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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
Q

Benign, asx proteinuria common in school-aged children.

A

orthostatic proteinuria

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26
Q

Sudden onset edema of eyes and genitals in patient < 6 yo with +2 proteins in urine and elevated triglycerides. Likely dx?

A

Minimal Change Disease

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27
Q

Signs of nephrotic syndrome (seen in Minimal Change Disease but not in orthostatic proteinuria)

A

edema
proteinuria
hyperlipidemia
low albumin (low blood protein)

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28
Q

Signs of UTI in pediatrics

A 
Fever without source
Poor feeding, vomiting
Sudden incontinence or enuresis
Strong smelling urine
Abdominal tenderness
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29
Q

Renal U/S vs VCUG for UTI evaluation in children?

A

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

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30
Q

Causative organisms of UTI

A

E. coli (>75%)

Klebsiella, Proteus, Enterococci, Group B strep, Pseudomonas
Adenovirus

31
Q

Recurrent UTI’s lead to progressive ______ damage.

A

renal

32
Q

Gold Standard for UTI dx? Gold Standard for infants?

A

urine culture (children/adults)

cathed specimen (infants)

33
Q

UTI treatment

A

Cipro x 7-14 days

adjust per culture

34
Q

When should UTI be admitted for IV therapy?

A
  • any infant < 3 mon with febrile UTI
  • signs of sepsis, urinary obstruction, or significant underlying disease
  • unable to tolerate fluids/meds
35
Q

VCUG gold standard for _______.

A

vesicoureteral reflux

36
Q

primary vs secondary enuresis? which is more concerning?

A

primary: accidents in child who have never been potty trained
secondary: accidents after successful potty training (> 6 mon dry)
* secondary more concerning

37
Q

Must presume _______ in any baby < 3 mon old with unexplained fever.

A

pyelonephrities; admit for IV fluids and do renal US

38
Q

Neuro problems with enuresis

A

spina bifida

cerebral palsy

39
Q

Inheritance of infantile PCKD

A

autosomal recessive

40
Q

All patients with infantile/recessive PCKD have what?

A

congenital hepatic fibrosis; causes secondary portal HTN

41
Q

PCKD treatment

A
  • Manage HTN, liver disease

- 50% need renal transplant by age 60

42
Q

Dx of adult PCKD

A

+FHX
recurrent UTI, pyelo
renal U/S: 2 cysts in one kidney or 1 on each kidney

43
Q

How is recessive PCKD dx’d?

A

renal U/S in utero showing oligohydraminos

44
Q

inability to pull back foreskin and “ballooning” of foreskin

A

phimosis

45
Q

Phimosis treatment

A

Urologist ASAP if can’t urinate

Normal retraction at 3 yo

46
Q

What is paraphimosis? How is it treated?

A

retraction of foreskin past coronal sulcus; tight ring impairs blood flow

medical emergency! manual reduction

47
Q

apparent small sized penis due to pubic region fat

A

buried penis

48
Q

Lab changes in Congenital Adrenal Hyperplasia

A

Elevated adrenal androgens (DHEA, testosterone)

Low Na, high K, low glucose

49
Q

salt wasting and dehydration symptoms + ambiguous genitalia

A

Congenital Adrenal Hyperplasia

50
Q

inflammation of glans and foreskin of penis

A

Balanoposthitis/Posthitis

51
Q

Common causes of Balanoposthitis/Posthitis

A

Candida, Strep

phimosis

52
Q

Hypo or Epispadias

A

urine exits in wrong spot either below (hypo) or above (epi)

53
Q

penis length 2 std deviations below mean

A

microphallus

54
Q

Endocrinologic and genetic causes of microphallus

A

endo: hypogonadotropic hypogonadism, primary testicular failure
genetic: Prader Willi Syndrome

55
Q

Normal progression of testes descent and by what age?

A

abdomen -> inguinal canal -> scrotal sac

by 6 months old

56
Q

retractible testes vs cryptorchidism

A

retractible are descended testes that pull up into inguinal canal due to hyperactive cremasteric reflex

cryptorchidism are true undescended testes

57
Q

How should undescended testes be dx’d and tx’d?

A
  • 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
Q

Risk of undescended testes

A

crypto: infertility, testicular cancer

59
Q

+ Prehn

A

elevation of testes relieves pain; seen in undescended testes

60
Q

Non-painful swelling of testes in 16 yo with “bag of worms” felt on palpation.

A

varicocele

61
Q

Newborn boy with non-painful testes. Edema and + transillumination sign on PE.

A

hydrocele

62
Q

Management of varicocele and hydrocele

A

varicocele - benign; infertility risk

hydrocele - resolves at age 6-12 mon; no infertility risk

63
Q

Male with acute abdominal pain radiating to groin, N/V. Testes are swollen and tender with (-) Prehn sign and no cremasteric reflux.

A

testicular torsion

64
Q

dx and tx of testicular torsion

A

scrotal U/S with flow doppler

Immediate referral to urology for surgery

65
Q

Testicular pain without N/V. + Prehn sign and cremasteric reflex intact. Likely dx?

A

epididymitis

66
Q

How to r/o testicular torsion in suspected epididymitis?

A

testicular US

67
Q

Sudden onset of pain in upper pole of testes and “blue dot” sign on exam.

A

torsion of appendix testes

68
Q

Etiology of epididymitis

A

viral or bacterial
STDs
urethritis, prostatitis, UTI

69
Q

Possible cause of bilateral testicular pain 4-6 days after parotiditis?

A

Mumps (check vaccine status)

70
Q

Complications of mumps

A

infertility

aseptic meningitis

71
Q

When is an inguinal hernia a medical emergency?

A

incarcerated/unreducable protrusion that does not cause pain

72
Q

Painful scrotal swelling DDX

A 
Epididymitis
Orchitis/Mumps
Testicular torsion
Torsion of Appendix testes
Incarcerated Inguinal Hernia
73
Q

Painless scrotal swelling DDX

A 
Hydrocele
Varicocele
Unincarcerated Inguinal Hernia
Nephrotic Syndrome
Testicular Tumors
Fragile-X syndrome
Klinefelter Syndrome
74
Q

Chromosomal defect that causes macro-orchidism and one that causes micro-orchidism

A

Macro: Fragile-X

Micro: Klinefelter Syndrome

Pediatrics Module (15 decks)

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