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Peds II Exam 1 > Urology > Flashcards

Urology Flashcards

1
Q

inability to retract the foreskin

A

phimosis

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2
Q

main cause of pathologic phimosis

A

early forcible retraction

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3
Q

Sx of patho phimosis

A

secondary non-retractibility after having fully retractable before; painful erections
irritation/bleeding
dysuria/urinary retention
recurrent infections

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4
Q

Tx for patho phimosis

A

stretching
topical corticosteroid
circumcision (rarely needed)

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5
Q

Paraphimosis

A

retractable foreskin that can not be returned to natural position; MEDICAL EMERGENCY

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6
Q

Pathophys of paraphimosis

A

entrapment –> impaired venous flow –> engorgement –> arterial compromise

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7
Q

Causes of paraphimosis

A

forcible retraction
infection/inflamation
genitourinary procedure (iatrogenic)
sex, trauma

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8
Q

Sx of paraphimosis

A

swelling
pain
irritability in a preverbal infant

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9
Q

PE for paraphimosis

A

edema, tenderness
constricting band
color change if ischemia is present

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10
Q

Tx for paraphimosis

A

pain control
timely manual reduction in office or ED
surgical intervention by urology

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11
Q

Benefits of circumcision

A 
decrease UTIs
penile cancer?
inflammation/dermatoses
STD
benefits greater in those w/ congenital uropathy
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12
Q

risk of circumcision

A

procedure related complications (inadequate removal, bleeding, infection, urethral complications)

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13
Q

Contraindications for cicumcision

A

unstable infant, congenital penile anomolies (hypospadias, chordee)

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14
Q

Types of circumcision methods

A

gomco vs. plastibell

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15
Q

Epispadias

A

congenital anomaly w/ abnormal dorsal displacement of urethral opening

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16
Q

epispadias may occur w/

A

bladder exstrophy (exposed bladder, into lower abdomen)

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17
Q

Hypospadias

A

urethral opening on the ventral side (more common than epispadias) - can be on glans, shaft, scrotum, perineum

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18
Q

may accompany hypospadias

A

chordee

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19
Q

Chordee

A

abnormal penile curvature

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20
Q

Considerations w/ hypospadias or chordee

A

palpate testes: if crytorchidism consider disorder of sexual dev. (DSD)
refer to urology

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21
Q

Tx for hypospadias or chordee

A

CIRCUMCISION NOT DONE DURING NEWBORN PERIOD

surgery performed ~6 months of age to fix hypo or chordee

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22
Q

cryptorchidism

A

hidden/absent testis; does not descend by 4 months of age

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23
Q

most common GU congenital abnormality

A

cryptorchidism

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24
Q

Risks of cryptorchidism

A

testicular torsion
subfertility (improves if corrected before 1 yo)
testicular cancer

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25
Q

Types of cryptorchidism

A 
absent (agenesis or atrophy)
undescended 
retractile (overactive cremasteric reflex)
Ascending
ectopic
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26
Q

Presentation of cryptorchidism

A

usually unilateral
location: suprascrotal
US if not palpable

Most descend spontaneously by 3-4 months

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27
Q

Tx for cryptorchidism

A

urology referral; surgery as soon after 6 mo as possible (before 1 yo); orchiopexy (brought down and attached to scrotum)

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28
Q

Torsion

A

twisting of spermatic cord due to poorly anchored testicle; VASCULAR COMPROMISE RISK

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29
Q

Incidence of torsion

A

neonatal

puberty (12-18)

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30
Q

Presentation of torsion

A

abrupt onset of severe pain

n/v

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31
Q

PE for torsion

A

edematous, indurated, erythematous scrotum
swollen, tender, slightly elevated
ABSENT CREMASTERIC REFLEX
NEGATIVE PREHN’S SIGN*

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32
Q

Dx for torsion

A

hx and PE

doppler US is confirmatory (sees blood flow)

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33
Q

Tx for torsion

A

immediate urology consult

surgical detorsion and fixation (orchiopexy) of both testes

34
Q

Prognosis of torsion

A

4-6 hrs: 100% viable
12 hrs: 20% viable
24 hrs: 0% viable

35
Q

UTI

A

cystits vs pyelonephritis (kidneys infected); usually from ascending bacteria (e.coli***, klebsiella, proteus, entercoccus, s. aureus)

36
Q

Sx of UTI

A

FUO, vomiting, irritability, poor appetitie

Older children: dysuria, frequency, ab pain, back pain, urinary incontinence

37
Q

PE fo UTI

A

vitals, ab exam
suprapubic and CVA exam
examine external genitalia
search other sources of fever

38
Q

How to collect UA

A 
clean-void specimen if potty trained
cath speciment
suprapubic aspiration (if cath not feasible)
39
Q

Dx of UTI

A

UA and culture
(+) bacteriuria w/ pyuria, leukocyte esterase, nitrate (produced by gram neg rods)
C&S: to direct tx

40
Q

Tx of UTI

A 
Duration of tx 3-10 days
Abx depends on C&S:
- cephalosporin (cephalexin and cefdinir)
- amoxicillin
- augmentin
- bactrim
41
Q

F/u for UTI

A

no f/u needed if C&S

renal bladder US (RBUS)
voiding cystourethrogram (VCUG)
Renal scintigraphy
42
Q

when to f/u for UTI

A

RBUS when:
- <2 yo w/ first febrile UTI
children w/ recurrent
children w/ UTI and FH of renal or urological disease, poor growth or HTN
children who do not respond to abx therapy

43
Q

Voiding cystourethrogram (VCUG)

A

invasive, radiation, catheter

test of choice to detect vesicouretral reflux (VUR)
children of any age >2 febrile UTIs
children of any age w/ 1st febrile UTI AND any anomaly on RBUS or temp >102.2 and pathogen other than E.coli, or poor growth or HTN

44
Q

Vesicoureteral reflux (VUR)

A

retrograde flow of urine from bladder into upper urinary tract, usually due to closure of ureterovesicular junction (UVJ)

45
Q

Presentation of vesicoureteral reflux

A

hydronephrosis (prenatal)

post natal febrile UTI

46
Q

Dx of VUR

A

VCUG

47
Q

VCUG

A

catheter placed and contrast injected; under fluoroscopy, movement of contrast and anatomy watched while pt voids; graded I (mild) to V severe

48
Q

Risks in patients w/ VUR

A

recurrent infections

scarring and damage to kidney

49
Q

Management of VUR

A

many cases spontaneously resolve
watchful waiting/surveillance?
low dose prophylactic antibiotics
surgical correction

aggressive screening (UA) in febrile/symptomatic pts

50
Q

Renal scintigraphy

A

nuclear medicine scan using radioisotope dimercaptosuccinic acid (DMSA) to detect acute pyelonephritis and renal scarring;

decreased uptake of DMSA indicates scarring or inflammation; not recommended in evaluation of kids w/ first UTI

51
Q

Indications for referral in kids with UTI

A 
severe VUR (grade III-V) or obstruction
renal abnormalities
impaired kidney function
elevated BP
bowel or bladder dysfunction refractory to primary care measures
52
Q

Horseshoe kidney

A

most common type of renal fusion; caused by abnormal migration in 5th-9th week gestation

53
Q

S/sx of horseshoe kidney

A

usually asymptomatic
may have pain, hematuria

most have associated uro problem (VUR, hypospadias, undescended testes) or may be associated w/ other genetic disorders;

54
Q

Risk with horseshoe kidney

A

small risk of Wilms Tumor (most common renal malignancy in kids)

55
Q

Dx of horseshoe kidney

A

US, VCUG (if UTI), serum creatinine

normal Cr and no hydronephrosis: no further eval
Cr elevated or hydronephrosis: renal scan

56
Q

Management of horseshoe kidney

A

excellent prognosis w/o intervention

w/ VUR: consider prophylactic abx

57
Q

Nocturnal enuresis (NE)

A

incontinence in kids >5 yo; common

58
Q

Etiology of NE

A

genetic
bladder maturation
organic cause

59
Q

Tx for NE

A

1st line: most spontaneously resolve – education (motivation, urination, fluid intake)

2nd line: pharm >6yo:

60
Q

Pharmacologic tx for NE

A

DDAVP/Desmopressin (synthetic ADH) – effective short term but high relapse rate

61
Q

Ddx for hematuria

A 
UTI, kidney stone, malignancy
trauma
post-infectious glomerulonephritis
neoch-schonlein purpura
hemolytic uremic syndrome
alport syndrome
62
Q

Labs for microscopic hematuria (>3 RBCs)

A
  1. if asymptomatic, repeat UA dip and microscopy in 2-3 weeks (if resolved, follow up prn); consider urine cx if UTI suspected, RBUS, referral
63
Q

Gross hematuria labs

A

UA w/ microscopy/urine cx
serum Cr
Serum complement (low level in SLE, glomerular etiology)
Consider antistreptolysin Ab (ASO), ANA

Imaging: RBUS/CT w/o contrast

If persistent- refer

64
Q

Post infectious glomerulonephritis sx

A

7-14 days after GAS (pharyngitis or impetigo)

throat
bloat- edema peri-orbital or peripheral due to kidneys not removing waste and fluid
coke- colored urine
elevated BP

65
Q

Labs for post-infectious glomerulonephritis

A

gross hematuria (dark cola urine) - RBC Casts** (diagnositc of GN)
increased serum Cr
+ASO (antistreptolysin Ab) titer
low complement (C3, C4)

66
Q

Tx for GN

A

supportive

67
Q

Immunoglobulin A vasculitis henoch-schonlein purpura (HSP)

A

IgA vasculitis: immune mediated, cause unknown

68
Q

Sx of HSP

A

Tetrad:

  • Abdominal pain
  • typical maculopapular purpuric rash (usually on LE)
  • arthralgias (knees/ankles)
  • renal involvement
69
Q

Tx for HSP

A

supportive; spontaneously resolution of symptoms

70
Q

HUS cause

A

shiga toxin producing E.coli

71
Q

Sx of HUS

A

prodrome w/ abd pain, vomiting, diarrhea (usually bloody)

Followed by triad:

  • hemolytic anemia
  • thrombocytopenia
  • AKI
72
Q

Labs for HUS

A

CBC, peripheral smear, renal function, UA

73
Q

Tx for HUS

A

supportive, possible dialysis

no abx

74
Q

Alport syndrome aka

A

hereditary nephritis

75
Q

cause of alport syndrome?

A

genetic mutations that affect collagen proteins in kidneys, eyes and ears

76
Q

Sx of alport syndrome

A 
\+FH of end stage renal failure
Syndrome includes:
- glomerular disease (microhematuria)
- deafness
- visual distruabnce
77
Q

Proteinuria

A

foamy urine, excessive proteins in urine

78
Q

Ddx for proteinuria

A 
Benign/transient (fever, hypovolemia, exercise)
SLE
DM
GN
Nephrotic syndrome*
79
Q

Nephrotic syndrome

A

renal disease (intrinsic or post infectious) causing massive renal protein loss in urine

80
Q

Sx of Nephrotic syndrome

A 
O's:
PrOteinuria
O shaped face (edema due to water retention)
HypOalbuminemia
Hyperlipidemia
81
Q

Why do Nephrotic syndrome have HLD

A

body compensates for protein loss by increasing the synthesis of albumin, as well as other molecules including LDL and VLDL

82
Q

Evaluation of proteinuria

A 
BP
UA w/ microscopy
first AM void UA to check for proteinuria prior to meal/activity
protein/Cr ratio
CMP
Hx
refer to nephrology

Peds II Exam 1 (4 decks)

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