Urology Flashcards
Newborn with prenatal ultrasound (US) positive for hydronephrosis (>10mm AP diameter of the renal pelvis. What is the next best step?
Renal US after 48h of life
What is the best test to confirm the diagnosis of urinary tract infection (UTI)
Urine culture
A one-year-old child presents with the first febrile UTI.What is the appropriate imaging study?
Renal-bladder US (RBUS)
What is the gold standard test for the diagnosis of anatomical details of the renal system and degree of reflux?
Voiding cystourethrography (VCUG). It should not be routinely performed in children after a first febrile UTI
What are the indications of VCUG?
Findings on RBUS that suggest the presence of high-grade vesicoureteral reflux or the recurrence of febrile UTIs
What is the main difference between cystitis and acute pyelonephritis?
Presence of fever and urine infection is highly suggestive of pyelonephritis
Prevalent cause of recurrent UTIs in children
Constipation
Child with an indwelling catheter and a urine dipstick analysis negative for nitrites
Enterococcal UTI
Empiric antibiotics in patients suspected of having an enterococcal UTI
Combination of ampicillin or amoxicillin and, third-generation cephalosporin or aminoglycoside
A 4-year-old boy with weak urine stream, failure to thrive, recurrent UTIs, enuresis. The renal US is positive for bilateral hydronephrosis. What is the best test to establish the diagnosis?
VCUG for the possibility of a posterior urethral valve
A 4-year-old female with a history of chronic constipation presenting with vaginal bleeding and urethral mass
Female urethral prolapse
A 6-year-old female with persistently damp underwear (day and night)
Ectopic ureter
A 7-year-old uncircumcised boy with penile pain, swollen foreskin O/E: head of the penis is enlarged and congested with a collar of edematous foreskin. A constricting band of retracted foreskin is noted past the head of the penis. What is the best treatment?
Emergent reduction of the foreskin to its anatomical position. May apply compression, sugar, pin-pricks to decrease the edema
What are the most common anatomical contraindications of circumcision?
Hypospadias with incomplete foreskin, epispadias, ambiguous genitalia
An uncircumcised 3-year-old boy presents with a nonpainful, white, mobile mass just distal to the corona of the boy’s penis
Reassurance (normal smegma)
Full-term male newborn presents with right undescended testis. The remainder of the physical examination is unremarkable. What is the next best step?
Referral to a surgeon if the testis remains undescended at 6months of age
A 15-year-old boy presents with a painless, solid, firm, irregular mass in the left testicle
Testicular cancer until proven otherwise
A 12-year-old boy presents with sudden onset of testicular pain, vomiting, the right testicle is swollen, tender, absent cremasteric reflex
Testicular torsion
Patient presents with testicular torsion
Immediate urology consult (the testicular US should not delay the consultation)
A 12-year-old boy presents with pain, tenderness, and swelling in the upper pole of the right testicle. O/E: bluish dot is visible through the scrotum
Torsion of the testicular appendage
A 12-year-old boy presents with soft non-tender fullness within the left hemiscrotum, homogenous glow without internal shadows on transillumination; testes are palpable posteriorly
Hydrocele
An 18-year-old male presents with a left-sided mass that feels like a bag of worms; the left testicle is smaller than normal; the mass increases in size with Valsalva maneuver
Varicocele
Adolescent male is complaining about a mobile nodule noted above the testis; the mass does not increase with Valsalva
Spermatocele
A sexually active adolescent male presents with testicular pain that improves with testicular elevation; he has dysuria and fever. The cremasteric reflex is intact
Epididymitis
A 10-year-old boy with a sudden onset of right flank colicky abdominal pain, nausea, vomiting, frequent urination. Physical examination is normal. The urine test is positive for 20 RBCs. The renal US shows 3mm stone in the right ureter
Pain medicine, aggressive hydration (most stones smaller than 5mm pass spontaneously in children)
A 10-year-old boy presents with blood in urine and difficulty voiding after blunt trauma to the genital area. O/E: there is a drop of blood on the meatus
Urethral injury (best study is retrograde urethrography)
