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12. UroPed (1583) > Paediatric urology > Flashcards

Paediatric urology Flashcards

1
Q

How common is congenital urogenital anomalies on prenatal ultrasounds?

A

up to 2%

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2
Q

What is the most common urogenital anomoly that is discovered on prenatal ultrasounds?

A

60% is hydronephrosis

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3
Q

How common is UPJ obstruction?

A

1:1500

males 2:1 females in newborn

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4
Q

Differential diagnosis with hydronephrosis in newborns:

A 
UPJ problems 43%
VUR (vesicourethral reflux) 24%
Megaureter 12%
PUV (posterior urethral valves) 11%
Duplex systems 10%
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5
Q

What carachterises Megaurethers?

A

More often males
More on the left side

Can be caused by obstruction and/or reflux

Is primary or secondary (PUV, neurogenic bladder)

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6
Q

If a hydronephrosis is not an obstruction, what else can it be a sign of?

A

VUR (vesicourethral reflux)

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7
Q

What information is needed from the antenatal ultrasound if a hydronephrosis is discovered?

A 
Laterality, grade of dilatiation, echogenicitiy of the kidney
With or without a dilated urether
Bladder volume and emptying
Sex of child
Amniotic fluid volume
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8
Q

What is a VCUG?

A

Voiding CystoUrethroGram

Gold standard for imaging the bladder and urethra

Can detect:
Vesicoureteral reflux
urethral valves 
ureteroceles
diverticula
neurogenic bladder
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9
Q

What is a MAG3?

A

Type of Dynamic Renography

shows:
blood flow to the kidney
renal clearance
drainage function

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10
Q

When should UPJ obstruction be operated?

A 
Decreased renal function <40% on affected side
Increasing hydronephrosis
Manifesting symptoms
Poor drainage
grade III and IV dilatation
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11
Q

What are the goals in diagnosing and treating UPJ obstruction?

A

Perserve renal function

Less:
UTI
Pain
Hematuria
Urolithiasis
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12
Q

What share of megaurethers will resolve spontaneously?

A

85%

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13
Q

When should a megaurether be surgically corrected?

A

Progression in dilatation
Deterioration of renal function
Symptomatic

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14
Q

What is more common, a complete duplex system or a partial?

A

Partial

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15
Q

What other conditions are a duplex collecting system associated with?

A

Ectopic urether

Ureterocele

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16
Q

What are the most common sites for an ectopic urether?

A

Males: posterior urethra

Females: bladder neck, urethra, vagina

more common in girls

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17
Q

What is a ureterocele?

A

Malformation characteried by pseudo-cystic dilatation of the distal, intravesical portion of urethra

are often a source of obstruction

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18
Q

How common are ureteroceles?

A

1:4000

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19
Q

How common are ureteroceles in duplex systems?

A

80% are found in upper pole urether

20% in single systems

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20
Q

How common are bilateral ureteroceles?

A

10%

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21
Q

What is the ratio boys:girls in the prevalence of ureteroceles?

A

1:4-7

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22
Q

What is a Posterior Urethral Valve?

A

Obstructing membranous fold within the lumen of the posterior urethra

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23
Q

What is the most common urinary obstruction that affects newborn boys?

A

Posterior Urethral Valve (PUV)
1: 5000-8000 live births

is lifethreatening
35% renal insufficiency despite optimal treatment

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24
Q

How do you treat PUV and what is the result?

A

Shunting
Fetal valve ablation

bladder decompression
restoration of amniotic fluid
lungs can expand
restoration of surfactant
no benefit for renal function
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25
Q

At what age is the foreskin most often retractable?

A

90% at 3 years old

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26
Q

How many boys still have physiological fimosis at 17?

A

1%

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27
Q

How do you treat secondary fimosis?

A

Stereoid creme (class III-stereoids, twice daily 39 days)
Dorsal slit
Circumcision

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28
Q

What are the medical indications for circumcision?

A

Congenital urinary tract malformation to reduce risk for UTI
Secondary phimosis with recurrent UTI
BXO (balanitis xerotica obliterans)

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29
Q

What is the NNT to prevent UTI for circumcisions?

A

111

therefore not justified as a routine

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30
Q

What are the contraindications for circumcision?

A

acute infection
congenital anomalies
bleeding disorders

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31
Q

What is the complication rate for circumcision?

A

0,2-5%

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32
Q

What is the incidence of hypospadias?

A

1:300 newborn boys

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33
Q

In hypospadias, how many are distal and how many are proximal?

A

Distal 80%

proximal 20%

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34
Q

What factors are associated with hypospadias?

A

Mainly unknown

low birth weight
young and older mothers
vegeterian diet during pregnancy
IVF
some genetic disorders
disorders of sexual differentation
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35
Q

What are the indication for surgical correction of hypospadias?

A

Straighten the penis
Enable standing voiding
Enable normal sexual function
Meatal stenosis correction

cosmetic- foreskin reconstruction

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36
Q

What is the most prevalent procedure for correcting hypospadias?

A

Tubularised incised plate
if proximal, two stage procedure

with buccal or skin behind the ear
(important, skin without hair)

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37
Q

What are longtime complications after hypospadia surgery?

A

urethrocutaneous fistula 7-25%

Stricture/stenosis 5-15%

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38
Q

What is Epispadias?

A

Defect in the dorsal wall of the urethra

together with incontinence and small penis size

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39
Q

What is the incidence of epispadias?

A

1: 120 000 male births

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40
Q

How do you define a micropenis?

A

stretched penis length < 2,5 SD of age specific length

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41
Q

What other conditions are micropenises associated with?

A 
Hypogonadism 
PAIS
Chromosomal abberations
-Klinefelter's syndrome
-Prader- Willis syndrome
Idiopathic
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42
Q

What other investigations should be conducted on a patient with a micropenis?

A

Karyotype
Hormonal analysis
hCG stimulations test
Paediatric endocrinologist

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43
Q

When is surgical intervention varranted for a hydrocele?

A

If persistent >12 months

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44
Q

Differential diagnoses for acute onset scrotal masses:

A 
Torsion
Trauma
Abscess
Orchitis
Epididymnitis
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45
Q

Differential diagnoses for non-acute onset scrotal masses:

A 
Hydrocele
Hernia
Spermatocele
Varicocele
Neoplasia
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46
Q

What is the most common age for testicular torsion?

A

12-20 years

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47
Q

What is the difference between regular testicular torsion and Neonatal testicular torsion?

A

Neonatal testicular torsion can be extravaginal

48
Q

What are the most common viral causes for epididymo-orchitis in children?

A

Adenovirus

Mumps

49
Q

What is Acute Idiopathic scrotal edema?

A

Inflammation, tenderness and swelling of scrotal skin
can extend to the perineum & abdomen

age 2-10
non-tender testis
spntanous resolution <72 hours
UL -thickening of scrotal skin

Colud be an allergic reaction

50
Q

How common is cryptorchidism?

A

3% at birth

1% at 1 year

51
Q

How often is cryptochidism bilateral?

A

30%

52
Q

How often is the testicle palpable in cryptochidism?

A

80%

53
Q

How often is the testicle absent in cryptochidism?

A

of those that are not palpable 20% are without testicle

54
Q

When should cryptiochidism be corrected?

A

Before 1 year of age

55
Q

____ is not necessary for renal scarring to occur

A

renal scarring

56
Q

VCUG after UTI

  1. After 1st UTI with abnormal ____
  2. After ___ UTI without other abnormalities
A

renal u/s

2nd

57
Q

Prescribe prophylactic antibiotics to patients with VUR & ____ or ____

A

febrile UTIS or bowel-bladder dysfunction

58
Q

All newborn males with bilateral undescended testes must undergo workup for ___

A

DSD

59
Q

Providers should not perform ____ in patients with cryptorchidism prior to urologic referral

A

ultrasound/imaging

60
Q

Pulling down a possibly retractile testes into the scrotum for 30 second fatigues the _____ allowing for better assessment

A

cremasteric muscle

61
Q

History of UDT is an independent predictor of ____

A

infertility

unilateral UDT - 10.5% infertility
bilateral UDT - 35% infertility

62
Q

Prepubertal orchiopexy reduces risk of ____

A

testicular cancer

63
Q

Bladder capacity at full term - ___ cc

A

50cc

64
Q

Normal APD diameters on renal u/s

16-28 week: < ____ mm
28 weeks: < ___ mm
2 days+ postnatal:

A

4, 7, 10

65
Q

DMSA binds to ____ cells

A

renal tubule

66
Q

____ is the most common cause of neonatal hydronephrosis

A

UPJ obstruction

67
Q

Epididymitis in prepubertal boy is concerning for ____

A

duplication system with ectopic ureter

68
Q

What is the incidence of renal abnormalities detected on prenatal testing?

A

0.28% -1.4%

69
Q

What is the definition of prenatal hydronephrosis?

A

Anteroposterior diameter greater than 5mm.

70
Q

Large non communicating renal cysts on prenatal US?

A

Multicystic dysplastic kidney

71
Q

Appearance of ARPKD on prenatal US?

A

Highly echogenic kidney

72
Q

What does the keyhole sign mean on perinatal US?

A

Dilated posterior urethra. Posterior urethral valves.

73
Q

Fetus is found to have antenatal hydronephrosis. What is the management?

A

Repeat RUS >48 hours after birth.

74
Q

How should severe ANH be managed?

A

infants with severe ANH should be placed on a prophylactic antibiotic (amoxicillin, 10 to 25 mg/kg/day) and undergo VCUG.

75
Q

What is the management of bilateral ANH?

A

RUS and VCUG promptly after birth

76
Q

What is the most common cause of BL ANH in males?

A

Posterior urethral valves.

77
Q

What is the most common cause of BL ANH in Females?

A

Obstructing ureterocele.

78
Q

What is a type I posterior urethral valve?

A. A fold of tissue running between the bladder neck and verumontanum
B. A membrane of tissue from the verumontanum to the membarnous urethra
C. A diaphragm of tissue with a central lumen at the level of the membranous urethra
D. A membrane of tissue from the proximal verumontanum dorsally to the bladder neck

A

B. A membrane of tissue from the verumontanum to the membarnous urethra

79
Q

What is most commonly affected by a ureteral ectopia in a duplicated system?

A. The ureters of both poles of the kidneys
B. The ureter of the upper pole of the kidney
C. The ureter of the lower pole of the kidney
D. There is no rule in this type of malformation

A

B. The ureter of the upper pole of the kidney

80
Q

When does urine production begin in the human fetus?

A. At 2 to 3 weeks
B. At 4 to 6 weeks
C. At 10 to 12 weeks
D. At 14 to 16 weeks

A

C. At 10 to 12 weeks

81
Q

What is the approximate incidence of hypospadias?

A. 1 to 125
B. 1 to 250
C. 1 to 500
D. 1 to 1000

A

B. 1 to 250

82
Q

The SIOP guidelines for the treatment of a Wilms’ tumour are chronologically as follows:

A. First radiation treatment, then surgery and then chemotherapy
B. First surgery, then chemotherapy and then radiation treatment
C. First chemotherapy, then surgery and then radiation treatment
D. First chemotherapy, then surgery and then chemotherapy again

A

D. First chemotherapy, then surgery and then chemotherapy again

83
Q

A 14-year-old wheelchair-bound girl with a myelo-meningocele has urinary and faecl incontinence. She is on clean intermittent catheterisation and anticholinergics. Bladder capacity is 150 mL, leak point pressure is 60 cm H2O, no reflux. What is the most appropriate management?

A. Bladder augmentation and cathererisable stoma and eppendicostomy (ACE)
B. Bladder augmentation
C. Bladder augmentation and bladder neck reconstruction and catheterisable stoma
D. Appendicostomy (ACE)

A

A. Bladder augmentation and cathererisable stoma and eppendicostomy (ACE)

84
Q

Which is the most likely diagnosis in a dehydrated neonate with cyanotic heart disease, a hight red blood count, hematuria and a palpable renal mass?

A. Wilms’ tumour
B. Polycystic kidney
C. Renal vein thrombisis
D. Congenital hydronephrosis

A

C. Renal vein thrombisis

85
Q

A newborn infant presents with episodes of vomiting, dehydration, cyanosis. He shows severe electrolyte and water imbalances. A small penis with chordee, proximal hypospadias and bilateral impalpable testicles are noted. The most probable diagnosis is:

A. Adrenogenital syndrome
B. Hypospadias with renal dysplasia
C. Hypospadias and polycystic kidneys
D. Obstructive uropathy associated with hypospadias

A

A. Adrenogenital syndrome

86
Q

Distal hypospadias in a boy is usually:

A. Associated with renal abnormalities
B. Treated at the age of 6-18months
C. Treated by multiple stage operations
D. Diagnosed before birth by ultrasonography

A

B. Treated at the age of 6-18months

87
Q

By which triad of findings is the prune-belly syndrome in boys characterized?

A. Reflux, hypspadias, undescended testicles
B. Vesical extrophy, undescended testicles, reflux
C. Vesical extrophy, reflux, hypoplasia of the abdominal wall
D. Reflux, undescended testicles, hypoplasia of the abdominal wall

A

D. Reflux, undescended testicles, hypoplasia of the abdominal wall

88
Q

When should the urinary tract be screened in a boy with hypospadias?

A. In every case
B. In case of an esophageal atresia
C. With unilateral undescended testis
D. In case of midshaft hypospadias

A

B. In case of an esophageal atresia

89
Q

What is needed for the development of the Wolffian duct deriviatives in the 46XY fetus?

A. Testosterone
B. 5-α-reductase
C. Dihydrotestosterone
D. Müllerian inhibiting factor

A

A. Testosterone

90
Q

Which condition has been reported to occur in association with posterior urethral valves?

A. Exomphalos
B. Hypospadiass
C. Cryptorchidism
D. Orthotopic ureterocele

A

C. Cryptorchidism

91
Q

In a young boy with acute scrotum which is more suggestive for testicular torsion?

A. Presence of hydrocele
B. Elevation of the scrotum may reduce complaints
C. Presence of fever
D. Loss of cremaster reflex

A

D. Loss of cremaster reflex

92
Q

Which is the most successful method of varicocele treatment in adolescents?

A. Antegrade sclerosation
B. Microsurgical inguinal ligation
C. Laparoscopic ligation
D. Lymphatic sparing suprainguinal ligation

A

B. Microsurgical inguinal ligation

93
Q

In an 8-month-old severely ill girl suffering from a proven first febrile urinary tract infection, what is the first advisable diagnostic modality?

A. Renal and bladder ultrasound
B. Voiding cystourethrography (VCUG)
C. Mercaptoacetytriglycin (MAG3) scan
D. Dimercaptosuccinic acid (DMSA) scan

A

A. Renal and bladder ultrasound

94
Q

When should intermittent catheterization and antimuscarinic treatment be started in children with neurogenic bladder and bowel emptying problems?

A. Soon after birth
B. In infancy
C. Before puberty
D. If upper tract deterioration is present

A

A. Soon after birth

95
Q

According to the EAU guidelines congenital penile curvature is:

A. Commonly associated with urethra malformation
B. Most commonly dorsally deviated
C. Always ventrally deviated
D. Sometimes laterally deviated

A

D. Sometimes laterally deviated

96
Q

What is the incidence of posterior urethral valves?

A. 1 in 3 000
B. 1 in 7 000
C. 1 in 10 000
D. 1 in 50 000

A

B. 1 in 7 000

97
Q

Which is an indication to recommend adolescent varicocelectomy?

A. Grade 2 right-sided varicocele
B. Varicocele associated with hydrocele
C. Ipsilateral testicular hypoplasia
D. Grade 3 varicocele with normal sperm parameters

A

C. Ipsilateral testicular hypoplasia

98
Q

Which of the following DSD conditions has the highest risk for the development of a malignant germ cell tumour?

A. 45X0 Turners syndrome
B. 47XXY Klinefelters syndrome
C. 46XY complete gonadal dysgenesis
D. 46XX congenital adrenal hyperplasia

A

C. 46XY complete gonadal dysgenesis

99
Q

Vesico-amniotic shunting during pregnancy:

A. Has no effect on lung function
B. Is associated with significant morbidity
C. Is offered routinely in cases of posterior urethral valves
D. Has improved long-term outcomes in boys with posterior urethral valves

A

B. Is associated with significant morbidity

100
Q

During pregnancy an US at 20 weeks gestation shows normal amniotic fluid and a significant hydronephrosis on the left side. At 32 seeks the US shows the same hydronephrosis:

A. The parents have to be counseled and offered drainage of the left kidney
B. If the pulmonary situation allows, early delivery should be promoted around week 36-38
C. No specific measures are necessary and the baby should be delivered at term
D. After delivery an US study of the kidneys should be done on day 1 or 2

A

C. No specific measures are necessary and the baby should be delivered at term

101
Q

The age and the appearance of a child with a Wilms’ tumour is most frequently as follows:

A. A 3-year old who looks very ill
B. A 7-year old who looks very ill
C. A 3-year old who does not look ill
D. A 7-year old who does not look ill

A

C. A 3-year old who does not look ill

102
Q

What is the most common cause of bladder outflow obstrucion in males during the neonaltal and infancy period?

A. Vesico-ureteral reflux
B. Posterior urethral valves
C. Urethral congenital stricture
D. Hypospadis

A

B. Posterior urethral valves

103
Q

The urachus involutes to become:

A. The appendix testes
B. The veru montanum
C. The lateral umbilical folds
D. The median umbilical ligament

A

D. The median umbilical ligament

104
Q

At what age should surgery be carried out for boys with undescended testes?

A. At birth
B. Around 6 months of age
C. Around 12 months of age
D At 2 years of age

A

C. Around 12 months of age

105
Q

Complete double urethers are seen when:

A. Two metanephric blastema develop
B. Two ureteric buds arise from the mesonephric duct
C. A single ureteric bud divides into two parts
D. Two mesonephric ducts arise from urogenital sinus

A

B. Two ureteric buds arise from the mesonephric duct

106
Q

Which of the following possible abnormalities is most commonly found in a complete duplex system?

A. VUR in both ureters
B. Obstruction in both ureters
C. VUR in the lower pole moiety
D. Veisco-ureteral reflux (VUR) in the upper pole moiety

A

C. VUR in the lower pole moiety

107
Q

Which radiopharmaceutical is the agent of choice for demonstrating renal scarring in childhood?

A. 99m Tc-DPTA
B. 99m Tc-DMSA
C. 99m Tc-MAG3
D. 99m Tc Gluconate

A

B. 99m Tc-DMSA

108
Q

A 10-month-old otherwise normal boy underwent a pyeloplasty. In the immediate postoperative phase the amount of fluid for intravenous maintenance is:

A. 25 ml/kg/24hr
B. 50 ml/kg/24hr
C. 100 ml/kg/24hr
D. 200 ml/kg/24hr

A

C. 100 ml/kg/24hr

109
Q

After having one child with hypospadias, what is the relative risk for a couple of giving birth to another child with hypospadias?

A. Approxiamately 1%
B. Approxiamately 17%
C. Approxiamately 42%
D. Approxiamately 62%

A

B. Approxiamately 17%

110
Q

Which gene does NOT play a role in the development of hypospadias?

A. Wilm’s tumor gene 1 (WT1)
B. Sonic hedgehehog gene (SHH)
C. Homeox gene a13 (HOXa13)
D. Fibroblast growth factor 8 (FGF8)

A

A. Wilm’s tumor gene 1 (WT1)

111
Q

In a 13-year-old girl with urinary incontinence since birth the diaper test shows a continuous leakage of urine with low volume. What is the most likely diagnosis?

A. Lazy bladder
B. Ectopic ureter
C. Vaginal pooling
D. Urge syndrome

A

B. Ectopic ureter

112
Q

The most accurate diagnosis in acute scrotum in children is provided by:

A. CT-scan
B. Doppler-ultrasound
C. operative exploration
D. Testicular nuclear scan

A

C. operative exploration

113
Q

What is the main cause of nocturnal enuresis in children?

A. An imbalance of urine production and bladder capacity
B. An insufficient nocturnal ADH secretion
C. A problem of high arousal combined with either a high night-time urine production or a night-time OAB (or both)
D. A delay in maturity of the pontine micturition center in combination with an insufficient nocturnal ADH secretion

A

C. A problem of high arousal combined with either a high night-time urine production or a night-time OAB (or both)

114
Q

Which patients should be categorised as “high”-risk for vesicoureteral reflux (VUR) and be advised open surgery (ureteral reimplantation) rather than endoscopic surgery or antibiotic prophylaxis?

A. Toilet-trained boys and girls with low-grade VUR and lower urinary tract and bowel symptoms
B. Small, not toilet-trained boys and girls with bilateral high-grade (4-5) VUR and unilateral renal damage
C. Small, not toilet-trained boys and girls with bilateral high-grade (4-5) VUR and bilateral renal damage
D. Toilet-trained boys and girls with high-grade reflux, recurrent UTI, unilateral renal damage and unilateral high-grade (4-5) VUR

A

D. Toilet-trained boys and girls with high-grade reflux, recurrent UTI, unilateral renal damage and unilateral high-grade (4-5) VUR

115
Q

A patient experienced an anaphylactic reaction to chlorhexidine. What may be unsafe to use during a future cystoscopy?

A. Antibiotics
B. Sterile water
C. Local /topical anaesthetic
D. Water soluble iodine based skin preparation

A

C. Local /topical anaesthetic

12. UroPed (1583) (13 decks)

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