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Peds I & II > GU > Flashcards

GU Flashcards

1
Q

MC organism in UTI

A

E. coli

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2
Q

Newborn UTI sx’s

A

Non-specific:

  1. Fever
  2. HYPOthermia
  3. Jaundice
  4. Poor feeding
  5. Irritability
  6. FTT, sepsis
  7. +/- strong, foul-smelling or cloudy urine
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3
Q

Pre-scheool children UTI sx’s

A
  1. Abd or flank pain
  2. Vomiting
  3. Fever
  4. Urinary sx’s
  5. CVAT=UNUSUAL
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4
Q

School-aged children UTI sx’s

A

Classic cystitis sx’s

+/- Pyelo

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5
Q

What is gold standard diagnosis in UTI’s

A

Urine culture (properly collected)

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6
Q

UTI tx in older infants & children

A

3rd Gen. Cephalosporin OR
Aminoglycoside

x7-10 days

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7
Q

When would you admit an infant to the hospital for IV abx?

A
  1. <3 months
  2. Septic
  3. Dehydrated
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8
Q

Define Vesicouretral Reflux (VUR)

A

Reflux of urine from bladder into ureter/upper urinary tract

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9
Q

When does the incidence of VUR increase?

A

infants w/ prenatal hydronephrosis

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10
Q

Who is VUR MC in?

A

White
Females
Strong FHx

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11
Q

What is the MC type of VUR?

A

Primary VUR

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12
Q

Define Primary VUR

A

Short Ureters: Incompetent or inadequate closure of ureterovesical junction

Congenital*

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13
Q

Define Secondary VUR

A

Abnormally hight voiding pressure in bladder=Blockage

  1. Functional bladder obstruction
  2. Anatomic dysfunction
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14
Q

Prenatal VUR sx’s

A

Hydronephrosis on US

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15
Q

Postnatal VUR sx’s

A

Febrile UTI

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16
Q

Prenatal imaging follow-up in UNILATERAL Hydronephrosis VUR visualized

A

Repat US @ 1 week of age

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17
Q

Prenatal imaging follow-up in BILATERAL hydronephrosis VUR visualized

A

Repat US + Voiding Cystourethrogram (VCUG)

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18
Q

Postnatal work-up with UTI in VUR

A

Renal and Bladder US

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19
Q

Postnatal work-up with FEBRILE UTI in VUR

A

Voiding Cystourethrogram (VCUG)

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20
Q

Grade I and II VUR treatment

A

Monitor for spontaneous resolution

80% resolve by age 5

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21
Q

Garde III-IV VUR treatment

A

Prophylactic abx:

  1. TMP-SMX
  2. Nitrofurantoin

*D/c when VUR resolves

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22
Q

Surgical correction indications

A
  1. Grade V reflux w/ scarring
  2. Persistent Grade Iv/V reflux in children >2
  3. Failed medical therapy or ADE from abx
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23
Q

What is the MCC of urinary tract obstruction in males?

A

Posterior Urethral Valves (PUV)

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24
Q

What is present in 1/2 to 1/3 of pt’s with PUV?

A

VUR

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25
Q

30% of PUV pt’s will develop __?

A

ESRD or renal insufficiency

*Monitor for renal failure!

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26
Q

Prenatal US findings in PUV

A
  1. BILATERAL Hydronephrosis
  2. Distended & thickened bladder
  3. +/- Oligohydramnios
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27
Q

What are pt’s @ risk of postnatal in PUV? Why?

A

Lung Hypoplasia d/t Oligohydramnios

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28
Q

Older boys si/sx’s with PUV

A
  1. Straining to urinate
  2. UTI
  3. Daytime and nocturnal enuresis
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29
Q

PUV diagnosis in postnatal boys

A

VCUG: Dilated and elongated posterior urethra

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30
Q

Prenatal PUV Treatment

A

Vesicoamniotic shunt placement

*experimental

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31
Q

Postnatal PUV Treatment

A

Transurethral Cath Ablation

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32
Q

Define Daytime Frequency

A

Voiding 8x or more during waking hrs

33
Q

Define Straining

A

The application of abdominal pressure (Valsalva) to initiate and maintain voiding

34
Q

Define Enuresis

A

Repeated urination into clothing (day & nighttime):

  1. > 5 y.o,
  2. @ least 2x/wk for 3 months
35
Q

Define Diurnal Enuresis

A

Wetting while awake

36
Q

Define Primary Enuresis

A

Children who have NEVER been consistently dry @ night

37
Q

Define Secondary Enuresis

A

Resumption of wetting after @ least 6 months of dryness

38
Q

What is Nocturnal Enuresis often associated with?

A

Constipation

39
Q

Nonpharm Tx in Nocturnal Enuresis

A

Bedwetting alarms x3 months

40
Q

Pharm Tx in Nocturnal Enuresis (IF all else fails)

A

Desmopressin Acetate (DDAVP): Synthetic ADH

*short term

41
Q

Define Daytime Urinary Incontinence

A

Wetting accident @ least once every 2 weeks

42
Q

When should you consider an underlying cause in Daytime Urinary Incontinence?

A

Continence NOT achieved by 6 y.o.

43
Q

List the associated disorders in Daytime Urinary Incontinence

A
  1. Overactive Bladder=Urinary urgency*
  2. Voiding postponement & under-active bladder: Postpone peeing, low frequency voiding, valsalva to aid in voiding
  3. Dysfunctional voiding: Detrusor contractions during voiding against closed external urinary sphincter
44
Q

Daytime Urinary Incontinence treatment

A
  1. Tx underlying pathology
  2. Behavioral Therapy
  3. Anticholinergic: Oxybutynin
45
Q

Define Exstrophy of Bladder

A

Open, inside-out bladder

Congenital Anomaly

46
Q

Who is Exstrophy of Bladder MC in?

A

White infants
First born
Males

47
Q

Define Diastasis of Pubic Symphsis

A

Outward malrotation of pelvic bones

Si/sx in Exstrophy of Bladder

48
Q

What does Diastasis of Pubic Symphsis place the infant @ risk for?

A

Hip dysplasia

49
Q

Exstrophy of Bladder treatment

A
  1. Induced vaginal delivery or planned C-section

2. Surgery w/in 72 hrs of delivery

50
Q

Define Hypospadias

A

Abnormal VENTRAL placement of urethral opening

51
Q

What is Hypospadias associated with?

A
  1. Chordea: Abnormal ventral curvature of penis

2. Cryptorchidism

52
Q

Hypospadias increased the risk of __?

A

Inguinal hernias

53
Q

ISOLATED Hypospadias Treatment

A

Repaire before 18 mos

54
Q

Hypospadias with Cryptorchidism is at an increased risk for __?

A

Disorders of Sexual Development (DSD):

Congenital Adrenal Hyperplasia=Salt wasting form of DSD

55
Q

Congenital Adrenal Hyperplasia electrolyte findings

A
  1. Low sodium

2. High potassium

56
Q

What imaging will you order in Hypospadias with Cryptorchidism?

A

Pelvic US

57
Q

What is the MC Congenital Abnormality of GU tract in males?

A

Cryptorchidism

58
Q

Define Cryptorchidism

A

Undescended testis by 4 mos

59
Q

Pt’s are @ risk for __ in Cryptorchidism

A
  1. Infertility
  2. Testicular Malignancy

*5-10x higher risk

60
Q

What labs/tests do you order for the dx of Cryptorchidism @ 2-6 months?

A
  1. LH
  2. FSH
  3. Testosterone
  4. Inhibit B
  5. HcG stimulation test
61
Q

At what age do you perform surgery in Cryptorchidism? Surgery treatment options?

A

@ 6-12 months

  1. Orchiopexy: Palpable testi
  2. Exploratory surgery: Nonpalpable
62
Q

What is the MC associated abnormality in Testicular Torsion?

A

Bell Clapper Deformity: Testis lies horizontally

63
Q

Testicular Torsion PEx/Diagnostic findings

A
  1. Doppler US: Decreased perfusion
  2. Absent Cremasteric reflex
  3. Tender, swollen, elevated testi
64
Q

Viable testis (BOTH) testicular torsion treatment

A

Surgical Detorsion + Orchopexy

65
Q

Non-Viable testis testicular torsion treatment

A

Orchiectomy

66
Q

100% viability is achieved if detorsion within__?

A

4-6 hrs

67
Q

0% viability if detorsion is not achieved after__?

A

24 hrs

68
Q

Define Hydrocele

A

Collection of peritoneal fluid between parietal and visceral layers of tunica vaginalis

69
Q

Define Communicating Hydrocele

A
  1. Failure of tunica vaginalis to close during development

2. Peritoneal fluid

70
Q

Communicating Hydrocele clinical presentation

A

Increase in size during day OR w/ valsava maneuver (crying, screaming)

71
Q

Define Non-Communicating Hydrocele

A
  1. NO connection to peritoneum

2. Fluid= comes form mesothelial lining of tunica vaginalis

72
Q

Non-Communicating Hydrocele can be a secondary etiology of the following__

A
  1. Epididymitis
  2. Orchitis
  3. Testicular torsion
  4. Trauma
  5. Tumor

*work these up!

73
Q

Diagnosis of a Hydrocele?

A

+ Transillumination

74
Q

Define Varicocele

A

Collection of dilated and tortuous veins surrounding spermatic cord

75
Q

Varicocele is the MC on the __side. Why?

A

Left side

Left entering renal vein @ 90 degree angle

76
Q

Varicocele is associated with __ in 30% of males

A

Infertility

77
Q

Varicocele Clinical presentation

A
  1. Dull ache or fullness of scrotum when upright

2. “Bag of worms”

78
Q

Varicocele treatment

A

Observation

79
Q

Why is a right sided varicocele concerning? Work-up?

A

Doppler US to r/o IVC obstruction:

  1. Kidney tumor
  2. Abd mass
  3. IVC thrombus
  4. Right renal vein thrombus

Peds I & II (8 decks)

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