Nephro/Uro Flashcards
1
Q
- 4 year old child with nephrotic syndrome on steroids. Presents with a swollen and tender abdomen. Looks septic. What test would give you the diagnostic:
a. Paracentesis
b. CT scan
c. MRI
D. Laparotomy
A
Paracentesis
2
Q
- Patient presents with edema, abdominal distension, and proteinuria. Patient also has fever and is found to have spontaneous bacterial peritonitis. What is the MOST likely pathogen causing the SBP.
a. Steptococcal pneumoniae
b. E. Coli
c. Enterococcus
d. Listeria
A
Strep pneumo
3
Q
- 5 yo girl diagnosed with nephrotic syndrome and on high dose steroids. You’ve counselled that she shouldn’t receive any live vaccines. What should she get now?
a. HPV vaccine
b. HAV vaccine
c. Pneumococcal polysaccharide (23-valent) vaccine
d. Meningococcal conjugate vaccine
A
Pneumococcal polysaccharide 23-valent
Highest risk of strep pneumo
- Give 13-valent conjugate vaccine + 23-valent polysaccharide vaccine
- Annual influenza (+household)
- Defer live vaccines until prednisone <1mg/kg/d or <2mg/kg/d on alt days. Live vaccines contraindicated while on steroid sparing agents (cyclophosphamide, cyclosporine)
- If exposed to varicella, give VZV Ig. Avoid direct exposure to GI + resp secretions of vaccinated contacts for 2-6wks after vaccination with live varicella
4
Q
- Child with 4+ proteinuria, distended abdo, fever. Most likely organism causing acute abdomen?
a. Ecoli
b. Strep pneumo
—————-
Child presents with facial edema, generalized edema and has proteinuria 4+, and concentrated urine 1.020. abdominal ascites. Physician performs peritoneal tap. What organism are you likely to find?
a. strep. Pneumoniae
b. e. coli
A
Strep pneumo
5
Q
- Periorbital swelling with no tenderness, no fever and normal blood pressure. What do you do?
a. reassure
b. check for proteinuria
c. start antibiotics
A
Check for proteinuria
6
Q
- Child with generalized edema, abdomen tender, 4+ protein in urine, hypoalbuminemic for 8 days.
a. Nephrotic syndrome with peritonitis
b. Appendicitis
A
Nephrotic syndrome with peritonitis
Urinary losses of IgG + complement
7
Q
- 14 year old boy in office for pre-camp physical, 3+ protein in urine x2, exam is normal, what is most likely cause?
a. exercise induced
b. IgA nephropathy
c. nephritic syndrome
d. orthostatic
A
Orthostatic proteinuria
8
Q
- 15 yo with 3+ proteinuria on routine exam.
a) Check Protein twice each am
b) 24 hr urine protein
c) renal function tests
A
Check protein twice each AM
9
Q
- 12y old with diabetes Type I since the age of 5 with microalbuminuria despite optimum control of his diabetes. What should you start him on:
a. hydrochlorothiazide
b. nifidepine
c. enalapril
—————-
Diabetic with microalbuminuria. What would you prescribe?
a. Enalapril
b. Hydrochlorothiazide
c. Nifedipine
d. Salt and water restriction
A
Enalapril
10
Q
- A child presents with hypertension, urine dip shows blood and protein, creatinine and urea are elevated, C3 and C4 are normal. What is the most likely diagnosis?
a. SLE
b. Membranoproliferative glomerulonephritis
c. Post-infectious glomerulonephritis
d. IgA nephropathy
A
IgA nephropathy
11
Q
- What glomerular disease is associated with a low C3?
a. Membranous nephropathy
b. Alports
c. IgA nephropathy
d. Membranoproliferative glomerulonephritis
A
MPGN
12
Q
- 7yo M with recent URTI who presents with respiratory distress and BP 150/110. Most likely diagnosis?
a. Pneumonia
b. Post strep GN
A
PSGN
13
Q
- 4 year old girl with glomerulonephritis, hypertension, and vomiting x3 days. Most probable test to determine diagnosis (*question worded poorly)
a) C3
b) Renal Biopsy
A
C3
14
Q
26.
Kid w PSGN, what to order?
a. Complements
A
Complement
15
Q
- Patient with history of sore throat. Urine shows microscopic hematuria. What is the natural course?
a. It will resolve over time
b. Progress to chronic renal disease
c. microscopic hematuria
d. proteinuria and hypertension
A
It will resolve over time
C. Can have persistent microscopic hematuria for up to 1-2y, but eventually should resolve
B. <2% progress to chronic renal disease
D. Glomerulonephritis has HTN but minimal proteinuria
16
Q
- Child with proteinuria (4+), hematuria, hypertension, low C3. (No mention of any viral symptoms nor URTI). What do you expect in 6 months?
a. Proteinuria, hematuria
b. Hypertension, proteinuria, hematuria
A
Persistent proteinuria + hematuria
(Sick Kids consensus)
Low C3 Primary 1. PSGN - microscopic hematuria up to 2y - HTN resolves by 4-6wks - C3 normalizes by 6-8wks - 10-20% can have nephrotic range proteinuria 2. MPGN - IgG + C3 deposition - nephrotic + microscopic hematuria - 20% have HTN at presentation
Secondary
- Vasculitis + AI (SLE neprhitis)
- Subacute bacterial endocarditis
- Shunt nephritis
- Cryoglobinemia
17
Q
- Child with recent URTI. Now has periorbital edema and microscopic hematuria. What test to do that distinguishes between post-infectious GN and ___________ ?
a. C3
b. 24 hour protein
c. RBC casts
—————
PSGN vs. IgA - which test differentiates?
a. immunoglobulins
b. C3
c. 24-hour urine collection
d. ANA
A
C3
18
Q
- Which of the following is a presentation of HUS?
a. Coombs + anemia
b. Thrombocytopenia
c. Myoglobinuria
A
**Thrombocytopenia
HUS
- MAHA
- microangiopathic => vessel injury that causes mechanical breakdown of RBCs-> anemia
- Coombs is usually negative except in pneumococci-assoc’d HUS - Uremia
- Thrombocytopenia
- normal coags
19
Q
- A child with recent Group A strep infection, normal C3, C4, slightly increased creatinine, Platelets and low hemoglobin, with blood in the urine
a. HSP
b. HUS
c. Post strep GN
d. IgA nephropathy
—————–
Pt had GAS 2 weeks ago. Now presents with hemoglobin 70, Platelets of 30 and rising Cr and BUN. What is the diagnosis?
a. HUS
b. HSP
A
HUS
Normal C3C4 => not PSGN
Anemia
Renal insufficiency
Thrombocytopenia
Microscopic hematuria
20
Q
- Recurrent hematuria in a young male with a speech delay
a. IgA nephropathy
b. Alport syndrome
c. PSGN
d. MPGN
A
Alport syndrome
21
Q
- When should repair for a persistent hydrocele occur?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
A
Refer at 12mo
Occur by 18mo
22
Q
- Name 2 indications for surgery for a hydrocele.
A
- Persists beyond 12mo
- Communicating hydrocele
- Symptomatic hydrocele
23
Q
- A 10 year old boy presents with 12 hours of scrotal pain. He has focal tenderness at the upper pole of the testis with a focal blue discolouration, and there is some edema. What is the best next step?
a. Ultrasound
b. Analgesia and scrotal support
C. Urology consult
——————— - Testicle w blue dot?
a. Reassure
———————
A
Analgesia, scrotal support, reassurance
Appendix testis torsion (occurs in 2-10yo, rare in adolescents)
24
Q
- 13 y.o. presents with 3 day history of gradually worsening scrotal pain. On exam, you note tenderness at the superior pole of the right testis, with a bluish discolouration at the tip. Most appropriate next step in management:
a. testicular U/S with dopplers
b. testicular nuclear scan
c. urethral swab for chlamydia
d. supportive care and reassurance
————————
14 yo male presents with gradual onset of left testicular pain. Tenderness isolated to upper pole of testicle with bluish hue. What diagnostic test?
a. testicular nuclear scan
b. reassure and send him
c. testicular ultrasound
d. urethral chlamydial swab
A
Testicular U/S with dopplers
Though this is most likely torsion of the appendix testis given the isolation to the upper pole, it’s unusual in adolescents, so it would be worthwhile assess on testicular ultrasound rather than just reassuring
Uretheral chlamydial swab probably assessing for epididymitis
25
7. 8 yo with description of torsion of appendix testis. Blue dot.
a. u/s with dopplers
b. analgesia and support testicle
c. stat surgical consult
Analgesia + support testicle
26
48. A 14 year old boy presents with an acutely painful scrotum. You suspect testicular torsion. Which of the following is true?
a. absence of the cremasteric reflex is common
b. blue discoloration of the scrotum is pathognomonic
c. you have 36 hours to treat before losing the testes
Absence of the cremasteric reflex is common
B. Blue discoloration of the scrotum is suggestive of appendix testis torsion
C. <6H for 90% survival of testes
27
70. Description of testicular torsion. How can this diagnosis be confirmed?
a. testicular ultrasound
b. nuclear scan
Testicular ultrasound with dopplers
28
49. A 10 month old boy comes to ER. Acute onset of scrotal swelling. Parents have noted on and off swelling in the past few days. Today a bit irritable. VSS stable. On exam, swollen scrotum, does not reduce; transilluminates well, testicle palpable separately. Likely diagnosis?
a. epididmytis
b. testicular torsion
c. acute hydrocele
d. incarcerated hernia
---------------
Smooth, firm, tubular mass in scrotum that transilluminates, not febrile, irritable for a week. Discomfort with examination, testes palpable and are distinct from this mass. Not reducible, no vomiting.
a. incarcerated inguinal hernia
b. acute non-communicating hydrocoele
c. epididymitis
d. testicular torsion
Acute non-communicating hydrocele
29
3 mo baby boy with right inguinal mass. Anorexia and irritability x 3 days. Mass transilluminates, soft and separate from testes. Diagnosis:
a. acute non-communicating hydrocele
b. incarcerated inguinal hernia
c. Tumor
d. torsion of testes
Incarcerated inguinal hernia
b/c right inguinal mass!
- can get reactive hydrocele
30
34. 9 month old with unilateral cryptorchidism. Next step?
a. refer for orchidopexy/refer to urology
b. reassess at 12 months
c. abdominal ultrasound
Refer for orchiodopexy
If doesn't descend by 4mo, unlikely to descend on own
Should be surgically corrected no later than 9-15mo
31
43. Why do orchidopexy?
a. decrease malignancy risk
b. allow self examination
c. increase fertility potential
Decrease malignancy risk
| Increase fertility potential
32
33. Antenatal diagnosis of hydronephrosis. What to do before d/c?
a. VCUG
b. MAG scan
c. Ultrasound
U/S
33
69. 6mm pelvicaliceal dilatation noted on antenatal and postnatal u/s. What should be done next?
a. start prophylactic antibiotics
b. VCUG
c. DMSA
d. repeat U/S in 2 months
Repeat in 2mo
<10mm so:
- No VCUG or DMSA
- No ppx ABx
34
22. 7 y.o boy presents with left-sided nighttime flank pain. An US reveals left-sided hydronephrosis. what do you do next?
a. VCUG
b. Nuclear scan with lasix washout
c. DMSA scan
d. CT abdomen with contrast
Nuclear scan with lasix washout
DMSA is for scarring of kidneys + differential function, does not give info on drainage + function
35
38. Midline mass and E.coli urosepsis, next diagnostic step:
a. VCUG
b. renal U/S
---------------
3 day old baby with E. coli bacteremia. Examination identifies midline abdominal mass. What investigation next?
a. renal ultrasound
b. abdominal CT
c. VCUG
---------------
Baby with htn, midline mass. Most likely to give Dx?
a. VCUG
b. Renal U/S
---------------
Newborn with increased creatinine, palpable mass in midline. How do you confirm the diagnosis?
a. VCUG
b. Abdo Ultrasound
c. CT abdo
Renal US for next step
| VCUG for confirming PUV
36
27. You are asked to assess a 10 day old baby with weak abdominal muscles and cryptorchidism. The baby is also found to have bilateral flank masses. What is the most likely association with this picture to explain the flank masses?
a. polycystic kidneys
b. multicystic dysplastic kidneys
c. hydronephrosis
d. bilateral wilms tumors
---------
What does a prune belly boy have?
a. Hydronephrosis
b. Multicystic kidney
c. Polycystic kidney
d. bilateral Wilms tumour
Hydronephrosis
Prune belly syndrome
- 90% male, most are sporadic
- often stillborn
1. weak abdo muscles
2. cryptorchidism
3. urinary tract abnormalities
- ++distended bladder
- VUR + ureteral dilatation
- dilated urethra
- kidneys were various degrees of dysplasia
- patent urachus or urachal diverticulum
Complications
- CVS, resp (pulm hypoplasia), GI, MSK anomalies
Tx
- UTI prophylaxis
- abdo surgery
- renal transplant
Prognosis
- poor (many die in first few months b/c of pulmonary hypoplasia)
37
41. Child with back pain. Ultrasound shows left hydronephrosis. Test to give Dx?
a. Mag-3-Scan
b. Urine culture
------------
9yo boy complains of back pain. Renal ultrasound shows unilateral hydronephrosis. Renal function is normal. What do you do?
a. VCUG
b. DMSA
c. CT abdomen with contrast
d. Mag-3 scan (with lasix washout) – best for obstruction
Mag-3-Scan to assess for renal function + Dx obstruction
VCUG if
1) RBUS suggestive of selected renal abN, obstruction, or high grade VUR
OR 2) <2yo with second documented UTI
DMSA
- requires radiation, unlikely to alter management
- choose only if Dx of acute UTI or recurrent UTIs in question
Non-contrast CT AP could help assess for calculus + hydronephrosis
38
45. Newborn baby. Noted to have pelvicaliectasis on antenatal U/S and hydronephrosis on post-natal renal U/S. Otherwise looks well and planning discharge. What is your next investigation?
a. DMSA scan as outpatient
b. VCUG as outpatient
c. Repeat renal U/S in 6 weeks
d. Arrange IVP
---------------
2-day old baby with antenatal hydro, confirmed on post-natal U/S to have moderate-severe hydronephrosis. BW shows normal renal function, baby seems to be peeing well.
a. consult urology prior to discharge (exact wording)
b. DMSA
c. arrange for an outpatient VCUG
d. follow up in 2 months
VCUG as an outpt
Need to investigate with VCUG b/c mod-severe hydronephrosis, but no concern for bladder outlet obstruction (peeing well) + normal renal function. Can be done as an urgent outpt set-up
Urology consult - would be routine, but not before discharge?
39
3. A child with grade IV unilateral VUR presents with second UTI. Most recently she had a pylonephritis that was cultured and resistant to TMP-SMX and nitrofurantoin. You are thinking of starting prophylaxis. What do you start?
a) Cefixime
b) TMP-SMX
c) Ciprofloxacin
d) No prophylaxis indicated.
No prophylaxis b/c resistant to both meds that are used as first line for prophylaxis
Do not broaden b/c risk of resistance
40
39. 6 year old with history of utis now off prophylaxis for 2 years and symptom free a VCUG shows gr 1-2 reflux what do you do
a. continue observation, no intervention
Continue observation, no intervention
41
55. 6 y.o. girl with a history of bilateral VUR and recurrent UTIs, including two febrile illnesses. Has been off antibiotics and infection-free for two years. Repeat u/s and VCUG show normal kidneys, but grade 1-2 reflux bilaterally. What do you recommend:
a. consider operative repair
b. repeat cystogram every 2 years
c. restart prophylactic antibiotics
d. continue non-interventional observation
Continue non-interventional observation
42
66. 6 yo female with prior history of recurrent UTI, 2 of them afebrile, known bilateral reflux. Last VCUG shows ongoing low grade reflux. She has been off antibiotics and infection free for 2 years. What to do next?
a. Restart antibiotics
b. Observe only
c. VCUG every 2 years
Observe only
43
8. Children with turners have which renal abnormality at rates higher than healthy population?
A. horseshoe kidney
B. MCDK
C. Vesicoureteral reflux
Horseshoe kidneys
Turner renal malformations
1. Pelvic kidney
2. Horseshoe kidney
3. Double collecting system
4. Complete absence of one kidney
5. UPJ obstruction
44
46. A 12 year old boy notices a mass on one of his testicles. He has no other systemic symptoms. Which of the following investigations do you do first?
a. testicular scan
b. ultrasound
c. beta HCG and AFP
---------------
13yo boy with painless testicular mass. Next step:
a. U/S testes
b. CT abdomen
c. Beta HCG and alpha fetoprotein
U/S testes
Painless scrotal mass
1. Testicular tumour
2. Hydrocele
3. Inguinal hernia
4. Varicocele
5. Spermatocele
Painful scrotal mass
1. Testicular torsion
2. Torsion of appendix testis
3. Epididymitis
4. Trauma
5. Incarcerated inguinal hernia
6. Mumps orchitis
45
63. 14 year old male discovers testicular mass on self exam, otherwise painless and asymptomatic. What is your INITIAL investigation?
a. Testicular ultrasound
b. Abdominal CT
c. AFP/B-HCG
d. CXR
------------
Adolescent boy with nonpainful testicular mass. What test should be done?
a. Ultrasound
b. Mumps serology
c. CT pelvis
d. reassess in 1 month
Testicular U/S
Painless scrotal mass
1. Testicular tumour
2. Hydrocele
3. Inguinal hernia
4. Varicocele
5. Spermatocele
Painful scrotal mass
1. Testicular torsion
2. Torsion of the appendix testis
3. Epididymitis
4. Trauma
5. Mumps orchitis
46
10. 5 yr old nauseated, confused then seizing 12 hrs post-op tonsillectomy. labs show Na 121 and serum osmolality 260. What finding is most consistent with diagnosis?
A. urine osmolality is higher than serum osmolality
B. urine NA < 20
C. urine osmolality is lower than serum osmolality
D. high urine output
Urine osmol is higher than serum osmol
Low Na
Low serum osmol (Normal osmolality 280)
Probably SIADH post-op
not peeing out
increase urine osmol
47
11. Which of the following is seen in distal RTA?
a. Hyperkalemia
b. Hyponatremia
c. Hypophosphatemia
d. Hypercalciuria
Hypercalciuria
48
19. A child has constipation, vomiting and cause of low Glc, Low K, Low Na, high Cl non anion gap Met acidosis. No FTT. Urine pH 7.5.
a) CF
b) RTA
RTA
Hyperchloremic meta acidosis. No AG
Low Na, low K, low gluc -> most likely fanconi (prox RTA)
49
21. Child with distal RTA who doesn’t take his meds. 2 months after last visit, presents with bilateral leg weakness and doesn’t want to walk. What does he have?
a. Chronic acidosis
b. Hypokalemia
c. Hypocalcemia
d. Hypomagnesemia
Hypokalemia
- causes skeletal muscle weakness prox in LE and progresses to trunk + UE
- if <2.5, can have cramps, fasciculations, rhabdomyolysis, myoglobinuria
- if <2.0, can have muscle paralysis -> resp failure
- constipation + ileus (from smooth muscle weakness)
```
Hypocalemia
"SAT until numb"
- Sx
- Arrhythmia
- Tetany (Trousseau, Chovstek)
- numbness in hands, feet, + around mouth
```
50
23. School aged child with pH 7.15, HCO3 9, Na 138, Cl 121, PO4 0.7, K 3.0. Also has urine pH of 5 and glucose in urine. What do you check? Which test is most likely to reveal the diagnosis?
a. Leukocyte for cystine
b. Urine ca/cr ratio
Leukocytes for cystine
Met acidosis, hyperchloremic. AG =8 (no gap)
RTA!
normal Na, low K, low phos
glucose in urine, urine pH <5.5
all suggest Fanconi syndrome (proximal RTA)
```
Cystinosis
A. defected in cysteine metabolism -> cysteine accumulates in 1) kidney, 2) liver, 3) eye, 4) brain
B. Presentation
- Fanconi syndrome
- blond + fair skinned (decreased pigmentation)
C. Dx:
1) high leukocyte cystine content
2) detect cystine crystals in cornea
D. Mgmt
- Cysteamine PO + ocular drops
```
51
58. Patient to ER with following labs: Na 135, K 2.3, Cl 116, Bicarb 9, pH 7.14, most likely cause?
a. RTA
b. DKA
c. lactic acidosis
d. vomiting
metabolic acidosis, mildly
higher chloride
AG = 9 normal
low k!
RTA
52
62. Distal RTA (type 1), what is the electrolyte abnormality?
a. Glycosuria
b. Hypercalciuria
c. Increased anion gap acidosis
Hypercalciuria
RTA has non-AG met acidosis
Glycosuria is prox RTA
53
13. What is the most common cause for hypertension in a newborn?
a. Coarctation of the aorta
b. Renovascular
c. Hydronephrosis
Renovascular
54
20. Kid with elevated BP confirmed by ambulatory monitoring. what’s next?
a) Renal US
b) Treat with nifedipine
c) Recheck in a month
d) Ambulatory monitoring
Renal U/S
- as part of initial workup
- wouldn't treat with nifedipine without knowing the BP
- since it's confirmed elevated BP, would recheck but need to evaluate further
- has already underwent ambulatory monitoring
55
35. An 11y.o. girl has hypertension, as confirmed by ambulatory blood pressure monitoring. Her blood pressure is 128/84, which is just above the 95th percentile for both systolic and diastolic blood pressure. She has no other medical history and is asymptomatic. Her exam is normal. She has a normal CBC, BUN, creatinine, and urinanalysis. What is your next step?
a. 24h urine for catecholamines
b. Renal ultrasound
c. Start treatment with enalapril
d. Repeat ambulatory blood pressure monitoring
---------------
11yo girl is found to be hypertensive based on an ambulatory blood pressure monitoring results with BP > 95th percentile 125/95. Physical exam is normal. What should you do?
a. repeat ABPM in a month
b. Start captopril and see in a week
c. renal ultrasound
d. 24 hr catecholeamine collection
----------------
Kid with htn diagnosed by 24 hour BP monitoring. Describe BP over the 95%. Normal lytes, renal function. Next test?
a. Renal U/S
b. Repeat holter in 1mo
c. Monitor clinically
Renal U/S
If Dx with HTN, do diagnostic work up for target organ damage
Mainstay of Tx if lifestyle changes
Pharmacotherapy to bring BP below 95%tile (90%tile in CKD)
- ACEI/ARB: diabetes + microalbuminuria, proteinuric kidney disease
- BB/CCBs: HTN + migraine H/A
- if severe HTN/HTN crisis: labetolol, nipride, nicardipine
56
50. Which of the following is important in measuring blood pressure:
a. height
b. weight
c. Tanner stage
Height
57
51. Kid with hypertension confirmed by ambulatory blood pressure monitoring. Has BP 121/86. What do you do?
a. start him on captopril
b. observe and repeat an ambulatory blood pressure test
c. renal ultrasound
Renal U/S
Once Dx HTN, do diagnostic W/U including evaluation for target-organ damage
Mainstay is lifestyle modification
Pharmacotherapy to reduce BP below 95%tile (90%tile in CKD)
ACEI/ARBS: diabetes + microalbuminuria OR proteinuric renal disease
BB+CCBs: HTN + migraine H/A
Severe HTN/HTN crisis: labetolol, nipride, nicardipine
58
65. 7 year old girl with BP 140/80 with sx of ?PSGN & no signs given in history of end-organ damage. Management?
a. IV labetolol
b. PO nifedipine
c. Salt/H2O restriction
----------------
HTN in PSGN. Tx?
a. SL nifedipine
b. fluid and salt restriction
c. nitroprusside
Fluid + salt restriction
No end organ damage or encephalopathy
59
66. Which is (not- question likely remembered wrong) a factor in determining what a child’s mean BP should be:
a. Height
b. Weight
c. Tanner stage
d. Ethnicity
--------------
Blood pressure in children is most closely related to:
a. Weight
b. Height
c. Race/ethnicity
---------------
Normative values of blood pressure in children is related to:
a. Weight
b. Height
c. Race/ethnicity
Height
60
71. What is the most common etiology of hypertension in adolescents?
a. essential hypertension
b. renal artery stenosis
c. congenital renal disease
d. coarctation of the aorta
Essential HTN
61
15. Most common renal stone in children
a) Calcium oxalate
b) Cystine
c) Urate
d) Struvite
Calcium oxalate
90% calcium
60% oxalate
62
61. Teenager found to have struvite stone. What would be next investigation?
a. Urine calcium/Po4
b. Urine culture
c. 24 hour urine ca
Urine culture
Struvite stones (ammonium phosphate) commonly caused by UTIs (urea-splitting orgnaism - Kleb, Ecoli, proteus, pseudomonas) -> urinary alkalinization + excessive proD'n of ammonia -> precipitation of ammonium phosphate + calcium phosphate
63
73. A 3 year old girl has an abdominal ultrasound done by her family doctor to investigate abdominal pain. The ultrasound is normal except for an incidental finding of a renal cyst. What should be done?
a. urgent referral to nephrology
b. CT scan
c. VCUG
d. Follow-up only
Follow-up only
Approach to cyst
Unilateral cysts
- simple cysts
- multicystic dysplastic kidney (parenchymal, small, echogenic, disorganized)
```
Bilateral cysts
- large:
1) if FHx then ADPKD
2) if liver involvement, then ARPKD
Both require supportive mgmt
- small:
1) medullary cystic disease
2) glomerulocystic kidney (cortical cysts)
3) cystic renal dysplasia
```
64
37. RVT etiology:
a. UVC
b. IDM with polycythemia and dehydration
---------------
3 day old baby has gross hematuria and flank mass. Renal ultrasound with doppler identifies the diagnosis. What is the most likely etiology?
a. polycythemia and mother with IDM
b. prior use of umbilical venous catheter ?thrombosis
c. pre-eclampsia
---------------
Baby with renal mass and hematuria. Most likely associated with? **?? least likely associated with?
a. IDM (most likely)
b. polycythemia
c. dehydration
d. UVC (least likely)
IDM with polycythemia + dehydration
NOTE: in newborns, RVT accounts for approx. 10% of venous thrombosis and is the most common form of thrombosis not associated w/ a vascular catheter
65
14. Photo of young girl given (see below)> What is your treatment?
a. U/S abdo/pelvis
b. Call CAS
c. Karyotype
d. Topical estrogen
Topical estrogen
Labial adhesion?
- Sx: none, vulvitis, urethritis, urinary dribbling, UTi
- Dx: central semitranslucent line on visual inspection
- Tx
> If aSx: none
> If Sx: 6wks with gentle traction
1st line: topical estrogen cream (stop if breast budding occurs)
2nd line: betamethasone ointment
- Resolve in 6-12wks
- Prevent recurrence with vaseline to inner labia for 1mo
66
24. Shows picture of genitalia (looks labial adhesions) in an 18mo girl. What to do?
a. Estrogen cream to the affected area
b. Abdo US
c. Call CAS
d. Refer to urology
Topical estrogen cream
Labial adhesions
Sx: none, vulvitis, urethritis, urinary dribbling, UTI
Dx: central translucent line on visual inspection
Tx:
- if aSx: none
-if Sx: 6wks w gentle traction
1st line: topical estrogen cream (stop if breast budding)
2nd line; topical betamethasone ointment
- Resolves in 6-12wks
- Prevent recurrence with vaseline x1mo
67
28. 6 yr American African girl presented with blood in underwear. She has some trouble urinating, no fever, no other symptoms. On exam there is a red mass coming out of vagina..
a. Urethral prolapse
b. Cancer
Urethral prolapse
- black girls 1-9yo
- bloody spotting on underwear or diaper +/- dysuria, perineal discomfort
- may be mistaken for sexual abuse
Tx
- estrogen cream 2-3X/d x4wks
- sitz baths
- Surgical excision + reapproximation of the mucosal edges is curative
