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pediatrics II > pediatric urology > Flashcards

pediatric urology Flashcards

1
Q

differentiate between dorsal and ventral aspect of penis

A
  • dorsum: superior surface of penis
  • ventral: underside of penis
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2
Q

phimosis

A

the inability to retract the foreskin

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3
Q

Define physiologic phimosis. When is foreskin able to be retracted?

A
  • normal state where foreskin adheres to the glans
  • adhesions decrease with age naturally
  • incidence of fully retractable foreskin: 50% by age 10 yr, 99% by age 12 yr
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4
Q

define pathologic phimosis

A

truly non-retractable foreskin due to scarring, fibrosis that occurs secondary to infections or inflammation, or early forcible retraction

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5
Q

clinical presentation

  • secondary non-retractability after having had fully retractable foreskin
  • painful erection
  • irritation or bleeding
  • dysuria
  • recurrent infections (UTI)
A

phimosis

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6
Q

treatment options for phimosis

A
  • stretching exercises
  • topical corticosteriod (betamethasone)
  • circumcision
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7
Q

for how long should parents not try to retract foreskin on infant

A
  • do not retract foreskin < 6 months
  • gentle retraction > 6 mo
  • cleaning with mild soap and water
  • return foreskin to natural position after cleaning
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8
Q

paraphimosis

A

retracted foreskin in an uncircumsized male that cannot be returned to natural position

  • pathophys:
    • entrapment -> impaired venous flow -> engorgement -> arterial compromise
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9
Q

clinical presentation

  • swelling of penis
  • penile pain
  • edema and tenderness of glans
  • painful swelling of distal retracted foreskin
  • penile shaft flaccid and unaffected
A

paraphimosis

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10
Q

name two common circumcision types

A
  1. Gomco
  2. Plastibell
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11
Q

hypospadias

A

congenital anomaly that results in the abnormal ventral displacement of the urethra

  • occurs in less than 1% of live births
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12
Q

hypospadias can present with an abnormal penile curvature upward or downward known as

A

chordee

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13
Q

treatment for hypospadias and chordee

A
  • circumcision NOT to be done during the newborn period
  • surgery by urology performed at 6 months
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14
Q

Cryptorchidism

A

a testis that is not within the scrotum and does not spontaneously descend into the scrotum by 4 months of age

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15
Q

what percentage of cryptorchidism resolve spontaneously

A

70%

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16
Q

cryptorchidism may increase risk of ?

A
  1. testicular torsion (10x more common)
  2. subfertility (improves if corrected before 1 yr of age)
  3. testicular CA
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17
Q

cryptorchidism: retractile testes

A

overactive cremasteric reflex pulls testis back inside

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18
Q

cryptorchidism: undescended testes

A

stopped short along normal path of descent

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19
Q

cryptorchidism, most common location of testes

A

suprascrotal

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20
Q

spontaneous descent of testes in cryptorchidism is rare after what age

A

6 months of age

  • usually descend by 2-3 months of age
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21
Q

treatment of cryptorchidism

A
  1. watchful waiting for spontaneous descent
  2. surgery recommended as soon after 6 months as possible if undescended
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22
Q

indications for referral when you diagnose cryptorchidism

A
  1. congenital palpable or nonpalpable undescended testes
  2. ascending testes in boys beyond infancy
  3. atrophic testes
  4. difficulty differentiating between undescended, retractile, or ectopic testis (at any age)
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23
Q

testicular torsion

A
  • twisting of the spermatic cord due to a poorly anchored testicle (should be attached to tunica vaginalis) that may result in vascular compromise
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24
Q

peak period of incidence of testicular torsion

A
  1. neonatal period
  2. puberty
25
Q

neonatal testicular torsion is what type

A

extravaginal

26
Q

clinical presentation

  • abrupt onset of severe testicular or scrotal pain, may radiate
  • pain usually constant
  • nausea and vomiting (90%)
  • edematous indurated erythematous scrotum
  • absent cremasteric reflex
  • negative prehn’s sign
A

testicular torsion

27
Q

Prehn’s sign

A

relief of pain with elevation of scrotum

  • can be positive in epididymitis
  • negative in testicular torsion
28
Q

test of choice to confirm testicular torsion

A

doppler ultrasound

29
Q

treatment of testicular torsion

A
  • immediate urology consult
  • surgical detorsion and fixation (orchiopexy) of both testes
    • detorsion within 4-6 hrs: 100% viable
    • detorsion within 12 hrs: 20% viable
30
Q

primary etiology of UTI

A

E-coli

31
Q

risk factors UTI

A
  • female
  • sexual activity
  • bladder catheterization
  • VUR: Vesico Ureteral Reflux
  • bowel and bladder dysfunction
32
Q

physical exam of possible UTI should include what two important things

A
  • BP
  • costovertebral tenderness
33
Q

what are required for diagnosis of UTI

A
  • UA
  • culture
34
Q

what can be positive in a UA if UTI is present

A
    • leukocyte esterase
    • nitrite (produced from gram negative rods)
35
Q

what must you do if you suspect a neonate has UTI

A

full septic workup (especially if febrile)

36
Q

treatment of UTI

A
  • choice of route: oral or parenteral is equally efficacious
  • choice of drug: begin with empiric therapy and adjust once you recieve sensitivity results
    • amoxicillin
    • augmentin
    • cephalosporin
    • bactrim
  • duration of treatment: 7-14 days
37
Q

what is the first line imaging study in UTI if indicated

A

renal and bladder ultrasound (RBUS)

38
Q

when is a renal and bladder ultrasound indicated with diagnosis of UTI

A
  • children younger than 2 y.o with first febrile UTI
  • children of any age with recurrent UTI
  • children with UTI and a + FH of renal or urologic dz, poor growth, or HTN
  • children who do not respond as expected to appropriate Abx therapy
39
Q

what is the test of choice to detect VUR (vesicoureteral reflux)

A

voiding cystourethrogram (VCUG)

  • should be done if any abnormality detected on RBUS
40
Q

vesicoureteral reflux

A

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

  • occurs in 30-45% of children with UTI
41
Q

management of vesicoureteral reflux

A
  • some cases ma spontaneously resolve (5-6 yrs)
  • low dose prophylactic Abx
  • surgical options
  • aggressive screening with UA if symptoms of UTI
42
Q

Enuresis

A

accidents occurring after successful potty-training

43
Q

diurnal Enuresis

A

accidents during the day (abnormal after 4 yo)

44
Q

treatment for Enuresis

A
  • behavioral modification vs pharmacology
    • timed voiding to cycle bladder
    • restrict fluids 90 min prior to bed
    • constipation management
    • DDAVP (synthetic ADH)
45
Q

when is noctural Enuresis abnormal

A
  • girls: after 5 yo
  • boys: after 6 yo
46
Q

differential for hematuria

A
  • UTI
  • meatal or perineal irritation
  • trauma
  • glomerular disease
  • menses, pyridium use, food dyes, beeturia
47
Q

PE for hematuria

A
  • BP
  • evaluate for periorbital or peripheral edema
  • skin exam (purpura)
  • CVA tenderness
  • visualize genitals
  • abdominal exam (discomfort or masses)
48
Q

abnormal Ca/Cr ratio. what does this check

A
  • > .20
  • renal stones
49
Q

clinical presentation

  • gross hematuria
  • increased serum creatinine
  • edema (peri-orbital, peripheral)
  • HTN
  • dark colored urine
A

glomerular disease

50
Q

clinical presentation

  • occurs 7-14 days after acute illness (group A B hemolytic strep)
  • cola-colored urine
  • some degree of renal insufficiency
    • ASO titer
  • complement (C3,C4) depressed
A

post-infectious glomerulonephritis

51
Q

Henoch-Schonlein Purpura

A
  • IgA auto-immune response to infectious process
  • may occur post URI
52
Q

clinical presentation

  • abdominal pain
  • +/- blood diarrhea
  • typical maculopapular purpuric rash on posterior thighs, legs, and buttocks
  • asymptomatic microhematuria most common
  • can have renal failure
A

Henoch-Schonlein Purpura

53
Q

what is the most common glomerular vascular case of actue renal failure in childhood

A

hemolytic uremic syndrome

54
Q

hemolytic uremic syndrome is associated with what infection

A

E coli O157:H7

55
Q

clinical presentation

  • bloody diarrhea
  • hemolysis
  • renal failure
  • electrolyte abnormalities can cause neurological problems including sz
A

hemolytic uremic syndrome

56
Q

alport syndrome

A
  • hereditary glomerulonephritis
  • autosomal dominant, X linked (M > F)
    • FH of end stage renal failure
57
Q

clinical presentation

  • microhematuria
  • proteinuria
  • HTN
  • deafness
  • visual disturbances
A

alport syndrome

58
Q

Proteinuria: Nephrotic syndrome: name four main characteristics

A
  • definition: renal disease causes massive renal protein loss that exceeds liver capacity to produce albumin
  • Nephrotic range proteinuria
  • Hypoalbuminemia
  • Edema (usually face)
  • Hyperlipidemia
59
Q

normal protein/creatinine ratio

A

< 0.20 mg protein to mg creatinine

pediatrics II (4 decks)

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