GU and Renal

Question 1

What is the presentation and management of labial adhesions?

Answer 1

• Females aged 1-6yo, often presents as recurrent UTIs

- Tx with 2-4 weeks of topical estrogen to lyse adhesions

Question 2

What is the presentation of hydrometrocolpos and its management?

Answer 2

• Pt presents with dysuria, abdominal pain, primary amenorrhea, and has visible purple membrane over vagina
• Obtain a gynecologic US and get an OB consult

Question 3

Give a differential diagnosis for vaginitis in the prepubertal child

Answer 3

UTI, strep infection, irritant, lichen sclerosis, sexual abuse

Question 4

What is the presentation and management of prepubertal vaginitis?

Answer 4

• dysuria, itching, erythema, vaginal discharge/bleeding

- advise on hygiene, sitz baths, it it’s strep (scarlitiniform rash) culture and appropriate antibiotics

Question 5

How can paraphimosis be managed?

Answer 5

• age 3-5, foreskin stuck in down position
• Ice penis, consider visous lidocaine nerve block at base of penis at 2 and 10 o’clock positions (W/out EPI!!!), apply constant and steady pressure

Question 6

What is balanoposthitis and how should it be managed?

Answer 6

• Infection of the foreskin/glans penis

- Advise on better hygiene, give topical antifungal and PO keflex, advise for sitz baths and NSAIDs

Question 7

• Define priapism

- Give a ddx for priapism

Answer 7

• > /=6 hour erection

- sickle cell, leukemic infiltration, viagra, trauma–>neurogenic shock

Question 8

How should priapsim be managed?

Answer 8

-provide hydration and analgesia, if sickle cell consider transfusion, if leukemia consider plasmapharesis, urology can irrigate the corporeal bodies, can consider vasoconstriction with papaverine or norepinephrine

Question 9

How should direct penile trauma be managed?

Answer 9

• If hematuria or a laceration is present evaluate for damage to the corporeal bodies with a retrograde urethrogram and consult urology
• simple lacerations can be sutured with absorbable sutures

Question 10

How should a penile zipper injury be managed?

Answer 10

• Consider penile nerve block with viscous lidocaine without epinephrine, apply mineral oil to the area for preparation
• Pry open the side of the zipper with a flat head screwdriver

Question 11

What is more common, torsion of a descended or undescended testicle?

Answer 11

-much more likely with an undescended testicle

Question 12

How should testicular torsion be evaluated for and managed?

Answer 12

• presents as a painful swollen testicle in horizontal lie (if descended) and absent cremasteric reflex
• obtain an emergent testicular doppler to eval for flow
• try manual detorsion by twisting outward in the open the book direction
• Urology needs to eval so surgical pinning can take place
• If you have a high index of suspicion for torsion, get the surgical consult first

Question 13

Give a ddx for epididymitis vs orchitis

Answer 13

mumps, chlamydia, gonorrhea, HSP

Question 14

What is the management of epididymitis/orchitis?

Answer 14

sitz baths, analgesia, abx if bacterial, scrotal elevation

Question 15

When should you consider an evaluation for nephrolithiasis?

Answer 15

Hx of metabolic abnormalities, taking diuretics, immobility

Question 16

Give a ddx for hematuria

Answer 16

UTI, Wilms vs neuroblastoma, toxins, nephrolithiasis, IgA nephropathy, hypercalciuria, benign hematuria, excercise

Question 17

What is the presentation of hemolytic uremic syndrome?

When should you consider TTP?

Answer 17

• edema, oliguria, petechiae, bloody diarrhea (w/out diarrhea in 20%), and recent strep infection
• Consider TTP if there are neuro sxs and fever

Question 18

What are the diagnostic criteria of HUS?

Answer 18

1) Acute renal failure
2) thrombocytopenia
3) microangiopathic hemolytic anemia

Question 19

How should HUS be managed?

Answer 19

-IVF, nephro consult, admit

Question 20

What is the presentation and management of nephrotic syndrome?
What complication should you watch for?

Answer 20

• presents with unexplained edema
• Check a urine dip and serum albumin, treat with steroids
• because patients also urinate out Igs they can become immunocompromised-if they are febrile consider them immunocompromised and rule out sepsis

Question 21

At what time period does the testicular salvage rate for testicular torsion halve if not de-torsed?

Answer 21

After 12 hours the salvage rate drops from 80–>40%

Question 22

What disease should a patient with recurrent episodes of Candidal balanoposthitis should be suspected of having?

Answer 22

Diabetes!

Question 23

• What is idiopathis scrotal edema?
• How does it present?
• How is it managed?

Answer 23

• Idiopathic scrotal edema is painless erythema and induration of the scrotum.
• This disorder typically occurs in patients between 2 and 11 years of age and can be either unilateral or bilateral. Patients develop painless erythema and induration of the scrotum, which may be pruritic. There is minimal tenderness on physical examination, but the edema and erythema may extend to the phallus, groin and abdomen. Fever is rare.
• Patients can be discharged home with outpatient follow up, once acute pathology has been ruled out. Most cases will resolve spontaneously within 1 to 4 days and do not require any treatment.

Question 24

When should renal imaging be obtained for a known UTI?

Answer 24

-AAP guideline recommends RUS for all children in the 2- to 24-month age group with a first febrile UTI. In cases where clinical improvement is not shown in 48 hours, RUS can be performed early to evaluate for pyonephrosis or development of a renal abscess. If the results of RUS are normal, no further testing is required. However, if the results suggest hydronephrosis, scarring, or other features of urinary obstruction, VCUG is indicated to diagnose vesicoureteral reflux.