peds exam 2 GU/endo

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1

the more concentrated the urine the ________ the specific gravity

higher

2

High level of ADH

SIADH

3

Low levels of ADH

DI

4

do peds have bigger or smaller kidneys?

bigger

5

do peds have a longer or shorter urethra?

shorter

6

when is bladder control usually achieved?

age 2

7

normal urine outputs

  • Infants & toddlers:
  • Preschool & school age =
  • Adolescents =
  • Infants & toddlers: 1-3 ml/kg/hr
  • Preschool & school age = 1-2 ml/kg/hr
  • Adolescents = 0.5-1 ml/kg/hr
8

minimum urine outputs

  • Under 1 year at least =
  • 1 year up to 30 kg =
  • 30kg & more at least =
  • Under 1 year at least = 2 ml/kg/hr
  • 1 year up to 30 kg = 1 ml/kg/hr
  • 30kg & more at least = 30 ml/hr or 0.5 ml/kg/hr
9

exposed or open dorsal urethra

epispadias

10

urethra just off the tip of the glans

hypospadias

11

when is corrective surgery for hypospadias/epispadias?

6-12 months

12

is a patient circumcised or uncircumcised prior to corrective surgery of hypospadias/epispadias?

uncircumcised

13

how long is a urethral stent/catheter placed to maintain patency after correction surgery of hypospadias/epispadias?

5-10 days

14

when can a patient have a bath after corrective surgery for hypospadias/epispadias?

after 3 days (if not stent)

15

medication for postop hypospadias/epispadias corrective surgery

abx, oxybutynin, pain medication

16

medication that controls bladder spasms

oxybutynin

17

how often is oxybutynin given?

q 8 hours

18

Involuntary voiding by a child old enough that bladder control is expected

enuresis

19

involuntary urination at night (sleeping hours)

nocturnal enuresis

20

diagnosis for nocturnal/enuresis

  • Must be twice a week for at least 3 months
  • Must be at least 5 years old
  • Rule out organic causes: structural defects, UTI, Endocrine: diabetes & pituitary, sickle cell, neurological
21

meds for nocturnal enuresis

desmopressin (DDAVP), tofranil (imipramine), ditropan (oxybutynin)

22

med that reduces urine volume at night

desmopressin (DDAVP)

23

side effects of tofranil

arrythmias, drowsiness, N/V, tachycardia

24

presence of bacteria in the urine (can be symptomatic or asymptomatic

bacteriuria

25

inflammation of the bladder

cystitis

26

Inflammation of upper urinary tract and kidneys

pyelonephritis

27

bacterial illness; urinary pathogens in blood

urosepsis

28

most common cause of UTI (organism)

E coli

29

single most contributing factor to UTI

urinary stasis

30

diagnostic tests for UTI

  • Ultrasound (bladder after voiding or anatomical structures)
  • Voiding Cystourethrography (VCUG)
  • Urine culture and sensitivity (cath or clean catch)
  • Urinalysis (nitrites, WBC, RBC, bacteria)
31

contrast medium injected into bladder through urethral catheter until the bladder is full

VCUG

32

s/sx of UTI in infants

jaundice, foul smelling urine, fever, poor feeding, vomiting, irritability, dehydration, screaming with urination, seizures, resp distress

33

s/sx of UTI in preschool

incontinence/enuresis, fatigue, abd/suprapubic/flank pain, pain with urination, fever, poor appetite, vomiting, diarrhea, blood in urine, edema, seizures, hypertension

34

Abnormal retrograde flow of bladder urine into ureters acting as a reservoir for bacteria

vesicoureteral reflux (VUR)

35

diagnostic for VUR

VCUG

36

primary cause of VUR

congenital abnormality in ureters

37

secondary cause of VUR

acquired

38

tx for VUR

abx, UA q few months, annual evaluation, surgical intervention

39

bulking agent, dextranomer-hyaluronic acid polymer (Deflux) injected into mucous membrane of ureter

STING procedure

40

what causes HUS (hemolytc-uremic syndrome)?

e coli (main cause), contaminated food/food borne, swimming pools/lakes

41

other organisms that can cause HUS?

  • Shigella
  • Salmonella
  • Streptococcus Pneumoniae infection (5-15%)
42

HUS risks

  • Children under 5 years of age
  • People over 75
  • Genetic
43

meds for HUS

quinine sulfate, chemotherapy, immunosuppressants, antiplatelet medications

44

patho of HUS

The toxin causes-

  • destruction of the glomerular arterioles
  • activates platelets
  • destruction of RBC (hemolytic)

= Acute Renal Failure

45

Triad of HUS

ART

anemia, renal failure, thrombocytopenia

46

the tiny filter units in the kidneys known as glomeruli become clogged with platelets and damaged red blood cells

HUS

47

s/sx of HUS

bloody stools, oliguria, petechiae, jaundice, diarrhea, abdominal tenderness, pale and lethargic, proteinuria, hematuria, BUN and creat elevated, seizure, HTN

48

tx for HUS

BMP/CBC/DIC, PICC, TPN, NG feeds, dialysis, plasmapheresis, fresh frozen plasma, blood transfusion, stop antibiotics

49

manifestions of nephrotic syndrome

  • Proteinuria
  • Hypoalbuminemia
  • Hyperlipidemia
  • lipiduria
  • Edema
  • Massive urinary protein loss
50

s/sx of nephrotic syndrome minimal change

occurs over weeks, weight gain, edema, ascites, frothy urine, anorexia, pallor/fatigue

51

diagnostic for nephortic syndrome minimal change

labs (low alobumin, low protein, high lipids), UA +2 protein, biopsy

52

why is nephrotic syndrome at increased risk for infection?

low on protein, losing immunoglobulin, giving steroids

53

meds for nephrotic syndrome

prednisone, lasix

54

diet for nephrotic syndrome

restrict sodium, possible fluid restriction, good nutrition

55

causes of acute post-strep glomerulonephritis (PSGN)

streptococcal infection

56

s/sx of glomerulonephritis

abrupt onset, hematuria, proteinuria, oliguria/dysuria, HTN, edema, flank pain/abd pain, anorexia, malaise/lethargy, altered immunity

57

Increased amount of protein reflects __________

increased severity of renal disease

58

diagnostic for acute glomerulonephritis

progression of edema, decrease urine output, tea color urine, UA (hematuria, proteinuria, WBCs), labs (elevated BUN/creat, elevated ESR, positive ASO titer, low H&H)

59

the most common of several antibodies that are produced by the body's immune system in response to a strep infection

ASO and anti-DNase B

60

meds for acute glomerulonephritis

abx, antihypertensives

61

diet for acute glomerulonephritis

limit sodium, fluid restrict, protein NOT restricted, possible K+ restrict

62

Most common malignant renal and intra-abdominal tumor of childhood

nephoblastoma

63

AKA wilms tumor

nephoblastoma

64

nephoblastoma is three times more common in ______ children

african american

65

peak age for wilms tumor dx

2-3 yr

66

clincal manifestations for wilms tumor (nephroblastoma)

abd swelling/mass, HTN, difficulty breathing, hematuria

67

dx for nephroblastoma

ultrasound, CT/MRI, CBC/BUN/creat

68

tx for nephroblastoma

chemotherapy, surgery (within 24-48 hr discovery), nephrectomy

69

Is epispadias on top or below shaft of penis?

On top

70

Is hypospadias on top or below shaft of penis?

Below

71

Is E. coli positive or negative gram stain bacteria?

Negative

72

What do positive nitrites indicate?

Presence of E Coli

73

What do you do first for HUS?

Labs

74

a condition that affects the blood and blood vessels. It results in the destruction of blood platelets (cells involved in clotting), a low red blood cell count (anemia) and kidney failure due to damage to the very small blood vessels of the kidneys

HUS

75

Normally impermeable to large proteins becomes permeable to proteins, especially albumin

glomerular membrane

76

albumin lost in urine

albuminuria or proteinuria

77

serum albumin decreased

hypoalbuminemia

78

Urine cloudy, smoky brown, resembles tea or cola

hematuria

79

what has edema with glomerulonephritis?

periorbital, hands, feet/ankles