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EOR - Pediatrics > Urology/Renal > Flashcards

Urology/Renal Flashcards

1
Q

failure of testes to descent (one or both)

A

cryptochordism

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2
Q

complications of unrepaired cryptochordism (2)

A

infertility
malignancy

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3
Q

dx for cryptochordism

A

US

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4
Q

tx for cryptochordism

A

orchiopexy by age 1
as soon as possible after 4 mos

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5
Q

t/f: bacterial UTIs are a common cause of pediatric morbidity

A

t!

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6
Q

mc bacterial pathogen in pediatric UTIs

A

e.coli

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7
Q

most significant rf for pediatric UTI

A

urinary tract abnl -> stasis, obstruction, reflux

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8
Q

sx of UTI in newborns (lots!)

A

fever
hypothermia
jaundice
poor feeding
irritability
vomiting
ftt
sepsis

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9
Q

most kids w. UTI will have what UA finding

A

pyuria (WBC > 5)

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10
Q

gs dx for UTIs

A

urine culture

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11
Q

UA specimen older kids vs infants/young kids

A

older: midstream, clean catch
infants/young kids: bladder cath vs suprapubic collection

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12
Q

what peds should get RBUS (renal bladder US) (4)

A

-all infants/kids 2-24 mos following first febrile UTI
-any ped w. recurrent febrile UTI
-any ped w. UTI and hx of renal or urologic dz/poor growth/HTN
-peds who do not respond as expected to abx following UTI

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13
Q

tx for pediatric UTIs: low risk of renal involvement vs high risk

A

low risk: keflex
high risk: cefixime vs cefdinir vs ceftibuten

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14
Q

abx NOT recommended for empiric tx for UTIs in peds due to resistance to e.coli

A

amoxicillin vs ampicillin

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15
Q

definition of enuresis

A

involuntary loss of urine in a child > 5 yo

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16
Q

successful bladder control is usually achieved by what age

A

24-36 mos

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17
Q

clinically significant enuresis (4)

A

-more than twice/week for >3 consecutive mos
-affects day-to-day life
->/= 5 yo
-not caused by substance

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18
Q

classifications of enuresis

A

primary: never had period of dryness
secondary: dry for several mos before regular wetting occurs

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19
Q

primary nocturnal enuresis is thought to be due to (2)

A

delayed maturational control
vs
inadequate levels of ADH during sleep

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20
Q

work up for enuresis

A

if > 5 yo:
-UA w. culture
-assess fluids/stooling/voiding habits

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21
Q

management of enuresis (2)

A

-behavioral mods (ex nighttime audio alarm)
-desmopressin acetate (DDAVP)

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22
Q

with tx, parents can expect enuresis to improve by _ %

A

15%

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23
Q

kids who remain enuretic past _ yo are at higher risk of never having sx resolve

A

10

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24
Q

5 yo w. coke colored urine w. (+) protein and elevated BP - PMH includes impetigo 3 weeks ago

A

glomerulonephritis

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25
Q

urine microscopy findings of glomerulonephritis

A

dysmorphic erythrocytes
RBC casts

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26
Q

glomerulonephritis is inflammation in the

A

glomerular basement membrane

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27
Q

hallmark finding of glomerulonephritis

A

hematuria

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28
Q

glomerulonephritis is classified in to

A

acute
chronic

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29
Q

types of acute glomerulonephritis (2)

A

-postinfectious: GAS
-rapidly progressive: goodpasture vs vasculitis

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30
Q

lab findings of postinfctious GN

A

(+) ASO titers
low serum complement (C3/C4)

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31
Q

tx for post infectious GN

A

supportive
+/- abx

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32
Q

hallmark finding of rapidly progressive GN

A

crescent formation on bx

due to fibrin and plasma deposition

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33
Q

hallmarks of goodpasture’s

A

(+) anti GBM abs
linear IgG deposits -> dx

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34
Q

tx for goodpasture’s (3)

A

high dose steroids
plasmapheresis
cyclophosphamide

35
Q

hallmarks of vasculitis (3)

A

lack of immune deposits
(+) ANCA abs
microscopic polyangitis

36
Q

types of chronic glomerulonephritis (3)

A

IgA nephropathy (berger)
alport’s membranoproliferative

37
Q

hallmarks of IgA nephropathy

A

-post URI or GI
-renal bx: mesangial deposits of IgA in glomeruli

38
Q

complication of IgA nephropathy

A

renal failure in 25%

39
Q

dx for IgA nephropathy

A

renal bx

40
Q

isolated, persistent, painless hematuria

A

alport’s

41
Q

2 complications of alport’s

A

renal failure
hearing loss

42
Q

what is anterior lenticonus

A

conical shape of anterior lens -> alport’s

43
Q

dx for alport’s

A

C3/C4 levels

44
Q

2 causes of membranoproliferative GN

A

SLE
viral hepatitis

45
Q

dx for chronic GN

A

proteinuria + HTN, azotemia, oliguria, hematuria

46
Q

hallmark finding of chronic GN

A

RBC casts

47
Q

UA findings of chronic GN (3)

A

proteinuria < 3.5 g/day
hematuria
RBC casts

48
Q

bx findings of chronic GN

A

hypercellular, immune complex deposition

49
Q

tx for chronic chronic GN (5)

A

abx if strep
steroids: IgA
salt restriction
BP control
immunosuppression: RPGN

50
Q

indication for dialysis w. chronic GN

A

symptomatic azotemia

51
Q

penis abnl’s to know (5)

A

hydrocele
hypospadias
paraphimosis
phimosis
testicular torsion

52
Q

1 day old infant male w. scrotal mass on PE that illuminates

A

hydrocele

53
Q

collection of fluid around the testicle or along the spermatic cord that leads to a nontender fluid-filled cystic mass

A

hydrocele

54
Q

t/f: hydrocele usually resolves w.o tx during first year of life

A

t!

55
Q

dx for hydrocele

A

scrotal US -> transillumination

56
Q

if you suspect a scrotal mass but it does not illuminate, consider

A

tumor
varicocele

57
Q

if hydrocele does not resolve w.in 12 mos, what do you do (2)

A

needle aspiration
surgery

58
Q

healthy newborn with urethral meatus proximal to the tip of the glans on the ventral aspect of the penile shaft

A

hypospadias

59
Q

hypospadias is mc when the urethra opens onto the

A

bottom (underside) of the penile shaft

60
Q

what defines the type of hypospadias

A

position of the urethral meatus

61
Q

3 different types of hypospadias

A

most -> least severe

glandular: head of penis
midshaft: middle of penis
penile/scrotal: penis and scrotum join

62
Q

dx for hypospadias is mc made during exam, but _ can help confirm

A

excretory urogram

63
Q

tx for hypospadias

A

surgery prior to 1-2 yo

64
Q

what is contraindicated in hypospadias

A

circumcision

foreskin may be used to reconstruct urethra

65
Q

foreskin of penis can’t be pulled back over the head

A

phimosis

66
Q

entrapment of foreskin in retracted position behind the glans

A

paraphimosis

67
Q

why is paraphimosis a medical emergency

A

causes a tourniquet effect

68
Q

management of paraphimosis (3)

A

-circumferential compression to glans
-dorsal slit
-circumcision once resolved

69
Q

management of phimosis (3)

A

-usually resolves by 5 yo
-betamethasone
-circumcision if persistent

70
Q

15 yo w. severe lower abd pain that radiates to left thigh, vomiting, hx of cryptochordism - normal vitals, benign abd exam, transillumination is negative

A

testicular torsion

71
Q

hallmark findings of testicular torsion

A

-diffusely tender elevated left testis
-loss of cremasteric reflex
-lifting testicle does NOT relieve pain

72
Q

twisting of testicle around the cord supplying blood to scrotum

A

cryptocordism

73
Q

what is this showing

A

asymmetric high riding testicle -> bell clapper deformity

74
Q

what is prehn sign, what does positive make you think of

A

relief of pain w. elevation of tender testis -> epididymitis

75
Q

typical presentation of testicular torsion (3)

A

-severe pain/swelling associated w. n/v
-absent cremaster reflex
-blue dot sign

76
Q

what is the blue dot sign

A

tender nodule 2-3 mm in diametr on upper pole of testicle

77
Q

dx for testicular torsion

A

US
radionuclide study -> gs

78
Q

what is this showing

A

lack of blood flow -> testicular torsion

79
Q

testicular torsion is a medical emergency and must be repaired w.in

A

4-6 hr

80
Q

complication of delayed repair of testicular torsion

A

infertility

81
Q

condition in which urine flows retrograde from bladder into ureters/kidneys

A

vesicoureteral reflux (VUR)

82
Q

typical presentation of VUR (2)

A

-young female
-recurrent infxns, esp cystitis or pyelonephritis

83
Q

dx/monitoring for VUR

A

dx w. VCUG
monitor w. serial US/VCUG

84
Q

management of VUR

A

mild-mod: self resolves
severe: surgery
new dx: +/- abx

EOR - Pediatrics (15 decks)

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