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Peds II Exam 1 > Urology > Flashcards

Urology Flashcards

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1
Q

inability to retract the foreskin

A

phimosis

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2
Q

main cause of pathologic phimosis

A

early forcible retraction

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3
Q

Sx of patho phimosis

A

secondary non-retractibility after having fully retractable before; painful erections
irritation/bleeding
dysuria/urinary retention
recurrent infections

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4
Q

Tx for patho phimosis

A

stretching
topical corticosteroid
circumcision (rarely needed)

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5
Q

Paraphimosis

A

retractable foreskin that can not be returned to natural position; MEDICAL EMERGENCY

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6
Q

Pathophys of paraphimosis

A

entrapment –> impaired venous flow –> engorgement –> arterial compromise

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7
Q

Causes of paraphimosis

A

forcible retraction
infection/inflamation
genitourinary procedure (iatrogenic)
sex, trauma

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8
Q

Sx of paraphimosis

A

swelling
pain
irritability in a preverbal infant

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9
Q

PE for paraphimosis

A

edema, tenderness
constricting band
color change if ischemia is present

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10
Q

Tx for paraphimosis

A

pain control
timely manual reduction in office or ED
surgical intervention by urology

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11
Q

Benefits of circumcision

A 
decrease UTIs
penile cancer?
inflammation/dermatoses
STD
benefits greater in those w/ congenital uropathy
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12
Q

risk of circumcision

A

procedure related complications (inadequate removal, bleeding, infection, urethral complications)

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13
Q

Contraindications for cicumcision

A

unstable infant, congenital penile anomolies (hypospadias, chordee)

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14
Q

Types of circumcision methods

A

gomco vs. plastibell

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15
Q

Epispadias

A

congenital anomaly w/ abnormal dorsal displacement of urethral opening

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16
Q

epispadias may occur w/

A

bladder exstrophy (exposed bladder, into lower abdomen)

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17
Q

Hypospadias

A

urethral opening on the ventral side (more common than epispadias) - can be on glans, shaft, scrotum, perineum

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18
Q

may accompany hypospadias

A

chordee

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19
Q

Chordee

A

abnormal penile curvature

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20
Q

Considerations w/ hypospadias or chordee

A

palpate testes: if crytorchidism consider disorder of sexual dev. (DSD)
refer to urology

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21
Q

Tx for hypospadias or chordee

A

CIRCUMCISION NOT DONE DURING NEWBORN PERIOD

surgery performed ~6 months of age to fix hypo or chordee

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22
Q

cryptorchidism

A

hidden/absent testis; does not descend by 4 months of age

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23
Q

most common GU congenital abnormality

A

cryptorchidism

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24
Q

Risks of cryptorchidism

A

testicular torsion
subfertility (improves if corrected before 1 yo)
testicular cancer

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25
Types of cryptorchidism
``` absent (agenesis or atrophy) undescended retractile (overactive cremasteric reflex) Ascending ectopic ```
26
Presentation of cryptorchidism
usually unilateral location: suprascrotal US if not palpable Most descend spontaneously by 3-4 months
27
Tx for cryptorchidism
urology referral; surgery as soon after 6 mo as possible (before 1 yo); orchiopexy (brought down and attached to scrotum)
28
Torsion
twisting of spermatic cord due to poorly anchored testicle; VASCULAR COMPROMISE RISK
29
Incidence of torsion
neonatal | puberty (12-18)
30
Presentation of torsion
abrupt onset of severe pain | n/v
31
PE for torsion
edematous, indurated, erythematous scrotum swollen, tender, slightly elevated ABSENT CREMASTERIC REFLEX NEGATIVE PREHN'S SIGN*
32
Dx for torsion
hx and PE | doppler US is confirmatory (sees blood flow)
33
Tx for torsion
immediate urology consult | surgical detorsion and fixation (orchiopexy) of both testes
34
Prognosis of torsion
4-6 hrs: 100% viable 12 hrs: 20% viable 24 hrs: 0% viable
35
UTI
cystits vs pyelonephritis (kidneys infected); usually from ascending bacteria (e.coli***, klebsiella, proteus, entercoccus, s. aureus)
36
Sx of UTI
FUO, vomiting, irritability, poor appetitie Older children: dysuria, frequency, ab pain, back pain, urinary incontinence
37
PE fo UTI
vitals, ab exam suprapubic and CVA exam examine external genitalia search other sources of fever
38
How to collect UA
``` clean-void specimen if potty trained cath speciment suprapubic aspiration (if cath not feasible) ```
39
Dx of UTI
UA and culture (+) bacteriuria w/ pyuria, leukocyte esterase, nitrate (produced by gram neg rods) C&S: to direct tx
40
Tx of UTI
``` Duration of tx 3-10 days Abx depends on C&S: - cephalosporin (cephalexin and cefdinir) - amoxicillin - augmentin - bactrim ```
41
F/u for UTI
no f/u needed if C&S ``` renal bladder US (RBUS) voiding cystourethrogram (VCUG) Renal scintigraphy ```
42
when to f/u for UTI
RBUS when: - <2 yo w/ first febrile UTI children w/ recurrent children w/ UTI and FH of renal or urological disease, poor growth or HTN children who do not respond to abx therapy
43
Voiding cystourethrogram (VCUG)
invasive, radiation, catheter test of choice to detect vesicouretral reflux (VUR) children of any age >2 febrile UTIs children of any age w/ 1st febrile UTI AND any anomaly on RBUS or temp >102.2 and pathogen other than E.coli, or poor growth or HTN
44
Vesicoureteral reflux (VUR)
retrograde flow of urine from bladder into upper urinary tract, usually due to closure of ureterovesicular junction (UVJ)
45
Presentation of vesicoureteral reflux
hydronephrosis (prenatal) | post natal febrile UTI
46
Dx of VUR
VCUG
47
VCUG
catheter placed and contrast injected; under fluoroscopy, movement of contrast and anatomy watched while pt voids; graded I (mild) to V severe
48
Risks in patients w/ VUR
recurrent infections | scarring and damage to kidney
49
Management of VUR
many cases spontaneously resolve watchful waiting/surveillance? low dose prophylactic antibiotics surgical correction aggressive screening (UA) in febrile/symptomatic pts
50
Renal scintigraphy
nuclear medicine scan using radioisotope dimercaptosuccinic acid (DMSA) to detect acute pyelonephritis and renal scarring; decreased uptake of DMSA indicates scarring or inflammation; not recommended in evaluation of kids w/ first UTI
51
Indications for referral in kids with UTI
``` severe VUR (grade III-V) or obstruction renal abnormalities impaired kidney function elevated BP bowel or bladder dysfunction refractory to primary care measures ```
52
Horseshoe kidney
most common type of renal fusion; caused by abnormal migration in 5th-9th week gestation
53
S/sx of horseshoe kidney
usually asymptomatic may have pain, hematuria most have associated uro problem (VUR, hypospadias, undescended testes) or may be associated w/ other genetic disorders;
54
Risk with horseshoe kidney
small risk of Wilms Tumor (most common renal malignancy in kids)
55
Dx of horseshoe kidney
US, VCUG (if UTI), serum creatinine normal Cr and no hydronephrosis: no further eval Cr elevated or hydronephrosis: renal scan
56
Management of horseshoe kidney
excellent prognosis w/o intervention w/ VUR: consider prophylactic abx
57
Nocturnal enuresis (NE)
incontinence in kids >5 yo; common
58
Etiology of NE
genetic bladder maturation organic cause
59
Tx for NE
1st line: most spontaneously resolve -- education (motivation, urination, fluid intake) 2nd line: pharm >6yo:
60
Pharmacologic tx for NE
DDAVP/Desmopressin (synthetic ADH) -- effective short term but high relapse rate
61
Ddx for hematuria
``` UTI, kidney stone, malignancy trauma post-infectious glomerulonephritis neoch-schonlein purpura hemolytic uremic syndrome alport syndrome ```
62
Labs for microscopic hematuria (>3 RBCs)
1. if asymptomatic, repeat UA dip and microscopy in 2-3 weeks (if resolved, follow up prn); consider urine cx if UTI suspected, RBUS, referral
63
Gross hematuria labs
UA w/ microscopy/urine cx serum Cr Serum complement (low level in SLE, glomerular etiology) Consider antistreptolysin Ab (ASO), ANA Imaging: RBUS/CT w/o contrast If persistent- refer
64
Post infectious glomerulonephritis sx
7-14 days after GAS (pharyngitis or impetigo) throat bloat- edema peri-orbital or peripheral due to kidneys not removing waste and fluid coke- colored urine elevated BP
65
Labs for post-infectious glomerulonephritis
gross hematuria (dark cola urine) - RBC Casts**** (diagnositc of GN) increased serum Cr +ASO (antistreptolysin Ab) titer low complement (C3, C4)
66
Tx for GN
supportive
67
Immunoglobulin A vasculitis henoch-schonlein purpura (HSP)
IgA vasculitis: immune mediated, cause unknown
68
Sx of HSP
Tetrad: - Abdominal pain - typical maculopapular purpuric rash (usually on LE) - arthralgias (knees/ankles) - renal involvement
69
Tx for HSP
supportive; spontaneously resolution of symptoms
70
HUS cause
shiga toxin producing E.coli
71
Sx of HUS
prodrome w/ abd pain, vomiting, diarrhea (usually bloody) Followed by triad: - hemolytic anemia - thrombocytopenia - AKI
72
Labs for HUS
CBC, peripheral smear, renal function, UA
73
Tx for HUS
supportive, possible dialysis | no abx
74
Alport syndrome aka
hereditary nephritis
75
cause of alport syndrome?
genetic mutations that affect collagen proteins in kidneys, eyes and ears
76
Sx of alport syndrome
``` +FH of end stage renal failure Syndrome includes: - glomerular disease (microhematuria) - deafness - visual distruabnce ```
77
Proteinuria
foamy urine, excessive proteins in urine
78
Ddx for proteinuria
``` Benign/transient (fever, hypovolemia, exercise) SLE DM GN Nephrotic syndrome* ```
79
Nephrotic syndrome
renal disease (intrinsic or post infectious) causing massive renal protein loss in urine
80
Sx of Nephrotic syndrome
``` O's: PrOteinuria O shaped face (edema due to water retention) HypOalbuminemia Hyperlipidemia ```
81
Why do Nephrotic syndrome have HLD
body compensates for protein loss by increasing the synthesis of albumin, as well as other molecules including LDL and VLDL
82
Evaluation of proteinuria
``` BP UA w/ microscopy first AM void UA to check for proteinuria prior to meal/activity protein/Cr ratio CMP Hx refer to nephrology ```

Peds II Exam 1 (4 decks)

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