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Pediatric Rotation > Urology/Renal > Flashcards

Urology/Renal Flashcards

1
Q

What is the most common genitourinary defect in boys?

A

Cryptorchidism

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2
Q

Which side is more commonly affected in Cryptorchidism in infant boys?

A

Right side is more common

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3
Q

A mother is concerned about her infant boy with cryptorchidism. When do you tell her the testicle will most likely descend?

A

Within the first year of life

The majority descend within 3 months

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4
Q

When is surgery indicated for cryptorchidism?

A
  • If the testes has not descended within a year

- An Orciopexy is performed

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5
Q

What are 2 sequelae of cryptorchidism?

A
  1. Increases risk of testicular cancer

2. infertility

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6
Q

What is a sequelae of a hydrocele?

A

incarcerated hernia

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7
Q

When is surgery for a hydrocele indicated?

A

If it is not resolved by 6 months

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8
Q

T or F: It is common to have some level of hydrocele at birth.

A

True

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9
Q

What does a “patent processes vaginalis” mean?

A

Means there is a communication between the abdominal cavity and the scrotum–allowing fluid to move between the two

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10
Q

How long do the testicles maintain an intra-abdominal position?

A

Until about 7-9 months gestation, at this time, they descend through the inguinal canal

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11
Q

Where does the processus vaginalis end?

A

In the scrotum

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12
Q

When the glans penis is strangulated by an inflamed foreskin that cannot be placed back, what is this called?

A

Paraphimosis: TRUE MEDICAL EMERGENCY

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13
Q

How do you manage paraphimosis?

A
  • Place the penis is sugar water/sugar: acts like an osmotic to decrease swelling
  • STAT consult to pedi urology for emergency circumcision
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14
Q

What is phimosis?

A

Narrowing of the prepuce orifice

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15
Q

A 4 year old boy with a narrowed prepuce orifice tells his mother he is in pain. –what is the appropriate management?

A

Topical Betamethasone cream BID for 6 weeks WITH a 6-8 week f/u

  • 85% resolve with the steroid
  • remaining 15% need a circumcision
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16
Q

A 12 y/o male is in the office with testicular pain. The patient is in so much pain he has omitted twice. On PE, you see an edematous and erythematous scrotum, with an absent cremasteric reflex on the side of the affected testicle. When examining the patient, you notice a high riding, horizontal testicle. What is the next appropriate step?

A
  • Scrotal U/S + doppler

- Emergent orchiopexy by urology

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17
Q

How can you differentiate between a Testicular torsion and a torsion on the testicular appendix?

A

A torsion of the testicular appendix will have -a present cremasteric reflex

  • a vertical lying testicle
  • and the “blue dot” sign
18
Q

What is the most common urologic complaint?

A

Enuresis

19
Q

Are females or males more commonly affected by Diurnal enuresis?

A

Females are more affected

20
Q

Are females or males more commonly affected by nocturnal bedwetting?

A

Males are more commonly affected

21
Q

How much should a child be drinking?

A

1 oz/ 2lbs of body weight

22
Q

What is dysfunctional elimination syndrome?

A

Urinary retention is ALWAYS coupled with constipation (until proven otherwise)

23
Q

What is hypospadias?

A

Congenital disorder of the urethra where the urinary opening is not at the usual location on the head of the penis

24
Q

What are the different classifications of hypospadias?

A

“Go Call Patty Sue!”

  1. Glanular
  2. Coronal mid shaft
  3. Penoscrotal
  4. Scrotal
25
Q

What is hypospadias thought to result from what?

A

A failure of the urinary channel to completely tubularize to the end of the penis; the actual cause is unknown

26
Q

What is the most common associated defect with hypospadias?

A

Cryptorchidism

27
Q

A 3 month old male infant is brought in by his parents whose concern is their sons “spraying” urine stream. On PE, you notice a chordee. What is the most likely diagnosis?

A

Hypospadias

28
Q

What is the management for hypospadias?

A
  • surgical repair between 6-12 months of age

- hold off on circumscision

29
Q

What are the Grades I and II of Vesicourethral Reflux?

A

Grade I: reflux into a non-dilated ureter

Grade II: reflux into the renal pelvis and calyces without dilatation

30
Q

What are the Grades III and IV of Vesicourethral Reflux?

A

Grade III: Mild/moderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices

Grade IV: dilation of the renal pelvis and calyces with moderate urethral tortuosity

31
Q

What is Grade V of Vesicourethral Reflux?

A

Gross dilation of the ureter, pelvis, and calyces; ureteral tortuosity; loss of papillary impressions

32
Q

How do you diagnose Vesicourethral Reflux?

A

VCUG

33
Q

How do you treat Vesicourethral Reflux?

A
  • Main goal is to protect the kidneys*
  • Prevent UTIs
  • This may mean prophylactic abx in children too young to potty train
34
Q

T or F: In pediatrics, a urine culture must always be obtained?

A

True

35
Q

What is the difference between older children with cystitis and infants and young children?

A
  • Infants and young children: fever without any other obvious source; no focal complaints
  • older children: NO FEVER; may actually complain about suprepubic tenderness. fullness, dysuria, frequency and/hesitancy
36
Q

If a child <3 has a UTI, what is the next appropriate step?

A

warrants a VCUG and renal U/S

37
Q

If a child >3 has a UTI, what are some common etiologies?

A
  1. Poor hygiene during toiling
  2. Bubble baths
  3. Dysfunctional Elimination Syndrome*
38
Q

What is the treatment for Cystitis?

A 
Augmenting
Bacterium
However, due to resistance: 
Cefuroxime, 
Cephalexin, 
or Ceftriaxone can be used

< 1yr: child needs parenteral abx like Ceftrixone (maybe admission)

1-2 yrs: parenteral is still likely needed; IM Ceftriaxone can be given w/ parents consent w/o admission

> 3yrs: PO abx are adequate

39
Q

In children > 3 yrs, what is the most common cause of cystitis?

A

DES

Best tx is prevention, encourage child to void every 2 hrs

40
Q

What is your initial diagnosis based on the following:

  • “very ill” appearing child
  • fever higher than 102 degrees
  • positive UA/cultures
A

Pyelonephritis

41
Q

What test/study should you do to confirm your diagnosis?

  • “very ill” appearing child
  • fever higher than 102 degrees
  • positive UA/cultures
A

CT is the gold standard

RUS is also useful with less radiation risk

42
Q

What is the treatment for this patient?

  • “very ill” appearing child
  • fever higher than 102 degrees
  • positive UA/cultures
A
  • Augmentin
  • Bacterium

However, due to resistance:
-Cefuroxime,
-Cephalexin,
or Ceftriaxone can be used

< 1yr: child needs parenteral abx like Ceftrixone

1-2 yrs: parenteral is still likely needed; IM Ceftriaxone can be given w/ parents consent w/o admission

> 3yrs: PO abx are adequate

*Admission is generally needed to ensure abx compliance!

Pediatric Rotation (7 decks)

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