Exam 2 - GU

Question 1

Inadequate tx of pediatrics UTI can lead to recurrent UTI, gross renal scarring and increased risk for HTN and CKD in adulthood.

Question 2

What are some S/s of complicated UTI

Answer 2

Toxicity, persistent vomiting, dehydration, renal angle tenderness, renal impairment, clinical non responsiveness to tx after 48hrs.

Question 3

During the 1st year of life, ____ have a higher risk of. UTI compared to _____.

After 1st year of life, ____ have higher rate

Answer 3

Males
Females (2.5-5.4:1)

Females (10:1)

Question 4

During the neonatal period, the UTI route of infection is most likely from ________ versus other age groups where it usually _______

Answer 4

Hematogenous - from the blood
Ascension from urethra to bladder, ureter and kidneys.

Question 5

Most common UTI pathogens

Answer 5

E. Coli, Lactobacilli and enterococcus.

Question 6

Age and gender are the most important factors in prevalence of UTIs.

Question 7

What is vesicouretreral reflux?

Answer 7

Urine backs up into ureters from bladder - valve doesn’t close when bladder contracts.

Question 8

Infants with a febrile UTI are assumed to ______ and treated accordingly to prevent _____

Answer 8

Have pyelonephritis
Bacteremia.

Question 9

Look for bacteria, leukocytes, nitrates, protein and blood in UA for UTI.

Question 10

1st UTI with fever obtain _________
2nd UTI with fever obtain ________

Answer 10

Renal and bladder US. If abnormal, obtain VCUG
VCUG and referral

Question 11

Febrile infants < 60 days should have _____

Answer 11

A clean cath to assess for UTI.

Question 12

Infants <4 weeks with fever and UTI should _____.
Give what abx?

Answer 12

Be hospitalized and given IV abx due to risk for bacteremia and meningitis
Ceftriaxone and gentamycin.

Question 13

Choice of PO abx for UTI

Answer 13

Amoxi-Clavullante (Augmentin)
Bactrim
Cephalexin
Cefixime.

Question 14

UTI prophylaxis dose should be :
Do not use _____ for prophylaxis in VUR

Answer 14

1/4 - 1/2 treatment dose.
Cephalosporins.

Question 15

Casts and proteins in urine signify

Answer 15

Glomerular hematuria.

Question 16

Harriet Lane pg 532-533

Question 17

For all UAs with glomerular results. (RBC casts, dysmorphic RBCs and protein) obtain ___________ and consider ______

Answer 17

CBC w/ diff, serum electrolytes, BUN/Cr, Serum protein/albumin

Consider ANA, HepB+C, HIV, C3/C4, ASO titer, ESR, cholesterol or others based on history.

Question 18

What are some classic findings of nephritis?

Answer 18

Hypertension, hematuria, oliguria, edema, proteinuria.
UA will show: dysmorphic RBCs, cast cells, WBCs and protein.

Question 19

Treatment of strep with abx does NOT prevent _____

Answer 19

Poststreptococcal glomerulonephritis (PSGN)

Question 20

How can you rule out bad causes of proteinuria vs orthostatic proteinuria?

Answer 20

Send cup home and collect FIRST VOID in the AM.

Question 21

Treatment of nephrotic syndrome

Answer 21

Based on etiology - Corticosteroids, hospitalization, biopsy eval.

Question 22

Some causes of Primary Enuresis (monosymptomatic)

Answer 22

Never achieved night time continence:
Deep sleep, hereditary, not physically developed, small bladder, GU system disorder, stressful life events, drug induced, chronic constipation.

Question 23

Some causes of secondary Enuresis (non-monosymptomatic)

Answer 23

Has incontinence after over 6months of being continent at night
Bacteruria, acquired neurogenic bladder, renal tubular defect, urethral obstruction, DM, seizure disorder, OSA, pelvic mass, DI.

Question 24

Reduce Na intake, diuretics, abx are other tx options for PSGN