GU

Question 1

Testicular torsion is most common at what age?

Answer 1

Adolescence 12- 16 yrs

Question 2

Torsion of hydatid of Morgagni is AKA? Common age of presentation

Answer 2

AKA torsion of testicular appendage
Usually pre pubertal males

Note: blue dot sign - tender nodule with blue discoloration on the upper pole of the testis

Question 3

Blue dot sign is seen in what pathology?

Answer 3

Torsion of testicular appendage

Question 4

Torsion of testicular appendage require surgical intervention T/F

Answer 4

F - if diagnosis is clear not indication for surgery, symptoms should resolve w/in 48 hrs

Question 5

Management of a hydrocele?

Answer 5

If < 2 yrs reassurance only, 95% will resolve by 2 yrs old

If > 2 yrs old ligation of processus vaginalis

Question 6

Mgmt of priapism?

Answer 6

Mgmt is different for ischaemic vs non ischaemic

Ischaemic is painful and non ischaemic is not

Ischaemic is an emergency - needs surgery consult. Tc ice pack, oral analgesia and cavernous phenylephrine and aspiration if there for > 4 hrs

Question 7

What is the only absolute medical indication for circumcision?

Answer 7

BXO (balantitis xerotica obliterans)

Note: as 10% of cases will have narrowing of urethra and hence urethral calibration is also indicated.
Other relative indications: recurrent paraphimosis, posterior urethral valves or high grade VUR (due to abnormal tract/increase risk UTIs)

Question 8

Balantitis xerotica obliterans vs phimosis

Answer 8

BXO - thickened non retractile foreskin, it does not evert and is scarred. Leads to a pin hole opening

Phimosis: non retractile foreskin, mild erythema, ballooning of foreskin on micturition and white debris

Question 9

What is the mgmt of phimosis in a baby?

Answer 9

Reassurance; foreskin in only retractable in 1% of babies at birth; only 1% of 16 yrs old will have a foreskin that is non retractable

Question 10

Presence of pus cell in the urine of a pt who has recently been started on a new medication.

Answer 10

Acute interstitial nephritis

Common meds: beta lactams, sulphonamides, rifampicin, ethambutol, erythromycin

Question 11

What is the mgmt of a chronic ovarian cyst > 5cm?

Answer 11

Ovary sparing cystectomy

At 5cm or greater there is a risk of torsion

Question 12

According to NICE guidelines in a child over 3 yrs old what is the appropriate duration of treatment with oral abx for cystitis?

Answer 12

3 days

NB: pyelonephritis is 7-10 days

Question 13

In hypospadias where does the urethra open?

Answer 13

Ventrally just before the glans

Other features: a chordee (tilt ventrally) and hooded foreskin
Note: epispadias is much less common and is an opening on the dorsal side

Question 14

What is the mgmt of the lack of a palpable testis?

Answer 14

Normal up until 6 months

After 6 months should have a diagnostic laparoscopy and possibly the first stage if orchidopexy.

NB: no form of imaging is reliable enough to determine whether a testes is present or not

Question 15

Vesicoureteric reflux is most accurately diagnosed by a DMSA scan T/F

Answer 15

F - DMSA scan is the best investigation to look for renal scars
Micturating cystography is used for diagnosis

Question 16

Most vu reflux spon resolves the age of 3 yrs T/F

Answer 16

F - most resolves by 5 yrs

Question 17

Of children who present to the hospital with a UTI about what % have VUR?

Answer 17

30 - 40%

Question 18

Umbilicus draining in a infant, differentiate patent vitellointestinal remnant from urachal sinus

Answer 18

Patent vitellointestinal remnant - more likely to drain pus or intestinal contents
Patent urachal sinus - as is bladder, more likely to drain clear

Do USS to investigate these

Question 19

Causes of secondary hyperoxaluria?

Answer 19

Overall it is due to fat malabs –> short gut, Crohns, CF and pancreatitis

Can lead to oxalate stones

Question 20

In a patient with a UTI and a large renal stone what is the most likely type of stone?

Answer 20

Struvite (mix of Mg, ammonium, phos and ca due to proteus)

Can cause a large stag horn calculus and renal impairment

Question 21

Are uric acid stones radio opaque or lucent?

Answer 21

Lucent

Note: radio opaque = ca, struvite and cystine stones

Question 22

In a patient with grade V VUR when is surgery indicated?

Answer 22

1. Anyone > 5 yrs old
2. 1-5 years old if bilateral (even if no scarring)
3. 1-5 years old with scarring

Note: if unilateral and no scarring in 1-5 yr old no surgery, only antibiotic prophylaxis

Question 23

Features of an atypical UTI

Answer 23

Poor urine flow
Abdo and/or bladder mass
Positive culture of non- E coli organism
Raised Cr
Signs of sepsis
Failure to respond to appropriate antibiotic treatment within 48hrs

Note: according to NICE guidelines any children with any feature of atypical UTI need ultrasound

Question 24

What is the definition of recurrent UTIs

Answer 24

3 or more lower UTIs
OR 2 or more of UTIs of which at least one is upper

Note: prophylactic antibiotics rec for recurrent UTIs

Question 25

When a patient is having a MCUG for VUR work up what preperation need to be undertaken before hand?

Answer 25

Patient should be started on prophylactic abx orally for 3 days with the MCUG being done on the 2nd day

Question 26

What is the incidence of hypospadias?

Answer 26

1 in 300 live male births

Question 27

How does detrusor instability typically present?

Answer 27

Urge incontinence , due to spon contraction of the bladder muscle

Question 28

Clinical presentation of ureterocele?

Answer 28

1. Recurrent cystitis
2. Renal outflow obstruction which can lead to renal failure

Note: can also have no symptoms

Question 29

Hydrocoele vs varicocoele

Answer 29

Hydrocoele - acute onset, can be post traumatic, transilluminates

Varicocoele - chronic onset, “bag of worms” consistency

Question 30

Relief of pain following elevation of the scrotum is present in what pathology?

Answer 30

Epididymititis. It is known as Prehn sign

Note: this is usually absent in torsion

Question 31

Where does a Gardner duct cyst develop?

Where does a Skene duct cyst develop?

Answer 31

Gardner: Anteriolateral aspect of the superior vagina
Skene: Around the urethral opening

Question 32

Gold standard investigation for Asherman syndrome?

Answer 32

Hysteroscopy or sonohysterography

Question 33

What is the tx of varicocele?

Answer 33

Observation only

Note: surgical correction if persistent severe testicular pain; testicular growth retardation or arrest over a 6-12 month period of observation; volume disparity of over 2mm between testes or if present in a solitary testes

Question 34

Which side is varicocele more common?

Answer 34

Left

Question 35

A varicocele in a pre adolescent boy needs a work up. T/F

Answer 35

T - due to association with malignancy (Wilms or neuroblastoma) or obstructive uropathy

No work up needed in adolescent

Question 36

What is paraphimosis?

Answer 36

Inability place the retracted foreskin back to its anatomical position

Note: Foreskin retracted past the coronal sulcus may
become edematous, making the replacement of the foreskin over the glans more difficult. Reduction is emergent and may require sedation

Question 37

Balanitis vs balanoposthitis?

Answer 37

Balanitis: inflammation of the glans penis only

Balanoposthitis: inflammation of the glans penis and foreskin

Question 38

In an infant with a weak urine stream what needs to be considered?

Answer 38

If male infant posterior urethral vales

Question 39

Lifetime risk of testicular cancer is increased in those with an undescended testicle, the risk is present in both testicles T/F

Answer 39

T - the risk of malignancy is increased in both testes even if only one is undescended

Question 40

Silk glove sign on exam is associated with what pathology?

Answer 40

Inguinal hernia