Term
| what is the most common pediatric kidney tumor? |
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Definition
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Term
| how common is hematuria in children? |
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Definition
| pretty rare - usually children will only present w/an abdominal mass before hematuria (otherwise asymptomatic) |
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Term
| how do genetics affect presentation of bilateral renal cystic disease? |
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Definition
| the autosomal recessive form will usually present in infancy (smaller cysts), while the autosomal dominant form doesn't usually present until adulthood (larger cysts) |
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Term
| does every child who has antenatal hydronephrosis require sx? |
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Definition
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Term
| what is the risk of malignancy w/multicystic dysplastic kidney? |
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Definition
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Term
| what is the etiology for uteropelvic junction obstruction? is this usually operated on? how do pts w/this present? |
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Definition
| uteropelvic junction obstruction: a collagen problem causing the pelvis to expand over the ureter and block passage of urine - can require sx (present with failure to thrive, pain in older children (infection is rare)) |
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Term
| why do the ureters always cross in a mackie stevens kidney (one w/two ureteral buds)? |
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Definition
| there is a sweet spot on the mesonephric duct during development, and if there are 2 urethral buds, (one higher than it should be/one lower than it should be) they will cross each other trying to correct their displacment. (if the bud comes off too medial: pushes it lateral in the bladder causing vesicoureteral reflux and if the bud comes off more cephalad: it is incorporated into a more caudad position in urethra (highest ureter comes to the lowest point of connection, why they twist)) *severe vesicoureteral reflux = severe dysplasia, b/c indicative of other developmental problems) |
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Term
| how can the ureter coming off the kidney too close to the upper pole (developmental defect) cause a ureterocele? |
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Definition
| ureters coming off too close to the upper pole of the kidney usually connect too caudally on the bladder, sometimes to the point of blocking the valve emptying the bladder into the urethra. (an ectopic ureter is an even more exaggerated form of this same issue, where the ureter misses the bladder completely and drains into the perineum). |
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Term
| what is a posterior urethral valve? |
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Definition
| a film-like membrane which can cause damage (urine can't get to amniotic cavity, causes cyst formation). it is easy to fix, but usually undetected until damage has occurred. |
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Term
| what is prune belly syndrome? |
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Definition
| an abdominal wall deficiency including bilateral undescended testes and urinary tract abnormalities. |
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Term
| what is the best defense against UTIs? |
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Definition
| frequent and complete urinary voiding - urethral bacteria are constantly entering the bladder (in both M+F) |
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Term
| how long do bacteria have to be in the bladder until they can start colonizing? |
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Definition
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Term
| what are symptoms of a UTI in a newborn? |
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Definition
| may just not be feeding well, afebrile |
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Term
| what are symptoms of a UTI in a toddler? |
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Definition
| uncomfortable, abdominal upset and some fever |
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Term
| what are symptoms of a UTI in a preschooler? |
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Definition
| preschoolers are more articulate, feel/report burning on urination |
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Term
| how soon should a UTI be treated to prevent scarring? |
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Definition
| within 72 hrs of onset of symptoms (so early dx is important) |
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Term
| what are determinants of whether a UTI will occur? |
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Definition
| bacterial virulence (minimize antibx exposure), anatomy/physiology, and behavior (teach kids to relax). |
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Term
| what diagnostics are used in pediatric urology? |
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Definition
| US (well tolerated/noninvasive - not sensitive to kidney scarring), VCUG (voiding cystourethrogram - very invasive), renal scanning (gallium scan which labels WBCs and localizes in kidney), CT scanning (high radiation exposure), and MRI (as speed of testing improves will be primary) |
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Term
| what are the complications faced in a pediatric pt w/vesicoureteral reflux? |
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Definition
| these pts do have a higher risk of UTIs, renal scarring, dysplasia, and voiding dysfunction - but the etiology for all of those symptoms has not been completely correlated. |
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Term
| what does a refluxing ureter generally look like as it meets the bladder? |
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Definition
| refluxing ureters generally hit the bladder at a direct angle (referred to as a "lateral angle") as opposed to a more healthy, oblique angle |
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Term
| *exam question #1: infants w/a UTI should be referred for a voiding cystourethrogram when?* |
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Definition
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Term
| what are some common associations for hypospadias? |
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Definition
| more common in whites/italians/jews/twins. phytoestrogens/environmental factors may be involved and other UT congenital anomalies often co-present. |
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Term
| *exam question #2: when referring a patient with hypospadias, the pediatric urologist who is accepting care of the patient will ask questions about physical exam which will be helpful for planning surgery. although other questions may be relevant he will ask about:_____________?* |
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Definition
| *specifically about the position of the urethral meatus, degree of curvature and ventral skin thickness* |
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Term
| what is important in evaluation of an intersex infant? |
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Definition
| palpate for 1 or 2 gonads. symmetric exams: global problem such as congenital adrenal hyperplasia (missing an enzyme) or male pseudo-hermaphrodite (both testes/ovaries). asymmetric: true hermaphrodite (ovotestis) or mixed gonadal dysgenesis (testes don't form properly) |
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Term
| what is the tx for intersex pts? |
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Definition
| steroid replacement therapy - need to tx early and *determine sex of child (before they go home - could be CAH and pt may go into steroid shock later)* |
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Term
| *exam question #3: a patient with bilateral impalpable testes should be __________ ?* |
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Definition
| a pt w/*bilateral impalpable testes should be referred immediately before hospital discharge for *workup of congenital adrenal hyperplasia (CAH). |
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Term
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Definition
| the absence of one or both testes from the scrotum |
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Term
| what are common causes of cryptorchidism? |
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Definition
| physical: genetic defect in genitofemoral nerve, which causes the gubernaculum to less able to pull the testes down. endocrine: *lack of/blunting of surge in in FSH/LH as 4-6 wks followed by testosterone/inhibin |
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Term
| *exam question #4: pts w/cryptorchidism should be referred to a pediatric urologist at what age?* |
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Definition
| *3 months* (b/c there is still time for a hormonal surge to correct cryptorchidism within this 3 month time frame) |
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Term
| what is the theory as to why pt w/cryptorchidism have a higher risk of testicular CA? |
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Definition
| the lack of a normal hormonal surge keeps apoptosis from occurring to germ cells = higher incidence of testicular CA around age 13 |
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Term
| what are indications for sx on pts w/undescended testes? |
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Definition
| psychological, infertility, CA, hernia, and torsion |
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Term
| *exam question #5: potential benefits from the orchiopexy in boys with cryptorchidism include:_____________?* |
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Definition
| *improved fertility potential, possible reduced CA risk, eliminated risk of spermatic chord torsion and eliminated risk of hernia* |
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Term
| is there a difference in the anatomy between a hydrocele and scrotal hernia? |
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Definition
| no - a hernia just involves a bowel loop |
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Term
| what are the pros for circumcision? |
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Definition
| lower incidence of CA/cervical CA, decreased UTI incidence, and aesthetic similarity to peer group |
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Term
| what are the cons for circumcision? |
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Definition
| painful (requires general anesthetic), carries complications (can lose part of the glans), and cost to society |
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Term
| *exam question #6: the foreskin in newborns is _______?* |
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Definition
| *not normally retractile* |
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Term
| what is paraphimosis? tx? |
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Definition
| if the foreskin on a male infant and is pulled back and *doesn't pull forward again - can lead to pronounced and painful swelling. tx: apply pressure to the swollen portion of the penis, get fingers over the top, and push the penis inside. |
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Term
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Definition
| bacterial infection below the prepuce, under the foreskin. tx: antibx, may require emergent dorsal slit |
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Term
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Definition
| *sterile sloughed skin debris behind the glans of the penis and under the foreskin. |
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Term
| what needs to be taken into consideration when parents request repeat circumcision? |
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Definition
| a newborn's penis is longer than it will be again until they get to about 16 b/c of prepubic fat gain - which can give the impression of an incomplete circumcision. if circumcision is performed on a slightly older baby too much skin may be accidentally removed. |
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Term
| what can happen if too much skin is left following a circumcision? |
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Definition
| cicatrix - where the urethra is blocked by scarring, requires sx |
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Term
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Definition
| narrowing of the urethral opening (occurs from the ventrum out) - common after circumcision, tissue just needs to be opened up. |
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Term
| what is bladder exstrophy? |
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Definition
| a rare congenital anomaly in which part of the urinary bladder is present outside the body |
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Term
| *exam question #6: a female infant with hydrocolpos may have obstruction of drainage at: _____________?* |
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Definition
| *the cervical os (transversevaginal septum) or the introitus (imperforate hymen)* |
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Term
| what is hydrocolpos? what is the most common cause? tx? |
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Definition
| blockage of vaginal drainage - usually due to an imperforate hymen, which presents as amenorrhea and a dilated vagina on US. tx: incise the hymen for drainage. |
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