Peds Genitourinary

Question 1

MC pathogen that causes UTI

Answer 1

E.coli

Question 2

What are classic symptoms seen in school age children with UTI?

Answer 2

frequency, dysuria, & urgency

FLANK PAIN

Question 3

What finding in a urinary analysis is a major finding with a UTI?

Answer 3

Nitrites

Question 4

CVA tenderness is unusual in which age group?

Answer 4

Pre-school aged kids, CVA tenderness is unusual

Question 5

Gold standard test for UTI?

Answer 5

Urine culture

Midstream

Question 6

Treatment of UTI in a infant <3 months?

Answer 6

IV antibiotics

Question 7

Treatment of UTI for children?

Answer 7

Amoxicillin
TMP-SMX
Cephlasporin (Keflex)

Question 8

What is Vesicoureteral Reflux (VUR)

Answer 8

Reflux of urine from bladder into the ureter/upper urinary tract

Question 9

What gender and race is VUR most common in

Answer 9

White

Females

Question 10

What is Primary VUR (short ureters)

Answer 10

incompetent or inadequate closure of the ureterovesical junction (UVJ)

Due to a congenitally short intravesicular ureter

Question 11

What is Secondary VUR (blockage) ?

Answer 11

Due to an abnormally high voiding pressure in bladder which results in failure of the closure of UVJ during bladder contraction

Question 12

What the most common for of reflux: Primary or Secondary

Answer 12

Primary

Question 13

What are signs and symptoms in Prenatal and Post natal Vescicoureteral Reflux?

Answer 13

Prenatal: hydronephrosis on prenatal u/s

Postnatal: febrile UTI

Question 14

What is the diagnostic work that needs to be done with VUR suspected in Prenatal baby?

Answer 14

Prenatal hydronephrosis (on prenatal u/s):

unilateral: repeat ultrasound at 1wk of age
bilateral: repeat ultrasound + VCUG

Question 15

What is the diagnostic workup for a Postnal with supsected VUR?

Answer 15

Postnatal work up

UTI: renal & bladder u/s
Febrile UTI: Voiding Cystourethrogram (VCUG)

Question 16

What are the different Grades found on a Voiding Cystourethrogram?

Answer 16

Grade I – reflux into the ureter no dilation

Grade II – Reflux to the kidneys

Grade III – Reflux to the kidneys w/ dilation of ureter only

Grade IV – Reflux w/ dilation of ureter and mild blunting of renal calyces

Grade V –Reflux w/ dilation of ureter & blunting of reflux calyces

Question 17

Treatment for Grade I-II VCUG?

Answer 17

Grade I and II
Monitor for spontaneous resolution (by age 5, 80% spontaneously resolve)

Consider prophylactic antibiotics

Question 18

Treatment for Grade III-V?

Answer 18

Now need prophylactic antbx

TMP-SMX or Nitrofurantoin

Question 19

What is a Posterior Urethral valve?

What damage can this cause?

Answer 19

Obstructing membranous folds within the lumen of the posterior urethra

It Obstructs normal flow of urine

Question 20

What diagnostic imaging is used to determine the presence of Posterior Urethral Valve

Answer 20

Prenatal U/S

Question 21

What findings on U/S will show Posterior Urethral Valve?

Answer 21

Bilateral hydronephrosis, distended
Thickened bladder
Possible oligohydramnios (low amniotic fluid)

Question 22

Treatment of PUV in prenatal infants?

Treatment of PUV in postnatal infants?

Answer 22

Surgery prenatal-

Correction of electrolyte abnormalities
Foley catheter
Drain the urinary tract after stabilization
Surgical correction (transurethral catheter ablation)

Question 23

Definitions of:

Daytime frequency

Incontinence

Urgency

Straining

Answer 23

Daytime frequency: voiding 8x or more during waking hrs

Incontinence: uncontrolled leakage of urine, can be continuous or intermittent

Urgency: sudden & unexpected experience of an

Straining: the application of abdominal pressure (Valsalva maneuver) to initiate & maintain voiding

Question 24

What is Enuresis?

Answer 24

Repeated urination into clothing by a child > than 5y/o

Question 25

What is diurnal enuresis vs Nocturnal?

Answer 25

Diurnal enuresis = wetting while awake | Nocturnal enuresis = voiding during sleep (bedwetting)

Question 26

Difference between primary vs secondary nocturnal enuresis?

Answer 26

Primary enuresis = occurring in children who have NEVER been consistently dry though the night Secondary enuresis = resumption of wetting after at least 6mo of dryness (parents divorced, scary movie)

Question 27

What are signs or criteria that technically diagnoses nocturnal enuresis?

Answer 27

at least 2x per week for 3 months

Question 28

What is the biggest risk factor that can develop nocturnal enuresis?

Answer 28

Often associated w/ underlying CONSTIPATION

Question 29

Treatment of nocturnal enuresis?

Answer 29

Limit liquids before sleep Awaken the child at night to use bathroom Bedwetting alarms Every time the alarm goes off, child should go to toilet & void

Question 30

How long should nocturnal enuresis behavioral treatment be done to be effective

Answer 30

Must continue therapy for 3 months & be consistent

Question 31

If behavioral therapy doesn't fix nocturnal enuresis what medication can be given?

Answer 31

Desmopressin Acetate (DDAVP)-

Question 32

How many accidents are considered to be due to Urinary Incontinence?

Answer 32

Wetting accident at least once every 2 weeks

Question 33

What is a hallmark finding associated with an Overactive Bladder?

Answer 33

Urinary urgency

Question 34

What is Exstrophy of the Bladder

Answer 34

Open, inside-out bladder - the inner surface is exposed

Question 35

How can Extrophy be detected in a prenatal infant?

Answer 35

prenatal u/s

Question 36

What is Hypospadias?

Answer 36

Results in abnormal ventral placement of the urethral opening foreskin doesn’t fuse onto ventral aspect of penis

Question 37

What is Cryptochordism?

Answer 37

cryptorchidism (undescended testes)

Question 38

What procedure should not be done in an infant with Hypospadias?

Answer 38

Do not circumcise patients at birth (foreskin used for repair)

Question 39

What is considered the most common congenital abnormlity in the GU tract?

Answer 39

Cryptochorchidism

Question 40

What is considered a Bell clapper deformity?

Answer 40

Testicular Torsion

Question 41

What are the two peak incidences that testicular torsion can occcur?

Answer 41

Neonaatal (less likely) 12-18 in males (more likely)

Question 42

Signs and symptoms of Testicular torsion?

Answer 42

Abrupt onset of severe testicular or scrotal pain | Testi is sually swollen and elevated

Question 43

What diagnostic tests will indicate a Testicular torsion?

Answer 43

Absent cremasteric reflex negative prehn sign (no relief w/ elevation of testes)

Question 44

What treatment can be done by the provider and by a surgeon?

Answer 44

Manual detorse Orchiopexy

Question 45

Which layers do hydroceles occur in?

Answer 45

Collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis.

Question 46

Do hydrocels typically resolve on their own?

Answer 46

Resolve spontaneously, by the 1st birthday