1What are some differential dx for a UTI?
urethritis
vaginitis
pinworms
polynephritis
posterior urethral valves
obstructed urinary tract
2What is the standard for diagnosing a UTI?
urine culture
3What is the preferred method of collection in an infant who is not potty trained?
suprapubic or catheterization
4What is the preferred method of collection in a patient who is potty trained?
clean voided specimen
5What is the number of colonies needed in order to diagnose a UTI?
more than 100,000 in a clean voided sample
more than 50,000 in a catheterization
6What does a RBUS (renal bladder ultrasound) show?
the size and shape of the kidneys
presences of duplication and dilation of the ureters
existence of gross anatomic abnormalities
7What disease/condition can RBUS identify?
renal or perirenal abscess
hydronephrosis in children with acute UTI who fail to improve with antimicrobial therapy
8What are the indications for ultrasonography?
children younger than 2 with a first febrile UTI
children of any age with recurrent febrile UTIs
children of any age with UTI who have a family hx of renal or urologic disease, poor growth or hypertension
children who do not respond as expected to appropriate antimicrobial therapy
9What test is used to establish the presence and degree of VUR?
voiding cystourethrogram
10What are the indications for VCUG?
children of any age with two of more febrile UTIs
children of any age with first febrile UTI AND
any anomalies on renal US
combo of fever (greater than 39) and a pathogen other than E. coli
poor growth or hypertension
11What is renal scintigraphy?
DMSA is injectected IV and uptake by the kidneys is measure two-four hours later
areas of decreased uptake represent polynephritis or scaring
12What is renal scintigraphy used to detect?
acute polynephritis and renal scarring
13Why are renal scintigraphy not used as often?
expensive
invasive
exposes kids to radiation
14Renal scarring is associated with
VUR (especially high grade VUR)
15When should you worry about renal scarring with UTI?
abnormal renal bladder US
inflammatory markers (indicates polynephritis)
fever
UTI caused by an organism other than E. coli
16When should you refer a patient with a UTI (or frequent UTIs)?
dilating vesicoureteral reflux (grades III to V)
obstructive uropathy
renal abnormalities
impaired kidney function
elevated BP
bowel and bladder dysfunction refractory to PCP measures
17What are considered true undescended testes?
may remain in:
abdominal cavity
in the inguinal canal (intracanicular)
just outside the external ring (suprascrotal)
18What are some locations of ectopic testes?
prepenile
superficial ectopic
tranverse scrotal
femoral
perineal
19What are retractile testes?
normal testes that have been pulled into a suprascrotal position by the cremasteric reflex
20How can retractile testes be brought into a dependent scrotal poistion?
overcoming the cremasteric reflex by holding the testis in the scrotum for atleast one minute
21Spontaneous descent of the testis is rare after how long?
6 months
22What is a common complication of undescended testis?
infertility (abscent spermatogenesis)
23What is advantegeous to fertility preservation in patients with cryptochidism?
early orchiopexy
24Men with undescended testis have an increased risk of developing?
testicular cancer
25What is hypospadias?
abnormal placement of the urethral opening
26Where can the urethral opening may be located with hypospadias?
anywhere within the glans
shaft
scrotum
perineum
27What is dorsal hooded prepuce?
abnormal foreskin due to its incomplete closure around the glans
28What is chordee?
abnormal penile curvature
29What is the most common location of the displace urethra?
glans and corona
30What is often presents with hypospadias?
cryptochidism
31What is epispadias?
failure of the urethra to close normally and as a result the inner lining of the urethra lays flat and exposed on the dorsal surface of the penis
32What condition is associated with epispadias?
bladder exstrophy
33What is VUR?
due to incompetent or inadequate closure of the ureterovesicular juntion which contains a segment of the ureter within the bladder wall
34In primary VUR how does the anti-reflux mechanism fail?
the intravesical ureter is shortened so that it is not able to be compressed by the surrounding bladder muscles
35How is VUR diagnosed?
VCUG
36How does VUR predisopose patients to acute polynephritis?
reflux causes possible bacterial in the bladder to the kidney
37What medical treatment is used for VUR?
daily administration of a prophylactic antibiotic agent
38What are the three types of dysfunctional voiding?
daytime urinary incontinence
night time urinary incontinence (enuresis)
mixed daytime and night time incontinence
39What are some causes for nocturnal enuresis?
maturational delay
genetics
small bladder capacity
nocturnal polyuria
40What are the mechanisms for increased night time urine output?
increased fluid intake before bed
reduced response to ADH
decreased secretion of ADH
41Does ADH secretion usual increase or decrease at night?
increases
42What is desmopressin?
a first line treatment for children older than 5 whos bed wetting has not responded to advice about fluid intake, toileting or an appropriate reward system
43What consitutes increased daytime frequency?
8 or more voids during waking hours
44What constitutes decreased daytime frequency?
3 or less voids during waking hours
45What is defined as the observed ejection of urine with a weak force and may be pertinent finding in all age groups?
weak stream
46What could weak stream indicate?
a stenosis
47What is defined as a voiding stream of urine that occurs in several discrete bursts rather than the normal continous stream and is a normal physiological pattern in children 3 or older?
intermittent stream
48What is defined as burning or discomfort during voiding?
dysuria
49What is defined as awakening to void at night?
nocturia
50What is defined as difficulty in the initiation of voiding or if a child must wait a considerable amount of time before voiding starts? It can be applied to children who have achieved bladder control regardless of age
hesitancy
51WHat is defined as the application of abdominal pressure by the child to initiate and maintain voiding? It can be a pertinent finding in all age groups.
straining
52What are some holding maneuvers?
standing on tiptoes
forcefully crossing legs
squatting with a hand pressed against the perineum
53are holding maneuvers normal?
yes it indicated achieved bladder control
54What is involuntary urine leakage immediately after completion of voiding in children who have achieved bladder control regardless of age?
postmicturition dribbling
55What are some causes of dysfunctional voiding?
neurogenic bladder - spinal bifida, spinal cord trauma
56What are some co-existing disorder with dysfunctional voiding?
constipation
encopresis
57What are some treatments for dysfunctional voiding?
timed voiding
double voids
bowel cleanse