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Rotation 1: Pediatrics > Urology/Renal (3%) > Flashcards

Urology/Renal (3%) Flashcards

1
Q

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

A

poor

crescent

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

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2
Q

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

A

transillumination

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3
Q

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

A

Goodpasture’s dz

Vasculitis

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4
Q

What is vesicourethral reflux?

A

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

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5
Q

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

A

males

URI or GI

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6
Q

Pts with vesicourethral reflux have sx similar to pts with ______

A

cystitis

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7
Q

How to tx paraphimosis?

A

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>

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8
Q

What are some sx a pt may experience with cystitis?

A

dysuria, increased frequency, urgeny, hematuria, suprapubic discomfort

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9
Q

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

What is the cremasteric reflex?

A

(-) (absent)

elevation of the testicle after stroking upper inner thigh

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10
Q

How to tx Goodpasture’s dz?

A

High dose corticosteroids + cyclophosphamide + plasmaphersis

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11
Q

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

What is Prehn’s sign?

A

(-)

no pain relief with scrotal elevation

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12
Q

Management of testicular torsion?

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

<em>Orchiopexy = testicle fixation in the scrotum</em>

  1. Orchiectomy if the testicle is not salvageable
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13
Q

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

A

“bell clapper” deformity of the processus vaginalis

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14
Q

How to treat IgA nephropathy?

A

ACE Inhibitors, +/- Corticosteroids

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15
Q

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

A

GABHS

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16
Q

Tx for pyelonephritis?

A

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

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17
Q

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

A

teenagers

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18
Q

Tx for complicated cystitis?

A

Fluoroquinolone PO or IV, Aminoglycosides

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19
Q

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

A

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

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20
Q

T/F: Testicular torsion is a true urologic emergency

A

TRUE!!!

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21
Q

What type of hydrocele is worse with valsalva?

A

Communicating

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22
Q

What is a potential complication of cryptorchidism?

A

Testicular cancer

subfertility

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

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23
Q

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

A

In the inguinal canal

24
Q

What is (+) blue dot sign indicate?

A

torsion of appendix of testicle (mullerian remnant)

25
Q

What two body systems does Goodpasture’s dz affect?

A

Kidney

Lung

26
Q

What is the most common cause of painless scrotal swelling?

A

Hydrocele

27
Q

What are the different types of hydrocele?

A

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

28
Q

What is paraphimosis?

Is it a urologic emergency?

A

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!

29
Q

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

A

TRUE

  • 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*
30
Q

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

A

Usually will self-resolve as child grows older and ureters grow in size

Abx may be required

Surgery if severe

31
Q

_________ is a similar disease to IgA nephropathy (berger’s disease) but associated with generalized IgA vasculitis

A

Henoch schonlein purpura

32
Q

What is enuresis?

A

Bedwetting

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

33
Q

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

A

vesicourethral reflux, newborns with FUO (fever of unknown origin)

Other: DM, catheter

34
Q

What are medication options for management of uncomplicated cystitis?

A

Nitrofurantoin

Fluoroquinolones

Trimethoprim-sulfamethoxazole

35
Q

How to dx a pt with acute glomerulonephritis?

Gold standard?

A

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)

36
Q

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

A

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

37
Q

What is cryptorchidism?

What population is at highest risk?

Most common on right or left?

A

Undescended testicle

Premature infants or low birth weight

Right sided

38
Q

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

A

Microscopic Polyangiitis (vasculitis of small renal vessels): +P-ANCA

Granulomatosis with Polyangiitis (Wegener’s): necrotizing vasculitis +C-ANCA

39
Q

What is complicated cystitis?

A

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

40
Q

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

A

IgA Nephropathy (berger’s disease)

41
Q

What is the most common organism to cause cystitis?

A

E. coli

42
Q

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

A

TRUE

except in cases of RPGN

43
Q

What is hypospadias?

A

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

44
Q

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

A

Amoxicillin, Augmentin, Cephalexin, Cefpodoxime, Nitrofurantoin, Fosfomycin, Sulfisoxazole is safe except in last days of pregnancy (Increased kernicterus)

45
Q

Tx for enuresis?

A

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

46
Q

Tx for rapidly progressive glomerulonephritis?

A

Corticosteroids + Cyclophosphamide

47
Q

What are tx options for cryptorchidism?

A

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

48
Q

What is the best initial test to dx testicular torsion?

A

Testicular doppler US

49
Q

What is phimosis?

How does it differ from paraphimosis?

A

Phimosis is the inability to retract foreskin over the glans

Not emergent!

Management is circumcision

50
Q

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

A

congenital

acquired

51
Q

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

A

2-14 y/o

boy

facial

cola-colored/dark

52
Q

What are the clinical manifestations of testicular torsions?

A

ABRUPT onset of scrotal, inguinal or lower abdominal pain (usually <6 hours}, ± nausea & vomiting

If nausea/vomiting presents, suspect torsion (usually absent in epididymitis)

53
Q

How to dx a pt with cystitis?

A

UA

Diptick

54
Q

Recommended tx for hypospadias?

A

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

55
Q

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

A

protein and RBCs

56
Q

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

A

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)

Rotation 1: Pediatrics (13 decks)

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