Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Peds EOR > Urology/Renal > Flashcards

Urology/Renal Flashcards

1
Q

What is cryptorchidism?

A

the failure of testes to descend (one or both)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the characteristics of cryptorchidism?

A
  • an undescended testicle is generally rare in full-time babies but common in baby boys born prematurely (30%)
  • if not repaired risks infertility and malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is cryptorchidism dx?

A

-ultrasound may be helpful identifying undescended testicles in abdominal space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the tx of cryptorchidism?

A

treat with surgery (orchiopexy) by age 1

-the current recommendation is to correct as soon as possible after 4 months of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is cystitis?

A

bacterial UTIs are frequent cause of pediatric morbidity

  • cystitis is when the infection is limited to the bladder
  • girls have a 10-fold risk over boys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the most common bacterial pathogen in cases of UTI in children?

A

escherichia coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most significant risk factor for UTI in children?

A

the prescience of a urinary tract abnormality that causes stasis, obstruction of reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of cystitis in older children?

A

similar to those in adults and include fever, frequency, urgency, dysuria, incontinence, abdominal pain, and hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the symptoms in newborns and infants with UTI?

A

nonspecific signs, including fever hypothermia, jaundice, poor feeding, irritability, vomiting, failure to thrive, and sepsis
-strong, foul-smelling or cloudy urine may be noted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the dx of cystitis?

A

screening urinalysis indicates pyuria (>5 WBCs/HPF) in most children with UTI some children can have sterile pyuria with UTI

  • urine culture is the gold standard for diagnosis, susceptibility testing should be performed
  • in toilet-trained older children a midstream, a clean-catch method is usually satisfactory
  • in infants and younger children, bladder catheterization or suprapubic collection is necessary in most cases to avoid contaminated samples
  • bagged urine specimens are helpful only if negative
  • asymptomatic bacteriuria is detected in 0.5-1% of children screened with urine culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Who needs to get a renal and bladder ultrasonography (RBUS)?

A
  • vesicoureteral reflux (VUR) is detected in 30-50% of children presenting with a UTI at <1 y/o
  • the American academy of pediatrics (AAP) recommends RBUS for all infants and children 2 to 24 months following their first febrile UTI
  • children of any age with recurrent febrile UTIs
  • children of any age with a UTI who have a family history of renal or urologic disease, poor growth, or hypertension
  • children who do not respond as expected to appropriate antimicrobial therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the tx of cystitis?

A
  • cephalosporin x 14 days are the first-line oral agent in the treatment of UTI in children without genitourinary abnormalities
  • first-generation cephalosporin (Keflex 50-100 mg/kg BID) for low risk of renal involvement
  • second-generation (cefuroxime) or third-gen (cefixime, cefdinir, ceftibuten) for those with a high likelihood of renal involvement
  • amoxicillin and ampicillin are not routinely recommended for empiric therapy because of the high rate of resistance of E. coli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is enuresis?

A

involuntary loss of urine in child older than 5 years

-it may be nocturnal or daytime, or both and primary or secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is successful bladder control usually achieved?

A

between the ages of 24 and 36 months, although many developmentally normal children take significantly longer

  • clinically significant: occurs > two times per week for > three consecutive months or affects day to day life
  • age: > 5 years old
  • not caused by other substances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is primary enuretics?

A

patients who have never successfully maintained a dry period
-primary nocturnal enuresis is thought to be due to delayed maturational control or inadequate levels of ADH secretions during sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is secondary enuretics?

A

dry for several months before regular wetting occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is enuresis dx?

A

enuresis should first be tested with a urinalysis and urine culture to rule out infection
-then a thorough history and physical with fluid intake, stool, and voiding diary should be compiled in order to investigate abnormal patterns seen in conditions like constipation or diabetes insidious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the tx of enuresis?

A

patients younger than 5 years of age do not require investigation or treatment, patients and family should be informed that bed-wetting is normal at their age and will likely resolve with time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the behavioral modification for the tx of enuresis?

A

nighttime audio alarm that sounds as soon as the child starts to urinate, eventually conditioning controlled bladder emptying before enuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the medications that can be used to tx enuresis?

A

desmopressin acetate (DDAVP) acts to concentrate the urine, if given in the evening, less urine is produced overnight, decreasing the likelihood of wetting

  • with all therapies, the cure rate is 15% per year after the age of 5
  • children who remain enuretic past age 8 have a 10% risk of never resolving their symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is glomerulonephritis?

A

implies inflammation of the glomerular basement membrane
-antigen-antibody complexes are formed or deposited in the sub epithelial or subendothelial areas, immune mediators follow, resulting in inflammatory injury

22
Q

What is the hallmark of the glomerulonephritis?

A

hematuria, overt or microscopic

23
Q

What is acute glomerulonephritides?

A

post infectious - group A strep (skin or throat) - 10-14 days after infection - diagnosed with ASO titers and low serum complement - treatment is supportive + antibiotics

  • group A streptococcal skin infection 3-6 weeks prior
  • throat infection 1-3 weeks prior
  • serum C3 and C4 can be decreased
  • kidney biopsy not usually necessary
24
Q

What is rapidly progressive glomerulonephritis?

A

crescent formation on biopsy due to fibrin and plasma protein deposition

25
Q

What is good pasture’s syndrome?

A

(+) anti-GBM antibodies, dx linear IgG deposits, treat with high dose steroids, plasmapheresis + cyclophosphamide

26
Q

What is vasculitis?

A

lack of immune deposits (+) ANCA antibodies

  • microscopic polyangitis (+) P-ANCA
  • granulomatosis with polyangiitis (Wegener’s) (+) C-ANCA
27
Q

What are the chronic glomerulonephritides disease?

A
  • IgA Nephropathy (Berger disease)
  • Alport’s Syndrome
  • Membranoproliferative glomerulonephritis
28
Q

What is IgA nephropathy (Berger disease)?

A
  • often affects young males within days (24-48 hours) after URI or GI injection - caused by IgA immune complexes which are first line of defense in respiratory and GI secretions so infections cause an overproduction which then damages the kidneys
  • slowly progresses to renal failure in 25% of cases
  • renal biopsy alone makes the diagnosis demonstrating mesangial despots of IgA in the glomeruli
29
Q

What is Alpert’s syndrome?

A
  • presents as isolated persistent painless hematuria
  • a genetic condition that occurs in children resulting in renal failure and hearing loss
  • ophthalmologic exam reveals anterior lenticonus - anterior part of the lens has a conical shape
  • DX: C3 and C4 levels
30
Q

What is membrnoproliferative glomerulonephritis?

A

due to SLE, viral hepattisi

31
Q

What are the manifestations of glomerulonephritis?

A

proteinuria, HTN, azotemia, oliguria (<400 ml urine/day), hematuria (RBC casts) hallmark, edema is not as much as nephrotic syndrome

32
Q

How is glomerulonephritis dx?

A
  • urinalysis: proteinuria <3.5 grams per day (a 24-hour urine), hematuria, RBC casts
  • biopsy: hyper cellular, immune complex deposition
33
Q

What is the tx of glomerulonephritis?

A

positive streptococcal cultures are treated with appropriate antibiotic therapy

  • steroids and other immunosuppressive drugs may be used to control the inflammatory response
  • dietary management: salt and fluid restriction
  • hypertension when present can be severe, requiring vasodilators, diuretics, and fluid restriction
  • dialysis should be performed if symptomatic azotemia
  • IgA nephropathy - glucocorticoids
  • rapidly progressive glomerulonephritis - immunosuppressive therapy
  • use of medications to control hyperkalemia, pulmonary edema, peripheral edema, acidosis, and hypertension
  • may require renal transplant - most syndromes recur in the transplanted kidney
34
Q

What is a hydrocele?

A

a collection of fluid around the testicle or along the spermatic cord leading to a non-tender fluid-filled (cystic) mass

35
Q

What are the characteristics of a hydrocele?

A
  • this occurs when lymphatic drainage from the scrotum is impaired, leading to swelling and enlargement
  • hydrocele is common in newborns and typically disappears without treatment during the first year of life
  • however, treatment is indicated if the mass becomes large and uncomfortable
36
Q

How is a hydrocele dx?

A

scrotal ultrasound can be used in the diagnosis of both hydrocele and varicocele
-the hydrocele can be visualized with transillumination Tumor or varicocele which both do not transilluminate

37
Q

What is the tx of hydrocele?

A

treatment usually involves watchful waiting

  • in rare circumstances, surgery is needed
  • most hydroceles will resolve within the first 12 months of life without treatment and do not need to be reassessed unless present after 1-year
  • if elective repair is indicated treatment consists of needle aspiration or surgery
  • patients will require scrotal support after treatment, and they should be monitored for bleeding or infection at the site after intervention
38
Q

What is hypospadias?

A

(more common than epispadias)

when the urethra opens onto the bottom (undersea) of the penile shaft

39
Q

What defines the hypospadias?

A

the position of the urethral meatus

  • granular - head of the penis (lease severe)
  • midshaft - middle of the penis
  • penalscrotal - where the penis and sctorum come together (most severe)
40
Q

How is the dx of hypospadias?

A

usually made during the newborn exam but imaging studies (excretory urogram) can aid in the diagnosis

41
Q

What is the tx of hypospadias?

A

surgical repair, usually performed before 1-2 years of age

-do not circumcise - foreskin may be used to reconstruct the urethra

42
Q

What is paraphimosis?

A

an inability to return the foreskin to normal position

  • entrapment of the foreskin behind glans
  • causes a tourniquet effect and is a medical emergency
  • more acute than phimosis
43
Q

How is paraphimosis treated?

A

treat by applying firm circumferential compression to the glans with the hand - may relieve edema sufficiently to allow the foreskin to be restored to its normal position

  • if this technique is ineffective, a dorsal silt using local anesthetic relieves the condition temporarily
  • circumcision is then done when edema has resolved
44
Q

What is phimosis?

A

is an inability to retract the foreskin

  • usually resolves by age five
  • unable to retract the foreskin
  • more chronic than paraphimosis
45
Q

What is the tx of phimosis?

A

treat with betamethasone topically, if no improvement circumcision

46
Q

What is a testicular torsion?

A

caused by a twisting of the testicle around the cord supplying blood to the scrotum

47
Q

What are the signs and symptoms of testicular torsion?

A
  • asymmetric high riding testicle “bell clapper deformity” negative preens sign (lifting of testicle will not relieve pain)
  • teenage males
  • sudden, severe pain and swelling in the testicle are symptoms
  • associated with nausea and vomiting
  • very tender to palpation
  • cremaster reflext absent
  • blue dot sign: tender nodule 2 to 3 mm in diameter on the upper pol of the testicle
48
Q

How is a testicular torsion dx?

A

diagnose with ultrasound and radionuclide study (gold standard)

49
Q

What is the tx of testicular torsion?

A

surgical emergency: repair both tests within 4-6 hours

-a longer wait may affect fertility

50
Q

What is a vesicoureteral reflux?

A

a condition in which urine flows retrograde or backward, from the bladder into the ureters/kidneys
-in young female patients, any history that points to recurrent infection, especially cystitis or pyelonephritis, should trigger an evaluation for vesicoureteral reflux (VUR)

51
Q

How is vesicoureteral reflux dx?

A

diagnose by using VCUG and monitor by using serial ultrasonography and VCUGs

52
Q

What is the tx of vesicoureteral reflux?

A

mild to moderate VUR often resolves spontaneously, but the more serious disease may require surgical intervention
-children with newly diagnosed VUR are given prophylactic antibiotics depending on their clinical course

Peds EOR (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions