GU

Question 1

Tx of enuresis or bed wetting

Answer 1

Behavioral: 1st-line therapy – motivational therapy (children 5-7 years old), education & reassurance
• Bladder training: regular voiding schedule, deliberate voiding prior to sleeping, waking the child up to urinate inter

mittently,A avoid caffeine-based drinks & high sugar content, restrict fluids
Enuresis alarm: most effective long-term therapy, usually used if children fail to respond to behavioral therapy and before medical therapy

• Sensor placed on the bed pad & goes off when wet – continued until minimum of 2w of consecutive dry nights

Desmopressin: used in nocturnal polyuria with normal bladder functional capacity, better for short term use

• MOA: Synthetic ADH which reduces urination & may cause hyponatremia - liberal use of salt to reduce incidence Imipramine: TCA used in refractory cases
• MOA: stimulates ADH secretion, detrusor muscle relaxation & decreases time spent in REM sleep

Question 2

Immunologic inflammation of the glomeruli→protein & RBC leakage into the urine

Answer 2

Glomerulonephritis (Nephritic Syndrome)

Question 3

2 types of Glomerulonephritis (Nephritic Syndrome)

Answer 3

• *1. IgA Nephropathy (Berger’s disease): MCC of acute glomerulonephritis**, often affecting young males within days (24-48hours) after URI or GI infection (d/t IgA immune complexes), IgA is the first-line defense in respiratory & GI secretions, so infections may cause IgA overproduction
• *2. Post-infectious: MC after group A streptococcus**, 10-14 day after skin (impetigo) or pharyngeal infection (may occur after any infection)

Question 4

2-14 year old boy with facial edema up to 3 weeks after Strep with scanty, cola-colored/dark urine

Answer 4

infectious: MC after group A streptococcus = Glomerulonephritis (Nephritic Syndrome)-

Question 5

Rapidly progressive glomerulonephritis (RPGN): associated w/ poor prognosis (rapid progression to ESRD – weeks/months) – Crescent formation on biopsy*** (crescents formed d/t fibrin & plasma protein deposition collapsing the crescent shape of Bowman’s capsule)

MCC

Answer 5

Goodpasture’s Disease (only presents w/ RPGN): (+) anti-GBM antibodies against type IV collagen of the glomerular basement membrane in kidney & lung alveoli – presents w/ AGN + hemoptysis
Vasculitis: characterized by lack of immune deposits & (+) ANCA antibodies

Microscopic Polyangiitis (vasculitis of small renal vessels): (+) P-ANCA

Granulomatosis w/ polyangiitis (Wegener’s): necrotizing vasculitis: (+) C-ANCA

Question 6

Glomerular damage→increased urinary protein loss (no RBC loss)

Answer 6

Nephrotic Syndrome

Question 7

Proteinuria, hypoalbuminemia, edema, HLD* ; Edema = predominant feature (especially in children), may see ascites

Answer 7

Nephrotic Syndrome

Question 8

Dx of Nephritic syndrome

Answer 8

UA: Proteinuria (usually 3.5g+/day), urine dipstick protein (3+/4+), fatty casts, oval fat bodies “maltese cross”**

Question 9

Serous fluid collection within the layers of the tunica vaginalis of the scrotum

Answer 9

Hydrocele

Question 10

MCC of painless scrotal swelling – idiopathic MC, a reactive hydrocele can occur w/ inflammatory conditions (Orchitis, testicular tumor, epididymitis)

Answer 10

Hydrocele

Question 11

Dx of hydrocele

Answer 11

Testicular U/S – initial test of choice: used to r/o testicular tumor and other masses

Question 12

Congenital anomaly of the male urethra that results in abnormal ventral placement of the urethral opening, penile curvature & abnormal foreskin development

Answer 12

Hypospadias

Question 13

Tx of hypospadias

Answer 13

Do NOT circumcise in the neonatal period because the foreskin may be used to repair the defect • Elective surgical correction (arthroplasty) may include penile straightening

• Hypospadias repair usually performed in healthy full-term infants most commonly between 6 months-1 year

Question 14

Retracted foreskin that can’t be returned to the normal position

Answer 14

Paraphimosis = Emergency

Question 15

Tx of paraphimosis

Answer 15

Manual Reduction: restore original position of the foreskin, reduce

edema w/ cool compresses or pressure dressing then gentle pressure

to restore the foreskin to normal position

Pharmacologic therapy: granulated sugar, injection of hyaluronidase

Definitive: Circumcision or incision (dorsal slit)

Question 16

Inability to retract the foreskin over the glans

Answer 16

Phimosis = Not emergent

Question 17

Tx of phimosis

Answer 17

Normal in children & resolves by age 5

Question 18

PE findings from testicular torsion

Answer 18

Abrupt onset of scrotal, inguinal or lower abdominal pain

(usually <6 hours), with a swollen, tender retracted testicle

If N&V is present, suspect torsion (usually absent in epididymitis)

(-) Prehn Sign – no pain relief w/ elevation, (-) (absent) cremasteric reflex on affected side – no elevation of the testicle after stroking the inner thigh

Question 19

Dx & Tx of testicular torsion

Answer 19

Emergency surgical exploration = definitive diagnosis,

preferred over U/S if torsion is very likely

Testicular doppler ultrasound – best initial imaging

modality – decreased/absent blood flow

Radionuclide scan = gold standard – decreased uptake

Tx = Urgent detorsion

Question 20

Failure of one or more testes to descend by 4 months

Answer 20

Cryptorchidism

Question 21

Tx of Cryptorchidism

Answer 21

Monitor over first 6m, most descend by 3m – Still not

descended? Orchiopexy as early as 4-6m & definitely by 2 y/o

Detected at puberty? Orchiectomy to reduce ca risk

hCG or GnRH – Prader-Willi Syndrome

Question 22

Retrograde passage of urine from the bladder into the upper urinary tract

Answer 22

Vesicoureteral Reflux

Question 23

Tx of Vesicoureteral Reflux

Answer 23

Mild to moderate/ grades I to II: resolves spontaneously – observe or antibiotic prophylaxis to reduce the rusk of recurrent UTI (Bactrim, Trimethoprim, or Nitrofurantoin)

Grades III-IV: Surgical correction is definitive treatment

Question 24

Dx of Vesicoureteral Reflux

Answer 24

Voiding cystourethrogram – imaging test of choice