Missed rosh - GU/renal

Question 1

What is a Wilms tumor? how does it typically present?

Answer 1

Wilms tumor is a common kidney malignancy found in children; associated with many congenital abnormalities

presentation:
* abdominal pain
* hard, round, smooth, nontender mass that DOES NOT cross the midline
* fever, HTN, hematuria
* < 15 y/o

Question 2

What is the most common kidney malignancy in teenagers aged 15–19?

Answer 2

Renal cell carcinoma.

Question 3

What are the common etiologies of glomerularnephritis (nephritic syndrome)?

Answer 3

• IgA nephropathy (Berger’s disease) - MCC of acute glomerularnephritis; think in young males days after URI or GI infection
• Post-infectiours - MC after group A strep infection (skin or pharyngeal)
• mebranoproliferative - SLE, hepatitis

Question 4

how is diagnosis of poststreptococcal glomerulonephritis made?

Answer 4

+ ASO titer or + strep culture and clincial sx of hematuria, proteinuria, generalized edema, and/or elevated BP

Question 5

What is the amount of protein in the urine typically seen in nephrotic syndrome?

Answer 5

> 3 g

Question 6

what are the hallmark features of nephrotic syndrome?

Answer 6

• proteinuria
• hypoalbuminemia
• edema - peripheral, orbital, scrotal
• hyperlipidemia

Question 7

what is the most common cause of nephrotic syndrome in children?

Answer 7

minimal change disease –> assume this is the cause if pt improves with corticosteroids

Question 8

what is the first-line tx of nephrotic syndrome in children?

Answer 8

corticosteroids –> titrated dose of prednisone

assume minimal change dz if responsive

Question 9

what are the classic sx of acute cystitis in children?

Answer 9

> 2: frequency, urgency, dysuria, new-onset incontinence, suprapubic pain, hematuria

< 2: consider in those with fever of unknown origin; boys who are uncircumsised are at incr. risk

Question 10

what are treatments of enuresis in children?

Answer 10

• 1st line = behavioral changes/ therapy (voiding schedule, voiding prior to sleep, avoiding caffeine-based drinks, etc.)
• enuresis alarm
• desmopression
• imipramine - TCA used on refractory cases

Question 11

what is the most common cause of scrotal swelling?

Answer 11

hydrocele

Question 12

what are the clinical manifestations of testicular torsion?

Answer 12

• ABRUPT onset of scrotal, inguinal, or lower abdominal pain with a swollen, retracted testical
• nausea and vomiting
• (-) Phren sign = no relief w/ elevation
• (-) Cremasteric reflex on affected side

Question 13

most concerning complication of cryptorchidism

Answer 13

testicular cancer –> if not spontaneously descended by 2 need surgical

also infertility (75% bilateral)

Question 14

what is vesicoureteral reflux? what are the different types?

Answer 14

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

primary VUR: most common; dt inadquate closure of ureterovesical junction

secondary VUR: dt abnormally high voiding pressure in the bladder

Question 15

what are the clinical manifestations and dx test of choice for vesicoureteral reflux?

Answer 15

clinical manifestations: hx of recurrent UTI, especially cystitis or pyelo in young females

dx: voiding cystourethrogram

Question 16

tx of vesicoureteral reflux

Answer 16

grade 1-2: resolves spontaneously; obs or ppx abx

grade 3-4: surgical correction