Urology/Renal

Question 1

Define Phimosis

Answer 1

• Inability to retract the foreskin

Question 2

Management of Phimosis

Answer 2

• corticosteroids
• Circumcision

Question 3

Do no retract foreskin before infant turns what age

Answer 3

• 6 months

Question 4

Define Paraphimosis

Answer 4

• Retracted foreskin in an uncircumscribed male that can not be returned to natural position
• entrapment -> impaired venous flow -> engorgement -> Arterial compromise

Question 5

Management of paraphimosis

Answer 5

• manual reduction
• or urology consult for surgery

Question 6

Define hypospadias

Answer 6

Congenital anomaly that results in abnormal ventral placement of the urethra

Question 7

Management of hypospadias

Answer 7

• Referral to Urology
• surgery performed at 6 months

Question 8

Define Cryptorchidism

Answer 8

• A testis that is not within the scrotum and does not spontaneously descend by 4 months of age

Question 9

Cryptorchidism may increase the risk of these conditions

Answer 9

• Testicular cancer
• Subfertility (improved if corrected before 1 yr of age)
• testicular torsion (10x more common)

Question 10

Most common located for cryptorchidism

Answer 10

• suprascrotal

Question 11

Tx for cryptorchidism

Answer 11

• Spontaneous descent is rare after 6 months
• surgery around 6 months

Question 12

Define testicular torsion

Answer 12

• Twisting of the spermatic cord due to a poorly attached testicle (should be anchored to tunica vaginalis) that may result in vascular compromise

Question 13

Peak incidence of testicular torsion

Answer 13

• Neonatal - extravaginal
• puberty

Question 14

Test of choice to diagnose testicular torsion

Answer 14

• Ultrasound

Question 15

Tx of testicular torsion

Answer 15

• immediate urology referral
• surgerical detorsion and fixation
• detorsion within 4-6 hrs = 100% viable; after 12 hrs = 20% viable; after 24 hours = 0% viable

Question 16

Antibiotic choices for children diagnosed with UTI

Answer 16

• augmentin
• amoxicillin
• cephalexin (keflex)
• bactrim

Question 17

What imaging study is first line in child with UTI if indicated

Answer 17

• Renal and bladder US

Question 18

Indications for Renal and Bladder US in children

Answer 18

• Children < 2 y.o. With first febrile UTI
• Children at any age with recurrent UTI
• Children with UTI and + FH of renal or urologic disease, poor growth, or HTN
• children who do not respond as expected to appropriate abx therapy

Question 19

Test of choice for vesicoureteral reflux

Answer 19

• Voiding cystourethrogram

Question 20

Define vesicoureteral reflux

Answer 20

• Retrograde flow of urine from bladder into the upper urinary tract

Question 21

Define Enuresis

Answer 21

• Accidents occurring after successful potty training

Question 22

Define diurnal enuresis

Answer 22

• Accidents occurring during the day
• abnormal after 4 y.o.

Question 23

When is nocturnal enuresis abnormal

Answer 23

• Boys: after age 6 y.o.
• Girls: after age 5 y.o.

Question 24

Diagnostics for abnormal enuresis

Answer 24

• UA
• RBUS
• referal to urology

Question 25

Tx for enuresis

Answer 25

* Timed voiding q 2 hrs * no liquids 90 min before bed * constipation management * DDAVP (synthetic ADH)

Question 26

Define hydrocele

Answer 26

* Cystic collection of fluid in testicle * MC cause of painless scrotal swelling

Question 27

Differentiate between a communicating and no communicating hydrocele

Answer 27

* Communicating: fluid from hydrocele connects to peritoneal cavity from a patent processes vaginalis * Noncommunicating: no connection to peritoneum due to closed processes vaginalis

Question 28

Cause of congenital hydrocele

Answer 28

* Due to incomplete obliteration of the processes vaginalis * defect usually close within 1st year and may not require tx

Question 29

List the hallmark signs of glomerulonephritis

Answer 29

* HTN * hematuria * edema * azotemia

Question 30

What is IGA Nephropathy (Berger dz)

Answer 30

* type of glomerulonephritis that often occurs 24-48 hrs after **URI or GI** infection * due to IgA immune complexes

Question 31

Post infectious glomerulonephritis occurs after infection with

Answer 31

* GABHS * 10-14 days after skin (ex. Impetigo) or pharyngeal infection

Question 32

How is Post infectious glomerulonephritis diagnosed

Answer 32

* ASO titer * low serum complement