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Peds II > Exam 1 - Urology > Flashcards

Exam 1 - Urology Flashcards

1
Q

What are some possible benefits to a circumcision?

A

Decreased rates of UTI, penile inflammation/dermatoses, and some STIs

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2
Q

What are some contraindications to having a circumcision?

A
  • Unstable infant

- Congenital penile anomalies

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3
Q

What are the two types of circumcision procedures?

A
  • Gomco (clamp and bell)

- Plastibell

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4
Q

What is the term for the inability to retract the foreskin?

A

Phimosis

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5
Q

What is pathologic phimosis and how is it caused?

A

Non-retractable foreskin due to scarring/fibrosis that occurs secondary to infection, inflammation, or early forcible retraction

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6
Q

How can pathologic phimosis present?

A
  • Secondary non-retractability after having fully retractable foreskin
  • Painful erections
  • Irritation or bleeding
  • Dysuria and/or urinary retention
  • Recurrent infections
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7
Q

What are treatment options for pathologic phimosis?

A
  • Stretching exercises (gently pulling foreskin back QID)
  • Topical corticosteroid
  • Circumcision
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8
Q

What is important to discuss in regards to patient education associated with care of an uncircumcised penis?

A
  • Avoid forcible retraction at any age
  • Stop retraction if met with any resistance
  • Return foreskin to natural position after cleaning
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9
Q

What is paraphimosis?

A

Retracted foreskin in an uncircumcised male that cannot be returned to natural position

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10
Q

What is important to know about paraphimosis?

A

It is a urologic emergency due to arterial compromise

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11
Q

What are potential symptoms of paraphimosis?

A
  • Swelling of penis
  • Penile pain
  • Irritability in preverbal infant
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12
Q

Male patient presents with the following symptoms:

  • Edema and tenderness of the glans
  • Tender swelling of the distal retracted foreskin, causing a constricting band
  • Slight color change of the penile skin

What is the likely diagnosis?

A

Paraphimosis

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13
Q

What are treatment options for paraphimosis?

A
  • Pain control
  • Timely, manual reduction in office or ED
  • Surgical intervention by urology
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14
Q

What is an abnormal dorsal displacement of the urethral opening?

A

Epispadias

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15
Q

What other abnormality can epispadias occur with?

A

Bladder exstrophy (exposed bladder onto the lower abdomen)

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16
Q

What is an abnormal ventral displacement of the urethral opening?

A

Hypospadias

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17
Q

What is abnormal penile curvature called?

A

Chordee

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18
Q

What other abnormality can hypospadias occur with?

A

Chordee

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19
Q

You have diagnosed a patient with hypospadias and/or chordee, and upon palpating the testes you find that they have cryptorchidism. What should you consider?

A

Disorder of Sexual Development

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20
Q

At what age would surgical treatment be performed in a patient with hypospadias and/or chordee?

What procedure should not be performed?

A

Surgical correction would be performed at around 6 months of age in term infants.

Circumcision should NOT be done during the newborn period in these patients.

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21
Q

What is cryptorchidism?

A

Testes that are not within the scrotum and do not descend by 4 months of age (hidden or absent)

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22
Q

What is the most common GU congenital abnormality?

A

Cryptorchidism

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23
Q

What can cryptorchidism increase the risk of?

A
  • Testicular torsion
  • Subfertility
  • Testicular cancer
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24
Q

What is the clinical presentation of a male with cryptorchidism?

A

Absent testicle unilaterally (more common) or bilaterally with flat, underdeveloped scrotum

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25
Q

What is the treatment for cryptorchidism?

A

Urology referral:

- Surgery (orchiopexy) recommended after 4 months of age but before 2 years

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26
Q

What is testicular torsion?

A

Torsion of the spermatic cord due to a poorly anchored testicle what poses risk of vascular compromise

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27
Q

When are the two age peaks in which the incidence of testicular torsion rises?

A
  • Neonatal period

- During puberty (12-18)

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28
Q

What is the common clinical presentation associated with testicular torsion?

A
  • Abrupt onset of severe and constant testicular or scrotal pain
  • Nausea and vomiting
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29
Q

What are physical exam findings that are associated with testicular torsion?

A
  • Affected testis tender, swollen and slightly elevated
  • Absent cremasteric reflex
  • Negative Prehn sign
30
Q

What is a positive Prehn sign?

In what condition is Prehn sign usually positive

A

Testicular pain is relieved when the testicle is lifted.

Epididymitis

31
Q

What is the confirmatory test of choice for testicular torsion?

A

Doppler Ultrasound

32
Q

What is the treatment for testicular torsion?

A
  • Immediate urology consult

- Surgical detorsion and fixation (orchiopexy) of both testes if viable

33
Q

For 100% viability, when must detorsion be performed for testicular torsion?

When does viability become 0%

A

Within 4-6 hours

After 24 hours

34
Q

What is the most causative bacteria for UTI?

A

E. coli

35
Q

What are common physical exam findings associated with UTIs?

A

Suprapubic and CVA tenderness

36
Q

If a child is not potty trained, how should urine be collected?

A

Catheterization

37
Q

If clinical suspicion for UTI, what diagnostic studies should you obtain?

A

UA and culture

38
Q

What is typically seen on UA if patient has a UTI?

A
  • Significant bacteriuria with pyruia
  • (+) Leukocyte esterase
  • (+) Nitrite
39
Q

What antibiotic is 1st line oral treatment in kids for UTI?

A

Cephalosporin

40
Q

How should you treat a child with a UTI?

A

Begin with empiric antibiotic therapy and then adjust per C and S

41
Q

What is the duration of treatment for UTIs in pediatric patients (febrile vs. afebrile)?

A

Febrile: 10 days

Afebrile (and immune competent): 3-5 days

42
Q

If imaging if needed for evaluation of UTI, what is the 1st line study?

A

Renal and Bladder Ultrasound (RBUS)

43
Q

What is the most common reason to obtain a Renal and Bladder Ultrasound for patients with UTI?

A

Child < 2 years old with first febrile UTI

44
Q

What is the test of choice to detect Vesicoureteral Reflux (VUR)?

A

Voiding Cystourethrogram (VCUG)

45
Q

What is Vesicoureteral Reflux (VUR)?

A

Retrograde urine flow from the bladder into the upper urinary tract

46
Q

When should you consider obtaining VCUG for possible Vesicoureteral Reflux?

A

Children of any age with more 2 or more febrile UTIs

Children of any age with 1st febrile UTI and

  • Any anomaly on RBUS OR
  • Temp of 102.2 of more and pathogen other than E. coli OR
  • Poor growth or HTN
47
Q

What is a nuclear medicine scan using radioisotope dimercaptosuccinic acid (DMSA) to detect acute pyelonephritis and renal scarring?

A

Renal scintigraphy

48
Q

What is nocturnal enuresis?

A

Urinary incontinence during sleep in kids 5 years or older (more common in boys)

49
Q

While behavioral modifications can be used for treatment in Nocturnal Enuresis, what is the pharmacotherapy option and at what age can it be given?

A

DDAVP/Desmopression (synthetic ADH)

Given at over 6 years of age

50
Q

What is the best screening tool for hematuria?

A

Urine Dipstick

51
Q

If patient has a positive dipstick for hematuria, what RBC value should be seen on microscopic examination?

A

> 5 RBCs per hpf

52
Q

If patient has positive dipstick for hematuria and microscopic hematuria, but is asymptomatic with a normal physical, what should your plan be?

A

Repeat UA weekly x 2 weeks. If resolved, f/u prn

53
Q

What are the management options for VUR?

A
  • Surveillance
  • Prophylactic antibiotics
  • Surgical options
54
Q

When does Poststreptococcal Glomerulonephritis typically occur?

A

Typically occurs 7-14 days after infection with group A beta-hemolytic strep (usually pharyngitis or impetigo)

55
Q

What symptoms are typically associated with Poststreptococcal Glomerulonephritis?

A
  • Edema
  • Cola-colored urine (gross hematuria)
  • Elevated BP
  • Some degree of renal insufficiency

“Throat, Bloat, Coke”

56
Q

What is diagnostic of Poststreptococcal Glomerulonephritis on urine microscopy?

A

RBC casts

57
Q

What lab tests should you consider in a patient with cola-colored urine and decreased renal function 2 weeks after having strep throat?

What diagnosis are you trying to confirm with these tests?

A
  • UA
  • Throat or skin culture (demonstrate recent GAS infection)
  • ASO or streptozyme (demonstrate recent GAS infection)
  • Complement level

Poststreptococcal Glomerulonephritis

58
Q

What is the classic tetra of IgA Vasculitis (HSP)

A
  • Palpable purpura
  • Arthritis/arthralgia
  • Abdominal pain
  • Renal disease
59
Q

What is the treatment for IgA Vasculitis (HSP)?

A

Supportive care

Symptoms spontaneously resolve

60
Q

What is the classic triad of Hemolytic-Uremic Syndrome (HUS)?

A
  • Hemolytic anemia
  • Thrombocytopenia
  • Acute kidney injury
61
Q

Shiga toxin-producing E. coli is the most common cause of what disorder?

A

Acquired Hemolytic-Uremic Syndrome (HUS)?

62
Q

What symptoms typically precede HUS by 5-10 days?

A

Abdominal pain, vomiting, diarrhea

63
Q

What are the initial labs that you should obtain when suspicious of HUS?

A
  • CBC
  • Peripheral smear
  • Renal function
  • UA
  • Stool testing
64
Q

What is one of the main causes of acute kidney injury in kids?

A

Hemolytic-Uremic Syndrome (HUS)

65
Q

What is the treatment for Hemolytic-Uremic Syndrome (HUS)?

A

Supportive care

66
Q

What should you be concerned for if the patient has proteinuria?

A

Renal disease

67
Q

When looking at urine, what is a sign of proteinuria?

A

Foamy urine

68
Q

What is Nephrotic Syndrome?

A

Renal disease causing massive renal protein loss in urine

69
Q

What are the four main characteristics of Nephrotic Syndrome?

A
  • Nephrotic range proteinuria
  • Hypoalbuminemia
  • Edema (usually face)
  • Hyperlipidemia
70
Q

Horseshoe kidney increases risk of what kind of cancer?

A

Wilms tumor, most common renal malignancy in kids

Peds II (11 decks)

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