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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
Q

Due to incompetent or inadequate closure of the ureterovesical junction (UVJ) that contains a segment of the ureter within the bladder wall (intravesical ureter)

A

Vesicoureteral Reflux

26
Q

Diagnosis of vesicoureteral reflux

A
  1. Contrast voiding cystourethrogram
  2. Radionuclide cystogram
  3. UA, serum creatinine, renal imaging
27
Q

Management of vesicoureteral reflux

A

Spontaneous resolution

28
Q

Complications of vesicoureteral reflux

A

Loss of renal parenchyma

May lead to decreased renal function

29
Q

Immunologic inflammation of the glomeruli causing protein and RBC leakage into the urine

A

Glomerulonephritis

30
Q

HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia (nitrogen in blood) are hallmarks

A

Glomerulonephritis

31
Q

Types of glomerulonephritis

A
  1. IgA Nephropathy (Berger’s Dz)
  2. Post Infectious
  3. Membranoproliferative/Mesangiocapillary
  4. Rapidly progressive
  5. Goodpasture’s dz
  6. Vasculitis
32
Q

Most common cause of acute glomulonephritis

A

IgA nephropathy (Berger’s)

33
Q

Glomerulonephritis that often affects young males within days (24-48 hours) after URI or GI infection

A

IgA nephropathy

34
Q

Diagnosis of IgA nephropathy

A

IgA mesangial deposits on immunostaining

35
Q

Management of IgA nephropathy

A

ACEI +/- corticosteroids

36
Q

Glomerulonephritis that is most common after GABHS

A

Post infectious

37
Q

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)

A

Post infectious glomerulonephritis

38
Q

Diagnosis of post infectious glomerulonephritis

A 
Increased antistreptolysin (ASO) titers, low serum complement
Biopsy: hypercellularity, increased monocytes/lymphocytes, immune humps
39
Q

Management of post infectious glomerulonephritis

A

Supportive, +/- antibiotics

40
Q

Glomerulonephritis due to SLE, viral hepatitis (HCV, HBV)

A

Membranoproliferative/mesangiocapillary glomerulonephritis

41
Q

Glomerulonephritis associated with poor prognosis (progresses to end stage renal failure within weeks/months)

A

Rapidly progressive glomerulonephritis (RPGN)

42
Q

Crescent formation on biopsy

A

Rapidly progressive glomerulonephritis

Due to collapse of crescent shape of Bowman’s capsule

43
Q

Management of rapidly progressive glomerulonephritis

A

Corticosteroids + cyclophosphamide

44
Q

Two types of glomerulonephritis that only present with RPGN:

A

Goodpasture’s disease

Vasculitis

45
Q

Glomerulonephritis with + anti-GBM antibodies

A

Goodpasture’s disease

46
Q

Diagnosis of goodpasture’s disease

A

LInear IgG deposits

47
Q

Management of goodpasture’s disease

A

High dose corticosteroids + cyclophosphamide + plasmapheresis

48
Q

Glomerulonephritis that is characterized by lack of immune deposits and + ANCA antibodies

A

Vasculitis

Can either have p-ANCA or C-ANCA

49
Q

Diagnosis of glomerulonephritis

A
  1. Urinalysis
  2. Increased BUN, creatinine
  3. Renal biopsy gold standard
50
Q

Risk factors for cystitis

A

Sexual intercourse
Spermicidal use
Pregnancy

51
Q

Most common etiology for cystitis

A

E. coli
Staph
Enterococci for indwelling catheters

52
Q

Dysuria, increased frequency, urgency, hematuria, suprapubic discomfort

A

Acute cystitis

53
Q

Fever and tachycardia, back/flank pain, + CVAT, n/v

A

Pyelonephritis

54
Q

Diagnosis of cystitis/pyelonephritis

A
  1. Urinalysis
  2. Dipstick
  3. Urine culture
55
Q

If urinalysis shows WBC casts

A

Pyelonephritis

56
Q

Management of cystitis

A
  1. Pyridium
  2. Nitrofurantoin, ciproflox, bactrim, fosfomycin
  3. Pregnant: amoxicillin, augmentin
57
Q

Management of pyelonephritis

A

Fluoroquinolones IV or PO aminoglycosides

Pediatric EOR (10 decks)

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