Peds Gu

Front 1

approach to hydronephrosis and megaureter

Back 1

reflux present:
primary - primary reflex, prune belly
secondary - neuropathic bladder, posterior urethral valves

obx present:
primary - stenosis, ureterocele
secondary - stone, clot, obx by extrinsic tumor

neither reflux nor obx:
primary - congenital megauratur or adynamic segment
secondary - infx, post-op

Front 2

pathophys of posterior urethral valves

Back 2

2/2 membranous folds in prostatic urethra

Front 3

US findings assoc with post urethral valves

Back 3

thick walled bladder with dilated b/l renal cs and ureters
on VCUG, bladder is trabeculated

Front 4

what factors predispose pt to primary reflux

Back 4

intravesical portion of ureter acts like 1 way valve and prevents refulx, however if the ureter is abn in length, orientation, or location, the valve mechanism is disrupted

Front 5

pathophys of mulitcystic dysplastic kidney

Back 5

severe obx of renal cs during fetal development

Front 6

appearance of MCDK

Back 6

grape like clxn of variably sized cysts

Front 7

course of MCDK

Back 7

kdny usually decreases is size and eventually kidney is no longer visualized

potential increased risk for malig

Front 8

multilocular cystic nephroma

Back 8

rare type of cystic mass contianing multiple septae
it is not malig, but it is diff to distinguish from malignancy so is resected

Front 9

what is mesoblastic nephroma
age

Back 9

intrarenal heterogeneous soild mass
3 mo

Front 10

ddx mesoblastic nephroma

Back 10

wilms (indistinguishable)

Front 11

pathology of nephroblastomatosis

Back 11

persistent nephrogenic rests that can develop into wilms

Front 12

when should it be suspected that nephroblastomatosis develop into wilm's

Back 12

if spherical lesion becomes larger and demonstrates increased inhomogeneous enhancement

Front 13

weigert meyer rule

Back 13

in duplicated cs, the upper pole moiety inserts inferomedially --> obx by ureterocele

LP moiety scars down and it pushes down on the lower pole moiety which inserts normall and is prone to reflux and looks like a drooping lilly on VCUG

Front 14

what is a ureterocele
what does it look like

Back 14

dilatation of distal ureter
seen in bladder during early filling views, appeaers as filling defect
the dilated portion of the ureter is btwn mucosal and muscular layer of bladder

Front 15

what is the urachus

Back 15

embryologic structure that communicates btwn apex of bladder and ublicius

Front 16

types of urachal abn

Back 16

urachal sinus: blind ending umbilical pouch
patent urachus: cnxn btwn umbilicus and bladder
urachal cyst - no cnxn to bladdder/urachus (patent at mid-portion)
urachal diverticulu - patent urachus at bladder

Front 17

complication of urachal remnant

Back 17

increased risk of CA, therefore should be removed

Front 18

appearance of chronic pyelo

Back 18

loss of renal parenchyma/renal scarring

Front 19

most common congenital obx in urinary tract

Back 19

UPJ obx

Front 20

other things assoc with UPJ obx

Back 20

reflux
renal duplication
UVJ obx

Front 21

main cause of most UPJ obx

Back 21

congenital narrowing >
anomalous BV that causes extrinsic compression

Front 22

pathogenesis of multicystic dysplasic kidney (MCDK)

Back 22

severe obx of renal cs during fetal development

Front 23

appearance of MCDK

Back 23

grapelike collection of variably sized cysts that do not communicate

Front 24

appearance of MCDK in older children

Back 24

MCDK will usually decrease in size over time;
dysplastic renal tissue will no longer be visualized after time

Front 25

management of MCDK

Back 25

follow with U/S

Front 26

complications of MCDK

Back 26

HTN, which, if it develops is usually tx w nephrectomy

Front 27

pathogenesis of ureteropelvic duplicationn

Back 27

premature division or duplication of ureteral bud
most commonly u/l

Front 28

pathophys of primary megaureter

Back 28

aperistaltic segment of the distal ureter --> obx

GU equivalent of Hirschsprung's

Front 29

which ureter is more commonly involved in primary megaureter

Back 29

left

Front 30

prune belly syndrome

Back 30

hypoplasia of abd muscles
cryptorchidism
abn of urinary tract (severe b/l hydro, trabeculated, hypertrophied bladder, urachal diverticulum, hydroureter)

Front 31

hydrometrocolpos

Back 31

vagina and uterus dilate when fluid accumulates in the reproductive tract

there is ox of the genital outflox tract

Front 32

presentation of hydrometrocolpos/hematometrocolpos

Back 32

fixed midline mass may be palpable
mass be lrg enough to cause ureteral obx and hydro

Front 33

appearance of hydrometrocolpos on US

Back 33

mass appears tubular or elliptical, at midline

the vagina is more elastic than the uterus, so the bulk of hte mass is comprised of fluid in vaginal canal

Front 34

appearance of kidneys in infantile polycystic kidney disease

Back 34

1-2 mm cysts throughout cortex and medulla
kdnys are grossly enlarged and diffusely increasd in echogenicity

cystic structures are sometimes n/v b/c they are so big

Front 35

appearance of juvenile polycystic kidney disease

Back 35

pts present with hepatosplenomegaly and portal HTN
kdnys may be big and have varying sized cysts or may be nml
liver shows increased echotxt, 2/2 fibrosis

Front 36

most common renal malig in children

Back 36

wilms tumor

Front 37

how does wilms tumor present

Back 37

asx abd mass +/- pain (usually present if there is hemorrhagE)

Front 38

conditions assoc with wilms tumor

Back 38

beckwith widemann syndrome
congenital hemi-hypertrophy

Front 39

common location for mets in wilms tumor

Back 39

invasion of renal vein and into IVC
20% --> pulm mets
must also look for thrombus extending into right atrium

Front 40

appearance of wilms tumor on US

Back 40

lrg, well defined mass arising from kdny
increased echotxt, heterogeneous

Front 41

which GU malig is generally assoc with "claw sign"

Back 41

wilms

Front 42

where does neuroblastoma commonly metastasize to

Back 42

liver and bone

Front 43

labs in neuroblastoma

Back 43

elevated VMA

Front 44

prognostic factors assoc with neuroblastoma

Back 44

childrlen <1 yo, disease spreads to liver and skin, good prog

>1yo, spreads to bone, poor prog

Front 45

which GU malig in children engulfs, rather than displaces BV

Back 45

neuroblastoma

Front 46

what is the most common malignant sarcoma of childhood
age

Back 46

pelvic rhabdomyosarcoma
>/= 3 yo

Front 47

locations of malignant sarcoma

Back 47

pelvis
GU tract
head/neck

Front 48

most common locations w/i GU tract for rhabdomyosarc

Back 48

bladder
prostate
spermatic cord
paratesticular tussue
uterus
vagina
perineum

Front 49

most likely dx for an extratesticular scrotal masS

Back 49

embryonal rhabdomyosarcoma arising from the spermatic cord or epididymis

Front 50

management of torsion of the testicular appendage

Back 50

self limited, sx not required

Front 51

appearance of testicular appendage torsion

Back 51

mass of increased echogenicity seene btwn superior pole of tesis and epididymis
a testicular appendage is greater than 5mm is greatest indicator for torsion