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Pediatric EOR > Urology / Renal > Flashcards

Urology / Renal Flashcards

1
Q

Increased risk of cryptorchidism

A

Premature infants

Low birth weight

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2
Q

70% of cryptorchidism will:

A

Descend spontaneously

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3
Q

Complications of cryptorchidism

A
  1. Testicular cancer in both affected and unaffected testicle
  2. Infertility
  3. Testicular torsion
  4. Inguinal hernias
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4
Q

Management of cryptorchidism

A
  1. Orchiopexy - before 1 y/o
  2. Observation if < 6 months
  3. hCG or GNRH
  4. Orchiectomy if found later in life
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5
Q

Most cryptorchidism will descend by:

Rarely spontaneously descend after:

A

3 months

6 months

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6
Q

Most common cause of painless scrotal swelling

A

Hydrocele

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7
Q

Congenital hydrocele in infants usually close by ___________ and may not require treatment

A

1 year

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8
Q

A communicating hydrocele will be worse with:

A

Valsalva

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9
Q

Management of hydroceles

A
  1. Usually no tx needed

2. Surgical repair if persists after 1 year

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10
Q

Inability to retract foreskin over the glans

A

Phimosis

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11
Q

Management of phimosis

A

Not emergent

Circumcision

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12
Q

Foreskin becomes trapped behind corona of glans and forms right band, constricting penile tissues

A

Paraphimosis

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13
Q

Management of paraphimosis

A
  1. Manual Reduction: reduce edema with cool compresses or pressure dressing then gentle pressure
  2. Pharmacologic therapy: granulated sugar, injection of hyaluronidase
  3. Incision - dorsal slit
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14
Q

Spermatic cord twists and cuts off testicular blood supply due to congenital malformation which allows the testicle to be free floating in the tunica vaginalis causing it to twist on itself

A

Testicular torsion

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15
Q

If nausea/vomiting present in the setting of abrupt onset of scrotal or inguinal pain, suspect:

A

Torsion

Usually absent in epididymitis

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16
Q

Physical exam signs for testicular torsion

A

Negative Prehn’s sign
Negative cremasteric reflex
Blue dot sign at upper pole
Bell clapper deformity

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17
Q

Pain relief of scrotal elevation

A

Prehn’s sign

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18
Q

Diagnosis of testicular torsion

A
  1. Testicular doppler ultrasound - best initial
  2. Emergency surgical exploration require if US unable to exclude
  3. Radionuclide scan (not used frequently)
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19
Q

Management of testicular torsion

A
  1. Detorsion and orchiopexy within 6 hours and in obvious cases (testicle fixation in scrotum)
  2. Orchiectomy if testicle not salvageable
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20
Q

Distinct episodes of urinary incontinence while sleeping in children > 5 y/o in the absence of symptoms of infection

A

Enuresis

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21
Q

Management of enuresis

A
  1. Behavioral
  2. Enuresis alarm
  3. Desmopressin DDAVP (may cause hyponatremia)
  4. Tricyclic antidepressants
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22
Q

Abnormal urethral placement (proximal and ventral)

A

Hypospadias

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23
Q

Abnormal foreskin resulting in an incomplete closure around the glans leading to the appearance of a dorsal hooded prepuce, abnormal penile curvature

A

Hypospadias

24
Q

Management of hypospadias

A

Urology referral and surgical correction

25
Due to incompetent or inadequate closure of the ureterovesical junction (UVJ) that contains a segment of the ureter within the bladder wall (intravesical ureter)
Vesicoureteral Reflux
26
Diagnosis of vesicoureteral reflux
1. Contrast voiding cystourethrogram 2. Radionuclide cystogram 3. UA, serum creatinine, renal imaging
27
Management of vesicoureteral reflux
Spontaneous resolution
28
Complications of vesicoureteral reflux
Loss of renal parenchyma | May lead to decreased renal function
29
Immunologic inflammation of the glomeruli causing protein and RBC leakage into the urine
Glomerulonephritis
30
HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia (nitrogen in blood) are hallmarks
Glomerulonephritis
31
Types of glomerulonephritis
1. IgA Nephropathy (Berger's Dz) 2. Post Infectious 3. Membranoproliferative/Mesangiocapillary 4. Rapidly progressive 5. Goodpasture's dz 6. Vasculitis
32
Most common cause of acute glomulonephritis
IgA nephropathy (Berger's)
33
Glomerulonephritis that often affects young males within days (24-48 hours) after URI or GI infection
IgA nephropathy
34
Diagnosis of IgA nephropathy
IgA mesangial deposits on immunostaining
35
Management of IgA nephropathy
ACEI +/- corticosteroids
36
Glomerulonephritis that is most common after GABHS
Post infectious
37
Glomerulonephritis that classically presents as a 2-14 y/o boy with facial edema up to 3 weeks after Strep with scanty, cola-colored urine (hematuria and oliguria)
Post infectious glomerulonephritis
38
Diagnosis of post infectious glomerulonephritis
``` Increased antistreptolysin (ASO) titers, low serum complement Biopsy: hypercellularity, increased monocytes/lymphocytes, immune humps ```
39
Management of post infectious glomerulonephritis
Supportive, +/- antibiotics
40
Glomerulonephritis due to SLE, viral hepatitis (HCV, HBV)
Membranoproliferative/mesangiocapillary glomerulonephritis
41
Glomerulonephritis associated with poor prognosis (progresses to end stage renal failure within weeks/months)
Rapidly progressive glomerulonephritis (RPGN)
42
Crescent formation on biopsy
Rapidly progressive glomerulonephritis | Due to collapse of crescent shape of Bowman's capsule
43
Management of rapidly progressive glomerulonephritis
Corticosteroids + cyclophosphamide
44
Two types of glomerulonephritis that only present with RPGN:
Goodpasture's disease | Vasculitis
45
Glomerulonephritis with + anti-GBM antibodies
Goodpasture's disease
46
Diagnosis of goodpasture's disease
LInear IgG deposits
47
Management of goodpasture's disease
High dose corticosteroids + cyclophosphamide + plasmapheresis
48
Glomerulonephritis that is characterized by lack of immune deposits and + ANCA antibodies
Vasculitis | Can either have p-ANCA or C-ANCA
49
Diagnosis of glomerulonephritis
1. Urinalysis 2. Increased BUN, creatinine 3. Renal biopsy gold standard
50
Risk factors for cystitis
Sexual intercourse Spermicidal use Pregnancy
51
Most common etiology for cystitis
E. coli Staph Enterococci for indwelling catheters
52
Dysuria, increased frequency, urgency, hematuria, suprapubic discomfort
Acute cystitis
53
Fever and tachycardia, back/flank pain, + CVAT, n/v
Pyelonephritis
54
Diagnosis of cystitis/pyelonephritis
1. Urinalysis 2. Dipstick 3. Urine culture
55
If urinalysis shows WBC casts
Pyelonephritis
56
Management of cystitis
1. Pyridium 2. Nitrofurantoin, ciproflox, bactrim, fosfomycin 3. Pregnant: amoxicillin, augmentin
57
Management of pyelonephritis
Fluoroquinolones IV or PO aminoglycosides

Pediatric EOR (10 decks)

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