GU Flashcards
(79 cards)
1
Q
MC organism in UTI
A
E. coli
2
Q
Newborn UTI sx’s
A
Non-specific:
- Fever
- HYPOthermia
- Jaundice
- Poor feeding
- Irritability
- FTT, sepsis
- +/- strong, foul-smelling or cloudy urine
3
Q
Pre-scheool children UTI sx’s
A
- Abd or flank pain
- Vomiting
- Fever
- Urinary sx’s
- CVAT=UNUSUAL
4
Q
School-aged children UTI sx’s
A
Classic cystitis sx’s
+/- Pyelo
5
Q
What is gold standard diagnosis in UTI’s
A
Urine culture (properly collected)
6
Q
UTI tx in older infants & children
A
3rd Gen. Cephalosporin OR
Aminoglycoside
x7-10 days
7
Q
When would you admit an infant to the hospital for IV abx?
A
- <3 months
- Septic
- Dehydrated
8
Q
Define Vesicouretral Reflux (VUR)
A
Reflux of urine from bladder into ureter/upper urinary tract
9
Q
When does the incidence of VUR increase?
A
infants w/ prenatal hydronephrosis
10
Q
Who is VUR MC in?
A
White
Females
Strong FHx
11
Q
What is the MC type of VUR?
A
Primary VUR
12
Q
Define Primary VUR
A
Short Ureters: Incompetent or inadequate closure of ureterovesical junction
Congenital*
13
Q
Define Secondary VUR
A
Abnormally hight voiding pressure in bladder=Blockage
- Functional bladder obstruction
- Anatomic dysfunction
14
Q
Prenatal VUR sx’s
A
Hydronephrosis on US
15
Q
Postnatal VUR sx’s
A
Febrile UTI
16
Q
Prenatal imaging follow-up in UNILATERAL Hydronephrosis VUR visualized
A
Repat US @ 1 week of age
17
Q
Prenatal imaging follow-up in BILATERAL hydronephrosis VUR visualized
A
Repat US + Voiding Cystourethrogram (VCUG)
18
Q
Postnatal work-up with UTI in VUR
A
Renal and Bladder US
19
Q
Postnatal work-up with FEBRILE UTI in VUR
A
Voiding Cystourethrogram (VCUG)
20
Q
Grade I and II VUR treatment
A
Monitor for spontaneous resolution
80% resolve by age 5
21
Q
Garde III-IV VUR treatment
A
Prophylactic abx:
- TMP-SMX
- Nitrofurantoin
*D/c when VUR resolves
22
Q
Surgical correction indications
A
- Grade V reflux w/ scarring
- Persistent Grade Iv/V reflux in children >2
- Failed medical therapy or ADE from abx
23
Q
What is the MCC of urinary tract obstruction in males?
A
Posterior Urethral Valves (PUV)
24
Q
What is present in 1/2 to 1/3 of pt’s with PUV?
A
VUR
25
30% of PUV pt's will develop __?
ESRD or renal insufficiency
*Monitor for renal failure!
26
Prenatal US findings in PUV
1. BILATERAL Hydronephrosis
2. Distended & thickened bladder
3. +/- Oligohydramnios
27
What are pt's @ risk of postnatal in PUV? Why?
Lung Hypoplasia d/t Oligohydramnios
28
Older boys si/sx's with PUV
1. Straining to urinate
2. UTI
3. Daytime and nocturnal enuresis
29
PUV diagnosis in postnatal boys
VCUG: Dilated and elongated posterior urethra
30
Prenatal PUV Treatment
Vesicoamniotic shunt placement
*experimental
31
Postnatal PUV Treatment
Transurethral Cath Ablation
32
Define Daytime Frequency
Voiding 8x or more during waking hrs
33
Define Straining
The application of abdominal pressure (Valsalva) to initiate and maintain voiding
34
Define Enuresis
Repeated urination into clothing (day & nighttime):
1. >5 y.o,
2. @ least 2x/wk for 3 months
35
Define Diurnal Enuresis
Wetting while awake
36
Define Primary Enuresis
Children who have NEVER been consistently dry @ night
37
Define Secondary Enuresis
Resumption of wetting after @ least 6 months of dryness
38
What is Nocturnal Enuresis often associated with?
Constipation
39
Nonpharm Tx in Nocturnal Enuresis
Bedwetting alarms x3 months
40
Pharm Tx in Nocturnal Enuresis (IF all else fails)
Desmopressin Acetate (DDAVP): Synthetic ADH
*short term
41
Define Daytime Urinary Incontinence
Wetting accident @ least once every 2 weeks
42
When should you consider an underlying cause in Daytime Urinary Incontinence?
Continence NOT achieved by 6 y.o.
43
List the associated disorders in Daytime Urinary Incontinence
1. Overactive Bladder=Urinary urgency*
2. Voiding postponement & under-active bladder: Postpone peeing, low frequency voiding, valsalva to aid in voiding
3. Dysfunctional voiding: Detrusor contractions during voiding against closed external urinary sphincter
44
Daytime Urinary Incontinence treatment
1. Tx underlying pathology
2. Behavioral Therapy
3. Anticholinergic: Oxybutynin
45
Define Exstrophy of Bladder
Open, inside-out bladder
| Congenital Anomaly
46
Who is Exstrophy of Bladder MC in?
White infants
First born
Males
47
Define Diastasis of Pubic Symphsis
Outward malrotation of pelvic bones
| Si/sx in Exstrophy of Bladder
48
What does Diastasis of Pubic Symphsis place the infant @ risk for?
Hip dysplasia
49
Exstrophy of Bladder treatment
1. Induced vaginal delivery or planned C-section
| 2. Surgery w/in 72 hrs of delivery
50
Define Hypospadias
Abnormal VENTRAL placement of urethral opening
51
What is Hypospadias associated with?
1. Chordea: Abnormal ventral curvature of penis
| 2. Cryptorchidism
52
Hypospadias increased the risk of __?
Inguinal hernias
53
ISOLATED Hypospadias Treatment
Repaire before 18 mos
54
Hypospadias with Cryptorchidism is at an increased risk for __?
Disorders of Sexual Development (DSD):
| Congenital Adrenal Hyperplasia=Salt wasting form of DSD
55
Congenital Adrenal Hyperplasia electrolyte findings
1. Low sodium
| 2. High potassium
56
What imaging will you order in Hypospadias with Cryptorchidism?
Pelvic US
57
What is the MC Congenital Abnormality of GU tract in males?
Cryptorchidism
58
Define Cryptorchidism
Undescended testis by 4 mos
59
Pt's are @ risk for __ in Cryptorchidism
1. Infertility
2. Testicular Malignancy
*5-10x higher risk
60
What labs/tests do you order for the dx of Cryptorchidism @ 2-6 months?
1. LH
2. FSH
3. Testosterone
4. Inhibit B
5. HcG stimulation test
61
At what age do you perform surgery in Cryptorchidism? Surgery treatment options?
@ 6-12 months
1. Orchiopexy: Palpable testi
2. Exploratory surgery: Nonpalpable
62
What is the MC associated abnormality in Testicular Torsion?
Bell Clapper Deformity: Testis lies horizontally
63
Testicular Torsion PEx/Diagnostic findings
1. Doppler US: Decreased perfusion
2. Absent Cremasteric reflex
3. Tender, swollen, elevated testi
64
Viable testis (BOTH) testicular torsion treatment
Surgical Detorsion + Orchopexy
65
Non-Viable testis testicular torsion treatment
Orchiectomy
66
100% viability is achieved if detorsion within__?
4-6 hrs
67
0% viability if detorsion is not achieved after__?
24 hrs
68
Define Hydrocele
Collection of peritoneal fluid between parietal and visceral layers of tunica vaginalis
69
Define Communicating Hydrocele
1. Failure of tunica vaginalis to close during development
| 2. Peritoneal fluid
70
Communicating Hydrocele clinical presentation
Increase in size during day OR w/ valsava maneuver (crying, screaming)
71
Define Non-Communicating Hydrocele
1. NO connection to peritoneum
| 2. Fluid= comes form mesothelial lining of tunica vaginalis
72
Non-Communicating Hydrocele can be a secondary etiology of the following__
1. Epididymitis
2. Orchitis
3. Testicular torsion
4. Trauma
5. Tumor
*work these up!
73
Diagnosis of a Hydrocele?
+ Transillumination
74
Define Varicocele
Collection of dilated and tortuous veins surrounding spermatic cord
75
Varicocele is the MC on the __side. Why?
Left side
| Left entering renal vein @ 90 degree angle
76
Varicocele is associated with __ in 30% of males
Infertility
77
Varicocele Clinical presentation
1. Dull ache or fullness of scrotum when upright
| 2. "Bag of worms"
78
Varicocele treatment
Observation
79
Why is a right sided varicocele concerning? Work-up?
Doppler US to r/o IVC obstruction:
1. Kidney tumor
2. Abd mass
3. IVC thrombus
4. Right renal vein thrombus
