Urology

Question 1

Two benefits of circumcision?

Answer 1

• Decrease rate of UTI

- Decrease rate of some STIs

Question 2

If cleaning an uncircumcised penis, you can clean with mild soap and water but then…

Answer 2

Return foreskin to natural position after cleaning

Question 3

What condition involves inability to retract foreskin due to scarring that occurs secondary to infection/inflammation?

Answer 3

Phimosis (pathologic)

Question 4

Two treatments for Phimosis?

Answer 4

• Stretching exercises

- Topical steroids

Question 5

What condition is a urologic emergency involving retracted foreskin (uncircumcised) that cannot be returned to natural position?

Answer 5

Paraphimosis

Question 6

What condition involves entrapment → impaired venous flow → engorgement → arterial compromise?

Answer 6

Paraphimosis

Question 7

What condition involves edema, tenderness of glans and distal retracted foreskin (band), color change (black/blue) if ischemic?

Answer 7

Paraphimosis

Question 8

What condition involves treatment of pain control, prompt manual reduction, surgical intervention by urology (dorsal slit)?

Answer 8

Paraphimosis

Question 9

What condition involves congenital anomaly (rare) with dorsal displacement of urethral opening?

Answer 9

Epispadias

Question 10

What condition may occur with bladder exstrophy (exposed bladder onto lower abdomen)?

Answer 10

Epispadias

Question 11

What condition involves congenital anomaly with ventral displacement of urethral opening?

Answer 11

Hypospadias

Question 12

Which condition may involve Chordee?

Answer 12

Hypospadias

Question 13

What condition involves abnormal penile curvature?

Answer 13

Chordee

Question 14

What condition involves PE findings of abnormal foreskin with second opening (one is false); examine for palpable testes (cryptorchidism?)

Answer 14

Hypospadias

Question 15

With what condition should NO circumcision be considered during newborn period?

Answer 15

Hypospadias

Question 16

What is the most common GU abnormality?

Answer 16

Cryptorchidism

Question 17

What condition involves no spontaneous descension into scrotum by 4 months (testes may be absent, undescended or retractile (also consider ascending or ectopic))?

Answer 17

Cryptorchidism

Question 18

What three conditions are of increased risk with Cryptorchidism?

Answer 18

• Testicular torsion
• Subfertility
• Testicular CA

Question 19

Which condition involves absent testicle unilateral or bilateral with flat, underdeveloped scrotum (may need US)? Where are the tests often displaced (think location)?

Answer 19

Cryptorchidism

- Undescended testes are often suprascrotal

Question 20

What condition involves treatment of most spontaneously resolve by 3-4 months; if not by 4 months, urology referral for surgery (orchiopexy to reposition/attach into scrotum)?

Answer 20

Cryptorchidism

Question 21

What condition is a urologic emergency involving twisting of spermatic cord due to poorly anchored testicle?

Answer 21

Testicular Torsion

Question 22

Which two conditions are considered urologic emergencies?

Answer 22

• Paraphimosis

- Testicular Torsion

Question 23

Which condition involves at risk for vascular compromise; two peak incidences in neonatal period and puberty (12-18 years)?

Answer 23

Testicular Torsion

Question 24

Which condition involves abrupt onset of severe, constant testicular/scrotal pain, N/V?

Answer 24

Testicular Torsion

Question 25

Which condition involves tender/swollen/slightly elevated affected teste, absent cremasteric reflex?

Answer 25

Testicular Torsion

Question 26

Which condition involves a negative Prehn sign?

Answer 26

Testicular Torsion

Question 27

Which diagnostic test should be used to confirm Testicular Torsion?

Answer 27

US

Question 28

Which condition involves immediate urology consult; surgical detorsion and fixation?

Answer 28

Testicular Torsion

Question 29

What is the most common etiology of a Urinary Tract Infection (UTI)?

Answer 29

E. coli

Question 30

What condition involves risk factors of young, uncircumcised, bowel/bladder dysfunction, vesicoureteral reflux (VUR), sexual activity?

Answer 30

Urinary Tract Infection (UTI)

Question 31

How do symptoms for UTI differ for younger children vs. older children?

Answer 31

- Younger children: non-specific (fever of unknown etiology, irritable, poor feeding - Older children: classic symptoms (dysuria/frequency/urgency, abdominal/back/flank pain)

Question 32

For UTI, what two diagnostic tests should be obtained, and what is the recommended way of doing this?

Answer 32

- UA (catheter specimen recommended) | - Culture

Question 33

What condition involves urine dipstick will show significant bacteriuria with pyuria?

Answer 33

Urinary Tract Infection (UTI)

Question 34

What is the first line treatment for Urinary Tract Infection (UTI)?

Answer 34

Cephalosporin

Question 35

In what population is Renal and Bladder US (RBUS) recommended for UTI?

Answer 35

All infants/children 2-24 months after 1st febrile UTI

Question 36

What condition is voiding cystourethrogram (VCUG) used to detect? In what population is it recommended (hint: ___ AND ___)?

Answer 36

``` Vesicoureteral Reflux (VUR) - Children of any age with 2+ febrile UTIs or 1st febrile UTI AND evident anomaly on RBUS, fever 102.2+ F, non-E. coli pathogen, poor growth/HTN ```

Question 37

What condition involves retrograde urine flow from bladder into upper UT?

Answer 37

Vesicoureteral Reflux (VUR)

Question 38

What are the three treatments for Vesicoureteral Reflux (VUR)?

Answer 38

- Surveillance - Low-dose prophylactic abx - Monitor reflux

Question 39

What is the most common type of renal fusion?

Answer 39

Horseshoe Kidney

Question 40

What condition involves usually asymptomatic but may have pain, hematuria if infection/obstruction?

Answer 40

Horseshoe Kidney

Question 41

What condition is often associated with anomalies and syndromes like VUR, hypospadias, undescended testes, other genetic disorders?

Answer 41

Horseshoe Kidney

Question 42

With what condition do most patients have excellent prognosis with no intervention?

Answer 42

Horseshoe Kidney

Question 43

With what condition is there slight increased risk for Wilms Tumor, and what is this?

Answer 43

Horseshoe Kidney | - Wilms Tumor: most common renal malignancy in kids

Question 44

What condition is most common in kids 5 years or younger (boys)?

Answer 44

Nocturnal Enuresis (NE)

Question 45

What condition involves treatment of behavioral modifications (reassurance, education and motivational therapy (ex. sticker chart))?

Answer 45

Nocturnal Enuresis (NE)

Question 46

What is the recommended pharmacotherapy for Nocturnal Enuresis (NE), and what is the recommended age for this?

Answer 46

DDAVP/Desmopressin (synthetic ADH) | - Age 6+ years

Question 47

What three conditions should definitely be considered for Hematuria?

Answer 47

- Poststreptococcal glomerulonephritis - IgA Vasculitis (Henoch-Schönlein Purpura (HSP)) - Hemolytic uremic syndrome (HUS)

Question 48

What condition involves "throat, bloat, coke", and what does each indicate?

Answer 48

Poststreptococcal Glomerulonephritis - Pharyngitis - Periorbital/peripheral edema - Gross hematuria/cola-colored

Question 49

What condition involves urine microscopy shows RBC casts?

Answer 49

Poststreptococcal Glomerulonephritis

Question 50

What condition often presents 1-2 weeks post-Group A beta-hemolytic strep?

Answer 50

Poststreptococcal Glomerulonephritis

Question 51

What condition involves + ASO titer/streptozyme test?

Answer 51

Poststreptococcal Glomerulonephritis

Question 52

What condition involves palpable purpura, arthritis/arthralgia, abdominal pain, renal disease?

Answer 52

IgA Vasculitis (Henoch-Schönlein Purpura (HSP))

Question 53

What is one of the primary causes of acute kidney injury in pediatrics?

Answer 53

Hemolytic uremic syndrome (HUS)

Question 54

If Hemolytic uremic syndrome (HUS) is acquired, what is the most common cause?

Answer 54

Shiga toxin-producing E. coli

Question 55

What condition involves hemolytic anemia, thrombocytopenia, acute kidney injury?

Answer 55

Hemolytic uremic syndrome (HUS)

Question 56

What condition involves foamy urine?

Answer 56

Proteinuria

Question 57

What condition is a marker of renal disease?

Answer 57

Proteinuria | - Excessive protein excreted in urine

Question 58

What condition involves renal disease causing massive renal protein loss in urine?

Answer 58

Nephrotic Syndrome

Question 59

What condition involves the "four O's", and what are they?

Answer 59

Nephrotic Syndrome - Nephrotic range proteinuria - Hypoalbuminemia - Edema (round O shape) - Hyperlipidemia

Question 60

What is the recommended treatment for Nephrotic Syndrome?

Answer 60

Refer to nephrology