Urology Take Home Quiz - Answers
1.
What is the next study that should be performed in an infant that has confirmed hydronephrosis on ultrasound?
VCUG
2. Name the clinical features of the following
a. Posterior urethral valves - Prenatal hydronephrosis , UTI, Incontinence, Renal Failure, Diminished urinary
stream, Pulmonary hypoplasia , Bladder distention, Hydroureteronephrosis
b. Prune belly syndrome - Triad: Abnormal abdominal musculature, Abdominal cryptorchidism , Floppy
dysmorphic urinary tracts, Other: Megalourethra , Prostatic hypoplasia, Dimples on lateral knees, GI or
Cardiac anomalies
c. Patent urachus - Umbilical drainage, Inflammation or Infection
3. How does UPJ obstruction present in
a. Neonates - Antenatal hydronephrosis , Neonatal flank mass, UTI
b. Older children and adolescents – recurrent abdominal pain
4. Extrophy
a. Compare and contrast the clinical features of cloacal and classic bladder extrophy.
Cloacal extrophy – large omphalocele, myelomeningocele, hydrocephalus, external bladder mucosa
separated into 2 widely separate halves with a strip of bowel mucosa in the middle, imperforate anus,
hypoplastic genitalia
Classic bladder extrophy – red mucosal surface on the infraumbilical abdominal wall, trigone and
ureteral surfaces may be visible inferiorly, epispadias, bifid scrotum, undescended testes, inguinal
hernias, widespread pubic symphysis, hemiclitoris, duplicate vagina
b. What is the embryonal defect in both cloacal and classic bladder extrophy and how do the 2 conditions
differ embryologically? Rupture of the cloacal membrane. In cloacal extrophy the membrane ruptures
prior to the urogenital septum making a complete descent. In bladder extrophy, the urogenital septum
has made a complete descent prior to rupture of the cloacal membrane.
5. Hypospadias
a. The parent of a child with hypospadias want a circumcision. What do you tell them?
They should delay circumcision because the extra skin may be useful in future repair.
b. A child has hypospadias and cryptorchidism. What further study should you do and why?
Karyotype concern for CAH, or testicular feminization
c. A child has hypospadias that is very proximal. What further study should be done?
Renal Ultrasound
6. Micropenis
a. What is the objective measure of micropenis: <2cm or <2 Standard Deviations STRETCH LENGTH
b. List the most common causes of micropenis: Hypogonadotropic hypogonadism
(Failure of hypothalamus to produce GnRH) or Primary testicular failure
(Deficient testosterone production)
7. List the treatment options for priapism. How does treatment differ in patients with Sickle Cell Disease?
a. Surgical intervention
i. Irrigate corpora cavernosa
ii. Shunt or vascular bypass
b. Sickle Cell
i. Exchange transfusion
8. Paraphimosis
a. Define paraphimosis: Prepuce retracted over glans to level of corona and cannot be easily reduced.
b. What is the most concerning complication of paraphimosis? Acts as a tourniquet causing ischemia to the
glans
9. List the physical exam findings in “torsion of spermatic cord.”
a. Scrotum red, swollen
b. Testis elevated
c. Transverse orientation of contralateral testis
d. Cremasteric reflex absent
e. Negative Prehn sign
i. Pain NOT improved with elevation of testis
10. How might an imperforate hymen present in a neonate? (pink or white bulge of membrane at introitus, may
only be seen by moving labia majora out of the way. Easily missed.) An adolescent? (Primary amenorrhea +/cyclic abdominal pain and fullness caused by hydrometrocolpos.)