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US Pediatric Boards Edited > Renal / GU > Flashcards

Renal / GU Flashcards

1
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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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
What diagnosis should you consider in an infant with bilateral flank masses and hx of oligohydramnios ?
Autosomal recessive polycystic kidney disease
26
What other malformation is associated with autosomal dominant (adult) polycystic kidney disease?
Intracranial aneurysm
27
What diagnosis presents with polyuria, enuresis and low specific gravity as well as short stature, anemia and eye problems?
Juvenile onset medullary cystic disease aka nephronopththisis
28
What eye problem is associated with nephronophthisis?
Retinitis pigmentosa
29
What diagnosis presents with dysuria, hematuria and abdominal pain as well as a mass from the urethral meatus?
Ureterocele
30
What is the appropriate management for grade 1 and 2 vesicoureteral reflux?
Periodic cultures
31
What is the appropriate management for grade 3 VUR?
Prophylactic antibiotics
32
What is the appropriate management for grade 4 and 5 VUR?
Surgery
33
What is the most common cause of urinary retention in females?
Ureterocele
34
What is the likely diagnosis in a male with urinary symptoms after recent surgical procedure?
Urethral stricture secondary to catheter placement
35
What diagnosis presents in a male newborn with palpable bladder and weak urinary stream?
Posterior urethral valves
36
What is the treatment for posterior urethral valves?
Immediate urological consult for surgery
37
What is the most appropriate step in an infant with palpable bladder and no urinary output?
Catheter
38
How does posterior urethral valves typically present in females?
It only occurs in males
39
What is the prognosis of posterior urethral valves after surgical correction ?
ESRD within 5 years
40
What is the most common viral cause of UTi?
Adenovirus
41
When is an ultrasound indicated after a UTI? (3 answers)
Symptoms of pyelonephritis Male gender Newborns
42
What syndrome presents with soft abdominal musculature, bilateral undescended testicles and distended bladder?
Prune belly (eagle Barrett) syndrome
43
Why are children with prune belly syndrome prone to chronic UTI, distended bladder and dilated ureter ?
Posterior urethral valves
44
What is the appropriate empiric antibiotic in suspected acute pyelonephritis ? (2 options)
Bactrim or 3rd generation cephalosporin
45
What are the 3 main findings in nephrotic syndrome ?
Hypoproteinemia Proteinuria Edema
46
What are 6 common laboratory abnormalities found in patients with nephrotic syndrome?
``` High LDL High factor 5 & 7 (hypercoagulability) Decreased immunoglobulins Low albumin Hypocalcemia Low thyroid function ```
47
What are 3 important complications of nephrotic syndrome?
Hyponatremia Thrombosis Peritonitis
48
What should you suspect in a patient with nephrotic syndrome who develops abdominal pain, hematuria and decreased urine output?
Vascular thrombosis
49
What is the best next step in a patient with new onset nephrotic syndrome who does not respond to steroids?
Renal biopsy
50
Which 3 causes of glomerulonephritis present with low complement levels?
Post streptococcal Membranoproliferative Lupus
51
What are the 4 main symptoms of glomerulonephritis ?
Hematuria Azotemia (high BuN) Proteinuria Oliguria
52
Which causes of glomerulonephritis present with normal complement levels? (5 answers)
``` HSP Idiopathic vasculitis Rapidly progressive GN IgA nephropathy Focal segmental glomerulosclerosis ```
53
What diagnosis should you consider in a patient who presents with hypertension, edema and hematuria?
Post strep glomerulonephritis
54
What's the difference in complement levels between post strep glomerulonephritis and lupus nephritis?
Post strep only causes low complement levels for 2 months but in lupus (and membranoproliferative GN) low c3 levels are sustained
55
In a patient with IgA nephropathy, What correlates with worsening disease?
Persistent proteinuria
56
What diagnosis presents with painless hematuria several days after URI?
IgA nephropathy (Berger disease)
57
What is the difference in the fractional excretion of sodium when differentiating pre-renal vs renal causes of acute renal failure ?
FeNa is low in pre-renal causes | FeNa is high in renal causes
58
What are options for management of hyperkalemia in patients with acute renal failure ? (3 answers)
Calcium gluconate Insulin & glucose Sodium polystyrene sulfonate
59
What type of infant formula should be used if an infant has acute renal failure ?
Formula that is low in phosphorus
60
When is erythropoietin indicated in patients with chronic renal failure?
When hgb <8
61
Why do patients with chronic renal failure develop metabolic acidosis? (3 answers)
Bicarb loss Decreased production of bicarb Decreased acid excretion
62
What happens to calcium and phosphate in chronic kidney disease and why?
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
What is the GFR in stages 4 and 5 of kidney failure?
Stage 4 = GFR 15-29 | Stage 5 = GFR <15 or dialysis
64
What is the GFR in stages 1 and 2 of kidney failure?
Stage 1 = high GFR > 90 | Stage 2 = GFR 60-89
65
What diagnosis should you consider in a patient who presents with pallor, decreased urinary output and bruising ?
HUS
66
What happens to serum complement levels in patients with HUS?
They are normal
67
What is the definition of hypertension ?
BP >95th%ile for age and sex on 3 separate occasions
68
What 4 classes of medications can cause HTN ?
Albuterol Contraception Corticosteroids Decongestants
69
What might be the cause of HTN in a patient who also complains of muscle cramps and weakness ?
Hyperaldosteronism - causes hypokalemia and HTN
70
What may be the cause of HTN in a patient with elfin facies, high calcium and friendly personality?
Supra valvular aortic stenosis (in patient with William syndrome )
71
What is the treatment for pheochromocytoma?
Alpha blocker (phenoxybenzamine) then surgical correction
72
What diagnosis should you consider in a short obese patient with HTN?
Cushing syndrome
73
What medication is contraindicated in patients with pheochromocytoma and why?
Beta blockers - leads to unopposed alpha effects and increased BP
74
What is the equation for determination of bladder capacity?
Age + 2
75
What are 4 common classes of nephrotoxic medications ?
Aminoglycosides Cyclosporine Tacrolimus Chemotherapeutics
76
What is the difference between an incarcerated inguinal hernia and inguinal lymphadenitis?
Both present with painful inguinal mass but lymphadenitis should be red and warm to the touch with distal site of infection
77
When is estrogen cream indicated for labial adhesions?
Pain or bacterial infections
78
How can you differentiate imperforate hymen from tubo-ovarian abscess?
Both present with intermittent abdominal pain but only an imperforate hymen has a palpable midline mass
79
What is the most appropriate step in a patient with symptoms of imperforate hymen?
Physical exam of genitalia
80
What are 4 non sexually transmitted causes of vulvovaginitis?
Pinworms Group A strep Staph Candida
81
What is a soft skin colored vaginal mass that presents with vaginal discharge?
Bartholin gland cyst
82
What is the appropriate treatment in a male with Undescended testicle?
Orchiopexy by age 1
83
What is the risk of malignancy in a patient with in descended testicle?
High risk despite orchiopexy - the opposite descended testicle also has high malignancy risk
84
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?
Examine in frog leg position to help bring down the retractile testicle
85
What are 4 syndromes associated with hypospadias?
Russell silver syndrome Laurence moon biedl syndrome Opitz syndrome Beckwith wiedemann syndrome
86
What is appropriate management of hypospadias in a newborn?
Surgical correction at 6 months
87
What is the incidence of renal anomalies with a distal hypospadias?
Low - no intervention is needed
88
What syndrome presents with micropenis, poor feeding and hypotonia?
Prader Willi
89
What syndrome is associated with micropenis, hypoglycemia, anosmia and Septo-optic dysplasia?
Kallmann syndrome
90
At what newborn penile length should an endocrine / genetic workup be performed?
Length <2.5 cm
91
What diagnosis presents with unilateral testicular pain and fever but no testicular mass?
Epididymitis
92
What is the difference between Orchitis and epididymitis?
Orchitis does not present with dysuria
93
What diagnosis should you consider in a child with recent immigration to the US and testicular pain and fever without dysuria?
Mumps
94
How can you determine the difference between epididymitis and testicular torsion on physical exam?
Torsion has loss of cremasteric reflex and testicle is high | In epididymitis, the testicle is low lying and reflex is still illicited
95
What is appropriate treatment of epididymitis in teenagers?
IM rocephin and PO doxycycline
96
When is phimosis considered clinically significant ?
In children >4 y/o
97
What is likely cause of tiny white bumps on the tip of the penis in a 4y/o male?
Inclusion cysts
98
What is the definition of balanitis?
Inflammation of the glans penis
99
What is the likely diagnosis in a male with penile pain and culture that reveals gram negative diplococci?
Gonorrhea
100
What diagnosis should you consider in a sexually active male with dysuria and conjunctivitis but negative gram stain?
Chlamydia causing Rieter syndrome (autoimmune response to chlamydia causing urethritis, conjunctivitis and arthritis)
101
What imaging and lab studies should be done in a patient with testicular mass? (4 answers)
Bilateral US LDH B-HCG Alpha fetoprotein
102
What are 4 major risk factors for testicular Cancer?
Cryptorchidism Previous testicular cancer Family hx Klinefelter syndrome
103
What is the cause of condyloma acuminata and how would you treat?
HPV - vaccinate
104
What diagnosis should you consider in a patient with whitish gray papules in the genital area that coalesce and typically present with fever?
Condyloma Lata (secondary syphilis)
105
What is the treatment in a patient with vulvovaginitis who has no signs of abuse, trauma or pinworms?
Sitz bath & reassurance
106
Up until what age can a patient present with congenital condyloma acuminata?
Age 3
107
What is the best diagnostic test to do when suspecting HSV?
Viral culture for herpes
108
What is the appropriate treatment for a patient with red crusted suprapubic macules and blue-gray dots?
Permethrin or malathion (for treatment for "crabs")
109
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?
Ovarian torsion | Doppler US
110
What is the appropriate treatment for a teenager with left sided abdominal pain and US showing 5 cm ovarian cyst?
Follow up US for all cysts smaller than 6 cm
111
What is the appropriate management for an ovarian cyst that is 7 cm and causing significant pain?
Laparoscopic cyst aspiration
112
What diagnosis should you consider in a female teenager with RUQ pain and vomiting who takes OCPs?
Fitz Hugh Curtis / perihepatitis
113
What is the definition of hematuria?
3 or more RBC per high power field

US Pediatric Boards Edited (23 decks)

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