Renal and GU tract

Question 1

List 7 conditions that cause penile pain:

Answer 1

• Priapism
  
  • Phimosis
  • Paraphimosis
  • Balanopthitis
  • Balanitis
  • Post circumcision complications
  • Hair tourniquet

Question 2

What is priapism

Answer 2

• Engorgement of the dorsal corpora cavernosa resulting in dorsal penile erection and ventral penile flacididty

Question 3

List conditions associated with priapism :

Answer 3

• Sickle cell disease
  
  • Leukemia
  • Spinal trauma
  • Immunosupressive disorders
  • Anticoagulation
  • Kawasaki’s disease
  • Intracavernosal injections (paperavene, phentolamine, prostaglandin 1)
  • Medications / Drugs
  • Urethral FB

Question 4

What drugs are associated with priapism?

Answer 4

• Phenothiazines
  
  • Sedative-hypnotics
  • SSRIs
  • Antihypertensives
  • Anticoagulants
  • Drugs of abuse (cocaine and EtOH and marijuana)
    Phentolamine: alpha adrenergic antagonist
    Paparevine (opium alkaloid antispasmodic)

Question 5

Differentiate low-flow and high-flow priapism

Answer 5

Low-flow priapism

• Decreased venous outflow with subsequent penile engorgement
• More common
• Stagnant hypoxic blood can result in thrombosis and ischemia
• Prolonged painful erection
• All other causes

High-flow priapism

• Excessive flow of arterial blood
• Painless (No ischemia)
• Stagnant hypoxic blood can results in thrombosis and ischemia
• Penile arterial laceration: excessive inflow of arterial blood
• Spinal trauma

Question 6

List the treatment of priapism in a child with sickle cell disease.

Answer 6

• Oxygen
  
  • Hydration
  • Analgesics

Question 7

List parenteral vasodilators that may be of benefit in priapism.

Answer 7

• Papaverine
  
  • Hydralazine
  • Terbutaline 0.5mg SQ q20min x 2 or adult dose PO (5-10mg then 5010mg 15 min later)

Question 8

What is an ED treatment that can be started for phimosis?

Answer 8

Betamethasone 0.6% cream x 6 weeks and urology follow-up

Question 9

Provide a list of causes for the acutely painful scrotum:

Answer 9

• Epididymitis
  
  • Orchitis
  • Torsion
  • Torsion of testicular appendage
  • Inguinal hernia

Question 10

Provide a list of causes for the swollen, or mass of the scrotum or testicle:

Answer 10

• Varicocele
  
  • Spermatocele
  • Hydrocele
  • Carcinoma

Question 11

List etiologies of orchitis.

Answer 11

- Viral:
	o Paramyxovirus
	o Mumps
	o EBV
	o Coxsackievirus
	o Arbovirus
	o Enterovirus

- Bacterial:
	o E coli
	o K pneumonia
	o P aeruginosa
	o S aureus
Sterptococcus

• Brucellosis
• Granulomatous disease
  Filariasis

Question 12

List clinical features of testicular torsion.

Answer 12

• Acute scrotal pain and swelling
  
  • Elevated testicle
  • Absent cremasteric reflex (not 100%)
  • Lt > Rt
  • nausea, vomiting
  • If undescended testicle à abdominal pain

Question 13

List testicular and scrotal tumours.

Answer 13

• Teratomas
  
  • Embyonal carcinomas
  • Yolk sac
  • Choriocarcinoma
  • Leydig’s cell
  • Sertoli cell tumours
    Lymphoma and leukemia mets

Question 14

What are RF for pediatric UTI

Answer 14

Girls
 Fever >2 days
- Age 39 C 
- White race
Absence of another source of infection

Boys

• Fever >24 hours
• Absence of another source of infection
• Nonblack race
• Temp >39 C

Question 15

When is renal ultrasonography indicated for UTI?

Answer 15

• Sick infant: in first 2 days of treatment to identify serious complicaitons
  
  • First UTI

Question 16

What are causes of red looking urine?

Answer 16

• Foods: Beets, blueberries

- Drugs: phenothiazines, ibuprofen