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Summer Disciplines 3 > Peds GU > Flashcards

Peds GU Flashcards

1
Q

Who are peds UTI more common in

A

women
UN-circumcised men
RF: constipation, vesicoureteral reflux, urinary tract obstruction, neurogenic bladder, poor perineal hygiene, structure abn, cath, sexual activity

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2
Q

MC UTI organisms are

A

*E. Coli!
Enterococcus (catheter)
Klebsiella, Proteus, other gram - bacteria

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3
Q

Sx of UTI are

A

Newborn: Fever*, poor feeding, irritable, jaundice, vomiting, sepsis, hypothermia +/- foul smelling/cloudy urine
Pre-school: abd/flank pain, frequency, dysuria, urgency (CVA ttp unusual this young unless it’s pyelo)
School age: *frequency, *dysuria, *urgency (pyelo has flank pain and fever)

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4
Q

How do you diagnose UTI

A

Clean catch UA: pyuria >5 WBC, Nitrite (unless young kids, neg. nitrite)
Gold: Urine culture***
Infants/not potty trained: Cath

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5
Q

What is a proper specimen for culture

A

Midstream clean catch
Separate labia
Retract foreskin

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6
Q

How do you Tx a UTI

A

<3 mo, septic, dehydrated: Admit for IV Abx

Older: Empiric Amoxicillin, Bactrim, or Keflex x 7-10 days

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7
Q

What is vesicoureteral reflux

A

Reflux of urine from bladder into ureter/upper urinary tract
30% of kids w/ febrile UTI
MC in white and females, <2 y/o

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8
Q

Explain Primary vs Secondary VUR

A

Primary: congenitally short ureter (MC)
Secondary: blockage from urogenic bladder or anatomic dysfunction

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9
Q

What are Sx of VUR

A

prenatal: hydronephrosis on US
postnatal: febrile UTI

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10
Q

How do you diagnose VUR

A

prenatal: US showing hydronephrosis. if unilateral, repeat US when 1 week old. if bilateral, repeat US and VCUG
postnatal: renal and bladder US if w/ UTI. VCUG** if febrile UTI

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11
Q

What are the grades of VCUG reflux

A

Grade I: reflux into ureter, no dilation
II: reflux to kidneys
III: reflux to kidneys with ureter dilation
IV: reflux w/ dilation of ureter, mild renal calyces blunting
V: reflux w/ dilation of ureter and blunting of reflux calyces

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12
Q

How do you treat VUR

A

I&II: spontaneous resolution by 5 y/o. +/- prophylactic Abx
III-V: Bactrim or Macrobid prophylaxis (d/c when VUR resolves) regardless of age
Last: surgical correction if grade V reflux w/ scarring, or IV-V persistence in >2-3 y/o, or if meds fail at any age

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13
Q

What are posterior urethral valves

A

obstructing membranous folds in lumen of posterior urethra, obstruct normal urine flow
MC in males

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14
Q

How do you diagnose PUV

A

Prenatal US: bilateral hydronephrosis (distended and thick bladder) +/- oligohydramnios
Postnatal: VCUG shows dilated and elongated posterior urethra during voiding phase

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15
Q

How do postnatal PUV present

A

oligohydramnios= high risk lung hypoplasia
FTT, distended abdomen, poor urinary system
Older boys: strain to urinate, UTI, day and night enuresis

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16
Q

How do you treat PUV

A

prenatal: experimental surgery in utero (shunt placement)
postnatal: correct electrolyte abn, foley catheter, transurethral catheter ablation of valve

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17
Q

PUV follow up includes

A

+/- clean intermittent cath-ing if w/ bladder dysfunction
Monitor for renal failure
Monitor for UTI

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18
Q

What are definitions from ICCS

A

daytime frequency: 8+ voids during waking hours
Incontinence: uncontrolled leakage
Urgency: sudden unexpected need to void
Nocturia: waking at night to void
Hesitancy: hard to initiate void
Straining: need abdominal pressure to initiate void
Dysuria: burning or discomfort during peeing

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19
Q

What is Enuresis

A

Repeat urination into clothing in 5+ y/o (Diurnal or Nocturnal) 2x week for min. 3 months
Primary: kids that have never been dry through the night
Secondary: resume wetting s/p 6 mo of nighttime dryness

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20
Q

RF for nocturnal enuresis are

A

Constipation*
FHx
Sleep apnea
Psychological (MC in secondary)

21
Q

How do you diagnose nocturnal enuresis

A

H&P to r/o underlying cause

UA (specific gravity and cultures) esp in girls

22
Q

How do you treat nocturnal enuresis

A 
Pt Ed (don't be judgmental as parent) 
limit liquids before sleep 
wake child at night 
bedwetting alarm* for 3 months minimum 
Last: Desmopressin acetate (short term),  Imipramine (high risk ADE)
23
Q

What is daytime urinary incontinence

A

wetting accident once q2 weeks, prevalence decreases with age
RF: female, Hx of nocturnal enuresis, UTI, Encoparesis

24
Q

Daytime urinary incontinence is associated with

A

Overactive bladder
Voiding postponement and under-active bladder
Dysfunctional voiding

25
How do you Dx daytime urinary incontinence
``` voiding diary VCUG US MRI spine Abd XR Refer to urology, nephrology, and neurosurg ```
26
How do you treat daytime urinary incontinence
Direct at underlying pathology Behavioral therapy Anticholinergics (Oxybutynin) (TCA do NOT work!!!)
27
What is Exstrophy of the bladder
an open, inside out bladder with exposed urethra and low set umbilicus, and anteriorly displaced anus MC in white and first born Risk of hip dysplasia and genital defects (more severe in boys)
28
How do you diagnose Exstrophy of bladder
prenatal US, confirm with MRI | Or diagnosed at birth if missed prenatally
29
How do you treat Exstrophy of bladder
Induced vaginal delivery or planned C section | Surgical repair after stabilization
30
What is hypospadias
Ventral placement of urethral opening (cause is unknown) Urethral folds fail to completely close Associated with chordee (curved), cryptorchidism, and inguinal hernia
31
With hypospadias, do NOT
Circumcise! we need the foreskin for repair
32
How is hypospadias diagnosed
Newborn physical: abnormal foreskin, curvature, and presence of "2" urethral openings
33
How do you Tx hypospadias
Isolated: repair before 18 months old w/ crypto: need more work up (pelvic US, karyotype, serum lytes for low Na high K) 2/2 increased risk for d/o of sex development
34
What is cryptorchidism
a hidden or undescended testicle | at risk for infertility and testicular malignancy
35
How do you diagnose cryptorchidism
clinically on newborn exam 2-6 mo: measure LH, FSH, inhibin B, and testosterone HCG stimulation test
36
How do you treat cryptorchidism
surgery if not descended by 6-12 months If palpable, orchipexy Not palpable, exploratory surgery
37
What is testicular torsion
twisting of testes on spermatic cord, testis inadequately fixed to tunica vaginalis (bell clapper deformity*) Causes venous compression, edema and ischemia of testicle
38
When is testicular torsion MC
Bimodal: | Neonatal (less common) and Puberty (MC 12-18)
39
Sx of testicular torsion are
Abrupt onset severe testicular or scrotal pain N/V Swollen scrotum Tender, swollen, elevated testes Doppler shows Decreased perfusion No cremasteric reflex NO phren sign (pain relief with elevation of testis)
40
How do you Tx torsion
Detorsion and fixation (orchiopexy) of both testis if viable Non-viable: orchiectomy Manual detorsion can be done before scrotal swelling under appropriate analgesia (open the book)
41
How do you know if a testicle is viable when torsed
4-6 hours: 100% viable >12 hours: 20% viable >24 hours: 0% viable
42
What is a hydrocele
peritoneal fluid collects between parietal and visceral layers of tunica vaginalis Common in newborns but may be concerning in older kids Should resolve by 1st bday Looks like a cystic scrotal mass
43
Difference between communicating and non-communicating hydrocele
Comm: results from failure of processus vaginalis to close during development, so fluid from peritoneum leaks in Non: fluid comes from mesothelial lining of tunica vaginalis, NOT connected to peritoneum. Work up epididymitis, orchitis, torsion, trauma
44
How do you diagnose a hydrocele
Transilluminate scrotum Doppler US Comm: increases during the day or w/ valsalva, crying, screaming Non-comm: never change in size
45
How do you treat a hydrocele
Surgical repair if: persist beyond 1 y/o communicating (but elective) idiopathic, Sx hydroceles that compromise skin integrity
46
What is a varicocele
dilated, tortuous veins around spermatic cord | MC on LEFT (bc R sperm vain drins directly into IVC while left sperm vein goes to left renal vein then IVC)
47
Sx of a varicocele are
ASx dull ache to scrotum on standing Palpable bag of worms
48
How do you Tx a varicocele
``` Persistent in supine or R sided: r/o IVC obstruction w/ Doppler (thrombus, abd mass, etc.) Manage conservatively (obs) Surgical ligation/testicular vein embolization to alleviate pain, heaviness, and swelling, or if bilateral ```

Summer Disciplines 3 (9 decks)

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