Urology Flashcards
1
Q
when to refer infants with undescended testicles to urology
A
at 3 to 6 months
2
Q
treatment for undescended testicle
A
orchiopexy by 12 to 18 months if still undescended
3
Q
non palpable testes in a newborn management
A
urology evaluation and testicular US prior to discharge
4
Q
syndromes associated with hypospadias
A
SLOB Silver Russell syndrome Laurence Moon Biedl syndrome Opitz syndrome Beckwith wiedmann syndrome
5
Q
hypospadias management
A
no circumcision and surgical correction at 6 months
6
Q
diagnosis of boy with micropenis, poor feeding and hypotonia
A
prader-willi syndrome
7
Q
diagnosis with unilateral scrotal pain, dysuria and fever, no scrotal mass
A
epididymitis
8
Q
testicular mass evaluation
A
bilateral US, LDH, b-HCG and alpha-fetoprotein levels
9
Q
microscopic hematuria definition
A
5 or more RBCs per hpf in 3 centrifuged samples of freshly voided urine obtained over several weeks
10
Q
microscopic hematuria mangement
A
repeat in a few weeks and if persistent check for hypercalciuria with urine Ca/Cr ratio …also monitor for HTN and proteinuria
11
Q
persistent microscopic hematuria work up
A
urine Ca/Cr ratio looking for hypercalciuria
- If >0.35 check 24 hour total calcium excretion (if >4 get renal US looking for stone)
- If <0.25 check BUN, Cr, electrolytes
12
Q
most likely cause of red/pink discoloration in diaper of newborn
A
urate crystals
13
Q
causes of gross hematuria
A
HSP, Hereditary nephritis Easy benign familial Membranoproliferative Alport, IgA Trauma UPJ obstruction Renal stones Infectious (post, ex: strep) Abnormal blood cells (ex: sickle cell)
14
Q
most common stones in kids
A
calcium stones (increased risk w/ distal RTA, hyperclaciuria from hyperPTH, hypercalcemia, loop diuretics)
15
Q
initial diagnostic study for renal stones
A
xray or US
16
Q
xray will not se what stones
A
uric acid stones (radiolucent), small stones and stones over bone
17
Q
stone size that may need percutaneous nephrolithotomy
A
> 5 mm
18
Q
long term treatment for kids with stones
A
increased fluid intake and restricting salt intake (if still not responding then thiazide diuretic)
19
Q
orthostatic proteinuria diagnosis
A
first void spot urine will show no proteinuria but during the day urine will have it, if Cr is fine then check in 3 months
20
Q
causes of transient proteinuria
A
fever, exercise, dehydration
21
Q
persistent orthostatic proteinuria management
A
if still occurring after 3 months then check protein/creatinine ratio (if >0.2 suggests renal disease)
22
Q
first symptom of Alport’s
A
hematuria by age 6
23
Q
initial kidney US in alports
A
normal - progresses to renal failure
24
Q
most commonly palpated renal mass in infants
A
hydronephrotic kidneys 2/2 UPJ obstruction and multi cystic dysplastic kidneys
25
enlarged kidney with non-communicating cysts with thin or no parenchyma and dysplasia
multicystic dysplastic kidney disease
26
bilateral kidney masses and signs of portal hypertension
autosomal receive polycystic kidney disease
27
most common cause of urinary retention in females
utererocele
28
palpable bladder and weak urinary stream in newborn
posterior urethral valves
29
prenatal US with bilateral hydronephrosis and reduced renal parenchyma
posterior urethral valves
30
diagnosis with bilateral hydronephrosis, undescended testicles and poor anterior abdominal wall musculature
prune belly syndrome (aka eagle barrett syndrome)
31
management of bilateral hydronephrosis on US
VCUG
32
posterior urethral valves occurs in
males only
33
UTIs most common in
males before 3 months, then females after that
34
first febrile UTI management
renal US - if abnormal then VCUG, if normal wait and see if they get another
35
triad of nephrotic syndrome
1. hypoproteinemia
2. proteinuria
3. edema
36
most common cause of nephrotic syndrome in kids
minimal change nephrotic syndrome
37
minimal change nephrotic syndrome is most common in
males ages 2 to 8
38
symptoms of minimal change nephrotic syndrome
decreased UOP, abdominal pain, diarrhea and weight gain with normal renal function
39
liver reaction to nephrotic syndrome
due to spilling of protein there is low oncotic pressure which causes the liver to make more VLDL causing high LDL/HDL ratio, and increased fibrinogen, factor V and VII causing hypercoagulability
40
effect of proteinuria in nephrotic syndrome
immunodeficiency due to loss of immunoglobulins
hypocalcemia due to low albumin
functional hypothyroidism due to loss of TBG
41
complications of nephrotic syndrome
hyponatremia, vascular thrombosis, peritonitis
42
hematuria in a child with minimal change disease
vascular thrombosis
43
increased risk of what infections with nephrotic syndrome
pneumococcus due to hypogammaglobulinemia
44
treatment of nephrotic syndrome
sodium restriction and prednisone
45
worse prognosis in nephrotic syndrome if
2 or more (get a renal biopsy)
- >10 years old
- persistent/gross hematuria
- HTN
- renal insufficiency
- low C3
46
management of continued proteinuria despite steroids with nephrotic syndrome
renal biopsy if proteinuria despite 4 weeks of daily prednisone and treatment with cyclophosphamide or cyclosporine
47
prognosis of nephrotic syndrome
based on response to prednisone
48
RBC casts
glomerular disease
49
symptoms of nephritic syndrome
Red urine
Oliguria
Proteinuria
Elevated BP and BUN (azotemia)
50
hematuria with proteinuria indicates
glomerulonephritis
51
focal segmental glomerulonephritis findings
edema, low serum albumin and normal C3 levels
52
Membranoproliferative glomerulonephritis findings
low C3
53
glomerulonephritis with low complement levels
PMS
Post strep
Membranoproliferative
Systemic Lupus
54
cause of post strep glomerulonephritis
deposition of immune complexes in the kidney
55
triad of post strep glomerulonephritis
HTN, edema and hematuria
56
cause of low serum albumin in post strep glomerulonephritis
hemodilution
57
how to differentiate post strep from membranoproliferative and lupus with labs
C3 will return to normal after a couple of months
58
glomerulonephritis with current sore throat
IgA nephropathy
59
IgA nephropathy aka
Berger;s disease
60
gross painless hematuria within days of a URI
IgA nephropathy
61
what correlates with worsening/progressive disease in IgA nephropathy
persistent proteinuria
62
diagnosis with hemolytic anemia, renal failure (elevated BUN), and thrombocytopenia
hemolytic uremic syndrome
63
initial signs of HUS
anemi and pallor, then abdominal pain and decreased UOP
64
HUS treatment
supportive
65
serum complement levels in HUS
normal
66
most common type of acute renal failure
pre-renal
67
FeNa in pre-renal failure
low (<1%)
68
urine osmolality in pre-renal failure
high (>350 mOsm)
69
FeNa in intrinsic renal failure
high (>1%)
70
urine osmolality in intrinsic renal failure
low (<35o mOsm)
71
FeNa calculation
(urine Na x serum Cr) / (serum Na x urine Cr)
72
GFR when Cr is 2x normal
half
73
Hgb in chronic kidney disease
decreased EPO from kidneys = normocytic anemia
74
serum creatinine levels correlate with
muscle mass
75
treatment of chronic kidney disease
restrict protein
76
metabolic acidosis with CKD
due to decreased bicarb production and decreased acid excretion - part of why they have growth failure
77
cause of HTN in CKD
salt and water retention, increased renin
78
secondary hyperPTH in CKD
due to decreased production of 1,25-dihydroxyvitamin D3 causing decreased calcium absorption, hypocalcemia, and elevated PTH
79
phosphorus and CKD
increased serum phosphorus bc can't excrete it leading to calcium loss and increased PTH
80
vaccine in CKD
need them all to qualify for transplant - give live sones prior to transplant bc can't have it once on immunosuppressives
81
titers that need checked when on dialysis
hep B (antibodies can be removed by dialysis)
82
HTN definiton
BP >95th%ile for age and sex on 3 different occasions
83
medications that can cause HTN
albuterol, OCPs, steroids, decongestants
84
history of prematurity and now with HTN think
renal artery stenosis 2/2 umbilical catheterization
85
HTN and joint pain/swelling think
connective tissue disorder ex: lupus
86
HTN and palpitations and weight loss think
pheochromocytoma
87
HTN and muscle cramps, weakness think
hypoK 2/2 hyperaldosteronism
88
calcium channel blockers used for HTN
nifedipine, amlodipine
89
vasodilators used for HTN
hydralazine, minoxidil
90
ACE inhibitors used for HTN
enalapril, lisinopril
91
ARBs used for HTN
losartan
92
beta blockers used for HTN
propranolol, atenolol
93
alpha 2 agonists used for HTN
clonidine
94
pheochromocytoma management
must have BP controlled by alpha adrenergic blocker (phenoxybenzamine) prior to surgery
- beta blockers contraindicated bc could lead to unopposed alpha effect and paradoxical increase in BP
95
next step if HTN cause is suspected to be renal
renal arteriography with differential central venous renin determination (ex: with renal artery stenosis renin levels will be higher in the vein of that kidney)
96
salt losing nephropathy without signs of nephritis or nephrosis, FTT, retinitis pigmentosa, cerebellar aplasia
juvenile nephronophthisis type 1
97
most common genital problem in newborn males
cryptorchidism
98
osdmolal gap calculation
measured osmolality-calculated
| calculated = 2[Na] + BUN/2.8 + glucose/18
99
urine anion gap calculation
Na + K - Cl
100
antibody found in granulomatosis with polyangitis (Wegener)
anti-proteinase-3 (anti-PR3)
101
common sites of thromboses in nephrotic syndrome
sagittal sinus and renal vein
102
most common inherited primary renal disease in the US
autosomal dominant polycystic kidney disease
103
CNS complication with ADPKD
berry aneurysm in the circle of willis
104
commonly used K+ sparing diuretic
spironolactone (aldosterone antagonist)
105
serum anion gap in RTA
normal
106
type of RTA with high serum K+
type 4
107
type of RTA that most commonly causes renal stones
type 1 (distal) due to hypercalciuria
108
type of RTA associated with Fanconi
type 2 (proximal)
109
condition most associated with a very low FeNa
prerenal azotemia
110
type of casts seen in ATN
large, muddy brown granular casts
111
microorganism associated with stag horn renal calculi
proteus
112
most common cause of hydronephrosis in infancy and childhood
uteropelvic junction obstruction
113
most common cause of bilateral urinary obstruction in male infants
posterior urethral valves
114
most common cause of obstructive uropathy that leads to renal failure in childhood
posterior urethral valves
115
boy w/ hematuria at the end of urination with spotting of blood in underwear, normal US and exam
urethrorrhagia
116
most common congenital anomaly of the penis
hypospadias
117
entrapment of foreskin behind the glans of the penis
paraphimosis - must be reduced or could necrose
118
most common cause of priapism
sickle cell
119
when to repair a hydrocele if it persists until then
1 year
120
when should inguinal hernias be repaired
at diagnosis
121
serum anion gap calculation
Na - (HCO3 + Cl)
122
most likely cause of recurrent gross glomerular hematuria in kids
IgA nephropathy
123
benign familial hematuria aka
thin basement membrane nephropathy
124
what additional vaccines should a child with minimal change nephrotic syndrome receive
PPSV23
125
consider what with eosinophils on UA
allergic interstitial nephritis
126
syndrome with hypoplastic patellae, dystrophic nails and renal disease
nail-patella syndrome
127
complement levels in post strep glomerulonephritis
low C3, normal or low C4
128
what is deposited in the glomerular basement membrane with anti-GBM disease
IgG and C3
129
best way to mange edema in a child with minimal change nephrotic syndrome
salt/sodium restriction
