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Pediatrics Module > Peds Nephro/GU > Flashcards

Peds Nephro/GU Flashcards

1
Q

Asymptomatic patient with 5+ RBC on UA and normal BUN/Cr. Possible dx?

A

Benign Familial Hematuria - check FHX

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2
Q

Color of blood from pre-renal, renal, and post-renal?

A

pre-renal (myoglobin) = dark red
renal (kidneys) = tea/cola
post-renal = bright red

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3
Q

Concern of adult smoker with painless gross hematuria?

A

transitional cell carcinoma of bladder; refer to urology

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4
Q

hematuria + hearing loss + visual changes =

A

Alport syndrome

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5
Q

Treatment of Alport syndrome

A
  • progressive; no tx
  • Refer to nephrology because leads to kidney failure
  • Need dialysis and transplant
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6
Q

hematuria + ASO titer =

A

Post-Strep Glomerulonephritis (PSGN)

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7
Q

UA results of PSGN

A

tea-colored

red cell casts

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8
Q

Supportive therapy for patients with proteinuria

A

HTN control (ACE-I)

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9
Q

gross hematuria + URI

A

IgA Nephropathy (Berger’s Disease)

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10
Q

IgA nephropathy treatment

A

self-limiting

Prednisone

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11
Q

Possible causes of Myoglobinuria

A

extreme exercise, high fever, crush injury, burn, sepsis

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12
Q

Labs in myoglobinuria

A

elevated CK, LDH
hyperkalemia
hyperphosphate
UA: dark urine, no blood

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13
Q

Myoglobinuria treatment

A

increase hydration
Mannitol
Alkalinize urine

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14
Q

Definition of hematuria

A

+5 RBC per high powered field on 2 separate occasions (microscopic or gross)

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15
Q

HUS is preceded by ______ infection 3-7 days prior.

A

E. coli

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16
Q

HA and petechial rash with decreased urination and dark urine following an episode of bloody diarrhea. Classic presentation of what dx?

A

HUS

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17
Q

Lab results of HUS

A
  • Anemia, thrombocytopenia
  • Elevated LDH, bili, PTT, d-dimer, BUN/Cr
  • Hematuria with RBC casts
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18
Q

HUS treatment

A

supportive

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19
Q

If HUS suspected, then what also must be checked for?

A

MAHA on peripheral blood smear

E. coli O157:H7 in stool

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20
Q

Henoch Schonlein Purpura triad

A
  1. vague abd pain
  2. arthritis
  3. rash - petechial, purpuric; ONLY waist down
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21
Q

Always check ______ levels when petechial rash.

A

platelet (order CBC)

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22
Q

What is major similarity and difference between HUS and HSP?

A

HUS has thrombocytopenia (low platelets) and HSP doesn’t

Both have petechial rash and hematuria

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23
Q

Henoch Schonlein Purpura treatment

A

NSAIDs

steroids for bloody stool

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24
Q

Gold standard lab for proteinuria

A

24 hr urine collection

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25
Benign, asx proteinuria common in school-aged children.
orthostatic proteinuria
26
Sudden onset edema of eyes and genitals in patient < 6 yo with +2 proteins in urine and elevated triglycerides. Likely dx?
Minimal Change Disease
27
Signs of nephrotic syndrome (seen in Minimal Change Disease but not in orthostatic proteinuria)
edema proteinuria hyperlipidemia low albumin (low blood protein)
28
Signs of UTI in pediatrics
``` Fever without source Poor feeding, vomiting Sudden incontinence or enuresis Strong smelling urine Abdominal tenderness ```
29
Renal U/S vs VCUG for UTI evaluation in children?
US: boy, < 2 yo, GU anomalies, recurrent UTI (+3/yr) VCUG: UTI fails to respond after 2 days of abx, < 2 yo with 2nd UTI, recurrent UTI any age
30
Causative organisms of UTI
E. coli (>75%) Klebsiella, Proteus, Enterococci, Group B strep, Pseudomonas Adenovirus
31
Recurrent UTI's lead to progressive ______ damage.
renal
32
Gold Standard for UTI dx? Gold Standard for infants?
urine culture (children/adults) cathed specimen (infants)
33
UTI treatment
Cipro x 7-14 days | adjust per culture
34
When should UTI be admitted for IV therapy?
- any infant < 3 mon with febrile UTI - signs of sepsis, urinary obstruction, or significant underlying disease - unable to tolerate fluids/meds
35
VCUG gold standard for _______.
vesicoureteral reflux
36
primary vs secondary enuresis? which is more concerning?
primary: accidents in child who have never been potty trained secondary: accidents after successful potty training (> 6 mon dry) * secondary more concerning
37
Must presume _______ in any baby < 3 mon old with unexplained fever.
pyelonephrities; admit for IV fluids and do renal US
38
Neuro problems with enuresis
spina bifida | cerebral palsy
39
Inheritance of infantile PCKD
autosomal recessive
40
All patients with infantile/recessive PCKD have what?
congenital hepatic fibrosis; causes secondary portal HTN
41
PCKD treatment
- Manage HTN, liver disease | - 50% need renal transplant by age 60
42
Dx of adult PCKD
+FHX recurrent UTI, pyelo renal U/S: 2 cysts in one kidney or 1 on each kidney
43
How is recessive PCKD dx'd?
renal U/S in utero showing oligohydraminos
44
inability to pull back foreskin and "ballooning" of foreskin
phimosis
45
Phimosis treatment
Urologist ASAP if can't urinate | Normal retraction at 3 yo
46
What is paraphimosis? How is it treated?
retraction of foreskin past coronal sulcus; tight ring impairs blood flow medical emergency! manual reduction
47
apparent small sized penis due to pubic region fat
buried penis
48
Lab changes in Congenital Adrenal Hyperplasia
Elevated adrenal androgens (DHEA, testosterone) | Low Na, high K, low glucose
49
salt wasting and dehydration symptoms + ambiguous genitalia
Congenital Adrenal Hyperplasia
50
inflammation of glans and foreskin of penis
Balanoposthitis/Posthitis
51
Common causes of Balanoposthitis/Posthitis
Candida, Strep | phimosis
52
Hypo or Epispadias
urine exits in wrong spot either below (hypo) or above (epi)
53
penis length 2 std deviations below mean
microphallus
54
Endocrinologic and genetic causes of microphallus
endo: hypogonadotropic hypogonadism, primary testicular failure genetic: Prader Willi Syndrome
55
Normal progression of testes descent and by what age?
abdomen -> inguinal canal -> scrotal sac | by 6 months old
56
retractible testes vs cryptorchidism
retractible are descended testes that pull up into inguinal canal due to hyperactive cremasteric reflex cryptorchidism are true undescended testes
57
How should undescended testes be dx'd and tx'd?
- If non-palpable, milk down from inguinal canal; monitor - If still not palpable, testicular US - If still not found, abd CT and send to urology for orchidopexy - If bilat check CAH and chromosomes)
58
Risk of undescended testes
crypto: infertility, testicular cancer
59
+ Prehn
elevation of testes relieves pain; seen in undescended testes
60
Non-painful swelling of testes in 16 yo with "bag of worms" felt on palpation.
varicocele
61
Newborn boy with non-painful testes. Edema and + transillumination sign on PE.
hydrocele
62
Management of varicocele and hydrocele
varicocele - benign; infertility risk hydrocele - resolves at age 6-12 mon; no infertility risk
63
Male with acute abdominal pain radiating to groin, N/V. Testes are swollen and tender with (-) Prehn sign and no cremasteric reflux.
testicular torsion
64
dx and tx of testicular torsion
scrotal U/S with flow doppler Immediate referral to urology for surgery
65
Testicular pain without N/V. + Prehn sign and cremasteric reflex intact. Likely dx?
epididymitis
66
How to r/o testicular torsion in suspected epididymitis?
testicular US
67
Sudden onset of pain in upper pole of testes and "blue dot" sign on exam.
torsion of appendix testes
68
Etiology of epididymitis
viral or bacterial STDs urethritis, prostatitis, UTI
69
Possible cause of bilateral testicular pain 4-6 days after parotiditis?
Mumps (check vaccine status)
70
Complications of mumps
infertility | aseptic meningitis
71
When is an inguinal hernia a medical emergency?
incarcerated/unreducable protrusion that does not cause pain
72
Painful scrotal swelling DDX
``` Epididymitis Orchitis/Mumps Testicular torsion Torsion of Appendix testes Incarcerated Inguinal Hernia ```
73
Painless scrotal swelling DDX
``` Hydrocele Varicocele Unincarcerated Inguinal Hernia Nephrotic Syndrome Testicular Tumors Fragile-X syndrome Klinefelter Syndrome ```
74
Chromosomal defect that causes macro-orchidism and one that causes micro-orchidism
Macro: Fragile-X Micro: Klinefelter Syndrome

Pediatrics Module (15 decks)

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