Urology/Renal (3%)

Question 1

Rapidly progressive glomerulonephritis (RPGN) is associated with a (poor/good) prognosis with _____ formation on bx

Answer 1

poor

crescent

^{crescents formed due to fibrin & plasma protein deposition collapsing the crescent shape of Bowman’s capsule}

Question 2

Can r/o a testicular tumor and rule in a hydrocele by performing what test on PE?

Answer 2

transillumination

Question 3

Any cause of AGN can present with RPGN, which 2 ONLY PRESENT with RPGN?

Answer 3

Goodpasture’s dz

Vasculitis

Question 4

What is vesicourethral reflux?

Answer 4

The backflow of urine from the bladder to the kidney

VUR allows bacteria, which may be present in the urine in the bladder, to reach the kidneys, which can lead to kidney infection, scarring, and damage

Question 5

Berger’s disease often affects young (males/females) within days after _______ or _______ infection

Answer 5

males

URI or GI

Question 6

Pts with vesicourethral reflux have sx similar to pts with ______

Answer 6

cystitis

Question 7

How to tx paraphimosis?

Answer 7

Manual reduction: restore original position of the foreskin

Reduce edema with cool compresses or pressure dressing then gentle pressure to restore the foreskin to its normal position

Pharmacologic therapy: granulated sugar, injection of hyaluronidase, Incision (ex. dorsal slit)

^{<em>osmotic agents, such as granulated sugar or mannitol have been reported as effective agents to reduce swelling</em>}

^{<em>Hyaluronidase has been effectively used in the pediatric population as a method of increasing fluid diffusion, thus decreasing local edema</em>}

Question 8

What are some sx a pt may experience with cystitis?

Answer 8

dysuria, increased frequency, urgeny, hematuria, suprapubic discomfort

Question 9

In testicular torsion, the cremasteric reflex is (+/-)

What is the cremasteric reflex?

Answer 9

(-) (absent)

elevation of the testicle after stroking upper inner thigh

Question 10

How to tx Goodpasture’s dz?

Answer 10

High dose corticosteroids + cyclophosphamide + plasmaphersis

Question 11

In testicular torsion, Prehn’s sign is (+/-)

What is Prehn’s sign?

Answer 11

(-)

no pain relief with scrotal elevation

Question 12

Management of testicular torsion?

Answer 12

1. Detorsion & orchiopexy w/in 6 hours and in obvious cases

^{<em>Orchiopexy = testicle fixation in the scrotum</em>}

2. Orchiectomy if the testicle is not salvageable

Question 13

Testicular torsion occurs when the spermatic cord twists & cuts off testicular blood supply due to congenital malformation (called a _____ ______), which allows the testicle to be free floating in the tunica vaginalis (90%) causing it to twist on itself

Answer 13

“bell clapper” deformity of the processus vaginalis

Question 14

How to treat IgA nephropathy?

Answer 14

ACE Inhibitors, +/- Corticosteroids

Question 15

Post infectious acute glomerulonephritis is most commonly seen after what infxn?

Answer 15

GABHS

Question 16

Tx for pyelonephritis?

Answer 16

Fluoroquinolone PO or IV, Aminoglycoside x14 days (7 days may be used in healthy, young women)

Question 17

A majority of testicular torsion cases occur in what age group?

Answer 17

teenagers

Question 18

Tx for complicated cystitis?

Answer 18

Fluoroquinolone PO or IV, Aminoglycosides

Question 19

If a pt has HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia, what underlying condition is present?

Answer 19

Acute glomerulonephritis

^{Azotemia is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (<em>urea, creatinine, various body waste compounds, and other nitrogen-rich compounds</em>) in the blood}

Question 20

T/F: Testicular torsion is a true urologic emergency

Answer 20

TRUE!!!

Question 21

What type of hydrocele is worse with valsalva?

Answer 21

Communicating

Question 22

What is a potential complication of cryptorchidism?

Answer 22

Testicular cancer

subfertility

^{<em>can be prevented with early dx and tx</em>}

Question 23

In crytorchidism, where is the undescended testicle most commonly located?

Answer 23

In the inguinal canal

Question 24

What is (+) blue dot sign indicate?

Answer 24

torsion of appendix of testicle (mullerian remnant)

Question 25

What two body systems does Goodpasture's dz affect?

Answer 25

Kidney Lung

Question 26

What is the most common cause of painless scrotal swelling?

Answer 26

Hydrocele

Question 27

What are the different types of hydrocele?

Answer 27

Communicating: Peritoneal/abd fluid enters the scrotum via a patent processus vaginalis that failed to close Noncommunicating: derived from fluid from the mesothelial lining of the tunica vaginalis (no connection to the peritoneum

Question 28

What is paraphimosis? Is it a urologic emergency?

Answer 28

FORESKIN BECOMES TRAPPED BEHIND THE CORONA OF GLANS & forms tight band, constricting penile tissues Foreskin cannot be pulled forward The ring of tissue impairs blood & lymphatic flow gangrene & auto-amputation (days to weeks) Urologic emergency!

Question 29

T/F: usually no tx is needed for a hydrocele

Answer 29

TRUE ## Footnote * most resolve by the pts 1st bday* * ^{surgical repair may be required if it persists beyond 1 year of age or if an older pt with a communicating hydrocele}*

Question 30

What is the recommended course of tx for a pt with vesicourethral reflux?

Answer 30

Usually will self-resolve as child grows older and ureters grow in size Abx may be required Surgery if severe

Question 31

\_\_\_\_\_\_\_\_\_ is a similar disease to IgA nephropathy (berger's disease) but associated with generalized IgA vasculitis

Answer 31

Henoch schonlein purpura

Question 32

What is enuresis?

Answer 32

**Bedwetting** distinct episodes of urinary incontinence while sleeping in children \>/=5 y/o in the absence of sx of infxn

Question 33

What are risk factors associated with cystitis in children/neonates?

Answer 33

**vesicourethral reflux, newborns with FUO (fever of unknown origin)** Other: DM, catheter

Question 34

What are medication options for management of uncomplicated cystitis?

Answer 34

Nitrofurantoin Fluoroquinolones Trimethoprim-sulfamethoxazole

Question 35

How to dx a pt with acute glomerulonephritis? Gold standard?

Answer 35

**_Urinalysis (UA)_**: **hematuria (RBC casts)**, dysmorphic RBCs, proteinuria (usually \<3g/d but may be in the nephrotic range), high specific gravity \> 1.020 osm, ± WBCs Increased BUN, increased Creatinine to varying degrees ***_Renal biopsy gold standard (not needed if poststrep suspected)_***

Question 36

In a pt with pyelonephritis, what sx may be present?

Answer 36

fever, tachycardia, back/flank pain, +CVA tenderness, N/V

Question 37

What is cryptorchidism? What population is at highest risk? Most common on right or left?

Answer 37

Undescended testicle Premature infants or low birth weight Right sided

Question 38

What two conditions present with + ANCA antibodies and a ack of immune deposits?

Answer 38

Microscopic Polyangiitis (vasculitis of small renal vessels): +P-ANCA Granulomatosis with Polyangiitis (Wegener's): necrotizing vasculitis +C-ANCA

Question 39

What is complicated cystitis?

Answer 39

underlying condition with risk of therapeutic failure: sx \>7 days, pregnancy, DM, immunosuppression, indwelling catheter, anatomic abnormality, elderly, males

Question 40

What is the most common cause of AGN in adults, worldwide?

Answer 40

IgA Nephropathy (berger's disease)

Question 41

What is the most common organism to cause cystitis?

Answer 41

E. coli

Question 42

T/F: Glomerulonephritis is usually self-limited with a good prognosis

Answer 42

TRUE ## Footnote *except in cases of RPGN*

Question 43

What is hypospadias?

Answer 43

An abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open

Question 44

If a pt with cystitis is pregnant, what tx options are there?

Answer 44

**_Amoxicillin_**, Augmentin, Cephalexin, Cefpodoxime, **_Nitrofurantoin_**, Fosfomycin, Sulfisoxazole is safe except in last days of pregnancy (Increased kernicterus)

Question 45

Tx for enuresis?

Answer 45

**Behavioral**: motivational, education, and reassurance; bladder training, avoid caffeine, fluid restriction **Enuresis** **alarm**: used if kids fail to respond to behavioral therapy **Desmopressin** (**DDAVP**): synthetic antidiuretic hormone (ADH) **TCAs**: Imipramine

Question 46

Tx for rapidly progressive glomerulonephritis?

Answer 46

Corticosteroids + Cyclophosphamide

Question 47

What are tx options for cryptorchidism?

Answer 47

**_Orchiopexy_** (as early as 6 months old, ideally before 1 y/o) _Observation_ *only* if \<6 months old hCG or gonadotropin releasing hormone prior to orchiopexy Orchiectomy recomended if detected at puberty to reduce testicular CA risk

Question 48

What is the best initial test to dx testicular torsion?

Answer 48

Testicular doppler US

Question 49

What is phimosis? How does it differ from paraphimosis?

Answer 49

Phimosis is the inability to retract foreskin over the glans Not emergent! Management is circumcision

Question 50

Hydroceles in infants are usually (congenital/acquired), and in adults are usually (congenital/acquired)

Answer 50

congenital acquired

Question 51

Post infectious glomerulonephritis classically presents as a \_\_\_\_-\_\_\_\_ y/o (boy/girl) with ______ edema up to 3 weeks after Strep with scanty, ________ urine

Answer 51

2-14 y/o boy facial cola-colored/dark

Question 52

What are the clinical manifestations of testicular torsions?

Answer 52

ABRUPT onset of scrotal, inguinal or lower abdominal pain (usually \<6 hours}, ± nausea & vomiting If nausea/vomiting presents, suspect torsion (*usually absent in epididymitis*)

Question 53

How to dx a pt with cystitis?

Answer 53

UA Diptick

Question 54

Recommended tx for hypospadias?

Answer 54

Some forms of hypospadias are very minor and do not require surgery However, treatment usually involves surgery to reposition the urethral opening and, if necessary, straighten the shaft of the penis Surgery is usually done between the ages of 6 and 12 months

Question 55

Acute glomerulitis is an immunologic inflammation of the glomeruli causing ____ and _____ leakage into the urine

Answer 55

protein and RBCs

Question 56

What is the difference between the two types of vesicourethral reflux?

Answer 56

**_Primary VUR_**: present at **birth**, caused by a defect in the development of the valve at the end of the ureter, **MC type of VUR**, usually detected shortly after birth **_Secondary VUR_**: **obstruction** in the bladder or urethra causes urine to flow backward into the kidneys, can occur at **any age**, can be caused by surgery, injury, a pattern of emptying the bladder that is abnormal, or a past **infxn** that puts pressure on the bladder, more common in children who have **other birth defects** (*i.e. spina bifida*)