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Peds Rotation > Urology 🤢 > Flashcards

Urology 🤢 Flashcards

1
Q

What is the CLASSIC timeline of hemolytic uremic syndrome?

A

Prodrome with BLOODY diarrhea, vomiting, and abdominal pain

Followed by the classic TRIAD:

  1. Hemolytic anemia
  2. Thrombocytopenia
  3. Acute Kidney Injury
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2
Q

Which one requires emergency treatment:

Phimosis or Paraphimosis

A

Paraphimosis

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3
Q

What disease:

Throat, bloat, coke

A

Post infectious glomerulonephritis

Throat: happens after GAS pharyngitis

Bloat: edema (periorbital or peripheral)

Coke: urine looks like coke

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4
Q

What is this:

Inability to retract foreskin

A

Phimosis

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5
Q

If you suspect a UTI, what labs do you need to order?

A

Urinalysis

Culture and sensitivities

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6
Q

What will you see in the urinalysis of someone with post-infectious glomerulonephritis?

A

Cola colored

RBC too numerous to count

RBC Casts (PATHOGNOMIC for GN)

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7
Q

How do you treat Pathologic phimosis?

A

Stretching exercises (gently pulling it back QID)

Topical steroid

Circumcision (last resort)

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8
Q

Is a vesicoureteral reflux common?

A

Yes. 1% of newborns have it, and 30-45% of children with UTIs have it

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9
Q

What will you see in the Urinalysis if your patient has UTI?

A

Bacteriuria

Pyuria

Leukocyte esterase (from breakdown of WBC)

Nitrite (produced by G- rods)

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10
Q

What is this:

Abnormal penile curvature

A

Chordee

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11
Q

Is it really obvious when a child has a horseshoe kidney?

A

No, usually asymptomatic

Maybe they have pain, infection or obstruction

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12
Q

What is this:

“Retracted foreskin in an uncircumcised male that cannot be returned to its natural position”

A

Paraphimosis

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13
Q

What is the most common renal malignancy in kids?

A

Wilms Tumor

(Risk increases if you have a horseshoe kidney_

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14
Q

Is red urine always hematuria?

A

No, it may be from eating beets, pyridium, or food dyes

A thorough history is KEY

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15
Q

How do you collect a urine specimen from a child who is NOT potty trained?

A

Catheterized specimen

Do NOT use a bag collection

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16
Q

What is chordee?

A

Abnormal penile curvature

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17
Q

How do you treat physiologic phimosis?

A

You don’t treat it

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18
Q

If your pt is struggling with nocturnal enuresis and he gets invited to a sleepover and is worried hell wet the bed, what is a good option?

A

DDAVP/Desmopressin

SHORT term

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19
Q

What is the classic tetrad of “Immunoglobulin A Vasculitis Henoch-Schonlein Purpura?”

A
  1. Abdominal pain
  2. Maculopapular rash usu on legs
  3. Joint pain usu knees and ankles
  4. Renal involvement
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20
Q

What are some of the downsides to a Voiding Cystourethrogram?

A

Invasive

Radiation

Catheter

Cost

Discomfort

MANY cases of vesicoureteral reflux will go away on their own

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21
Q

What is the problem with using DDAVP/Desmopressin for nocturnal enuresis?

A

It is effective short term, but has a high relapse rate

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22
Q

What is the first line imaging study for following up in a UTI (in patients for whom it is indicated)

A

Renal and Bladder Ultrasound (RBUS)*****

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23
Q

What are you thinking:

Hereditary glomerulonephritis affecting collagen proteins in kidneys, eyes, and ears

A

Alport Syndrome

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24
Q

What is the range of grades for vesicoureteral reflux?

***

A 
Grade 1(mild)-5(severe)
**************

IMPORTANT

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25
Q

What are the benefits of circumcsion?

A

UTI less likely

Some STIs less likely

Penis cancer less likely

Inflammation/dermatoses less likely

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26
Q

What is the most common bacteria in UTI?

A

E. Coli 80% of the time

Others are klebsiella, proteus, enterococcus, Staph aureus

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27
Q

True or False:

Circumcision leads to sexual dissatisfaction and breast feeding failure

A

False

Though it is true that Babby may not BF for 24 hrs after the procedure

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28
Q

What is cryptorchidism?

A

The scrotum is missing a testicle and it hasn’t descended bony 4 moths of age

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29
Q

What might make you suspect that a child has a vesicoureteral reflux?

A
  • seeing hydronephrosis on a prenatal ultrasound

- a child with a febrile UTI

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30
Q

Do AAP guidelines recommend routine screening UA in asymptomatic, healthy patients?

A

No

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31
Q

What are the 4 main characteristics of NephrOtic Syndrome?

A
  1. NephrOtic range prOteinuria
  2. HypOalbuminemia
  3. O shaped face (edema)
  4. Hyperlipidemia (dOnut blOOd)
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32
Q

If a child has had 1 febrile UTI, when should they get a voiding Cystourethrogram?

A

If they also have one of these:

  • any anomaly on RBUS
  • Temp >102.2 and pathogen other than E. coli
  • poor growth
  • HTN
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33
Q

In testicular torsion:
After _____ hours, the testis is 100% viable

After _____ hours, the testis is 20% viable

After ____ hours, the testis is 0% viable

A

4-6 hours=100%

12 hours= 20%

24 hours= 0%

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34
Q

What might cause foamy urine?

A

Proteinuria

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35
Q

What are the two types of circumcision ?

A

Gomco- a can opener?!? Seriously have no idea what this is about and I’m done looking at that picture

Plastibell-putting a tube around it and tying it tight until the tissue dies ?!?!?

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36
Q

How do you treat testicular torsion

A

Immediate urology consult

Surgical detorsion and fixation (orchiopexy) of BOTH testes so it doesnt happen again

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37
Q

If imaging is needed for evaluation of UTI, what is the first line study?

A

Renal and Bladder ultrasound (RBUS)

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38
Q

What is this:

“Retracted foreskin that cannot be returned top natural position”

A

Paraphimosis

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39
Q

What are the causes of paraphimosis?

A

Forceful retraction

Infection

Inflammation

Procedures

Trauma

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40
Q

When retracting the foreskin, what should you do if you are met with any resistance

A

Stop

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41
Q

What is the test of choice to detect VUR (vesicoureteral reflux)

A

Voiding cystourethrogram (VCUG)

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42
Q

What is the most common type of renal fusion?

A

Horseshoe kidney

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43
Q

What are you thinking:

Proteinuria, hypoalbuminemia, edema, hyperlipidemia

A

NephrOtic syndrome

44
Q

What is the most effective LONG term therapy for nocturnal enuresis?

A

Enuresis alarms

🚨🛌🚰

45
Q

What condition may accompany Hypospadias?

A

Chordee

46
Q

What are you thinking:

Bloody diarrhea, hemolytic anemia, thrombocytopenia, AKI

A

Hemolytic uremic syndrome

47
Q

Will the cremasteric reflex be intact in testicular torsion?

A

No

48
Q

What is nocturnal enuresis?

A

Bedwetting in kids 5 or older

49
Q

What is this:

“Torsion (twisting) of the spermatic cord due to a poorly anchored testicle”

A

Testicular Torsion

😵

50
Q

If a child of any age has had 2 or more febrile UTIs, what imaging study needs to be done?

A

Voiding Cystourethrogram

51
Q

What ages are males most likely to get testicular torsion?

A

Puberty (12-18 yrs) 90%

Neonatal period 10%

52
Q

Cryptorchidism may increase the risk for what?

A

Testicular torsion

Subfertility

Testicular Cancer

53
Q

What is the most common location for undescended testis?

A

Suprascrotal

54
Q

What is a condition that may accompany Epispadias?

A

Bladder exstrophy- bladder sticks out of their abdomen!!!!!!!!

55
Q

Does everyone agree on the best way to treat vesicureteral reflux?

A

No, there is controversy regarding the optimal management.

  • watchful waiting
  • low dose prophylactic antibiotics (most common)
  • surgical correction (grades 4 or 5)
56
Q

What is the difference between Epispadias and Hypospadias?

A

Epispadias- urethral opening is on dorsal side of penis

Hypospadias- urethra is on ventral side of penis

57
Q

Is a horseshoe kidney the only problem a kid might have?

A

No, 33-50% of patients with horseshoes also have another urological or genital abnormality.

Also increased risk for a Wilms tumor

58
Q

What is this:
“Nuclear medicine scan using radioisotope dimercaptosuccinic acid (DMSA) to detect acute pyelonephritis and renal scarring”

A

Renal scintigraphy

59
Q

What does the American Academy of Pediatrics say about circumcision?

A

Benefits outweigh the risks, but they’re not great enough to recommend routine circumcision for all newborn boys.

The final decision should be left to the parents.

60
Q

What lab tests need to be considered in a patient with cola colored urine and decreased renal function 2 weeks after a sore throat?

A

ASO (Antistreptolysin Ab) titer

Complement

61
Q

What are the 5 possible reasons for cryptorchidism?

A
  1. Absent testis- they just don’t have one
  2. Undescended testis- stopped short along normal descent
  3. Retractile testes- overactive cremasteric reflex pull it back inside
  4. Ascending testis- ?
  5. Ectopic testis- lives somewhere else
62
Q

What will you see in the blood results of someone with posit-infectious glomerulonephritis?

A

+ ASO (Antistreptolysin Ab) Titer ****

High creatinine

Low complement

63
Q

What is the most common bacteria to cause UTI?

A

E. coli

64
Q

What is Alport Syndrome?

A

An inherited disease caused by genetic mutations in collagen proteins

  • glomerular disease
  • deafness
  • visual disturbances
65
Q

What is the name of the surgery that is done when someone has testicular torsion?

A

Orchiopexy (detorsion and fixation)

66
Q

What are the risks of circumcision?

A

Procedure related complications

Bleeding, infection, urethral complication, inadequate skin removal

67
Q

What kinds of things can cause proteinuria?

A

Nephrotic syndrome***

Lupus

Diabetes

Glomerulonephritis

Benign- fever, hypovolemia, exercise

68
Q

If your patient has costoverterbal tenderness, what diagnosis should you be thinking of?

A

UTI

69
Q

Is it OK to forcibly retract the foreskin at any age?

A

No never

70
Q

What is the confirmatory test of choice in testicular torsion?

A

Doppler US

71
Q

What is this:

“Renal disease causing massive renal protein loss in urine”

A

NephrOtic syndrome

72
Q

Will Prehn’s sign be positive or negative in testicular torsion?

A

Negative

This is the test where elevating the scrotum relieves the pain. Works for epididymitis, but not testicular torsion

73
Q

What is the second line treatment for nocturnal enuresis if educational and motivational therapy aren’t enough?

A

DDAVP/Desmopressin (synthetic ADH)

74
Q

Is paraphimosis an emergency?

A

YES, possible ischemia and tissue death

75
Q

Does the pain of testicular torsion come on suddenly or gradually?

A

SUDDENLY

76
Q

What are the acute symptoms of post-infectious glomerulonephritis?

A

Cola-colored urine

Edema (kidneys not removing waste/fluid)

High BP

Renal insufficiency

77
Q

How badly does testicular torsion hurt?

A

Constant pain so bad it makes them throw up

78
Q

What is microscopic hematuria?

A

A urine sample that has >3 RBCs per hpf

??

79
Q

What are the contraindications for circumcision ?

A

Unstable infant

Congenital penile anomalies (hypospadias, chordee)- you want the foreskin intact so the urologist can use that skin when making a surgical repair

80
Q

How should you clean the foreskin?

A

Mild soap and water

Return to natural position after cleaning *******!!!

81
Q

What are the management options for vesicoureteral reflux?

A

Surveillance

Prophylactic Abx

Surgery

82
Q

What infection may occur 1-2 wks after infection with group A β-hemolytic strep?

A

Post-infectious glomerulonephritis

83
Q

What is the confirmatory test of choice to diagnose testicular torsion?

A

Doppler ultrasound

Will show you position of the testes and if there is blood flow

84
Q

What is the difference between Physiologic Phimosis and Pathologic Phimosis?

A

Physiologic- normal state where the foreskin adheres to the glans. Baby was born this way and it will loosen up over time

Pathologic- can’t retract foreskin due to scarring/fibrosis secondary to infection or inflammation

85
Q

What is it called when the urethra is displaced dorsally?

A

Epispadias

86
Q

When a circumcision is done in a medical setting, is anesthesia used?

A

Yes

87
Q

What is the most common cause of Pathologic phimosis?

A

A caregiver trying to FORCE the foreskin to retract which causes adhesions and scarring

88
Q

Should we give antibiotics to patients with hemolytic uremic syndrome

A

No

89
Q

What is the first line therapy for nocturnal enuresis?

A

Educational/motivational therapy:

Pee before bed

Don’t drink water right before bed

Sticker charts

Enuresis alarms

90
Q

What kind of symptoms will a very young child with a UTI have?

A

NON specific

Fever may be only sx

Vomiting, irritability, poor appetite

91
Q

What kinds of signs will older children have with a UTI?

A

Classic UTI symptoms:

Painful urination

Frequency

Urgency

Abdominal/back/flank pain

Suddenly wetting their pants

92
Q

Why is testicular torsion a medical emergency?

A

Risk of vascular compromise

93
Q

Is nocturnal enuresis common?

A

YES

15% of all 5 year olds do it

94
Q

What is it called when the urethra is displaced ventrally?

A

Hypospadias

95
Q

What is this:
“Retrograde flow of urine from the bladder into the upper urinary tract, usually due to inadequate closure of ureterovesicular junction”

A

Vesicureteral Reflux (VUR)

96
Q

What do you need to do if you discover that your patient has a horseshoe kidney?

A

Ultrasound

Serum creatinine

VCUG (if they have a UTI)

If their creatinine is normal and they have no hydronephrosis, you don’t have to do anything else. If they are, you need to more scans

97
Q

How do you treat UTI?

A

3-10 days of abx. Start with empiric treatment then adjust according to C&S.

Empiric options:

Cephalosporin (Cephalexin/Cefdinir)

Amoxicillin-resistance increasing

Augmentin-resistance increasing

Bactrim-resistance increasing

98
Q

How do you treat Immunoglobulin A Vasculitis Henoch-Schonlein Purpura?

A

Supportive care

Symptoms will spontaneously resolve

99
Q

Should you do a follow up Urinalysis and C&S after treating a UTI?

A

No, don’t need to repeat it since you got a culture

100
Q

How is paraphimosis treated?

A

Pain control

Timely, Manila reduction in office or ED

Surgical intervention

101
Q

What is this:

The inability to retract the foreskin”

A

Phimosis

102
Q

What should you do if your patient’s UA was positive for MICROSCOPIC hematuria and they’re otherwise asymptomatic?

A

Repeat the UA in 2-3 weeks.

3-4% of children will have small amounts of blood in their UA

103
Q

Who needs a Renal and Bladder Ultrasound (RBUS) in their follow up after a UTI?

A

<2 yrs old with first febrile UTI

Recurrent UTI

FH of renal/urologic disease, poor growth, or HTN

Do not respond to antibiotic therapy

104
Q

What should you do next if you diagnose a baby with hypospadias and/or chordee?

A

Check for palpable testes- make sure this isn’t a Disorder of Sexual Development

Refer to Urology

Do NOT circumcise them**

105
Q

What bacteria is associated with hemolytic uremic syndrome?

A

Shiga toxin producing E. Coli

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