Genitourinary

Question 1

Dysmenorrhea

Answer 1

intense pain and discomfort with cycle due to prostaglandin release. starts 1-2 days before bleeding. may have n/v/d, headache, dizziness, and back pain. pain lower/mid abdomen can radiate to back or thighs. cramps and stabbing.

Question 2

Dysmenorrhea diagnostics/management

Answer 2

Diff: UTI, celiac, lactose intolerance, gastroenteritis, hernia, IBD, renal calculi, cystitis, trauma, inflammation of muscles/ligaments, nerve compression, neuropathic pain, psych diagnoses. Educate and do ibuprofen 800mg q8 a few days before cycle starts. Hormonal therapy (OCs, skin patches, vaginal rings, progesterone treatments like IUD, subdermal implant, DMPA). Refer if this doesn’t help after a few months.

Question 3

Premenstrual Syndrome PMS

Answer 3

starts 5 days before period and ends up to 4 days after; for at least 2 cycles in a row. s/s: bloating, breast pain, headache, food cravings, anxiety, fatigue, irritability, depression. Mild to mod: increased aerobic exercise, relaxation, adequate sleep, avoiding high fat/salt/sugar/caffeine. Severe hormonal therapy.

Question 4

Vulvovaginitis

Answer 4

atrophic vaginal epithelium and absence of labial fat pads predispose it to trauma/irritation. can be d/t poor hygiene (noted around toilet training) or use of irritating detergent or soap. Can be infectious like GAS or H. flu. STI’s. Yeast unlikely d/t high vaginal pH prepuberty. Pinworms/lichen. Foreign body causes odor, discharge, and bleeding. Consider sexual abuse.

Question 5

Vulvovaginitis

Answer 5

nonspecific: discharge, with or without itching, erythema. Update hygiene practices. Irritant: soreness/itching, history of bubble bath etc. same tx. Specific bacterial: pain, itching bleeding, beefy red. Tx: penicillins for Strep, for shigella Bactrim or ampicillin. Pinworms: itching at night. Tx: mebendazole/albendazole once repeated in 2weeks.

Question 6

Labial Adhesions

Answer 6

girls 3mo-6years.

Question 6

Labial Adhesions

Answer 6

girls 3mo-6years. d/t hypo estrogen state. assess for functional problems; if not, good hygiene. in symptomatic, topical estrogen or steroids. common until they go through puberty.

Question 7

UTI

Answer 7

upper UTI: kidney/ureter, lower: bladder, urethra etc. Most commonly d/t E. coli; Females > males, preemies > term, high risk <1 year old, caucasian. UA to raise or lower suspicion, culture is gold standard prior to antibiotics. s/s: fever, vomiting, diarrhea, malaise, weight loss, dysuria/frequency/urgency, bad odor, abdominal or flank pain

Question 8

Cystitis

Answer 8

infection of the bladder, a lower tract UTI, see UTI

Question 9

Vesicoureteral reflex VUR

Answer 9

retrograde regurgitation from bladder into ureters and potentially kidney. Primary or secondary. Diagnosed via US, VCUG; can do DMSA, BP, creatinine, UA/culture. s/s: previous UTI, abnormal voiding pattern/dysfunction, constipation, hydronephrosis, etc. up to grade III resolve in 50% of kids. antibiotics and yearly US/VCUG in grade’s III-V; consider them in grade II, avoid in grade I. surgical correction considered III-V.

Question 10

Enuresis

Answer 10

urination at age when toilet training should be complete. >5 years old, one episode/month for 3 months. etiology: constipation, genetic disposition, DD, functional small bladder capacity, sleep disorders, stressors, polyuria, inappropriate training. UA recommended, maybe culture. Diff: pollakiuria, UTI, DM, sickle cell, CKD, structural issues, neurogenic bladder, hypercalciuria, vaginitis, sleep apnea.

Question 11

Hydronephrosis

Answer 11

significant dilation of one or both kidneys due to obstruction of UPJ, urethral valves, ectopic ureterocele, prune belly, or ureteral/ureterovesical obstructions. s/s: decreased UOP or abdominal mass. may need surgical repair if no spontaneous resolution by 6-12 months.

Question 12

Glomerulonephritis

Answer 12

inflammation of glomerulus in kidney often post strep. hematuria/proteinuria, edema, fever, flank pain, congestion, ear malformations, CVA tenderness, rashes/arthralgias. Diagnosis: UA, C3/C4, CBC, ESR, ASO titer, BMP. Diff: acute nephritis can be d/t systemic illnesses, vasculitis, drug reaction.

Question 13

Hematuria

Answer 13

5+ RBCs per HPF in 3 consecutive specimens over several weeks. >2 in unspun. Gross is visibly seen. Brown, tea-colored urine with casts/protein is usually glomerular in origin. Clots and red-pink with RBC/no protein usually from lower UT. etiology: hypercalciuria, IgA, nephropathy, glomerulonephritis, UTI, hydronephrosis, tumor ,csititis, polyps.

Question 14

Proteinuria

Answer 14

protein in urine, can be benign or from disease, noted on dipstick. + if 1+ or more with specific gravity <1.015. Isolated (orthostatic with normal lying down and persistent asymptomatic), transient (stress related, resolves in 1-2 weeks after), glomerular, and tubulointerstitial types. Diagnostics: UA 3x, first void sample, protein to creatinine ratio, 24hr creatinine collection, if >3, check CBC/lytes/LFP, refer etc.

Question 15

Renal tubular acidosis

Answer 15

dysfunction of renal tubular transport. type II most common, proximal, and leads to bicarb wasting. s/s: failure to gain weight, polyuria/polydipsia, muscle weakness, irritability prior to eating, v/d/constipation, preference for liquids over solids. Diagnostics: electrolytes, CO2, BUN/creatinine, alk-phos, UA, 24hr creatinine. US.

Question 16

Wilms Tumor

Answer 16

kidney tumor, mass on abdomen, don’t palpate can release tumor contents within kidney. stage I: only in kidney. II: beyond kidney but can be excised. III: postsurgicwal residual extension in abdomen. IV: mets, to lungs often. V: bilateral kidney. often has concurrent congenital defects. usually diagnosed <5 years. s/s: mass, pain, fever, dyspnea, diarrhea, vomiting, weight loss, malaise.

Question 17

STD

Answer 17

unsure what’s asked of me here..can cause infections?

Question 18

Undescended testes (cryptorchidism)

Answer 18

testes that don’t go to scrotum. failure to descend can be d/t: mechanical lesions, secondary to hormonal, chromosomal, enzymatic, or anatomic disorders. many descend within 3 months. retraction common in 3-7year old. Differentials: anarchism, chromosome problems. Tx: surgery 9-15months. refer by 6 months if undescended or if retractile testis doesn’t retain scrotal residence.

Question 19

hydrocele

Answer 19

Fluid accumulations in tunica vaginalis or processus vaginalis. Painless. Transilluminate. Common in neonates and self resolve over several months. If you can’t palpate testes can do ultrasound to assess them. CT can be done too. if there >1 year, associated with hernia. No tx unless lasting >1 year.

Question 20

Hypospadias

Answer 20

position of meatus on ventral surface of penis. sonography of kidney more likely abnormal with a proximal hypospadias. don’t circumcise because may use skin for reconstruction. surgical management at 6-12 months.

Question 21

Inguinal hernia

Answer 21

scrotal/inguinal swelling resulting in bulging of abdominal contents through weakness in wall. d/t incomplete closure of processus vaginalis. high risk: males obese, weight lifters, or family history, preemies; most diagnosed in first year. bilateral are common. s/s: swelling comes and goes and increases with straining/crying. silk glove sign.

Question 22

balantitis and balanoposthitis

Answer 22

balanitis is inflammation of the glans, and common in uncircumcised. Can trap infection. Tx: slight dilation of a snug preputial opening, warm baths, broad spectrum antibiotic for a few days if severe. balanoposthitis is inflammation of foreskin/glans penis.

Question 23

Phimosis

Answer 23

inability to retract a tight scarred prepuce. Tx: manual compression of glans and prepuce to allow reduction of band. persistent can have betamethasone cream bid 2-4 weeks.

Question 24

Paraphimosis

Answer 24

Tight ring d/t prepuce retraction over glans and can cause tourniquet and cause ischemia. If severe, dorsal slit may be made, surgically dividing the phimotic band. Circ. appropriate after an episode. most common adolescents

Question 25

Testicular torsion

Answer 25

twisting of the spermatic cord. has only 6 hours before irreversible injury destroys spermatogenic potential, so ER. immediate exploration to assess viability of testes. S/s: acute, painful swelling of scrotum, lower abdominal pain, n/v. In acute stage, can have hydrocele. Cremasteric reflex absent. Scrotum becomes firm, homogeneous mass. attempt gentle twisting in either direction > instant pain relief. Spermatic cord may need immediate surgery.

Question 26

Enuresis management

Answer 26

treat daytime/constipation before nocturnal. May need to refer. make siding schedule, limit night drinks. Good posture while urinating. Alarms for decreased maximal voided volumes. Drugs: desmopressin at night PRN. avoid high fluid intake with the med. Not first line: anticholinergics, oxybutynin, botox, imipramine. sacral nerve stimulation.

Question 27

UTI differentials/management

Answer 27

Diff: urethritis, vaginitis, viral cystitis, foreign body ,sexual abuse, dysfunctional voiding, appendicitis, PID. Tx: <2 year diagnosed UA with +nitrite/leukocyte and culture with 50,000 cfu/mL. If no leukocytes, no tx. <2 years get 7-14 days antibiotics. Bactrim, amoxicillin, augmentin, cephalexin, cefepime, nitrofurantoin. <1 mo inpatient and parenteral antibiotics. Pyelonephritis infants >1mo: cefixime, cephalexin, augmentin. Adolescents: augmentin, ciprofloxacin. <2, those with fever/pyelonephritis/recurrent should do renal/bladder US.

Question 28

Hematuria differentials

Answer 28

post-strep glomerulonephritis, renal disease, UTI, trauma, coagulopathy, crystalluria, nephrolithiasis. HSP. IgA nephropathy, sickle cell, rhabdo. Tx: refer gross hematuria unclear cause, symptomatic microscopic, or persistent hematuria/proteinuria.

Question 29

Proteinuria differentials

Answer 29

Penicillins, anti-inflammatory agents. Tx: if dipstick 1+, monthly recheck for 4-6mo, if persistent then refer. if >1+, evaluate for orthostatic. if first morning protein is 1-2+, do 24hr creatinine. if dipstick >2+ evaluate for nephrotic syndrome. If hematuria, eval for nephritis.

Question 30

Glomerulonephritis management

Answer 30

PSGN resolves by itself usually. may need fluids and Na restrictions, an antiHTN med, antibiotics if + cultures. Resolution occurs with dieresis. Hematuria continues 1-2 weeks.

Question 31

Renal tubular acidosis diff/management

Answer 31

secondary from hypothyroidism, systemic acidosis. tx: correct acidosis and maintain normal bicarb. oral alkalizing medications: Bicitra, polycitra, sodium bicarb, baking soda. maximize caloric intake, good follow up. primary self resolves in 1-2 years. all respond well to treatment.

Question 32

Wilms tumor diagnostics

Answer 32

chest/abdomen X-ray. abdominal US, UA, CBC/retic/liver and renal chem panels. CT scan to stage. Differential: neuroblastoma, multicystic kidney, hydronephrosis, renal cyst. Refer to h/o. surgerical removal, chemo/radiotherapy if advanced.

Question 33

Inguinal hernia diagnostics

Answer 33

abdominal x-ray, US. diff: hydrocele, undescended testes, inguinal lymphadenopathy. Tx: attempt to reduce it, referred to surgeon/urologist for repair in 1-2 weeks. don’t resolve spontaneously. If painful, hard tender, red mass, or not easily reduced, refer immediately.