasound shows a large, thickened bladder wall and bilateral hydroureteronephrosis. A VCUG demonstrates no VUR and a large PVR. The next step is:
A. MAG-3renogram.
B. MRIsean of lumbosacralspine.
C. urethral pressureprofile.
D. uroflow with EMG.
E. cystoscopyand urethral dilation.
