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Clin Med II - Exam 4 > Brian Miller - Pediatric/Adult Urology > Flashcards

Brian Miller - Pediatric/Adult Urology Flashcards

1
Q

common peds urology dx

A

congenital hydronephrosis

ureterocele

UTI

vesicoureteral reflux

dysfxn voiding

hypospadias

chordee/torsion

circumcision topics

preputial/labial adhesions

undescended testicles

testicle pain

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2
Q

normal urination

A

detrusor muscle contraction plus relaxation of urethral sphincter → passage of urine

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3
Q

dysfunctional urination

A

contraction of both detrusor and urethral sphincter → interrupted stream

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4
Q

dysfunctional voiding increases risk for (3)

A

UTIs

enuresis

incomplete bladder emptying

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5
Q

majority of dysfunctional voiding pt’s are identified

A

following PCP referral for:

recurrent UTI

AND/OR

intractable daytime enuresis

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6
Q

dysfunctional voiding is a common problem and accounts for up to __% of peds urology clinic visits

A

40%

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7
Q

mc cause of dysfunctional voiding

A

learned behaviors → holding

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8
Q

2 ex of learned behaviors/holding

A

response to potty training

environmental

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9
Q

3 other causes of dysfunctional voiding

A

infectious

detrusor over-activity

neurologic

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10
Q

sx of dysfunctional voiding

A

enuresis

interrupted stream

frequency

urgency

dysuria

malodorous urine

post-void dribbling

hematuria

abd/pelvis discomfort

hesitancy

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11
Q

symptoms of dysfunctional voiding often mimic

A

UTI

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12
Q

dysfunctional elimination syndrome

A

dysfunctional voiding

PLUS

constipation/encopresis

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13
Q

what is encopresis

A

fecal incontinence

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14
Q

imaging for dysfunctional voiding

A

KUB

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15
Q

dx procedure for dysfunctional voiding

A
  1. uroflow → measures voided urine over time
  2. bladder scan → after uroflow
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16
Q

labs for dysfunctional voiding

A

UA

urine culture

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17
Q

tx for dysfunctional voiding (5)

A

timed voiding

double voiding

good water intake

avoidance of bladder irritants

avoidance of constipation

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18
Q

pharm for dysfunctional voiding

A

alpha-blockers

anticholinergics

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19
Q

ex of alpha blockers

A

doxazosin

flomax → older kids

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20
Q

indications for anticholinergics for dysfunctional voiding

A

kids w. irritative voiding sx → urgency, frequency, enuresis

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21
Q

contraindications for anticholinergics for dysfunctional voiding

A

any kid w. elevated PVR (post void residual)

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22
Q

anticholinergics are better tolerated in __ version

A

extended release

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23
Q

imaging to help evaluate recurrent UTI

A

renal US

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24
Q

imaging to help evaluate constipation

A

KUB

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25
Q

imaging to help evaluate febrile UTI

A

voiding cystourethrogram (VCUG)

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26
Q

uroflow evaluates (3)

A

volume

voiding pressure

presence of staccato stream

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27
Q

bladder scan evaluates

A

incomplete bladder emptying → c.o urgency

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28
Q

what is this showing

A

large stool volume

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29
Q

bladder program involves (4)

A

timed voiding

double voiding

good water intake

avoidance of bladder irritants

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30
Q

bladder irritants (5)

A

citrus

caffeine

chocolate

carbonation

artificial red/purple dyes

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31
Q

UTIs are mc in males during __

and females __

A

males: 1st year of life
females: after 1st year of life

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32
Q

uncircumcised is rf for UTI during __

circumcised is rf for UTI __

A

uncircumcised: 1st year of life
circumcised: after 1st year of life

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33
Q

etiology of UTI in infants (3)

A

urinary stasis

constipation

neurogenic bladder

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34
Q

causes of UTI in older kids (3)

A

voiding dysfunction

constipation

upper tract pathology

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35
Q

hx clue for UTI

A

irritative voiding symptoms

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36
Q

ex of irritative voiding sx (6)

A

dysuria

enuresis

frequency

urgency

hematuria

hesitancy

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37
Q

first line lab to evaluate UTI

A

urinalysis

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38
Q

urinalysis is only a __ tool

A

screening

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39
Q

UA point of care test

A

UA dipstick

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40
Q

what UA test is more reliable than UA dipstick

A

UA microscopic

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41
Q

UA microscopic should be ordered if evaluating

A

hematuria

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42
Q

diagnostic test for UTI

A

urine culture

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43
Q

2 tests for UTI eval

A
  1. UA → screening
  2. urine culture → diagnosis
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44
Q

UTI + __ is more suggestive of renal involvment

A

fever

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45
Q

febrile UTI might indicate

A

pyelonephritis →

⅔ of infants < 2yo

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46
Q

imaging for all pt w. diagnosed UTI (febrile or non febrile)

A

RBUS

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47
Q

imaging for all pt. w. diagnosed UTI > 4 yo

A

KUB

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48
Q

indications for VCUG (voiding cystouretrogram) for UTI (3)

A

recurrent febrile UTI

1st UTI in circumcised male

atypical bacteria

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49
Q

tx for UTI

A
  1. targeted abx based on culture
  2. address underlying issues
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50
Q

3 conditions associated w. UTI

A

dysfunctional voiding

VUR

constipation

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51
Q

reflex of urine from the bladder, up the ureters, +/- to the kidney

A

vesicoureteral reflux

52
Q

what is this showing

A

grade 2 VUR

53
Q

what is this showing

A

grade 5 VUR

54
Q

tx for VUR

A

obs vs abx vs surgery

55
Q

most cases of VUR are found

A

after febrile UTI → VCUG ordered

56
Q

imaging for VUR

A

renal US

MAG 3 renal scan

57
Q

abx prophylaxis been associated w. __% reduction in incidence of recurrent UTI

A

35%

58
Q

antimicrobial prophylaxis for kids w. vesicoureteral reflux has been associated w. __% reduction in incidence of recurrent UTI

A

45

59
Q

consider circumcision in kid w.

A

VUR

PLUS

recurrent UTI

60
Q

indications for surgery for VUR (3)

A

breakthrough UTI

UTI following d/c of pabx

family preference

61
Q

if possible, avoid surgical intervention for VUR until after

A

1 yo

62
Q

religions associated w. circumcision

A

muslim

jewish

63
Q

__% of muslim men are circumcised globally

A

68.8

64
Q

prevalence of circumcision in US

A

75%

65
Q

global prevalence of circumcision

A

30#

66
Q

there has been a __ trend in circumcisions in the US

A

downward

67
Q

t/f: circumcision has minimal benefits on decreased HIV transmission and risk of penile ca

A

T!

68
Q

it takes __ circumcisions to prevent 1 UTI

A

100

69
Q

circumcision indication recs (2)

A

recurrent UTIs

at risk pt

70
Q

what pt’s are at risk for recurrent UTIs and may benefit from circumcision (3)

A

PUV (posterior urethral valves)

high grade VUR

neuropathic bladder

71
Q

penile carcinoma is associated w. (2)

A

phimosis

genital infxns

72
Q

3 contraindications for circumcision

A

no vit K at birth

fam hx bleeding d.o

anatomic anomalies

73
Q

what do you think when you see: meatus malpositioned, chordee, dorsal hooded ventral foreskin

A

hypospadias → anatomic anomaly

74
Q

ventral penile curvature

A

chordee

75
Q

incomplete ventral foreskin

A

dorsal hooded foreskin

76
Q

what is this showing

A

hypospadias

77
Q

you will almost never see __ on initial exam for hypospadias

A

complete prepuce

78
Q

other common penile abnormalities (4)

A

chordee → ventral curvature

penile torsion

hidden/buried penis

webbed penis

79
Q

2 tools used for circumcision

A

gomco clamp

pastibell

80
Q

2 tools used for circumcision

A

gomco clamp

pastibell

81
Q

which circumcision tool is quicker and has less bleeding risk

A

pastibell

82
Q

bleeding w. circumcision mc results from

A

disruption of frenular vessels in response to excessive force of frenulum

83
Q

other causes of bleeding w. circumcision (3)

A

mismatched gomco bell and late

premature removal of clamps

loose pastibell string

84
Q

__ should never be used in conjunction w.

__ bc devastating penile loss can occur

A

electrocautery

metal clamps

85
Q

rf for undescended testes

A

prematurity

fam hx

low birth wt

maternal dm

small for gestational age

86
Q

__% of undescended testes will spontaneously descend by 4 mo old

A

35-43%

87
Q

classification of undescended testes

A

undescended → true

retractile

ascended → previously descended

88
Q

types of undescended/true undescended testes

A

palpable

non-palpable

89
Q

best practice for undescended testes work up

A

do NOT obtain imaging for non palpable

90
Q

undescended testes should be referred to specialist if not descended by

A

6 mo

91
Q

2 concerns w. undescended testes

A

infertility

malignancy → 2-3 x normal risk

92
Q

adult urology conditions

A

nephrolithiasis

bph

hematuria

ED

priapism

trauma

urinary retention

incontinence

male infertility

hpogonadism

varicocele

hydrocele

spermatocele

93
Q

histologic dx that refers to proliferation of smooth muscle and epithelial cells w.in prostatic transition zone

A

bph

94
Q

normal prostate is __ g

A

20

95
Q

what scoring system is used for bph

A

IPSS: international prostate symptom score

96
Q

__ and

__ are crucial in bph evaluation

A

detailed h&p

97
Q

imaging for bph

A

cystoscopy

uroflow

bladder scan

98
Q

1st and 2nd line pharm for bph

A
  1. alpha-1 blockers (ABs)
  2. 5-alpha-reductase inhibitors (5-ARIs)
99
Q

suffix for alpha-1 blockers

A

-osin

100
Q

suffix for 5-ARIs

A

-teride

101
Q

2 mc used ABs

A

flomax

rapaflo

102
Q

s.e of ABs (5)

A

hypotn

syncope

dizziness

retrograde ejaculation

arrhythmias

103
Q

AB moa

A

relax smooth m (urethral sphincter)

104
Q

5-ARI moa

A

reduce size of prostate

105
Q

5-ARIs need to be used for __ to achieve results

A

6-12 mo

106
Q

s.e of 5-ARIs

A

decreased libido

ejaculatory dysfxn

possible bone loss

dpn

decreased psa levels

107
Q

3 non first line meds for bph

A

anticholinergics

beta-3 adrenergic agonists

phosphodiesterase type 5 (PDE-5( inhibitors

108
Q

indications for anthicholinergics for bph

A

irritative sx if they empty their bladder well

109
Q

pro of beta-3 adrenergic agonists

A

fewer s.e than anticholinergics

110
Q

ex of beta-3 adrenergic agonist

A

mirabegron (myrbetriq)

111
Q

indications for PDE-5 inhibitor for bph

A

concurrent bph and ed

112
Q

PDE 5 suffix

A

-afil

ex sidenafil (viagra)

113
Q

mc type of kidney stone

A

calcium oxalate

114
Q

other types of kidney stones

A

calcium phosphate

uric acid

struvite

cystine

115
Q

imaging for nephrolithiasis

A

renal us

non-contrast CT abd/pelvis → 96-100% sensitive

KUB

116
Q

indications for surgical intervention of nephrolithiasis

A

UTI

intractable pain

solitary kidney

failed trial of MET x 2-4 weeks

asymptomatic calculus 5 mm or larger

117
Q

what is MET

A

medical expulsive therapy →

tamsulosin (flomax)

118
Q

prevention of nephrolithiasis (6)

A

water!!

calcium foods

minimize oxalate

minimize animal pro

minimize

sat

119
Q

why are varicoceles almost always on the left

A

bc of 90 degree angle of drainage and valve failure on left

120
Q

what type of varicocele is concerning (2)

A

bilateral

right sided

121
Q

pain w. varicocele is aggravated by __

and worse at __

A

standing

end of the day

122
Q

imaging for left sided varicocele

A

abdominal us

123
Q

varicocele grading

A

1-3

124
Q

varicocele only palpable w. valsalva

A

grade 1

125
Q

varicocele that is nonvisible on inspection but palpable upon standing

A

grade 2

126
Q

varicocele that is visible on gross inspection

A

grade 3

Clin Med II - Exam 4 (20 decks)

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