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BOARDS > Urology > Flashcards

Urology Flashcards

1
Q

when to refer infants with undescended testicles to urology

A

at 3 to 6 months

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2
Q

treatment for undescended testicle

A

orchiopexy by 12 to 18 months if still undescended

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3
Q

non palpable testes in a newborn management

A

urology evaluation and testicular US prior to discharge

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4
Q

syndromes associated with hypospadias

A 
SLOB
Silver Russell syndrome
Laurence Moon Biedl syndrome
Opitz syndrome
Beckwith wiedmann syndrome
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5
Q

hypospadias management

A

no circumcision and surgical correction at 6 months

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6
Q

diagnosis of boy with micropenis, poor feeding and hypotonia

A

prader-willi syndrome

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7
Q

diagnosis with unilateral scrotal pain, dysuria and fever, no scrotal mass

A

epididymitis

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8
Q

testicular mass evaluation

A

bilateral US, LDH, b-HCG and alpha-fetoprotein levels

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9
Q

microscopic hematuria definition

A

5 or more RBCs per hpf in 3 centrifuged samples of freshly voided urine obtained over several weeks

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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

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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
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12
Q

most likely cause of red/pink discoloration in diaper of newborn

A

urate crystals

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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)
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14
Q

most common stones in kids

A

calcium stones (increased risk w/ distal RTA, hyperclaciuria from hyperPTH, hypercalcemia, loop diuretics)

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15
Q

initial diagnostic study for renal stones

A

xray or US

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16
Q

xray will not se what stones

A

uric acid stones (radiolucent), small stones and stones over bone

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17
Q

stone size that may need percutaneous nephrolithotomy

A

> 5 mm

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18
Q

long term treatment for kids with stones

A

increased fluid intake and restricting salt intake (if still not responding then thiazide diuretic)

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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

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20
Q

causes of transient proteinuria

A

fever, exercise, dehydration

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21
Q

persistent orthostatic proteinuria management

A

if still occurring after 3 months then check protein/creatinine ratio (if >0.2 suggests renal disease)

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22
Q

first symptom of Alport’s

A

hematuria by age 6

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23
Q

initial kidney US in alports

A

normal - progresses to renal failure

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24
Q

most commonly palpated renal mass in infants

A

hydronephrotic kidneys 2/2 UPJ obstruction and multi cystic dysplastic kidneys

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25
Q

enlarged kidney with non-communicating cysts with thin or no parenchyma and dysplasia

A

multicystic dysplastic kidney disease

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26
Q

bilateral kidney masses and signs of portal hypertension

A

autosomal receive polycystic kidney disease

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27
Q

most common cause of urinary retention in females

A

utererocele

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28
Q

palpable bladder and weak urinary stream in newborn

A

posterior urethral valves

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29
Q

prenatal US with bilateral hydronephrosis and reduced renal parenchyma

A

posterior urethral valves

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30
Q

diagnosis with bilateral hydronephrosis, undescended testicles and poor anterior abdominal wall musculature

A

prune belly syndrome (aka eagle barrett syndrome)

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31
Q

management of bilateral hydronephrosis on US

A

VCUG

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32
Q

posterior urethral valves occurs in

A

males only

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33
Q

UTIs most common in

A

males before 3 months, then females after that

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34
Q

first febrile UTI management

A

renal US - if abnormal then VCUG, if normal wait and see if they get another

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35
Q

triad of nephrotic syndrome

A
  1. hypoproteinemia
  2. proteinuria
  3. edema
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36
Q

most common cause of nephrotic syndrome in kids

A

minimal change nephrotic syndrome

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37
Q

minimal change nephrotic syndrome is most common in

A

males ages 2 to 8

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38
Q

symptoms of minimal change nephrotic syndrome

A

decreased UOP, abdominal pain, diarrhea and weight gain with normal renal function

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39
Q

liver reaction to nephrotic syndrome

A

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

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40
Q

effect of proteinuria in nephrotic syndrome

A

immunodeficiency due to loss of immunoglobulins
hypocalcemia due to low albumin
functional hypothyroidism due to loss of TBG

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41
Q

complications of nephrotic syndrome

A

hyponatremia, vascular thrombosis, peritonitis

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42
Q

hematuria in a child with minimal change disease

A

vascular thrombosis

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43
Q

increased risk of what infections with nephrotic syndrome

A

pneumococcus due to hypogammaglobulinemia

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44
Q

treatment of nephrotic syndrome

A

sodium restriction and prednisone

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45
Q

worse prognosis in nephrotic syndrome if

A

2 or more (get a renal biopsy)

  • > 10 years old
  • persistent/gross hematuria
  • HTN
  • renal insufficiency
  • low C3
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46
Q

management of continued proteinuria despite steroids with nephrotic syndrome

A

renal biopsy if proteinuria despite 4 weeks of daily prednisone and treatment with cyclophosphamide or cyclosporine

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47
Q

prognosis of nephrotic syndrome

A

based on response to prednisone

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48
Q

RBC casts

A

glomerular disease

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49
Q

symptoms of nephritic syndrome

A

Red urine
Oliguria
Proteinuria
Elevated BP and BUN (azotemia)

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50
Q

hematuria with proteinuria indicates

A

glomerulonephritis

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51
Q

focal segmental glomerulonephritis findings

A

edema, low serum albumin and normal C3 levels

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52
Q

Membranoproliferative glomerulonephritis findings

A

low C3

53
Q

glomerulonephritis with low complement levels

A

PMS
Post strep
Membranoproliferative
Systemic Lupus

54
Q

cause of post strep glomerulonephritis

A

deposition of immune complexes in the kidney

55
Q

triad of post strep glomerulonephritis

A

HTN, edema and hematuria

56
Q

cause of low serum albumin in post strep glomerulonephritis

A

hemodilution

57
Q

how to differentiate post strep from membranoproliferative and lupus with labs

A

C3 will return to normal after a couple of months

58
Q

glomerulonephritis with current sore throat

A

IgA nephropathy

59
Q

IgA nephropathy aka

A

Berger;s disease

60
Q

gross painless hematuria within days of a URI

A

IgA nephropathy

61
Q

what correlates with worsening/progressive disease in IgA nephropathy

A

persistent proteinuria

62
Q

diagnosis with hemolytic anemia, renal failure (elevated BUN), and thrombocytopenia

A

hemolytic uremic syndrome

63
Q

initial signs of HUS

A

anemi and pallor, then abdominal pain and decreased UOP

64
Q

HUS treatment

A

supportive

65
Q

serum complement levels in HUS

A

normal

66
Q

most common type of acute renal failure

A

pre-renal

67
Q

FeNa in pre-renal failure

A

low (<1%)

68
Q

urine osmolality in pre-renal failure

A

high (>350 mOsm)

69
Q

FeNa in intrinsic renal failure

A

high (>1%)

70
Q

urine osmolality in intrinsic renal failure

A

low (<35o mOsm)

71
Q

FeNa calculation

A

(urine Na x serum Cr) / (serum Na x urine Cr)

72
Q

GFR when Cr is 2x normal

A

half

73
Q

Hgb in chronic kidney disease

A

decreased EPO from kidneys = normocytic anemia

74
Q

serum creatinine levels correlate with

A

muscle mass

75
Q

treatment of chronic kidney disease

A

restrict protein

76
Q

metabolic acidosis with CKD

A

due to decreased bicarb production and decreased acid excretion - part of why they have growth failure

77
Q

cause of HTN in CKD

A

salt and water retention, increased renin

78
Q

secondary hyperPTH in CKD

A

due to decreased production of 1,25-dihydroxyvitamin D3 causing decreased calcium absorption, hypocalcemia, and elevated PTH

79
Q

phosphorus and CKD

A

increased serum phosphorus bc can’t excrete it leading to calcium loss and increased PTH

80
Q

vaccine in CKD

A

need them all to qualify for transplant - give live sones prior to transplant bc can’t have it once on immunosuppressives

81
Q

titers that need checked when on dialysis

A

hep B (antibodies can be removed by dialysis)

82
Q

HTN definiton

A

BP >95th%ile for age and sex on 3 different occasions

83
Q

medications that can cause HTN

A

albuterol, OCPs, steroids, decongestants

84
Q

history of prematurity and now with HTN think

A

renal artery stenosis 2/2 umbilical catheterization

85
Q

HTN and joint pain/swelling think

A

connective tissue disorder ex: lupus

86
Q

HTN and palpitations and weight loss think

A

pheochromocytoma

87
Q

HTN and muscle cramps, weakness think

A

hypoK 2/2 hyperaldosteronism

88
Q

calcium channel blockers used for HTN

A

nifedipine, amlodipine

89
Q

vasodilators used for HTN

A

hydralazine, minoxidil

90
Q

ACE inhibitors used for HTN

A

enalapril, lisinopril

91
Q

ARBs used for HTN

A

losartan

92
Q

beta blockers used for HTN

A

propranolol, atenolol

93
Q

alpha 2 agonists used for HTN

A

clonidine

94
Q

pheochromocytoma management

A

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
Q

next step if HTN cause is suspected to be renal

A

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
Q

salt losing nephropathy without signs of nephritis or nephrosis, FTT, retinitis pigmentosa, cerebellar aplasia

A

juvenile nephronophthisis type 1

97
Q

most common genital problem in newborn males

A

cryptorchidism

98
Q

osdmolal gap calculation

A

measured osmolality-calculated

calculated = 2[Na] + BUN/2.8 + glucose/18

99
Q

urine anion gap calculation

A

Na + K - Cl

100
Q

antibody found in granulomatosis with polyangitis (Wegener)

A

anti-proteinase-3 (anti-PR3)

101
Q

common sites of thromboses in nephrotic syndrome

A

sagittal sinus and renal vein

102
Q

most common inherited primary renal disease in the US

A

autosomal dominant polycystic kidney disease

103
Q

CNS complication with ADPKD

A

berry aneurysm in the circle of willis

104
Q

commonly used K+ sparing diuretic

A

spironolactone (aldosterone antagonist)

105
Q

serum anion gap in RTA

A

normal

106
Q

type of RTA with high serum K+

A

type 4

107
Q

type of RTA that most commonly causes renal stones

A

type 1 (distal) due to hypercalciuria

108
Q

type of RTA associated with Fanconi

A

type 2 (proximal)

109
Q

condition most associated with a very low FeNa

A

prerenal azotemia

110
Q

type of casts seen in ATN

A

large, muddy brown granular casts

111
Q

microorganism associated with stag horn renal calculi

A

proteus

112
Q

most common cause of hydronephrosis in infancy and childhood

A

uteropelvic junction obstruction

113
Q

most common cause of bilateral urinary obstruction in male infants

A

posterior urethral valves

114
Q

most common cause of obstructive uropathy that leads to renal failure in childhood

A

posterior urethral valves

115
Q

boy w/ hematuria at the end of urination with spotting of blood in underwear, normal US and exam

A

urethrorrhagia

116
Q

most common congenital anomaly of the penis

A

hypospadias

117
Q

entrapment of foreskin behind the glans of the penis

A

paraphimosis - must be reduced or could necrose

118
Q

most common cause of priapism

A

sickle cell

119
Q

when to repair a hydrocele if it persists until then

A

1 year

120
Q

when should inguinal hernias be repaired

A

at diagnosis

121
Q

serum anion gap calculation

A

Na - (HCO3 + Cl)

122
Q

most likely cause of recurrent gross glomerular hematuria in kids

A

IgA nephropathy

123
Q

benign familial hematuria aka

A

thin basement membrane nephropathy

124
Q

what additional vaccines should a child with minimal change nephrotic syndrome receive

A

PPSV23

125
Q

consider what with eosinophils on UA

A

allergic interstitial nephritis

126
Q

syndrome with hypoplastic patellae, dystrophic nails and renal disease

A

nail-patella syndrome

127
Q

complement levels in post strep glomerulonephritis

A

low C3, normal or low C4

128
Q

what is deposited in the glomerular basement membrane with anti-GBM disease

A

IgG and C3

129
Q

best way to mange edema in a child with minimal change nephrotic syndrome

A

salt/sodium restriction

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