Flashcards in Renal / GU Deck (113):
What is the definition of hematuria?
3 or more RBC per high power field
What is the likely diagnosis in a boy who participates in vigorous sports who has dark urine and 1-2 RBC on urinalysis ?
What should you do in a patient who presents with isolated asymptomatic microscopic hematuria?
Repeat UA in 2 weeks
What 2 things should be checked in a patient with persistent microscopic hematuria?
blood pressure and calcium/creatinine ratio
What is an abnormal calcium/creatinine ratio?
Greater than 0.25
What lab and imaging studies should be ordered in a patient with persistent microscopic hematuria and normal calcium/creatinine ratio? (7 answers)
What could be the cause of hematuria in a patient on LASIX?
What is the next step in a patient with elevated calcium/creatinine ratio? What result would be diagnostic?
24 hour collection
>4 mg/day confirms hypercalciuria
What diagnosis should you consider in a one day old patient who presents with palpable flank mass and unilateral mass on ultrasound?
What diagnosis should you consider in a patient with microscopic hematuria after a MVA? How would this present on imaging?
How do you confirm UPJ obstruction? What's the next test after the diagnosis is confirmed?
Renal scan shows delayed excretion
Vcug should be done to look for reflux in other kidney
When should cystoscopy be performed in a child with hematuria ?
Never - only indicated in adults
What are the common causes of gross hematuria in children? (9 answers)
H (HSP or hereditary nephritis)
E (bEnign familial)
A (Alport or IgA nephropathy)
U (UPJ obstruction)
R (renal stones)
I (infectious - strep)
A (abnormal sickle cells)
What diagnosis would you consider in a patient with painless tea colored urine?
What is the next step in a patient with isolated proteinuria that resolves on first void urine?
3 month follow up
What is the appropriate next step in a patient with isolated proteinuria even on first morning void? What finding would be considered abnormal?
Protein creatinine ratio (renal disease suggested if ratio >0.2)
What are 3 common causes of benign transient proteinuria?
What is the inheritance of Alport syndrome?
X linked dominant
What diagnosis should you consider in a patient with bilateral sensorineural hearing loss, ocular defects and renal failure ?
What is the likely diagnosis in a patient with a unilateral flank mass who has oligohydramnios in utero?
Multicystic dysplastic kidney
What is the gross pathology of a multicystic dysplastic kidney?
Enlarged kidney with non communicating cysts with thin parenchyma and dysplasia
What are other urinary tract anomalies that occur in 50% of patients with unilateral multicystic dysplastic kidney disease ? (4 answers)
Posterior urethral valves
Megaureter and duplication
What is the best initial study to diagnose multicystic dysplastic kidney?
What is the next best step in a patient with confirmed multicystic dysplastic kidney disease ?
Vcug to rule out other urinary tract anomalies
What diagnosis should you consider in a patient with kidney mass, palpable liver, thrombocytopenia and hematemesis?
Multicystic dysplastic kidney or autosomal recessive polycystic kidney disease
and resulting portal hypertension
What diagnosis should you consider in an infant with bilateral flank masses and hx of oligohydramnios ?
Autosomal recessive polycystic kidney disease
What other malformation is associated with autosomal dominant (adult) polycystic kidney disease?
What diagnosis presents with polyuria, enuresis and low specific gravity as well as short stature, anemia and eye problems?
Juvenile onset medullary cystic disease aka nephronopththisis
What eye problem is associated with nephronophthisis?
What diagnosis presents with dysuria, hematuria and abdominal pain as well as a mass from the urethral meatus?
What is the appropriate management for grade 1 and 2 vesicoureteral reflux?
What is the appropriate management for grade 3 VUR?
What is the appropriate management for grade 4 and 5 VUR?
What is the most common cause of urinary retention in females?
What is the likely diagnosis in a male with urinary symptoms after recent surgical procedure?
Urethral stricture secondary to catheter placement
What diagnosis presents in a male newborn with palpable bladder and weak urinary stream?
Posterior urethral valves
What is the treatment for posterior urethral valves?
Immediate urological consult for surgery
What is the most appropriate step in an infant with palpable bladder and no urinary output?
How does posterior urethral valves typically present in females?
It only occurs in males
What is the prognosis of posterior urethral valves after surgical correction ?
ESRD within 5 years
What is the most common viral cause of UTi?
When is an ultrasound indicated after a UTI? (3 answers)
Symptoms of pyelonephritis
What syndrome presents with soft abdominal musculature, bilateral undescended testicles and distended bladder?
Prune belly (eagle Barrett) syndrome
Why are children with prune belly syndrome prone to chronic UTI, distended bladder and dilated ureter ?
Posterior urethral valves
What is the appropriate empiric antibiotic in suspected acute pyelonephritis ? (2 options)
Bactrim or 3rd generation cephalosporin
What are the 3 main findings in nephrotic syndrome ?
What are 6 common laboratory abnormalities found in patients with nephrotic syndrome?
High factor 5 & 7 (hypercoagulability)
Low thyroid function
What are 3 important complications of nephrotic syndrome?
What should you suspect in a patient with nephrotic syndrome who develops abdominal pain, hematuria and decreased urine output?
What is the best next step in a patient with new onset nephrotic syndrome who does not respond to steroids?
Which 3 causes of glomerulonephritis present with low complement levels?
What are the 4 main symptoms of glomerulonephritis ?
Azotemia (high BuN)
Which causes of glomerulonephritis present with normal complement levels? (5 answers)
Rapidly progressive GN
Focal segmental glomerulosclerosis
What diagnosis should you consider in a patient who presents with hypertension, edema and hematuria?
Post strep glomerulonephritis
What's the difference in complement levels between post strep glomerulonephritis and lupus nephritis?
Post strep only causes low complement levels for 2 months but in lupus (and membranoproliferative GN) low c3 levels are sustained
In a patient with IgA nephropathy, What correlates with worsening disease?
What diagnosis presents with painless hematuria several days after URI?
IgA nephropathy (Berger disease)
What is the difference in the fractional excretion of sodium when differentiating pre-renal vs renal causes of acute renal failure ?
FeNa is low in pre-renal causes
FeNa is high in renal causes
What are options for management of hyperkalemia in patients with acute renal failure ? (3 answers)
Insulin & glucose
Sodium polystyrene sulfonate
What type of infant formula should be used if an infant has acute renal failure ?
Formula that is low in phosphorus
When is erythropoietin indicated in patients with chronic renal failure?
When hgb <8
Why do patients with chronic renal failure develop metabolic acidosis? (3 answers)
Decreased production of bicarb
Decreased acid excretion
What happens to calcium and phosphate in chronic kidney disease and why?
1,25 dihydroxyvitamin D3 decreases -- decreased calcium absorption -- high PTH but phosphate levels can't be excreted -- high phosphate suppresses calcitriol -- decreased absorption of Ca
What is the GFR in stages 4 and 5 of kidney failure?
Stage 4 = GFR 15-29
Stage 5 = GFR <15 or dialysis
What is the GFR in stages 1 and 2 of kidney failure?
Stage 1 = high GFR > 90
Stage 2 = GFR 60-89
What diagnosis should you consider in a patient who presents with pallor, decreased urinary output and bruising ?
What happens to serum complement levels in patients with HUS?
They are normal
What is the definition of hypertension ?
BP >95th%ile for age and sex on 3 separate occasions
What 4 classes of medications can cause HTN ?
What might be the cause of HTN in a patient who also complains of muscle cramps and weakness ?
Hyperaldosteronism - causes hypokalemia and HTN
What may be the cause of HTN in a patient with elfin facies, high calcium and friendly personality?
Supra valvular aortic stenosis (in patient with William syndrome )
What is the treatment for pheochromocytoma?
Alpha blocker (phenoxybenzamine) then surgical correction
What diagnosis should you consider in a short obese patient with HTN?
What medication is contraindicated in patients with pheochromocytoma and why?
Beta blockers - leads to unopposed alpha effects and increased BP
What is the equation for determination of bladder capacity?
Age + 2
What are 4 common classes of nephrotoxic medications ?
What is the difference between an incarcerated inguinal hernia and inguinal lymphadenitis?
Both present with painful inguinal mass but lymphadenitis should be red and warm to the touch with distal site of infection
When is estrogen cream indicated for labial adhesions?
Pain or bacterial infections
How can you differentiate imperforate hymen from tubo-ovarian abscess?
Both present with intermittent abdominal pain but only an imperforate hymen has a palpable midline mass
What is the most appropriate step in a patient with symptoms of imperforate hymen?
Physical exam of genitalia
What are 4 non sexually transmitted causes of vulvovaginitis?
Group A strep
What is a soft skin colored vaginal mass that presents with vaginal discharge?
Bartholin gland cyst
What is the appropriate treatment in a male with Undescended testicle?
Orchiopexy by age 1
What is the risk of malignancy in a patient with in descended testicle?
High risk despite orchiopexy - the opposite descended testicle also has high malignancy risk
What is the appropriate next step in a patient who was documented to have bilateral descended testicles who you now notice has one testicle that is Undescended?
Examine in frog leg position to help bring down the retractile testicle
What are 4 syndromes associated with hypospadias?
Russell silver syndrome
Laurence moon biedl syndrome
Beckwith wiedemann syndrome
What is appropriate management of hypospadias in a newborn?
Surgical correction at 6 months
What is the incidence of renal anomalies with a distal hypospadias?
Low - no intervention is needed
What syndrome presents with micropenis, poor feeding and hypotonia?
What syndrome is associated with micropenis, hypoglycemia, anosmia and Septo-optic dysplasia?
At what newborn penile length should an endocrine / genetic workup be performed?
Length <2.5 cm
What diagnosis presents with unilateral testicular pain and fever but no testicular mass?
What is the difference between Orchitis and epididymitis?
Orchitis does not present with dysuria
What diagnosis should you consider in a child with recent immigration to the US and testicular pain and fever without dysuria?
How can you determine the difference between epididymitis and testicular torsion on physical exam?
Torsion has loss of cremasteric reflex and testicle is high
In epididymitis, the testicle is low lying and reflex is still illicited
What is appropriate treatment of epididymitis in teenagers?
IM rocephin and PO doxycycline
When is phimosis considered clinically significant ?
In children >4 y/o
What is likely cause of tiny white bumps on the tip of the penis in a 4y/o male?
What is the definition of balanitis?
Inflammation of the glans penis
What is the likely diagnosis in a male with penile pain and culture that reveals gram negative diplococci?
What diagnosis should you consider in a sexually active male with dysuria and conjunctivitis but negative gram stain?
Chlamydia causing Rieter syndrome (autoimmune response to chlamydia causing urethritis, conjunctivitis and arthritis)
What imaging and lab studies should be done in a patient with testicular mass? (4 answers)
What are 4 major risk factors for testicular Cancer?
Previous testicular cancer
What is the cause of condyloma acuminata and how would you treat?
HPV - vaccinate
What diagnosis should you consider in a patient with whitish gray papules in the genital area that coalesce and typically present with fever?
Condyloma Lata (secondary syphilis)
What is the treatment in a patient with vulvovaginitis who has no signs of abuse, trauma or pinworms?
Sitz bath & reassurance
Up until what age can a patient present with congenital condyloma acuminata?
What is the best diagnostic test to do when suspecting HSV?
Viral culture for herpes
What is the appropriate treatment for a patient with red crusted suprapubic macules and blue-gray dots?
Permethrin or malathion (for treatment for "crabs")
What diagnosis should you consider in a female with sudden lower abdominal pain with radiation to the back, nausea and vomiting? How would you confirm diagnosis?
What is the appropriate treatment for a teenager with left sided abdominal pain and US showing 5 cm ovarian cyst?
Follow up US for all cysts smaller than 6 cm
What is the appropriate management for an ovarian cyst that is 7 cm and causing significant pain?
Laparoscopic cyst aspiration