Fetus and Newborn Committee

Question 1

When does the foreskin of a male newborn separate from the glans?

Answer 1

Process is gradual, 50% by 6 years of age, but may not be complete until puberty

Question 2

What is phimosis?

Answer 2

Phimosis is scarring and thickening of the foreskin that prevents retraction back over the glans

Question 3

What is the first line medical treatment for phimosis?

Answer 3

Topical steroid BID to foreskin with gentle traction

Question 4

After medical treatment for phimosis, what percentage of newborn males will have retractable foreskins?

Answer 4

Foreskin will be retractable in 80% of treated cases, avoiding the need for circumcision

Question 5

Based on studies, how many circumicisons are needed for normal infant boys at birth to prevent one UTI?

Answer 5

111-125 normal infant boys (whom the risk of UTI is 1-2%)

Question 6

Has circumcision been shown to be protective against gonorrhea or chlamydia?

Answer 6

No

Question 7

HPV vaccination in males may help decrease what kind of cancer?

Answer 7

Penile cancer.

There is a strong association between HPV infection and penile cancer regardless of circumcision status, with 80% of tumour specimens being HPV DNA-positive.

Question 8

What are the 4 potential benefits mentioned in the CPS statement about circumcision?

Answer 8

1. Decreases phimosis
2. UTI reduction
3. STI (particularly HIV) reduction
4. Cancer reduction

Question 9

What is the most common late complication of circumcision?

Answer 9

Meatal stenosis (2-10%)

Question 10

What are 2 medical conditions where neonatal circumcision may be contraindicated?

Answer 10

1. Hypospadias
2. Bleeding diathesis

Question 11

Circumcision may help decrease which STIs in males?

Answer 11

Mainly HIV, but also some studies report HSV and HPV

Question 12

What are the three mentioned acute complications associated with circumcision?

Answer 12

Minor bleeding

Local infection

Unsatisfactory cosmetic result

Question 13

What is the CPS’ stance on circumcisions?

Answer 13

The CPS does not recommend the routine circumcision of every newborn male

Question 14

Name 3 risk factors that have been shown to be associated with brachial plexus palsy

Answer 14

1. Large for gestational age
2. Maternal diabetes
3. Instrumental delivery

Question 15

The natural history of brachial plexus is not favourable in what percentage of infants?

Answer 15

20-30%

Question 16

Is perinatal brachial plexus palsy always preventable?

Answer 16

No

Question 17

What percentage of patients with perinatal brachial plexus palsy recover completely within the first month of life?

Answer 17

75%

Question 18

What would be the indication for sending a referral to a multidisciplinary brachial plexus team?

Answer 18

If the physical examination shows incomplete recovery by the end of the first month