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pediatric Boards > Renal / GU > Flashcards

Renal / GU Flashcards

0
Q

What is the likely diagnosis in a boy who participates in vigorous sports who has dark urine and 1-2 RBC on urinalysis ?

A

Myoglobinuria

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1
Q

What is the definition of hematuria?

A

3 or more RBC per high power field

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2
Q

What should you do in a patient who presents with isolated asymptomatic microscopic hematuria?

A

Repeat UA in 2 weeks

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3
Q

What 2 things should be checked in a patient with persistent microscopic hematuria?

A

blood pressure and calcium/creatinine ratio

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4
Q

What is an abnormal calcium/creatinine ratio?

A

Greater than 0.25

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5
Q

What lab and imaging studies should be ordered in a patient with persistent microscopic hematuria and normal calcium/creatinine ratio? (7 answers)

A 
Bun/creatinine
Electrolytes
C3/C4
ANA
ASO
ANCA
Renal/bladder US
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6
Q

What could be the cause of hematuria in a patient on LASIX?

A

Hypercalciuria

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7
Q

What is the next step in a patient with elevated calcium/creatinine ratio? What result would be diagnostic?

A

24 hour collection

>4 mg/day confirms hypercalciuria

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8
Q

What diagnosis should you consider in a one day old patient who presents with palpable flank mass and unilateral mass on ultrasound?

A

UPJ obstruction

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9
Q

What diagnosis should you consider in a patient with microscopic hematuria after a MVA? How would this present on imaging?

A

UPJ obstruction

Hydronephrosis

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10
Q

How do you confirm UPJ obstruction? What’s the next test after the diagnosis is confirmed?

A

Renal scan shows delayed excretion

Vcug should be done to look for reflux in other kidney

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11
Q

When should cystoscopy be performed in a child with hematuria ?

A

Never - only indicated in adults

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12
Q

What are the common causes of gross hematuria in children? (9 answers)

A 
H (HSP or hereditary nephritis)
E (bEnign familial)
M (membranoproliferative)
A (Alport or IgA nephropathy)
T (trauma)
U (UPJ obstruction)
R (renal stones)
I (infectious - strep)
A (abnormal sickle cells)
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13
Q

What diagnosis would you consider in a patient with painless tea colored urine?

A

Glomerulonephritis

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14
Q

What is the next step in a patient with isolated proteinuria that resolves on first void urine?

A

3 month follow up

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15
Q

What is the appropriate next step in a patient with isolated proteinuria even on first morning void? What finding would be considered abnormal?

A

Protein creatinine ratio (renal disease suggested if ratio >0.2)

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16
Q

What are 3 common causes of benign transient proteinuria?

A

Fever
Exercise
dehydration

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17
Q

What is the inheritance of Alport syndrome?

A

X linked dominant

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18
Q

What diagnosis should you consider in a patient with bilateral sensorineural hearing loss, ocular defects and renal failure ?

A

Alport syndrome

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19
Q

What is the likely diagnosis in a patient with a unilateral flank mass who has oligohydramnios in utero?

A

Multicystic dysplastic kidney

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20
Q

What is the gross pathology of a multicystic dysplastic kidney?

A

Enlarged kidney with non communicating cysts with thin parenchyma and dysplasia

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21
Q

What are other urinary tract anomalies that occur in 50% of patients with unilateral multicystic dysplastic kidney disease ? (4 answers)

A

UPJ obstruction
Vesicoureteral reflux
Posterior urethral valves
Megaureter and duplication

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22
Q

What is the best initial study to diagnose multicystic dysplastic kidney?

A

Renal ultrasound

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23
Q

What is the next best step in a patient with confirmed multicystic dysplastic kidney disease ?

A

Vcug to rule out other urinary tract anomalies

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24
Q

What diagnosis should you consider in a patient with kidney mass, palpable liver, thrombocytopenia and hematemesis?

A

Multicystic dysplastic kidney or autosomal recessive polycystic kidney disease
and resulting portal hypertension

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25
Q

What diagnosis should you consider in an infant with bilateral flank masses and hx of oligohydramnios ?

A

Autosomal recessive polycystic kidney disease

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26
Q

What other malformation is associated with autosomal dominant (adult) polycystic kidney disease?

A

Intracranial aneurysm

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27
Q

What diagnosis presents with polyuria, enuresis and low specific gravity as well as short stature, anemia and eye problems?

A

Juvenile onset medullary cystic disease aka nephronopththisis

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28
Q

What eye problem is associated with nephronophthisis?

A

Retinitis pigmentosa

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29
Q

What diagnosis presents with dysuria, hematuria and abdominal pain as well as a mass from the urethral meatus?

A

Ureterocele

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30
Q

What is the appropriate management for grade 1 and 2 vesicoureteral reflux?

A

Periodic cultures

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31
Q

What is the appropriate management for grade 3 VUR?

A

Prophylactic antibiotics

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32
Q

What is the appropriate management for grade 4 and 5 VUR?

A

Surgery

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33
Q

What is the most common cause of urinary retention in females?

A

Ureterocele

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34
Q

What is the likely diagnosis in a male with urinary symptoms after recent surgical procedure?

A

Urethral stricture secondary to catheter placement

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35
Q

What diagnosis presents in a male newborn with palpable bladder and weak urinary stream?

A

Posterior urethral valves

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36
Q

What is the treatment for posterior urethral valves?

A

Immediate urological consult for surgery

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37
Q

What is the most appropriate step in an infant with palpable bladder and no urinary output?

A

Catheter

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38
Q

How does posterior urethral valves typically present in females?

A

It only occurs in males

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39
Q

What is the prognosis of posterior urethral valves after surgical correction ?

A

ESRD within 5 years

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40
Q

What is the most common viral cause of UTi?

A

Adenovirus

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41
Q

When is an ultrasound indicated after a UTI? (3 answers)

A

Symptoms of pyelonephritis
Male gender
Newborns

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42
Q

What syndrome presents with soft abdominal musculature, bilateral undescended testicles and distended bladder?

A

Prune belly (eagle Barrett) syndrome

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43
Q

Why are children with prune belly syndrome prone to chronic UTI, distended bladder and dilated ureter ?

A

Posterior urethral valves

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44
Q

What is the appropriate empiric antibiotic in suspected acute pyelonephritis ? (2 options)

A

Bactrim or 3rd generation cephalosporin

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45
Q

What are the 3 main findings in nephrotic syndrome ?

A

Hypoproteinemia
Proteinuria
Edema

46
Q

What are 6 common laboratory abnormalities found in patients with nephrotic syndrome?

A 
High LDL
High factor 5 & 7 (hypercoagulability)
Decreased immunoglobulins
Low albumin
Hypocalcemia
Low thyroid function
47
Q

What are 3 important complications of nephrotic syndrome?

A

Hyponatremia
Thrombosis
Peritonitis

48
Q

What should you suspect in a patient with nephrotic syndrome who develops abdominal pain, hematuria and decreased urine output?

A

Vascular thrombosis

49
Q

What is the best next step in a patient with new onset nephrotic syndrome who does not respond to steroids?

A

Renal biopsy

50
Q

Which 3 causes of glomerulonephritis present with low complement levels?

A

Post streptococcal
Membranoproliferative
Lupus

51
Q

What are the 4 main symptoms of glomerulonephritis ?

A

Hematuria
Azotemia (high BuN)
Proteinuria
Oliguria

52
Q

Which causes of glomerulonephritis present with normal complement levels? (5 answers)

A 
HSP
Idiopathic vasculitis
Rapidly progressive GN
IgA nephropathy
Focal segmental glomerulosclerosis
53
Q

What diagnosis should you consider in a patient who presents with hypertension, edema and hematuria?

A

Post strep glomerulonephritis

54
Q

What’s the difference in complement levels between post strep glomerulonephritis and lupus nephritis?

A

Post strep only causes low complement levels for 2 months but in lupus (and membranoproliferative GN) low c3 levels are sustained

55
Q

In a patient with IgA nephropathy, What correlates with worsening disease?

A

Persistent proteinuria

56
Q

What diagnosis presents with painless hematuria several days after URI?

A

IgA nephropathy (Berger disease)

57
Q

What is the difference in the fractional excretion of sodium when differentiating pre-renal vs renal causes of acute renal failure ?

A

FeNa is low in pre-renal causes

FeNa is high in renal causes

58
Q

What are options for management of hyperkalemia in patients with acute renal failure ? (3 answers)

A

Calcium gluconate
Insulin & glucose
Sodium polystyrene sulfonate

59
Q

What type of infant formula should be used if an infant has acute renal failure ?

A

Formula that is low in phosphorus

60
Q

When is erythropoietin indicated in patients with chronic renal failure?

A

When hgb <8

61
Q

Why do patients with chronic renal failure develop metabolic acidosis? (3 answers)

A

Bicarb loss
Decreased production of bicarb
Decreased acid excretion

62
Q

What happens to calcium and phosphate in chronic kidney disease and why?

A

1,25 dihydroxyvitamin D3 decreases – decreased calcium absorption – high PTH but phosphate levels can’t be excreted – high phosphate suppresses calcitriol – decreased absorption of Ca

63
Q

What is the GFR in stages 4 and 5 of kidney failure?

A

Stage 4 = GFR 15-29

Stage 5 = GFR <15 or dialysis

64
Q

What is the GFR in stages 1 and 2 of kidney failure?

A

Stage 1 = high GFR > 90

Stage 2 = GFR 60-89

65
Q

What diagnosis should you consider in a patient who presents with pallor, decreased urinary output and bruising ?

A

HUS

66
Q

What happens to serum complement levels in patients with HUS?

A

They are normal

67
Q

What is the definition of hypertension ?

A

BP >95th%ile for age and sex on 3 separate occasions

68
Q

What 4 classes of medications can cause HTN ?

A

Albuterol
Contraception
Corticosteroids
Decongestants

69
Q

What might be the cause of HTN in a patient who also complains of muscle cramps and weakness ?

A

Hyperaldosteronism - causes hypokalemia and HTN

70
Q

What may be the cause of HTN in a patient with elfin facies, high calcium and friendly personality?

A

Supra valvular aortic stenosis (in patient with William syndrome )

71
Q

What is the treatment for pheochromocytoma?

A

Alpha blocker (phenoxybenzamine) then surgical correction

72
Q

What diagnosis should you consider in a short obese patient with HTN?

A

Cushing syndrome

73
Q

What medication is contraindicated in patients with pheochromocytoma and why?

A

Beta blockers - leads to unopposed alpha effects and increased BP

74
Q

What is the equation for determination of bladder capacity?

A

Age + 2

75
Q

What are 4 common classes of nephrotoxic medications ?

A

Aminoglycosides
Cyclosporine
Tacrolimus
Chemotherapeutics

76
Q

What is the difference between an incarcerated inguinal hernia and inguinal lymphadenitis?

A

Both present with painful inguinal mass but lymphadenitis should be red and warm to the touch with distal site of infection

77
Q

When is estrogen cream indicated for labial adhesions?

A

Pain or bacterial infections

78
Q

How can you differentiate imperforate hymen from tubo-ovarian abscess?

A

Both present with intermittent abdominal pain but only an imperforate hymen has a palpable midline mass

79
Q

What is the most appropriate step in a patient with symptoms of imperforate hymen?

A

Physical exam of genitalia

80
Q

What are 4 non sexually transmitted causes of vulvovaginitis?

A

Pinworms
Group A strep
Staph
Candida

81
Q

What is a soft skin colored vaginal mass that presents with vaginal discharge?

A

Bartholin gland cyst

82
Q

What is the appropriate treatment in a male with Undescended testicle?

A

Orchiopexy by age 1

83
Q

What is the risk of malignancy in a patient with in descended testicle?

A

High risk despite orchiopexy - the opposite descended testicle also has high malignancy risk

84
Q

What is the appropriate next step in a patient who was documented to have bilateral descended testicles who you now notice has one testicle that is Undescended?

A

Examine in frog leg position to help bring down the retractile testicle

85
Q

What are 4 syndromes associated with hypospadias?

A

Russell silver syndrome
Laurence moon biedl syndrome
Opitz syndrome
Beckwith wiedemann syndrome

86
Q

What is appropriate management of hypospadias in a newborn?

A

Surgical correction at 6 months

87
Q

What is the incidence of renal anomalies with a distal hypospadias?

A

Low - no intervention is needed

88
Q

What syndrome presents with micropenis, poor feeding and hypotonia?

A

Prader Willi

89
Q

What syndrome is associated with micropenis, hypoglycemia, anosmia and Septo-optic dysplasia?

A

Kallmann syndrome

90
Q

At what newborn penile length should an endocrine / genetic workup be performed?

A

Length <2.5 cm

91
Q

What diagnosis presents with unilateral testicular pain and fever but no testicular mass?

A

Epididymitis

92
Q

What is the difference between Orchitis and epididymitis?

A

Orchitis does not present with dysuria

93
Q

What diagnosis should you consider in a child with recent immigration to the US and testicular pain and fever without dysuria?

A

Mumps

94
Q

How can you determine the difference between epididymitis and testicular torsion on physical exam?

A

Torsion has loss of cremasteric reflex and testicle is high

In epididymitis, the testicle is low lying and reflex is still illicited

95
Q

What is appropriate treatment of epididymitis in teenagers?

A

IM rocephin and PO doxycycline

96
Q

When is phimosis considered clinically significant ?

A

In children >4 y/o

97
Q

What is likely cause of tiny white bumps on the tip of the penis in a 4y/o male?

A

Inclusion cysts

98
Q

What is the definition of balanitis?

A

Inflammation of the glans penis

99
Q

What is the likely diagnosis in a male with penile pain and culture that reveals gram negative diplococci?

A

Gonorrhea

100
Q

What diagnosis should you consider in a sexually active male with dysuria and conjunctivitis but negative gram stain?

A

Chlamydia causing Rieter syndrome (autoimmune response to chlamydia causing urethritis, conjunctivitis and arthritis)

101
Q

What imaging and lab studies should be done in a patient with testicular mass? (4 answers)

A

Bilateral US
LDH
B-HCG
Alpha fetoprotein

102
Q

What are 4 major risk factors for testicular Cancer?

A

Cryptorchidism
Previous testicular cancer
Family hx
Klinefelter syndrome

103
Q

What is the cause of condyloma acuminata and how would you treat?

A

HPV - vaccinate

104
Q

What diagnosis should you consider in a patient with whitish gray papules in the genital area that coalesce and typically present with fever?

A

Condyloma Lata (secondary syphilis)

105
Q

What is the treatment in a patient with vulvovaginitis who has no signs of abuse, trauma or pinworms?

A

Sitz bath & reassurance

106
Q

Up until what age can a patient present with congenital condyloma acuminata?

A

Age 3

107
Q

What is the best diagnostic test to do when suspecting HSV?

A

Viral culture for herpes

108
Q

What is the appropriate treatment for a patient with red crusted suprapubic macules and blue-gray dots?

A

Permethrin or malathion (for treatment for “crabs”)

109
Q

What diagnosis should you consider in a female with sudden lower abdominal pain with radiation to the back, nausea and vomiting? How would you confirm diagnosis?

A

Ovarian torsion

Doppler US

110
Q

What is the appropriate treatment for a teenager with left sided abdominal pain and US showing 5 cm ovarian cyst?

A

Follow up US for all cysts smaller than 6 cm

111
Q

What is the appropriate management for an ovarian cyst that is 7 cm and causing significant pain?

A

Laparoscopic cyst aspiration

112
Q

What diagnosis should you consider in a female teenager with RUQ pain and vomiting who takes OCPs?

A

Fitz Hugh Curtis / perihepatitis

pediatric Boards (23 decks)

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