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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
What is the treatment for cryptorchidism?
Urology referral: | - Surgery (orchiopexy) recommended after 4 months of age but before 2 years
26
What is testicular torsion?
Torsion of the spermatic cord due to a poorly anchored testicle what poses risk of vascular compromise
27
When are the two age peaks in which the incidence of testicular torsion rises?
- Neonatal period | - During puberty (12-18)
28
What is the common clinical presentation associated with testicular torsion?
- Abrupt onset of severe and constant testicular or scrotal pain - Nausea and vomiting
29
What are physical exam findings that are associated with testicular torsion?
- Affected testis tender, swollen and slightly elevated - Absent cremasteric reflex - Negative Prehn sign
30
What is a positive Prehn sign? In what condition is Prehn sign usually positive
Testicular pain is relieved when the testicle is lifted. Epididymitis
31
What is the confirmatory test of choice for testicular torsion?
Doppler Ultrasound
32
What is the treatment for testicular torsion?
- Immediate urology consult | - Surgical detorsion and fixation (orchiopexy) of both testes if viable
33
For 100% viability, when must detorsion be performed for testicular torsion? When does viability become 0%
Within 4-6 hours After 24 hours
34
What is the most causative bacteria for UTI?
E. coli
35
What are common physical exam findings associated with UTIs?
Suprapubic and CVA tenderness
36
If a child is not potty trained, how should urine be collected?
Catheterization
37
If clinical suspicion for UTI, what diagnostic studies should you obtain?
UA and culture
38
What is typically seen on UA if patient has a UTI?
- Significant bacteriuria with pyruia - (+) Leukocyte esterase - (+) Nitrite
39
What antibiotic is 1st line oral treatment in kids for UTI?
Cephalosporin
40
How should you treat a child with a UTI?
Begin with empiric antibiotic therapy and then adjust per C and S
41
What is the duration of treatment for UTIs in pediatric patients (febrile vs. afebrile)?
Febrile: 10 days Afebrile (and immune competent): 3-5 days
42
If imaging if needed for evaluation of UTI, what is the 1st line study?
Renal and Bladder Ultrasound (RBUS)
43
What is the most common reason to obtain a Renal and Bladder Ultrasound for patients with UTI?
Child < 2 years old with first febrile UTI
44
What is the test of choice to detect Vesicoureteral Reflux (VUR)?
Voiding Cystourethrogram (VCUG)
45
What is Vesicoureteral Reflux (VUR)?
Retrograde urine flow from the bladder into the upper urinary tract
46
When should you consider obtaining VCUG for possible Vesicoureteral Reflux?
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
What is a nuclear medicine scan using radioisotope dimercaptosuccinic acid (DMSA) to detect acute pyelonephritis and renal scarring?
Renal scintigraphy
48
What is nocturnal enuresis?
Urinary incontinence during sleep in kids 5 years or older (more common in boys)
49
While behavioral modifications can be used for treatment in Nocturnal Enuresis, what is the pharmacotherapy option and at what age can it be given?
DDAVP/Desmopression (synthetic ADH) Given at over 6 years of age
50
What is the best screening tool for hematuria?
Urine Dipstick
51
If patient has a positive dipstick for hematuria, what RBC value should be seen on microscopic examination?
> 5 RBCs per hpf
52
If patient has positive dipstick for hematuria and microscopic hematuria, but is asymptomatic with a normal physical, what should your plan be?
Repeat UA weekly x 2 weeks. If resolved, f/u prn
53
What are the management options for VUR?
- Surveillance - Prophylactic antibiotics - Surgical options
54
When does Poststreptococcal Glomerulonephritis typically occur?
Typically occurs 7-14 days after infection with group A beta-hemolytic strep (usually pharyngitis or impetigo)
55
What symptoms are typically associated with Poststreptococcal Glomerulonephritis?
- Edema - Cola-colored urine (gross hematuria) - Elevated BP - Some degree of renal insufficiency "Throat, Bloat, Coke"
56
What is diagnostic of Poststreptococcal Glomerulonephritis on urine microscopy?
RBC casts
57
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?
- UA - Throat or skin culture (demonstrate recent GAS infection) - ASO or streptozyme (demonstrate recent GAS infection) - Complement level Poststreptococcal Glomerulonephritis
58
What is the classic tetra of IgA Vasculitis (HSP)
- Palpable purpura - Arthritis/arthralgia - Abdominal pain - Renal disease
59
What is the treatment for IgA Vasculitis (HSP)?
Supportive care Symptoms spontaneously resolve
60
What is the classic triad of Hemolytic-Uremic Syndrome (HUS)?
- Hemolytic anemia - Thrombocytopenia - Acute kidney injury
61
Shiga toxin-producing E. coli is the most common cause of what disorder?
Acquired Hemolytic-Uremic Syndrome (HUS)?
62
What symptoms typically precede HUS by 5-10 days?
Abdominal pain, vomiting, diarrhea
63
What are the initial labs that you should obtain when suspicious of HUS?
- CBC - Peripheral smear - Renal function - UA - Stool testing
64
What is one of the main causes of acute kidney injury in kids?
Hemolytic-Uremic Syndrome (HUS)
65
What is the treatment for Hemolytic-Uremic Syndrome (HUS)?
Supportive care
66
What should you be concerned for if the patient has proteinuria?
Renal disease
67
When looking at urine, what is a sign of proteinuria?
Foamy urine
68
What is Nephrotic Syndrome?
Renal disease causing massive renal protein loss in urine
69
What are the four main characteristics of Nephrotic Syndrome?
- Nephrotic range proteinuria - Hypoalbuminemia - Edema (usually face) - Hyperlipidemia
70
Horseshoe kidney increases risk of what kind of cancer?
Wilms tumor, most common renal malignancy in kids

Peds II (11 decks)

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