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1. Disciplines 2 > Peds GU > Flashcards

Peds GU Flashcards

1
Q

What are UTI RFs?

A 
Constipation 
VUR 
Obstruction
Neurogenic bladder
Poor hygiene
Catherization 
Sexual activity
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2
Q

What are the classic s/s of cystitis in school aged children?

A

frequency, dysuria, urgency, flank pain

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3
Q

How do you dx UTI? What is gold standard?

A

UA: pyuria, nitrite

Gold = urine culture

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4
Q

How do you treat a UTI?

A

< 3mo old –> IV abx

Older infant/child –> amoxicillin, TMP-SXM, 1st gen ceph

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5
Q

What is vesicoureteral reflux (VUR)?

A

Reflux of urine from bladder into ureter/upper urinary tract

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6
Q

VUR is most common in what population?

A

White females

30-45% of children w/ febrile UTI

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7
Q

What are the 2 types of VUR?

A

Primary (short ureters): congenital, MC form

Secondary (blockage): high voiding pressure –> failure to close UVJ

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8
Q

How do you dx VUR?

A

Prenatal U/S: hydronephrosis

Postnatal: Renal & bladder U/S
If febrile –> voiding cystourethrogram

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9
Q

What are the different grades of VCUG reflux?

A

I: reflux into ureter
II: reflux into kidneys
III: reflux into kidneys w/ dilation of ureter
IV: reflux w/ dilation of ureter & mild calyceal blunting
V: reflux w/ dilation of ureter & calyceal blunting

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10
Q

How do you treat VUR grade I & II?

A

Monitor for spontaneous resolution

Consider prophylactic abx

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11
Q

How do you treat VUR grade III-V?

A

Abx prophylaxis

TMP-SMX or nitrofurantoin

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12
Q

What is the MC cause of urinary tract obstruction in the newborn male?

A

Posterior urethral valves (PUV)

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13
Q

What is PUV?

A

Obstructing membranous folds within the lumen of the posterior urethra

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14
Q

How do you dx PUV?

A

Prenatal U/S: bilateral hydronephrosis, distended & thickened bladder, oligohydramnios

Postnatal: VCUG

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15
Q

How do you treat PUV prenatally?

A

Vesicoamniotic shunt

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16
Q

How do you treat PUV postnatally?

A

Correct electrolytes
Foley cath
Ablation

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17
Q

What is the follow up care for PUV?

A

May require clean intermittent catherization

Monitor for renal failure, UTIs

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18
Q

What is enuresis?

A

Repeated urination (≥ 2x/wk) into clothing in children > 5yo

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19
Q

What are RFs for nocturnal enuresis? (4)

A

Constipation**
Fam hx
Sleep apnea
Psychological

20
Q

How do you treat nocturnal enuresis?

A

Bedwetting alarms
Desmopressin acetate
Imipramine

21
Q

What are RFs for daytime urinary incontinence?

A

Female
Hx of nocturnal enuresis
UTI
Encopresis

22
Q

What disorders are associated w/ daytime UI?

A

Overactive bladder: urgency

Voiding postponement & under-active bladder

Dysfunctional voiding

23
Q

How do you dx daytime UI?

A 
Diary
VCUG
U/S
MRI spine 
Abd xray
24
Q

How do you treat daytime UI?

A

Treat underlying condition
Behavioral therapy
Anticholinergics (oxybutynin)

25
Q

What is exstrophy of the bladder?

A

Open, inside-out bladder

First born, white males

26
Q

What are s/s of exstrophy of the bladder?

A
  • Open bladder & exposed urethra
  • Low set umbilicus
  • Diastasis of the symphysis pubis
  • Anteriorly displaced anus
  • Inguinal hernia
  • Genital defects
27
Q

How do you dx exstrophy of the bladder?

A

Prenatal U/S (confirmed w/ MRI sometimes)

28
Q

How do you treat exstrophy of the bladder?

A

Induced vaginal delivery or planned c-section, followed by surgery within 72 hours

29
Q

What are characteristics of hypospadias?

A

Ventral placement of urethral opening

10% have cryptorchidism

30
Q

Hypospadias: what should you NOT do?

A

Don’t circumcise at birth! Foreskin is used for repair

31
Q

How do you dx hypospadias?

A

Newborn PE:

  • abnormal foreskin
  • abnormal penile curvature
  • 2 urethral openings
32
Q

How do you treat isolated hypospadias?

A

Repair before 18mos

33
Q

How do you treat hypospadias w/ cryptorchidism?

A

Increased risk for DSD so requires further workup:
Pelvic U/S
Karyotype
Serum electrolytes

34
Q

What is the MC congenital abnormality of the GU tract?

A

Cryptorchidism

35
Q

Those w/ cryptorchidism are at increased risk for…

A

Infertility & testicular CA

36
Q

How do you dx cryptorchidism?

A

Newborn exam

2-6mo: Measure LH, FSH, inhibin B, testosterone

HCG stimulation test

37
Q

How do you treat cryptorchidism?

A

If no descent by 6-12 mos:

Palpable –> orchiopexy

Non-palpable –> exploratory surgery

38
Q

What is the MC associated abnormality of testicular torsion?

A

Bell clapper deformity

39
Q

Who is at increased risk for testicular torsion?

A

Neonatal

Males < 25yo: Puberty MC

40
Q

What are s/s of testicular torsion?

A

Abrupt onset pain
N/V
Swollen, edematous
Absent cremaster

41
Q

How do you treat testicular torsion?

A

Detorsion & fixation

Orchiectomy if nonviable (> 24 hrs)

42
Q

Describe a “communicating” hydrocele

A

Caused by failure of processus vaginalis to close

Peritoneal fluid around testis can pass through

43
Q

Describe a “non-communicating” hydrocele

A

No connection to peritoneum

Fluid comes from mesothelial lining of tunica vaginalis

44
Q

How do you dx hydroceles?

A

Transilluminate
Doppler U/S

Communicating may increase in size, but non-communicating stay the same

45
Q

On what side of the body are varicoceles MC?

A

Left!

46
Q

How do you treat varicoceles?

A

R/o IVC obstruction via:
Doppler U/S

Ligation or testicular vein embolization

1. Disciplines 2 (11 decks)

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