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Phase 2 PEDs > GU > Flashcards

GU Flashcards

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1
Q

GU radiology guidance - use what 1st?

A

1L - U/S (cant detect scars however)
2L - VCUG (voiding cysourethrogram - reflux/urethra)
3L - CT/MRI - kidney structure/Fx
4L - Radionuclide studies (Kidney size, scars, Fx)

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2
Q

UTI occurs MC in what pop?

A

Girls

Boys if uncircumcised

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3
Q

S/S of neonate w/ UTI?

A

FTT, fever, feeding problems (No localizing S/S)

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4
Q

S/S of 1mo-2yo w/ UTI?

A

FTT, Fever, feeding problem, - N/V/D

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5
Q

S/S of >2yo w/ UTI?

A

Classic S/S

  • Urgency/frequency
  • Dysuria
  • ABD pain or Back pain
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6
Q

Suspect UTI in all?

A

Infants/children w/ unexplained fever OR congenital urinary anomalies

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7
Q

UTI Dx requires what?

A

> 50k CFU and pyuria = infant/young
100k CFU and pyuria = Older/Adolescents
AND
UA - leukocyte esterase AND nitrite

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8
Q

Best way to collect UA in PEDs?

A

Transurethral cath

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9
Q

GOLD standard of UA Cx results for Dx?

A

> 50k CFU + pyuria - cath specimen
100k CFU (older/adolescent PEDs)
1-50k CFU if suprapubic tap (RPT Cx otherwise)

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10
Q

TXT of UTI?

A

PO Abx - Older PEDs and not Ill w/ POS UA Cx

Parenteral Abx - Toxic/dehydrated

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11
Q

Duration of Parenteral Abx for TXT of UTI?

A

Neonates - 10-14d

Older - 7-14d

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12
Q

When should F/U be made for UTI after initiation of Abx?

A

2d - assess improvement or not - REEVAL if not

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13
Q

When is RAD warranted for assessment of UTI?

A

Renal/Bladder U/S for

  • ALL boys w/ UTI
  • Girls depending on severity
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14
Q

IF U/S is ABNL what is next step of care?

A

VCUG (voiding cystourethogram)

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15
Q

Purpose of VCUG?

A

Eval recurrent UTI - despite NL U/S

Visualize for +- vesicoureteral reflux

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16
Q

Likelihood of VUR being present depends on?

A

The younger the pt the more likely

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17
Q

What is VUR?

A

Retrograde flow from bladder up to ureter or kidney

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18
Q

Causes of VUR?

A 
Congenital (UVJ) Ureterovesical Jx incompetence 
Outlet Obstruction (acquired or cystitis)
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19
Q

VUR is classified how?

A

Graded on how far reflux reached GU
I – Ureter only
II – Ureter, pelvis, calyx - NO Dilation
III – U/P/C - Mild/Mod Dil/Tortuosity - (Slt blunt fornices)

IV – U/P/C - Mod Dil/Toruosity - (Fornice angles gone - but maintains papillary impressions)

V – U/P/C - gross dilation/toruosity w/ fornice angles gone and papillary impression loss)

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20
Q

VUR mgmt?

A

Grade I/II - resolves w/out surgery

High grade VUR or recurrent UTI = Prph Abx

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21
Q

What procedure is used to correct VUR?

A

Dextranomer/hyaluronic acid copolymer (Mild/mod)

Controversial

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22
Q

Complications of VUR?

A

HTN

CKD

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23
Q

Nephrotic syndrome attributes?

A 
NO BLOOD in urine
Heavy proteinuria (ALB mostly) >2g/24h (UA up)
HO-proteinemia (Blood down)
HYP-Cholesterolemia
Edema
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24
Q

What lab/cell marker ass/w nephrotic syndrome?

A

HLA

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25
Nephrotic syndrome pathophys?
``` Increased GFR permeability > Proteins leak out - (Increased UA/ decreased blood) > Reduced plasma oncotic pressure > Fluid to interstitial spaces > Decreased volume in BVs activates RAAS > Increases NaCl reabsorption AND Hypoproteinemia increases hepatic lipoprotein synth > Liver makes ALB and Lipids > Hypercholesterolemia ```
26
Nephrotic syndrome classified how?
Primary | Secondary
27
Types of primary nephrotic syndrome?
(MCNS) - Minimal change Nephrotic syndrome (FSGS) - Focal segmental glomerulosclerosis Membranoproliferative Glomerulonephritis Idiopathic membranous nephropathy
28
MC form of Nephrotic syndrome?
MCNS
29
MCNS presents as?
No hematuria Renal insufficiency HTN HO-Complementemia (NOT C3 tho)
30
Which primary Nephrotic syndrome is ass/w persistence/renal failure over time?
Membranoproliferative Glomerulonephritis
31
Which primary Nephrotic syndrome is ass/w systemic infections in adolescents/children?
Idiopathic membranous nephropathy
32
Standout 2ndy Nephrotic syndrome causes?
SLE HSP DM
33
Nephrotic syndrome presents as?
Sudden onset - pitting edema or ascites (MC) Anorexia, Malaise, Abd pain HTN > Decline in ALB and Volume > HOTN Diarrhea Respiratory distress - (Pulm edema or Pleural effusion)
34
MC S/S of Nephrotic syndrome?
Sudden onset - pitting edema or ascites
35
Dx of Nephrotic syndrome?
2-3 random UA - w/ 2+ protein on each UA protein/creatinine ratio >0.2 1st AM UA >2 nephrotic range proteinuria Low blood - protein/albumin 24h UA protein >50 Fasting cholesterol - still HYP-cholesterol/lipid HO-complement C3 (Not w/ MCNS)
36
What Rads are indicated for Nephrotic syndrome?
``` Renal Bx (not if MCNS) Renal U/S ```
37
TXT of MCNS?
Prednisone w/out renal Bx (12w) Edema - Salt restriction - Loop diuretics HTN - BB or CCB - ACEI if refract HTN Immunosupressives - refract Nephrotic syndrome
38
TXT of all other primary Nephrotic syndrome?
Renal Bx 1st > CCS (prednisones Edema - Salt restric/loop diuretics HTN - BB/CCB/ACEI (refract) Immunosuppresives - refract Nephrotic syndrome
39
Cardinal features of Glomerulonephritis
``` BLOOD in urine Oliguria Proteinuria HTN Edema Renal insufficiency ```
40
Types of Glomerulonephritis?
IgA nephropathy (Bergers disease) Hereditary Nephritis (Alport syndrome) Post-Streptococcal Glomerulonephritis Rapidly progressive Glomerulonephritis
41
MC type of CHRONIC Glomerulonephritis?
IgA nephropathy (Bergers disease)
42
Which Glomerulonephritis has greatest risk of ESRD?
IgA nephropathy (Bergers disease)
43
IgA nephropathy is AKA?
Bergers disease
44
MC type of ACUTE Glomerulonephritis?
Post-Streptococcal Glomerulonephritis
45
Features of IgA nephropathy (Bergers disease)?
Acute GN Asymptomatic hematuria Recurrent gross hematuriaw/ URI
46
What levels of C3 complement is ass/w IgA nephropathy (Bergers disease)?
Normal C3 levels
47
Definitive Dx of IgA nephropathy (Bergers disease)?
Renal Bx - rarely needed
48
Hereditary Nephritis is AKA?
Alport syndrome
49
What is Hereditary Nephritis genetic etiology?
X-chromosome mutation affecting type IV collagen > | ABNL glomerular basement membrane
50
Hereditary Nephritis affects what gender the worse?
Males (Renal failure, Sensorineural hearing loss) Female = benign
51
When does Post-Streptococcal Glomerulonephritis begin?
5-21d s/p streptococcal pharyngitis infection | 4-6w post impetigo
52
TXT of Post-Streptococcal Glomerulonephritis?
Supportive - salt diet, diuretics, anti-HTN | Abx
53
Post-Streptococcal Glomerulonephritis outcome?
Benign
54
Rapidly progressive Glomerulonephritis complication?
Quick renal insufficiency > ESRD
55
Dx Rapidly progressive Glomerulonephritis?
Renal Bx - Glomerular epithelial cells proliferation w/ crescents
56
Hemolytic Uremic Syndrome is?
Glomerulovascular injury due to toxin/infection
57
Triad of HUS?
Microangiopathic hemolytic anemia Thrombocytopenia Renal injury
58
MC type of HUS?
Prodromal diarrheal illness from contaminated food/water
59
MC type of organism causing HUS?
E. Coli O157:H7 | - others - Shigella, other E.coli
60
HUS presents as?
``` Hemolytic anemia Enterocolitis + bloody stools Weak/lethargic/Irritable/pallor Oliguria 7-10d later Petechiae Dehydration or Volume overload (HTN) +- seizures, Cardiac dysfx, Colonic perforation ```
61
HUS TXT?
Support - HTN control | +- dialysis, Trxf
62
Should you TXT HUS (organism) w/ Abx or antidiarrheal agents?
No! Abx - killing bacteria releases toxins Antidiarrheal - keeps organism inside body longer
63
Types of congenital kidney ABNLs?
Polycystic Kidney Disease Horseshoe Kidney Renal agenesis
64
Congenital Polycystic Kidney Disease is due to?
Gene mutations AutoDom or AutoRec > cystic dysfx kidneys
65
MC inherited kidney disease is?
AD Polycystic Kidney Disease
66
Which Polycystic Kidney Disease gene/structure is affected?
``` AD = Polycystin 1 or 2 defects AR = Fibrocystin defects ```
67
Which Polycystic Kidney Disease genetic etiology is ass/w early childhood vs middle adult?
``` Childhood = AR Polycystic Kidney Disease Adult = AD Polycystic Kidney Disease ```
68
AR Polycystic Kidney Disease attributes?
Bilateral renal enlargement KF early in childhood Hepatic fibrosis > portal HTN Interstitial fibrosis > tubular atrophy
69
AR Polycystic Kidney Disease is ass/w what other S/S complications?
Flank masses Hepatomegaly PTX Protein or blood in urine
70
Horseshoe kidneys are ass/w what genetic d/o?
Turners
71
How does Horseshoe kidneys affect the pt?
Asymptomatic - even though fused together - still fx
72
Renal agenesis is AKA?
Renal aplasia
73
2 types of Renal agenesis?
Unilateral | Bilateral
74
Unilateral Renal agenesis is ass/w what population?
DM or AA
75
Unilateral Renal agenesis is ass/w what other complications?
VUR Turners syndrome VACTRL
76
Bilateral Renal agenesis is ass/w what complication?
- Insufficent lung development > respiratory distress AND Potter syndrome
77
Potter syndrome is ass/w what disease?
Renal agenesis
78
Potter syndrome has what triad of S/S?
Flat facies Clubfoot Pulmonary hypoplasia
79
Types of Scrotal/Testicular ABNLs?
Testicular torsion Cryptorchidism Hydrocele
80
Typical Testicular torsion Hx?
Sudden onset - intense unilateral pain Triggered by sudden movement/sports N/V
81
What deformity might be present w/ Testicular torsion?
Bell-clapper deformity - testicle not anchored posteriorly so it can move freely w/in the scrotom.
82
PE for Testicular torsion will present?
High riding testicle TTP, Edema Absent cremasteric reflex - Negative Prehns sign - No relief if testicle raised
83
DDx of Testicular torsion?
Epididymo-orchitis - Positve Prehn sign, no edema/red Apendiceal torsion - blue dot on top of scrotom Incarcerated inguinal hernia - Hernia/ w/ Valsalva -- bowel sounds over swelling (hernia)
84
Testicular torsion mgmt?
Immediate testicular U/S doppler Refer to urology Detorsion/Fixation of testis w/in 6hr to save
85
Cryptorchidism is?
Undescended testes
86
Cryptorchidism is MC in what population?
Premature infants
87
Complications ass/w Cryptorchidism?
Testicular cancer | Infertility
88
Mgmt of Cryptorchidism?
Not descended after 1yo = refer | Orchidopexy at 2yo if still not descended
89
Hydrocele is?
Fluid collection in tunic vaginalis
90
Hydrocele is MC in what population?
Neonates
91
Hydrocele is classified as?
Communicating - Ass/w peritoneal space OR Non-Communicating
92
Dx hydrocele w/?
Transillumination
93
TXT for Communicating Hydrocele?
Urology refer for surgical correction
94
MC type of Hydrocele?
Non-Communicating
95
Mgmt of non-communicating Hydrocele?
Resolves w/in 12mo > if not Refer by 18mo
96
Communicating Hydrocele attributes?
Smallest in AM Enlarges during the day Ass/w inguinal hernia
97
Types of penile ABNLs?
Hypospadias | Enuresis
98
Hypospadias is ass/w what other conditions?
Cryptorchidism | Inguinal hernias
99
Hypospadias mgmt?
Urology surgical correction before 18mo old
100
What should ne considered during the mgmt of Hypospadias?
NO circumcision - foreskin may be needed for repair
101
What is Enuresis?
Urinary incontinence in a child adequately mature
102
Types of enuresis?
Diurnal vs nocturnal enuresis Primary - never achieved dryness vs Secondary - dry at least 6mo
103
Which classifications of Enuresis is ass/w | - Organic etiology (UTI, DM, DI, Chronic constipation)
2ndy Diurnal/Nocturnal enuresis
104
Enuresis TXT?
1L - txt underlying organic causes 2L - Enuresis Alarm 3L - Rx - desmopressin

Phase 2 PEDs (23 decks)

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