Master the board step 3

Pediatrics
Diagnostic Testing and Treatment
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Best initial test: Plain film of the abdomen to rule out obstruction
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Next steps: Air enema, which is both diagnostic and curative. Manual
reduction may be needed if radiographic reduction is not successful.
Renal and Urologic Disorders
Urinary Tract Infections (UTIs) in Pediatrics
UTIs are more common in boys ≤ 1 year and girls > 2. Most girls develop
their first UTI by age 5 (peaks are during infancy and toilet training). The most
common agent is Gram-negative rods. Diagnosis is as with adults.
Diagnostic Testing
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Best initial test: Urinalysis
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Most accurate test: Urine culture
Treatment
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Cystitis (dysuria): Amoxicillin, trimethoprim-sulfamethoxazole
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Pyelonephritis (fever, flank pain): IV ceftriaxone or ampicillin plus gentamicin
Do not give the following:
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Sulfonamides or nitrofurantoin in infants < 1 month old (give ceftriaxone)
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Tetracyclines in children < 7 years
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Quinolones in children < 16 years
Note that children are at greatest risk of kidney damage, including kidney
scars, poor kidney growth, poor kidney function, and high blood pressure,
especially if an underlying urinary tract abnormality exists.
Further Management
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Do urine culture 1 week after stopping antibiotics to confirm sterile urine;
reassess periodically for next 1–2 years.
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Obtain voiding cystourethrogram (VCUG) and renal ultrasound in:
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Children of any age with ≥ 2 febrile UTI or
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First febrile UTI with any of the following:
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Family history of renal or urological disease
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Poor growth
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Hypertension
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Organism other than E. coli
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