pediatric urology Flashcards
1
Q
differentiate between dorsal and ventral aspect of penis
A
- dorsum: superior surface of penis
- ventral: underside of penis
2
Q
phimosis
A
the inability to retract the foreskin
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
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
5
Q
clinical presentation
- secondary non-retractability after having had fully retractable foreskin
- painful erection
- irritation or bleeding
- dysuria
- recurrent infections (UTI)
A
phimosis
6
Q
treatment options for phimosis
A
- stretching exercises
- topical corticosteriod (betamethasone)
- circumcision
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
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
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
10
Q
name two common circumcision types
A
- Gomco
- Plastibell
11
Q
hypospadias
A
congenital anomaly that results in the abnormal ventral displacement of the urethra
- occurs in less than 1% of live births
12
Q
hypospadias can present with an abnormal penile curvature upward or downward known as
A
chordee
13
Q
treatment for hypospadias and chordee
A
- circumcision NOT to be done during the newborn period
- surgery by urology performed at 6 months
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
15
Q
what percentage of cryptorchidism resolve spontaneously
A
70%
16
Q
cryptorchidism may increase risk of ?
A
- testicular torsion (10x more common)
- subfertility (improves if corrected before 1 yr of age)
- testicular CA
17
Q
cryptorchidism: retractile testes
A
overactive cremasteric reflex pulls testis back inside
18
Q
cryptorchidism: undescended testes
A
stopped short along normal path of descent
19
Q
cryptorchidism, most common location of testes
A
suprascrotal
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
21
Q
treatment of cryptorchidism
A
- watchful waiting for spontaneous descent
- surgery recommended as soon after 6 months as possible if undescended
22
Q
indications for referral when you diagnose cryptorchidism
A
- congenital palpable or nonpalpable undescended testes
- ascending testes in boys beyond infancy
- atrophic testes
- difficulty differentiating between undescended, retractile, or ectopic testis (at any age)
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
24
Q
peak period of incidence of testicular torsion
A
- neonatal period
- puberty
25
neonatal testicular torsion is what type
extravaginal
26
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
testicular torsion
27
Prehn's sign
relief of pain with elevation of scrotum
* can be positive in epididymitis
* negative in testicular torsion
28
test of choice to confirm testicular torsion
doppler ultrasound
29
treatment of testicular torsion
* 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
primary etiology of UTI
E-coli
31
risk factors UTI
* female
* sexual activity
* bladder catheterization
* VUR: Vesico Ureteral Reflux
* bowel and bladder dysfunction
32
physical exam of possible UTI should include what two important things
* BP
* costovertebral tenderness
33
what are required for diagnosis of UTI
* UA
* culture
34
what can be positive in a UA if UTI is present
* + leukocyte esterase
* + nitrite (produced from gram negative rods)
35
what must you do if you suspect a neonate has UTI
full septic workup (especially if febrile)
36
treatment of UTI
* 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
what is the first line imaging study in UTI if indicated
renal and bladder ultrasound (RBUS)
38
when is a renal and bladder ultrasound indicated with diagnosis of UTI
* 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
what is the test of choice to detect VUR (vesicoureteral reflux)
voiding cystourethrogram (VCUG)
* should be done if any abnormality detected on RBUS
40
vesicoureteral reflux
retrograde flow of urine from the bladder into the upper urinary tract
* occurs in 30-45% of children with UTI
41
management of vesicoureteral reflux
* some cases ma spontaneously resolve (5-6 yrs)
* low dose prophylactic Abx
* surgical options
* aggressive screening with UA if symptoms of UTI
42
Enuresis
accidents occurring after successful potty-training
43
diurnal Enuresis
accidents during the day (abnormal after 4 yo)
44
treatment for Enuresis
* behavioral modification vs pharmacology
* timed voiding to cycle bladder
* restrict fluids 90 min prior to bed
* constipation management
* _DDAVP_ (synthetic ADH)
45
when is noctural Enuresis abnormal
* girls: after 5 yo
* boys: after 6 yo
46
differential for hematuria
* UTI
* meatal or perineal irritation
* trauma
* glomerular disease
* menses, pyridium use, food dyes, beeturia
47
PE for hematuria
* BP
* evaluate for periorbital or peripheral edema
* skin exam (purpura)
* CVA tenderness
* visualize genitals
* abdominal exam (discomfort or masses)
48
abnormal Ca/Cr ratio. what does this check
* \> .20
* renal stones
49
clinical presentation
* gross hematuria
* increased serum creatinine
* edema (peri-orbital, peripheral)
* HTN
* dark colored urine
glomerular disease
50
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
post-infectious glomerulonephritis
51
Henoch-Schonlein Purpura
* IgA auto-immune response to infectious process
* may occur post URI
52
clinical presentation
* abdominal pain
* +/- blood diarrhea
* typical maculopapular purpuric rash on posterior thighs, legs, and buttocks
* asymptomatic microhematuria most common
* can have renal failure
Henoch-Schonlein Purpura
53
what is the most common glomerular vascular case of actue renal failure in childhood
hemolytic uremic syndrome
54
hemolytic uremic syndrome is associated with what infection
E coli O157:H7
55
clinical presentation
* bloody diarrhea
* hemolysis
* renal failure
* electrolyte abnormalities can cause neurological problems including sz
hemolytic uremic syndrome
56
alport syndrome
* hereditary glomerulonephritis
* autosomal dominant, X linked (M \> F)
* + FH of end stage renal failure
57
clinical presentation
* microhematuria
* proteinuria
* HTN
* deafness
* visual disturbances
alport syndrome
58
Proteinuria: Nephrotic syndrome: name four main characteristics
* definition: renal disease causes massive renal protein loss that exceeds liver capacity to produce albumin
* Nephrotic range proteinuria
* Hypoalbuminemia
* Edema (usually face)
* Hyperlipidemia
59
normal protein/creatinine ratio
\< 0.20 mg protein to mg creatinine
