July 14, 2010

MRCP 2 Question 14

A one year old boy is brought to his pediatrician by his mother who has noted colicky adominal pain and fever.

On examination his scrotal skin is erythematous and warm and he has a urethral discharge.

Investigation reveals a leukocytosis and pyuria. Sedimentation of the urine revealed E. coli which is successfully treated with antibiotics by his pediatrician.

When next seen at the clinic the next week he is symptom-free. The most appropriate next step would be:

a) complete urologic investigation
b) no further treatment or investigation is necessary
c) radionuclide scintigraphy
d) inguinal-scrotal ultrasound
e) ceftriaxone and doxycycline

The correct answer is A


The occurrence of epididymitis in infants suggests the presence of urinary infection and the likelihood of an associated structural genitourinary abnormality, requiring complete urologic investigation.

All pediatric cases of epididymitis require immediate consultation due to the high incidence of associated genitourinary anomalies.

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