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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
Q

How do you Dx daytime urinary incontinence

A 
voiding diary 
VCUG
US
MRI spine 
Abd XR 
Refer to urology, nephrology, and neurosurg
26
Q

How do you treat daytime urinary incontinence

A

Direct at underlying pathology
Behavioral therapy
Anticholinergics (Oxybutynin)
(TCA do NOT work!!!)

27
Q

What is Exstrophy of the bladder

A

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
Q

How do you diagnose Exstrophy of bladder

A

prenatal US, confirm with MRI

Or diagnosed at birth if missed prenatally

29
Q

How do you treat Exstrophy of bladder

A

Induced vaginal delivery or planned C section

Surgical repair after stabilization

30
Q

What is hypospadias

A

Ventral placement of urethral opening (cause is unknown)
Urethral folds fail to completely close
Associated with chordee (curved), cryptorchidism, and inguinal hernia

31
Q

With hypospadias, do NOT

A

Circumcise! we need the foreskin for repair

32
Q

How is hypospadias diagnosed

A

Newborn physical: abnormal foreskin, curvature, and presence of “2” urethral openings

33
Q

How do you Tx hypospadias

A

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
Q

What is cryptorchidism

A

a hidden or undescended testicle

at risk for infertility and testicular malignancy

35
Q

How do you diagnose cryptorchidism

A

clinically on newborn exam
2-6 mo: measure LH, FSH, inhibin B, and testosterone
HCG stimulation test

36
Q

How do you treat cryptorchidism

A

surgery if not descended by 6-12 months
If palpable, orchipexy
Not palpable, exploratory surgery

37
Q

What is testicular torsion

A

twisting of testes on spermatic cord, testis inadequately fixed to tunica vaginalis (bell clapper deformity*)
Causes venous compression, edema and ischemia of testicle

38
Q

When is testicular torsion MC

A

Bimodal:

Neonatal (less common) and Puberty (MC 12-18)

39
Q

Sx of testicular torsion are

A

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
Q

How do you Tx torsion

A

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
Q

How do you know if a testicle is viable when torsed

A

4-6 hours: 100% viable
>12 hours: 20% viable
>24 hours: 0% viable

42
Q

What is a hydrocele

A

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
Q

Difference between communicating and non-communicating hydrocele

A

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
Q

How do you diagnose a hydrocele

A

Transilluminate scrotum
Doppler US
Comm: increases during the day or w/ valsalva, crying, screaming
Non-comm: never change in size

45
Q

How do you treat a hydrocele

A

Surgical repair if:
persist beyond 1 y/o
communicating (but elective)
idiopathic, Sx hydroceles that compromise skin integrity

46
Q

What is a varicocele

A

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
Q

Sx of a varicocele are

A

ASx
dull ache to scrotum on standing
Palpable bag of worms

48
Q

How do you Tx a varicocele

A 
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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