A question that appeared in the August 2024 PLAB/UKMLA Exam Question: Investigating Recurrent UTIs in a Child
Key Points for Medical Students Preparing for UKMLA, PLAB, and Other Medical Exams
This blog post discusses a pediatric case featured in the August 2024 PLAB 1 / UKMLA exam. It focuses on the importance of selecting the correct investigation for a child with recurrent urinary tract infections (UTIs). Understanding the appropriate diagnostic approach for this common pediatric issue is vital for medical students preparing for various medical licensing exams, including the UKMLA, PLAB, and USMLE.
PLAB 1 Case Scenario: A 3-year-old girl presents with a history of multiple UTIs in the past year. Despite antibiotic treatment, the infections keep coming back. Her parents are understandably concerned.The Question:What is the most appropriate next investigation?
A) Abdominal ultrasound
B) Micturating cystourethrogram (MCUG)
C) Dimercaptosuccinic acid (DMSA) scan
D) Renal function tests
E) Urine culture and sensitivity
Answer with explanation is provided below
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Clinical Scenario
A 3-year-old girl presents with a history of multiple urinary tract infections (UTIs) over the past year. Despite treatment with antibiotics, the parents are concerned about the recurrence of infections.
Key Considerations:
Recurrent UTIs in Children: Recurrent UTIs in a child can be indicative of an underlying anatomical abnormality (e.g., vesicoureteric reflux or obstructive uropathy) or functional issues affecting the urinary tract.
Assessing Long-Term Impact: Recurrent UTIs can lead to renal scarring, which can predispose to hypertension and chronic kidney disease later in life. Timely investigation is critical to identify and address any underlying abnormalities.
Correct Answer: C) Dimercaptosuccinic acid (DMSA) scan
Why DMSA Scan is the Most Appropriate Investigation:
Identifying Renal Scarring: A DMSA scan is the gold standard for identifying renal scarring and assessing kidney function in children with recurrent UTIs. It helps detect whether the recurrent infections have caused permanent damage to the kidneys.
Guiding Further Management: The presence of scarring may necessitate further investigations (e.g., micturating cystourethrogram [MCUG]) or long-term management strategies, such as prophylactic antibiotics or surgical intervention.
Why Other Options are Less Appropriate:
A) Abdominal Ultrasound: While an abdominal ultrasound is non-invasive and can identify gross anatomical abnormalities (e.g., hydronephrosis or structural anomalies), it cannot detect renal scarring or subtle functional impairments. It is often used as an initial screening tool but is insufficient in this case.
B) Micturating Cystourethrogram (MCUG): MCUG is used to diagnose vesicoureteric reflux (VUR) or bladder outlet obstruction, but it is invasive and not routinely performed as the first-line investigation for recurrent UTIs. It is typically done only if the DMSA scan suggests scarring or a high suspicion of VUR exists.
D) Renal Function Tests: Blood tests such as serum creatinine and urea measure global renal function, but they do not provide specific information about localised scarring or structural abnormalities.
E) Urine Culture and Sensitivity: While important for diagnosing and guiding treatment of acute UTIs, it does not provide information about the long-term effects of recurrent UTIs or detect renal damage.
Management and Follow-Up:
Perform DMSA Scan: Conduct a DMSA scan to assess for renal scarring and guide further investigations.
Additional Investigations if Needed: If the DMSA scan identifies renal scarring or suggests a high likelihood of vesicoureteric reflux, an MCUG or additional imaging studies may be warranted.
Preventive Strategies: Depending on the findings, preventive measures such as antibiotic prophylaxis, addressing voiding dysfunction, or surgical correction may be necessary.
Parental Education: Educate the parents about the importance of early recognition and treatment of UTIs to minimise the risk of further complications.
Keywords:
UKMLA exam
PLAB exam
USMLE exam
Pediatrics
Recurrent UTIs
DMSA scan
Renal scarring
Medical student
Medical licensing exam
Pediatric UTI investigation
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Reference:
NICE Guidelines: Urinary Tract Infection in Children and Young People.
Remember: This blog post is for educational purposes only and should not be considered medical advice.
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