Term
| What 3 infections are included under "urinary tract infection"? |
|
Definition
-urethritis: urethra
-cystitis: bladder
-pyelonephritis: kidneys |
|
|
Term
| ___?___ is the pathogenic agent in 80-90% of childhood UTIs d/t fecal flora. |
|
Definition
|
|
Term
| What bacteria is a common cause of UTI in males? |
|
Definition
|
|
Term
| What viral agent is a common cause of UTIs? |
|
Definition
|
|
Term
| What are causes of immature kidneys? |
|
Definition
|
|
Term
| What are some congential urologic abnormalities? |
|
Definition
-reflux
-neurogenic: motor disability affects completeness of voiding |
|
|
Term
| ___?___ voiding can occur in busy school-aged children who don't like to take bathroom breaks. |
|
Definition
|
|
Term
| What are 2 examples of functional obstruction? |
|
Definition
-constipation: stool filling up descending colon
-pregnancy |
|
|
Term
| What are some examples of urinary trauma and irritants? |
|
Definition
-catheterization
-bubble baths
-sexual intercourse
-sexual abuse
-pinworms |
|
|
Term
| What are UTI symptoms in a newborn? |
|
Definition
-irritability
-poor feeding
-fever
-vomiting
-diarrhea |
|
|
Term
| What are UTI symptoms in infants and preschoolers? |
|
Definition
-irritability
-poor feeding
-fever
-vomiting
-diarrhea
-strong/foul smelling urine |
|
|
Term
| What are UTI symptoms in school age children and adolescents? |
|
Definition
-fever
-vomiting
-strong/foul smelling urine
-suprapubic or urethral pain
-frequency
-dysuria
-incontinence
-CVA tenderness |
|
|
Term
| What are 3 important components of the physical exam? |
|
Definition
|
|
Term
| What physical findings are associate with UTI? |
|
Definition
infants:
-weight loss
-poor feeding
-diarrhea
-fever
-irritability
-BP: elevated (reflux, nephropathology)
-abdominal: pain, tenderness, guarding
-urethral or vaginal irritation/discharge (in vulvovaginitis d/t irritation or STI) |
|
|
Term
| What are assessed in urinalysis? |
|
Definition
-sp gr
-pH
-protein
-blood
-nitrites
-leukocyte esterase
-ketones
-glucose |
|
|
Term
| What bacteria findings are diagnostic of a UTI in a clean catch specimen? |
|
Definition
| >50,000 colonies of a single organism |
|
|
Term
| What bacteria findings are diagnostic of a UTI in a catheter specimen? |
|
Definition
| >10,000 colonies of a single organism |
|
|
Term
| What bacteria findings are diagnostic of a UTI in a suprapubic specimen? |
|
Definition
| >1,000 colonies of a single organism |
|
|
Term
| When are radiologic studies indicated? |
|
Definition
-pyelonephritis
-UTI <3mos old
-males 1st infection, females 2nd infection |
|
|
Term
| What radiographic tests are used, and for what? |
|
Definition
-U/S: structure, developmental anomalies
-VCUG: reflux
-IVP or nuclear renal cortical scans: scarring, if VCUG positive |
|
|
Term
| What are the timing and treatment guidelines for VCUG (voiding cystourethrogram)? |
|
Definition
-4-6 weeks after UTI diagnosis
-prophylaxis until after VCUG |
|
|
Term
| Why is pediatric HTN difficult to detect? |
|
Definition
-equipment flawed
-spurious elevations common
-takes weeks to confirm
-norms complicated by age, wt, etc. |
|
|
Term
| In a hypertensive emergency, drop BP by no more than ___?___ |
|
Definition
|
|
Term
| Which short-acting IV medications are used in low doses in hypertensive emergencies? |
|
Definition
|
|
Term
| What are causes of hypertensive emergencies in a school age child? |
|
Definition
-chronic UTIs
-glomerular dz
-renovascular dz
-aortic coarctation
-essential HTN |
|
|
Term
| What are causes of hypertensive emergencies in teenagers? |
|
Definition
-glomerular dz
-renovascular dz
-essential HTN |
|
|
Term
| Why should the 1st morning urine be taken? |
|
Definition
| orthostatic proteinuria (with activity) can be normal |
|
|
Term
| What is the clinical gold standard to test for proteinuria? |
|
Definition
| urine protein:creatinine ratio |
|
|
Term
| What is the textbook gold standard for testing for proteinuria? |
|
Definition
| 24 hour urine protein collection |
|
|
Term
| What are the "start from the TOP" questions for proteinuria? |
|
Definition
-transient?
-orthostatic?
-persistent? |
|
|
Term
| When is microscopic hematuria likely benign? |
|
Definition
not associated with:
-proteinuria
-gross hematuria
-family h/o deafness or renal failure |
|
|
Term
| What are the findings with glomerular gross hematuria? |
|
Definition
+ casts
- pain
dysmorphic
+ proteinuria
+ sytemic dz
- stream variation
brown |
|
|
Term
| What are the findings with urologic gross hematuria? |
|
Definition
clots
+ pain
isomorphic
- proteinura
- systemic dz
+ stream variation
bright red |
|
|
Term
| What is the progression of hemolytic-uremic syndrome? |
|
Definition
-E. coli
-bloody diarrhea (abx given)
-renal failure, thrombocytopenia, microangiopathic anemia |
|
|
Term
| What is the progression of post-infectious glomerulonephritis? |
|
Definition
-4-6 wks after infection, usually strep pharyngitis
-brown tea-colored urine
-immune response: low complement C3 (check at 8 wks), high ASO titer
-most cases resolve on their own, but refer for renal failure, HTN, edema |
|
|
Term
| What are s/s of Henoch-Schonlein Purpura? |
|
Definition
-abdominal pain
-lower extremity purpura, doesn't blanch
-joint pains
-gross hematuria |
|
|
Term
| What are s/s of pediatric kidney stones? |
|
Definition
-less pain than adults
-usually only hematuria |
|
|
Term
| What is the cause and s/s of renal vein thrombosis? |
|
Definition
-complication of nephrotic syndrome
-flank mass
-back pain |
|
|
Term
| What are complications of renal parenchymal scars caused by the inflammatory response to pyelonephritis? |
|
Definition
-HTN
-renal dz
-renal failure |
|
|
Term
| What are complications of renal parenchymal scars caused by the inflammatory response to pyelonephritis? |
|
Definition
-HTN
-renal dz
-renal failure |
|
|
Term
| At what stage of VUR is a referral made? |
|
Definition
|
|
Term
| What courses of abx are used? |
|
Definition
-routine: 10 day
-complicated: 14 day |
|
|
Term
| What is first line treatment and dose for UTI? |
|
Definition
-trimethoprim-sulfamethoxazole (TMP/SMX)
-dose TMP 10 mg/kg/day plus 30-60 mg/kg/day BID (1 tsp/30 lbs) |
|
|
Term
| What are other treatments and doses for UTI? |
|
Definition
-amoxicillin 30-50 mg/kg/day BID
-amoxicillin/clavulanate 40 mg/kd/day BID |
|
|
Term
| If resolving, follow up culture after ___?___. If not resolving, after ___?___. |
|
Definition
|
|
Term
| What is the dose for prophylactic abx? |
|
Definition
|
|
Term
| Most VUR Grades ___?___ resolve as child grows if there's no dysfunctional voiding or dysfunctional elimination syndrome. |
|
Definition
|
|
Term
| How often are VCUGs performed to assess reflux? |
|
Definition
|
|
Term
| Secondary enuresis is recurrence of incontinence following at least ___?___ of dryness. |
|
Definition
|
|
Term
| By what age does enuresis usually resolve? |
|
Definition
|
|
Term
| What are causes of primary enuresis? |
|
Definition
-small bladder capacity
-toilet training problems
-delayed maturation of voiding inhibitory reflex
-sleep problems
-lack of inhibition of ADH
-increased fluid intake
-dysfunctional voiding |
|
|
Term
| What are causes of secondary enuresis? |
|
Definition
Dz:
-UTI
-DM
-GU abnormalities
Medications:
-diuretics
Family disruptions:
-stress |
|
|
Term
| What are some physical findings in enuresis? |
|
Definition
-hypo-, epispadias
-labial fusion
-dribbling of urine during exam |
|
|
Term
| What diagnostic tests are done with enuresis? |
|
Definition
-urinalysis and culture
-renal u/s or VCUG if abnormal studies or GU anomaly |
|
|
Term
| What are management options for enuresis? |
|
Definition
-address abnormality
-usually self-limited
-motivational therapy, avoiding criticism |
|
|
Term
| cryptochordism definition |
|
Definition
| absence of 1 or both testes in scrotal sac d/t failure of normal descent from abdomen in fetal development |
|
|
Term
| What conditions are associated with cryptochordism? |
|
Definition
-prematurity
-hormonal imbalance
-chromosomal abnormalities
-structural d/o
-family hx |
|
|
Term
| What tests are used for unilateral cryptochordism? |
|
Definition
|
|
Term
| What tests are used for bilateral cryptochordism? |
|
Definition
-karyotyping: chromosomal abnormalities
-hormonal: FSH and LH indicate anorchia
-imaging studies |
|
|
Term
| In cryptochordism, most spontaneous descents occur by ___?___ |
|
Definition
|
|
Term
| In cryptochordism, refer to urologist if undescended by ___?___ |
|
Definition
|
|
Term
| What are treatment options for cryptochordism? |
|
Definition
-hormonal therapy: hCG
-surgical intervention: orchipexy at 12-18 mos |
|
|
Term
| What are patient education points in cryptochordism? |
|
Definition
-r/o infertility in bilateral
-r/o testicular malignancy
-r/o inguinal hernia |
|
|
Term
|
Definition
| painless scrotal swelling d/t collection of peritoneal fluid w/i trunica vaginalis surrounding the scrotum |
|
|
Term
| What are the differences bw communicating and noncommunicating hydrocele? |
|
Definition
c: fluid flow, n: no fluid flow
c: vary in size, n: constant size
n: takes longer to go away |
|
|
Term
| What are physical findings in hydrocele? |
|
Definition
-scrotal edema or asymmetry: appear tense, normal skin, nontender
-fluctuance
-translucent with illumination |
|
|
Term
| What test is used in hydrocele? |
|
Definition
| abdominal u/s to differentiate from hernia |
|
|
Term
| ___?___ type hydrocele frequently develops into hernia needing surgical intervention. |
|
Definition
|
|
Term
| In both communicating and noncommunicating hydrocele, refer if persists beyond ___?___ |
|
Definition
|
|
Term
|
Definition
| congenital defect with urethral meatus on ventral surface of penis |
|
|
Term
|
Definition
| ventral curvature of penis d/t fibrous band of tissue |
|
|
Term
| What diagnostic tests are used in hypospadias? |
|
Definition
-radiography if meatus in perineum (severe)
-karyotype for chromosomal analysis |
|
|
Term
| How does hypospadias affect circumcision? |
|
Definition
| avoid in order to use foreskin for repair |
|
|
Term
|
Definition
| narrow, nonretractile (can't fully expose glans) foreskin of childhood |
|
|
Term
| Foreskin may not be fully retractable until ___?___ |
|
Definition
|
|
Term
| What are s/s of phimosis? |
|
Definition
-painful urination
-weak urine stream
-ballooning of foreskin when urinating |
|
|
Term
|
Definition
| inflammation of glans penis |
|
|
Term
| What are management guidelines for phimosis? |
|
Definition
-good hygiene
-gentle stretching during bath, no forceful retraction |
|
|
Term
| What are management guidelines for paraphimosis? |
|
Definition
reduce swelling:
-ice
-soaking
-gentle pressure by urologist |
|
|
Term
| meatal stenosis definition |
|
Definition
| narrowing of distal end of urethra |
|
|
Term
| What are causes of meatal stenosis? |
|
Definition
-mechanical irritation of diaper post-circumcision
-ischemia from frenular artery damage during circumcision
-inflammation secondary to dermatitis |
|
|
Term
| What are s/s of meatal stenosis? |
|
Definition
-penile pain/discomfort with urination
-narrow, dorsally diverted urine stream
-high velocity urine stream
-occasional bleeding following urinating |
|
|
Term
| What are physical findings of meatal stenosis? |
|
Definition
-inflammation of glans
-slit-like meatus |
|
|
Term
| What are management guidelines for meatal stenosis? |
|
Definition
-air exposure
-warm soaks/baths
-frequent diaper changes
-meatotomy |
|
|
Term
| testicular torsion definition |
|
Definition
| torsion of spermatic cord that can result in gangrene of testes |
|
|
Term
| Testicular torsion is most common in ___?___ |
|
Definition
|
|
Term
| What are s/s of testicular torsion? |
|
Definition
-acute painful swelling of scrotum
-n/v, anorexia
-minimal fever if any
-lack of urinary sx |
|
|
Term
| What are the physical findings in testicular torsion? |
|
Definition
-enlarged, highly tender testes
-scrotum on involved side edematous, warm, erythematous
-anxious, resistant to movement
-negative Prehn's sign: lifting testis doesn't relieve pain
-solid mass visualized with transillumination
-absence of cremasteric reflex |
|
|
Term
| What are tests are used for testicular torsion? |
|
Definition
-CBC: elevated WBC
-Doppler u/s: diminished flow
-u/a: normal or rapid leukocytosis |
|
|
Term
| Surgery is performed on testicular torsion within ___?___ to prevent loss of fertility and prevent atrophy and abscess. |
|
Definition
|
|
Term
| labial adhesion definition |
|
Definition
| benign fusion of labia minora |
|
|
Term
| What are s/s of labial adhesion? |
|
Definition
-asymptomatic
OR
-difficulty voiding
-general discomfort
-enuresis: diurnal when urine pools behind adhesion |
|
|
Term
| What are physical findings in labial adhesion? |
|
Definition
| Thin, flat, membrane of variable length found midline extending from clitoris to posterior fourchette when labia majora are gently separated can be complete or partial |
|
|
Term
| What are treatment and management guidelines for labial adhesion? |
|
Definition
-parental reassurance
-monitoring
-observe for UTI
-topical application of conjugated estrogen BID x2-3 weeks (separation by 8 wks in 90% cases)
-good hygiene
-application of moisturizing cream/jelly |
|
|
