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Royal College Exam > Urology > Flashcards

Urology Flashcards

1
Q

Definition of unresolved congenital hydronephrosis based on 3rd trimester antenatal ultrasound

A

> = 7mm

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2
Q

What could a single umbilical artery signify re: the kidney?

A

Unilateral renal agenesis

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3
Q

Incidence of unilateral renal agenesis

A

approx 1/750

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4
Q

Potter syndrome

A 
Bilateral renal agenesis
Incompatible with life
Pulmonary hypoplasia
Potter facies (widely set eyes, low set ears, broad/flat nose)
Limb anomalies
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5
Q

What is multicystic dysplastic kidney

A

Usually unilateral, NOT inherited condition causing replacement of the kidney by cysts

May be due to ureteral atresia

Most common cause of abdominal mass in the newborn!

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6
Q

What is the most common cause of an abdominal mass in the newborn?

A

Multicystic dysplastic kidney

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7
Q

Risks associated with multicystic dysplastic kidney

A 
Hypertension (0.2-1.2%)
Wilms Tumour (1/333)
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8
Q

Ask-Upmark kidney

A

aka segmental hypoplasia

small kidneys with grooves
pts have severe hypertension
resolves w/ nephrectomy

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9
Q

Anatomic kidney anomalies with increased risk of Wilms

A

Multicystic dysplastic kidney

Horseshoe kidney

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10
Q

Complication of horseshoe kidney

A

Wilms tumour
stone disease
hydronephrosis (due to UPJ obstruction)

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11
Q

Things that predispose to urinary reflux

A

kidney duplication (with an extra ureter inserting into bladder on one side)

ureterocele (cyst of the intramural portion of the distal ureter)

ureter diverticulum

neuropathic bladder (in myelomeningocele, sacral agenesis)

posterior urethral valves

renal agenesis, MCDK (predisposes to reflux on the contralateral side)

constipation

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12
Q

Reflux is more likely to resolve if….

A

lower grade
unilateral
younger age at diagnosis

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13
Q

AAP recommends to treat what grade of VUR?

A

Grade IV + V

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14
Q

Diagnosis of UTI

A

Urinanalysis demonstrating pyuria and culture growing > 50,000 CFU/mL (from a cath/suprapubic aspirate)

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15
Q

When do you do a VCUG?

A

VCUG is indicated if U/S shows hydronephrosis,
scarring, or other findings suggestive of high-grade VUR or obstructive
uropathy, and in other atypical or complex
clinical circumstances

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16
Q

Is there a role for antimicrobial prophylaxis if you are concerned about VUR?

A

No. The evidence does not support that antimicrobial prophylaxis prevents renal scarring or UTI

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17
Q

How should you counsel parents of a child with VUR?

A

Prompt assessment when febrile (within 48 hrs) is important - early treatment is key in preventing renal scarring!

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18
Q

Complications of VUR

A

UTI
hypertension
CKD

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19
Q

How can you manage severe VUR with frequent UTIs?

A

Can try prophylaxis (Not recommended though - septra or nitrofurantoin)

Deflux injections into ureter

Reimplantation of ureter

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20
Q

symptoms of obstructive renal insufficiency

A 
non-specific!
nausea, vomiting
mild abdo pain
diarrhea
poor urine stream
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21
Q

walnut-sized palpable mass just above the pubic symphysis in a newborn boy

A

posterior urethral valves

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22
Q

palpable abdominal mass in newborn

A

most likely multicystic dysplastic kidney

could also be hydronephrosis

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23
Q

AP diameter grading system for hydronephrosis

A

mild = 6-9mm

moderate = 9-15mm

severe = > 15 mm

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24
Q

For what degree of antenatal hydronephrosis would you perform a post-natal RBUS?

A

> = 10mm in the 3rd trimester

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25
Q

When should do you an urgent post-natal ultrasound?

A

If severe bilateral hydronephrosis
OR
if severe single kidney hydronephrosis

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26
Q

When should you start a baby with antenatally detected hydronephrosis on prophylactic antibiotics after birth?

A

when RPD > 10mm in 3rd trimester
OR
SFU grade IV

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27
Q

When does a baby require a post-natal VCUG?

A

If postnatal U/S shows persistent hydronephrosis RPD >10mm

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28
Q

If the post-natal VCUG does not show reflux, then what do you do?

A

If RPD 10-15mm, stop antibiotics and repeat U/S at 3 mos & 1 yr

If RPD > 15mm, do diuretic scan to look for obstruction

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29
Q

Gene/protein affected in autosomal recessive polycystic kidney disease

A

PKHD1, which encodes fibrocystin

30
Q

What other organ is involved/affected in AR PCKD?

A

the liver - can cause bile duct proliferation and fibrosis

indistinguishable from congenital hepatic fibrosis

31
Q

Presentation of AR PCKD?

A

bilateral flank masses during neonatal period or infancy

32
Q

DDX PCKD?

A

Multicystic dysplastic kidney
Wilms
Hydronephrosis
Bilateral renal vein thromboses

33
Q

Most common hereditary kidney disease

A

Autosomal dominant polycystic kidney disease (1/500 to 1/1000)

34
Q

mutations/protein causing autosomal dominant polycystic kidney disease

A

PKD1/2, encodes polycystin 1/2

35
Q

Autosomal dominant PCKD - when does it present?

A

ESRD in 4th/5th decade

36
Q

Extra-renal symptoms of AD polycystic kidney disease

A

Cysts in liver, pancreas, spleen, ovaries

Intracranial aneurysms

Mitral valve prolapse

Hernias, intestinal diverticula

Renal cell carcinoma

37
Q

Repair of UPJ obstruction

A

pyeloplasty (stenotic segment at UPJ is excised)

38
Q

Prune-belly syndrome - TRIAD

A

Deficient abdominal muscles
Undescended testes
Urinary tract abnormalities

39
Q

What is the likely underlying etiology of prune belly syndrome?

A

severe urethral obstruction in fetal life

40
Q

urinary tract abnormalities in prune belly syndrome

A

massive dilation of ureters / upper tracts / gigantic bladder

41
Q

how do you decompress suspected PUV?

A

insertion of an NG tube (NOT a foley catheter - the balloon may cause bladder spasm, inducing severe obstruction)

42
Q

Unfavourable prognostic factors relating to PUV

A
  • hydronephrosis before 24 weeks GA
  • persistently elevated serum creatinine after decompression
  • cortical cysts in kidneys
  • incontinence > 5 yrs old
43
Q

What is the bell clapper deformity?

A

Redundant tunica vaginalis, allowing excessive mobility of the testis - predisposing to torsion (often bilateral)

44
Q

What reflex should you check if you suspect testicular torsion?

A

cremasteric (stroke inner thigh, testis retracts) - is almost always absent

45
Q

Most common cause of testicular pain in boys aged 2-10yrs

A

torsion of the appendix testis

46
Q

PE sign for torsion of appendix testis

A

blue dot sign

47
Q

management torsion of the appendix testis

A

bed rest x 24 hrs, NSAIDs x 5 ds

48
Q

what side do varicocele usually present on?

A

LEFT

if right-sided, should work up for abdominal mass

49
Q

Why do you treat varicocele?

A

if significantly large, can affect fertility! need surgical excision/management

50
Q

What should you do if a boy has bilateral, non-palpable testes?

A

Refer to specialist for possible DSD!

51
Q

When should you refer a child with unilateral undescended testis for surgical management?

A

at 6 months CGA

will NOT descend after 4 mos

52
Q

risk factor for cryptorchidism?

A

prematurity
(testes descend at 7-8 mos GA)

secondary to inguinal hernia repair

53
Q

risks of cryptorchidism

A 
infertility
testicular cancer
testicular torsion
associated hernia
psychologic effects of undescended testis
54
Q

do boy with retractile testes have an increased risk of infertility or cancer?

A

POTENTIALLY!

1/3 of retractile testis become “acquired undescended” and then have the same risk of infertility/cancer as undescended

55
Q

how do you manage non-palpable testes?

A

referral for diagnostic laparotomy

U/S not sensitive to find testes if they are not located within inguinal canal/ring

56
Q

what is priapism?

A

a penile erection at least 4 hrs in duration, unrelated to sexual stimulation

can be ischemic, non-ischemic (high-flow) or intermittent

57
Q

most common cause of priapism in children

A

sickle cell disease!

58
Q

management of priapism in children with HbSS

A

exchange transfusion
hydration
pain management
oxygen

59
Q

cause of high-flow, non-ischemic priapism?

A

usually perineal injury causing caverous arterial laceration/flow

60
Q

management of urethral prolapse

A

sitz baths, topical estrogen x 2 weeks (girls)

may require surgery if persistent

61
Q

flank mass, hematuria, thrombocytopenic

A

renal vein thrombosis

62
Q

risk factors for renal vein thrombosis

A 
maternal diabetes
prematurity
dehydration
sepsis
polycythemia
CHD
63
Q

most common cause of renal stones in kids

A

hypercalciuria

64
Q

most common types of stones in kids

A

calcium oxalate

65
Q

increase your risk of stones

A 
hypercalciuria
oxaluria
stasis
infection
cystinuria
lasix
66
Q

inhibit formation of stones

A

citrate
phosphate
magnesium
high flow urine

67
Q

If struvite stones, think of….

A

upper UTI with klebsiella or proteus

68
Q

indications for surgical removal of kidney stone

A 
obstruction
infection (Urologic emergency!)
69
Q

ways to avoid formation of kidney stones…

A 
increase fluid intake
decrease meat/protein intake
drink lemonade (citrate) - inhibits stone formation
limit salt consumption (decreases calcium excretion)
70
Q

cystinosis causes….

A

Fanconi syndrome

71
Q

cystinuria causes…

A

cystine stones

Royal College Exam (32 decks)

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