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Paediatrics > genito-urinary > Flashcards

genito-urinary Flashcards

1
Q

Symptoms of balanitis

A
  • redness and itchiness of glans penis
  • often assoc with non-retractile foreskin (preputial adhesions)
  • dysuria
  • urethral discharge
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2
Q

What are the causes of balanitis

A

allergy
chlamydia
gonnorhea
syphillus

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3
Q

What is the management of balanitis

A

1% hydrocortisone cream for 1-2 weeks
miconidazole cream if confirmed candida
clean penis with luke warm water
Avoid soaps and bubble baths

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4
Q

What happens if you have chronic balanitis

A

Balanitis xerotic obliterans

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5
Q

What are the indications for circumcision following balanitis

A

recurrent infection
lichen sclerosis
persistent phimosis

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6
Q

Which commensal organism that can cause balanitis doesn’t always need treating

A

group B strep

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7
Q

When should you refer a child with balanitis

A
  • uncertainty with dianogsis
  • persistent or recurrent balanitis which is not responding to management
  • suspected lichen sclerosus and/or persistent phimosis — refer to a paediatric urologist or surgeon for consideration of circumcision.
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8
Q

What is phimosis

A

non-retractile foreskin

natural separation occurs around 5YO

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9
Q

What is the most common congenital defect of the penis

A

hypospadius

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10
Q

What is hypospadius

A
  • urethral meatus on the ventral aspect of the penis or scrotum, dorsal winged prepuce (foreskin), and ventral curvature of the penis (chordee)
  • foreskin incompletly formed ventrally
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11
Q

Which children with hypospadius should be referred to surgeons

A

all of them!!!

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12
Q

What other congenital anomalies can hypospadius be associated with

A
  • inguinal hernia
  • cryptorchidism,
  • other abnormalities of the renal tract.
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13
Q

What is the management of hypospadius

A

Surgery ~1YO by urologist/plastic surgeon

- do not have child circumcised pre-operatively as can be used as a graft if needed

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14
Q

What are the main complications of surgery to corret hypospadius

A
  • fistula
  • stenosis
  • dehiscence
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15
Q

What is a uretorecele

A

abnormal outpouch of the ureter into the bladder
predisposes children to recurrent UTIs
Can cause obstruction

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16
Q

What does the presence of absolute incontinence suggest

A

structural anomaly

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17
Q

What is a duplex kidney with ectopic ureter

A

2 ureters are coming from one kidney. In an ectopic, one ureter sits below the neck of the bladder leading to lack of control of micturition

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18
Q

What is vesicoureteric reflux

A

abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladde

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19
Q

What is the investigation of choice to look for vesicoureteric reflux

A

micturating cystography - is invasive and requires catheterisation

20
Q

What is DMSA scintigraphy

A
  • gold standard for detecting renal parenchymal defects
  • uses technetium
  • isotope is concentrated in the proximal renal tubules; its distribution correlates with functioning renal tissue
21
Q

WHat is tortid hydatid of Morgagni

A

torsion of the appendix teste - presents with upper pole testicular pain

22
Q

What are the featurs of tortid hydatid of Morgagni

A
  • upper pole testicular pain
  • present cremasteric reflex
  • blue dot sign
  • absence of nausea and vomiting
23
Q

What is the management of tortid hydatid of Morgagni

A
  • analgesia
  • scrotal support
  • bed rest
  • usually 5-10 days
  • surgery if ongoing pain/doubt of diagnoses
24
Q

What is idiopathic scrotal oedema

A
  • self limiting
  • scrotal swelling and erythema
  • no epidydimal or teste involvement
  • <10YO
  • resolves 3-10 days
25
Q

What is the triad of nephrotic syndrome

A

oedema
heavy proteinurea >1g/m/day
hypoalbuminaemia

26
Q

What investigations should you do if qureying nephrotic syndrome

A
  • urine dip
  • electrolytes and albumin
  • protein-createnine ratio rarely done in children
27
Q

What is the role of protien:creatine ratio in nephrotic syndrome

A

quantifies the amount of protein in urine

28
Q

what would be considered typical findings in a child with nephrotic syndrome

A
  • 1 - 10 years
  • normal BP
  • normal renal function
  • no macroscopic haematuria
29
Q

do you need to do a renal biopsy in a child with clinic triad of nephrotic syndrome

A

No - if fit triad, treat with steroids, those who respond in 4 weeks are 90% likely to have minimal change disease

30
Q

Who gets a renal biopsy in minimal change disease

A

atypical features

  • <1
  • macroscopic haematuria
  • high BP
  • abnormal renal function
31
Q

what is the most likely histology in typical nephrotic syndrome in children

A

minimal change

32
Q

what is the most likely histology in atypical nephrotic syndrome in children

A

focal segmental glomerulonephritis

33
Q

Non-pathological causes of proteinuria

A
  • transient proteinurea
  • fever induced
  • exercise induced
  • UTI
  • postural proteinurea
34
Q

Pathological causes of proteinuria

A
  • nephrotic syndrome
  • glomerulonephritis
  • CKD
  • tubular interstitial disease
35
Q

What are the main complications of nephrotic syndrome in children

A
  • hypovolaemia! may look overloaded but intravascularly deplete
  • infection
  • thromboembolism
36
Q

Signs of intravascular depletion

A
  • cool peripheries
  • increased core-peripheral temp gap (>2 degrees)
  • tachycardia
37
Q

Why are you at risk of thromboembolism with nephrotic syndrome

A
  • reduced levels of anti-thrombin 3 as its being lost in urine
  • this creates a pro-thrombotic state
38
Q

where is the most common sites of clot formation in a child with nephrotic syndrome

A
  • renal blood vessels

- sagittal sinus venous system

39
Q

how does renal vessel thrombosis present

A
  • macroscopic haematuria

- abdo pain

40
Q

How does sagittal venous sinus thrombosis present

A
  • worsening unremitting head ache

- opthalmic issues

41
Q

What is the management of thromboembolism

A
  • urgent imaging - renal US vs CT head

- anti-coagulation

42
Q

Risk factors of sagital venous sinus thrombosis in children

A
  • Pro-coagulant
  • Sickle cell anemia
  • Chronic hemolytic anemia
  • Beta-thalassemia major
  • Heart disease.
  • Iron deficiency
  • Certain infections
  • Dehydration
  • Head injury
  • For newborns, a mother who had certain infections or a history of infertility
43
Q

Causes of haematuria

A
  • UTI
  • glomerulonephritis
  • UT stones
  • trauma
  • renal tract injury
  • PCKD
  • Renal vein thrombosis
  • Arteritis
  • Haematological disorder
  • drugs - cyclophosphamide
  • exercise induced
  • fictitious
44
Q

post infectious causes of glomerulonephritis

A
  • bacterial - streptococcal/staphylococcalaureus/mycoplasma/pneumoniae salmonella
  • viral: herpes/EBV/varicella/CMV
  • fungi:candida, aspergillus
  • parasitic:toxoplasma, malaria, schistosomiasis
45
Q

Non-infectious causes of glomerulonephritis

A
  • membraneoproliferative glomerulonephritis
  • Iga nephropathy
  • Subacute bacterial endocarditis
  • Alports syndrome
  • Systemic disease - SLE

Paediatrics (21 decks)

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