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Phase 2 PEDs > GU > Flashcards

GU Flashcards

1
Q

GU radiology guidance - use what 1st?

A

1L - U/S (cant detect scars however)
2L - VCUG (voiding cysourethrogram - reflux/urethra)
3L - CT/MRI - kidney structure/Fx
4L - Radionuclide studies (Kidney size, scars, Fx)

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2
Q

UTI occurs MC in what pop?

A

Girls

Boys if uncircumcised

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3
Q

S/S of neonate w/ UTI?

A

FTT, fever, feeding problems (No localizing S/S)

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4
Q

S/S of 1mo-2yo w/ UTI?

A

FTT, Fever, feeding problem, - N/V/D

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5
Q

S/S of >2yo w/ UTI?

A

Classic S/S

  • Urgency/frequency
  • Dysuria
  • ABD pain or Back pain
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6
Q

Suspect UTI in all?

A

Infants/children w/ unexplained fever OR congenital urinary anomalies

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7
Q

UTI Dx requires what?

A

> 50k CFU and pyuria = infant/young
100k CFU and pyuria = Older/Adolescents
AND
UA - leukocyte esterase AND nitrite

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8
Q

Best way to collect UA in PEDs?

A

Transurethral cath

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9
Q

GOLD standard of UA Cx results for Dx?

A

> 50k CFU + pyuria - cath specimen
100k CFU (older/adolescent PEDs)
1-50k CFU if suprapubic tap (RPT Cx otherwise)

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10
Q

TXT of UTI?

A

PO Abx - Older PEDs and not Ill w/ POS UA Cx

Parenteral Abx - Toxic/dehydrated

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11
Q

Duration of Parenteral Abx for TXT of UTI?

A

Neonates - 10-14d

Older - 7-14d

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12
Q

When should F/U be made for UTI after initiation of Abx?

A

2d - assess improvement or not - REEVAL if not

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13
Q

When is RAD warranted for assessment of UTI?

A

Renal/Bladder U/S for

  • ALL boys w/ UTI
  • Girls depending on severity
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14
Q

IF U/S is ABNL what is next step of care?

A

VCUG (voiding cystourethogram)

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15
Q

Purpose of VCUG?

A

Eval recurrent UTI - despite NL U/S

Visualize for +- vesicoureteral reflux

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16
Q

Likelihood of VUR being present depends on?

A

The younger the pt the more likely

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17
Q

What is VUR?

A

Retrograde flow from bladder up to ureter or kidney

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18
Q

Causes of VUR?

A 
Congenital (UVJ) Ureterovesical Jx incompetence 
Outlet Obstruction (acquired or cystitis)
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19
Q

VUR is classified how?

A

Graded on how far reflux reached GU
I – Ureter only
II – Ureter, pelvis, calyx - NO Dilation
III – U/P/C - Mild/Mod Dil/Tortuosity - (Slt blunt fornices)

IV – U/P/C - Mod Dil/Toruosity - (Fornice angles gone - but maintains papillary impressions)

V – U/P/C - gross dilation/toruosity w/ fornice angles gone and papillary impression loss)

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20
Q

VUR mgmt?

A

Grade I/II - resolves w/out surgery

High grade VUR or recurrent UTI = Prph Abx

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21
Q

What procedure is used to correct VUR?

A

Dextranomer/hyaluronic acid copolymer (Mild/mod)

Controversial

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22
Q

Complications of VUR?

A

HTN

CKD

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23
Q

Nephrotic syndrome attributes?

A 
NO BLOOD in urine
Heavy proteinuria (ALB mostly) >2g/24h (UA up)
HO-proteinemia (Blood down)
HYP-Cholesterolemia
Edema
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24
Q

What lab/cell marker ass/w nephrotic syndrome?

A

HLA

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25
Q

Nephrotic syndrome pathophys?

A 
Increased GFR permeability >
Proteins leak out - (Increased UA/ decreased blood) >
Reduced plasma oncotic pressure >
Fluid to interstitial spaces >
Decreased volume in BVs activates RAAS >
Increases NaCl reabsorption 
AND
Hypoproteinemia increases hepatic lipoprotein synth >
Liver makes ALB and Lipids >
Hypercholesterolemia
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26
Q

Nephrotic syndrome classified how?

A

Primary

Secondary

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27
Q

Types of primary nephrotic syndrome?

A

(MCNS) - Minimal change Nephrotic syndrome
(FSGS) - Focal segmental glomerulosclerosis
Membranoproliferative Glomerulonephritis
Idiopathic membranous nephropathy

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28
Q

MC form of Nephrotic syndrome?

A

MCNS

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29
Q

MCNS presents as?

A

No hematuria
Renal insufficiency
HTN
HO-Complementemia (NOT C3 tho)

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30
Q

Which primary Nephrotic syndrome is ass/w persistence/renal failure over time?

A

Membranoproliferative Glomerulonephritis

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31
Q

Which primary Nephrotic syndrome is ass/w systemic infections in adolescents/children?

A

Idiopathic membranous nephropathy

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32
Q

Standout 2ndy Nephrotic syndrome causes?

A

SLE
HSP
DM

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33
Q

Nephrotic syndrome presents as?

A

Sudden onset - pitting edema or ascites (MC)
Anorexia, Malaise, Abd pain
HTN > Decline in ALB and Volume > HOTN
Diarrhea
Respiratory distress - (Pulm edema or Pleural effusion)

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34
Q

MC S/S of Nephrotic syndrome?

A

Sudden onset - pitting edema or ascites

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35
Q

Dx of Nephrotic syndrome?

A

2-3 random UA - w/ 2+ protein on each
UA protein/creatinine ratio >0.2 1st AM UA
>2 nephrotic range proteinuria
Low blood - protein/albumin
24h UA protein >50
Fasting cholesterol - still HYP-cholesterol/lipid
HO-complement C3 (Not w/ MCNS)

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36
Q

What Rads are indicated for Nephrotic syndrome?

A 
Renal Bx (not if MCNS)
Renal U/S
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37
Q

TXT of MCNS?

A

Prednisone w/out renal Bx (12w)
Edema - Salt restriction - Loop diuretics
HTN - BB or CCB - ACEI if refract HTN
Immunosupressives - refract Nephrotic syndrome

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38
Q

TXT of all other primary Nephrotic syndrome?

A

Renal Bx 1st > CCS (prednisones
Edema - Salt restric/loop diuretics
HTN - BB/CCB/ACEI (refract)
Immunosuppresives - refract Nephrotic syndrome

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39
Q

Cardinal features of Glomerulonephritis

A 
BLOOD in urine
Oliguria
Proteinuria
HTN
Edema
Renal insufficiency
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40
Q

Types of Glomerulonephritis?

A

IgA nephropathy (Bergers disease)
Hereditary Nephritis (Alport syndrome)
Post-Streptococcal Glomerulonephritis
Rapidly progressive Glomerulonephritis

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41
Q

MC type of CHRONIC Glomerulonephritis?

A

IgA nephropathy (Bergers disease)

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42
Q

Which Glomerulonephritis has greatest risk of ESRD?

A

IgA nephropathy (Bergers disease)

43
Q

IgA nephropathy is AKA?

A

Bergers disease

44
Q

MC type of ACUTE Glomerulonephritis?

A

Post-Streptococcal Glomerulonephritis

45
Q

Features of IgA nephropathy (Bergers disease)?

A

Acute GN
Asymptomatic hematuria
Recurrent gross hematuriaw/ URI

46
Q

What levels of C3 complement is ass/w IgA nephropathy (Bergers disease)?

A

Normal C3 levels

47
Q

Definitive Dx of IgA nephropathy (Bergers disease)?

A

Renal Bx - rarely needed

48
Q

Hereditary Nephritis is AKA?

A

Alport syndrome

49
Q

What is Hereditary Nephritis genetic etiology?

A

X-chromosome mutation affecting type IV collagen >

ABNL glomerular basement membrane

50
Q

Hereditary Nephritis affects what gender the worse?

A

Males (Renal failure, Sensorineural hearing loss)

Female = benign

51
Q

When does Post-Streptococcal Glomerulonephritis begin?

A

5-21d s/p streptococcal pharyngitis infection

4-6w post impetigo

52
Q

TXT of Post-Streptococcal Glomerulonephritis?

A

Supportive - salt diet, diuretics, anti-HTN

Abx

53
Q

Post-Streptococcal Glomerulonephritis outcome?

54
Q

Rapidly progressive Glomerulonephritis complication?

A

Quick renal insufficiency > ESRD

55
Q

Dx Rapidly progressive Glomerulonephritis?

A

Renal Bx - Glomerular epithelial cells proliferation w/ crescents

56
Q

Hemolytic Uremic Syndrome is?

A

Glomerulovascular injury due to toxin/infection

57
Q

Triad of HUS?

A

Microangiopathic hemolytic anemia
Thrombocytopenia
Renal injury

58
Q

MC type of HUS?

A

Prodromal diarrheal illness from contaminated food/water

59
Q

MC type of organism causing HUS?

A

E. Coli O157:H7

- others - Shigella, other E.coli

60
Q

HUS presents as?

A 
Hemolytic anemia
Enterocolitis + bloody stools
Weak/lethargic/Irritable/pallor
Oliguria 7-10d later
Petechiae
Dehydration or Volume overload (HTN)
\+- seizures, Cardiac dysfx, Colonic perforation
61
Q

HUS TXT?

A

Support - HTN control

+- dialysis, Trxf

62
Q

Should you TXT HUS (organism) w/ Abx or antidiarrheal agents?

A

No!
Abx - killing bacteria releases toxins
Antidiarrheal - keeps organism inside body longer

63
Q

Types of congenital kidney ABNLs?

A

Polycystic Kidney Disease
Horseshoe Kidney
Renal agenesis

64
Q

Congenital Polycystic Kidney Disease is due to?

A

Gene mutations AutoDom or AutoRec > cystic dysfx kidneys

65
Q

MC inherited kidney disease is?

A

AD Polycystic Kidney Disease

66
Q

Which Polycystic Kidney Disease gene/structure is affected?

A 
AD = Polycystin 1 or 2 defects
AR = Fibrocystin defects
67
Q

Which Polycystic Kidney Disease genetic etiology is ass/w early childhood vs middle adult?

A 
Childhood = AR Polycystic Kidney Disease
Adult = AD Polycystic Kidney Disease
68
Q

AR Polycystic Kidney Disease attributes?

A

Bilateral renal enlargement
KF early in childhood
Hepatic fibrosis > portal HTN
Interstitial fibrosis > tubular atrophy

69
Q

AR Polycystic Kidney Disease is ass/w what other S/S complications?

A

Flank masses
Hepatomegaly
PTX
Protein or blood in urine

70
Q

Horseshoe kidneys are ass/w what genetic d/o?

71
Q

How does Horseshoe kidneys affect the pt?

A

Asymptomatic - even though fused together - still fx

72
Q

Renal agenesis is AKA?

A

Renal aplasia

73
Q

2 types of Renal agenesis?

A

Unilateral

Bilateral

74
Q

Unilateral Renal agenesis is ass/w what population?

75
Q

Unilateral Renal agenesis is ass/w what other complications?

A

VUR
Turners syndrome
VACTRL

76
Q

Bilateral Renal agenesis is ass/w what complication?

A
  • Insufficent lung development > respiratory distress
    AND
    Potter syndrome
77
Q

Potter syndrome is ass/w what disease?

A

Renal agenesis

78
Q

Potter syndrome has what triad of S/S?

A

Flat facies
Clubfoot
Pulmonary hypoplasia

79
Q

Types of Scrotal/Testicular ABNLs?

A

Testicular torsion
Cryptorchidism
Hydrocele

80
Q

Typical Testicular torsion Hx?

A

Sudden onset - intense unilateral pain
Triggered by sudden movement/sports
N/V

81
Q

What deformity might be present w/ Testicular torsion?

A

Bell-clapper deformity - testicle not anchored posteriorly so it can move freely w/in the scrotom.

82
Q

PE for Testicular torsion will present?

A

High riding testicle
TTP, Edema
Absent cremasteric reflex -
Negative Prehns sign - No relief if testicle raised

83
Q

DDx of Testicular torsion?

A

Epididymo-orchitis - Positve Prehn sign, no edema/red
Apendiceal torsion - blue dot on top of scrotom
Incarcerated inguinal hernia - Hernia/ w/ Valsalva
– bowel sounds over swelling (hernia)

84
Q

Testicular torsion mgmt?

A

Immediate testicular U/S doppler
Refer to urology
Detorsion/Fixation of testis w/in 6hr to save

85
Q

Cryptorchidism is?

A

Undescended testes

86
Q

Cryptorchidism is MC in what population?

A

Premature infants

87
Q

Complications ass/w Cryptorchidism?

A

Testicular cancer

Infertility

88
Q

Mgmt of Cryptorchidism?

A

Not descended after 1yo = refer

Orchidopexy at 2yo if still not descended

89
Q

Hydrocele is?

A

Fluid collection in tunic vaginalis

90
Q

Hydrocele is MC in what population?

91
Q

Hydrocele is classified as?

A

Communicating - Ass/w peritoneal space
OR
Non-Communicating

92
Q

Dx hydrocele w/?

A

Transillumination

93
Q

TXT for Communicating Hydrocele?

A

Urology refer for surgical correction

94
Q

MC type of Hydrocele?

A

Non-Communicating

95
Q

Mgmt of non-communicating Hydrocele?

A

Resolves w/in 12mo > if not Refer by 18mo

96
Q

Communicating Hydrocele attributes?

A

Smallest in AM
Enlarges during the day
Ass/w inguinal hernia

97
Q

Types of penile ABNLs?

A

Hypospadias

Enuresis

98
Q

Hypospadias is ass/w what other conditions?

A

Cryptorchidism

Inguinal hernias

99
Q

Hypospadias mgmt?

A

Urology surgical correction before 18mo old

100
Q

What should ne considered during the mgmt of Hypospadias?

A

NO circumcision - foreskin may be needed for repair

101
Q

What is Enuresis?

A

Urinary incontinence in a child adequately mature

102
Q

Types of enuresis?

A

Diurnal vs nocturnal enuresis
Primary - never achieved dryness
vs
Secondary - dry at least 6mo

103
Q

Which classifications of Enuresis is ass/w

- Organic etiology (UTI, DM, DI, Chronic constipation)

A

2ndy Diurnal/Nocturnal enuresis

104
Q

Enuresis TXT?

A

1L - txt underlying organic causes
2L - Enuresis Alarm
3L - Rx - desmopressin

Phase 2 PEDs (23 decks)

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