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Peds > GU > Flashcards

GU Flashcards

1
Q

what is phimosis?

A

inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis

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2
Q

what are causes of phimosis?

A

pathologic or physiologic

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3
Q

what do you do for a pt w/phimosis whose family does not desire circumcision?

A

bethamethasone cream

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4
Q

can you do circumcision in office?

A

yes if pt is <1 month old and 10 lbs

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5
Q

when do you do circumcision in OR?

A

if pt is >6 month

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6
Q

what is smegma?

A

collection of skin cells. provides natural lubricant btw glans and prepuce that if often trapped under preputial adhesions and mistaken for pus or infection

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7
Q

what is infection of glans and foreskin a/w uncircumcised penis?

A

balanoposthitis

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8
Q

is meatal stenosis a/w circumcised or uncircumcised?

A

circumcised

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9
Q

a concerned parent asks you about retracting the foreskin of her 1 yo uncircumcised boy every day in warm water to help with its retraction. what do you suggest?

A

Leave the foreskin ALONE! natural retraction btw 4-7 years of age.

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10
Q

what is paraphimosis?

A

retracted foreskin of an uncircumcised male that cannot be pulled back over the glans…ouch!

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11
Q

how do you treat paraphimosis?

A
  1. manual reduction in ED or office

2. surgical correction with DORSAL slit and circumcision

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12
Q

How can uncircumcised male prevent paraphimosis?

A

if they ALWAYS pull foreskin back over the glans after voiding

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13
Q

what is hypospadias?

A

opening of urethra is on the underside, VENTRAL aspect of penis , midshaft, or proximal at the peno-scrotal junction….hypo:under

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14
Q

bifid scrotum may be a/w what penile concern?

A

hypospadias

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15
Q

what do you recommend to parents of a new born w/ hypospadias?

A

surgical correction recommended prior to potty training to avoid voiding frustration!

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16
Q

what is the post op risk of hypospadias correction surgery?

A

urethrocutaneous fistula

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17
Q

congenital chordee is a/w what other penile abnormality?

A

hypospadias

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18
Q

what is congenital chordee?

A

latin for downward curvature of penis

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19
Q

parents present their child as “born partially circumcised”. what do you immediately think of?

A

congenital chordee

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20
Q

what are physical exam findings for chordee?

A

curvature of shaft with classic DORSAL HOOD presentation

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21
Q

what is tx for chordee?

A

surgical correction to straighten penis and then finish circumcision

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22
Q

would you do circumcision for a pt with hypospadias or chordee in OFFICE?

A

Nope. must refer to pediatric urology

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23
Q

what is testicular torsion?

A

twisting of spermatic cord

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24
Q

in what population do you see testicular torsion often?

A
  1. prenatally in newborns

2. adolescents –this is common!!!

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25
Q

you suspect testicular torsion in office. what do you do?

A

send to ED

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26
Q

why testicular torsion is an emergency?

A

testicular necrosis may happen secondary to decreases blood flow

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27
Q

you advise your pt with testicular torsion to go to ED immediately but you feel they are not very serious. what do you tell them to encourage them?

A

That he may lose his testicles if not surgically corrected < 8-12 hrs !!!!

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28
Q

what are clinical presentation of testicular torsion?

A
  1. acute onset
  2. SEVERE PAIN radiating to groin
  3. n/v is common
29
Q

what do you find on PE of a pt suspecting testicular torsion?

A

testes are

  1. swollen
  2. discolored
  3. tender
  4. high-riding
  5. palpable twisted cord
30
Q

what reflex test do you do when suspecting testicular torsion and what do you find?

A

cremasteric reflex which is absent in ipsilateral testes

31
Q

when do you see a NEGATIVE prehn sign with no relief w/elevation?

A

testicular torsion

32
Q

you ordered scrotal doppler u/s because you are suspecting ….?

A

testicular torsion

33
Q

undescended testicles?

A

testicles do not descend to scrotal sac, normally fully descent by 6 month of age

34
Q

retractile testes?

A

normally descended testes that move in and out of the base of the scrotum

35
Q

what is the cause of retractile testes?

A

hyperactive cremasteric reflex

36
Q

parents report normal scrotal sac and normal fullness in warm bath or while sleeping but not otherwise. what are you thinking of?

A

retractile testes

37
Q

what are PE findings for retractile testes?

A
  1. cremasteric reflex noted
  2. can palpate and milk the testes down into scrotum
  3. pt assumes catcher position or sits cross-legged in warm tub and note palpable testes
38
Q

what do you do when you dx a pt with retractile testes?

A
  1. reassurance: most descend fully by puberty
  2. clinically monitor: palpate on well child visits
  3. observe for ascending testes: cord structures do not grow as pt does
  4. refer to uro
39
Q

what is cryptorchidism?

A

general term for TRUE pathological undescended testes

40
Q

what are classifications of cryptorchidism?

A
  1. uni vs. bilateral
  2. real cryptorchidism vs. ectopic testes
  3. palpable vs. non-palpable
41
Q

what are two most important risk a/w cryptorchidism?

A
  1. infertility

2. testicular cancer

42
Q

Seminoma is a/w ?

A

cryptorchidism

43
Q

what PE findings for cryptorchidism?

A

flat underdeveloped scrotum
inguinal hernia
hypospadias

44
Q

when do you refer to Uro?

A
  1. testes not descended by 6 months of age

2. dx laparoscopy and surgical orchidopexy by 9-12 months of age

45
Q

what is the most common bacterial cause of UTI in children?

A

E. coli in 60-80%

46
Q

when do you order urine culture for UTI?

A
  1. in children with a high likelihood of UTI

2. if the dipstick shows + LE and/or + nitrites

47
Q

what are the down sides of bag urine?

A

can’t avoid getting perineal vaginal wash in girl or contamination in uncircumcised boy

48
Q

is bag urine suitable for culture?

A

Nope. neg r/o UTI but positive is likely to be false-positive (88% fp overall)

49
Q

dx of UTI requires?

A

BOTH 1. positive culture AND 2. positive urinalysis

50
Q

positive urinalysis

A

dipstick: + LE and/or + nitrite
microscopy: white blood cells +/- bacteria

51
Q

what does + culture with - ua mean?

A
  1. contamination
  2. asymptomatic bacteruria
  3. ua not sensitive enough
52
Q

what is LE?

A

leukocyte esterase produced from the breakdown of leukocytes.

53
Q

is LE always indicative of infection?

A

Nope!. vaginitis/vulvitis can lead to inflammation without infection–>+LE

54
Q

+ Nitrites?

A

much more predictive of UTI

55
Q

a 6 yo female presents with dysuria, frequency, urgency, small-volume voids, lower abd pain, and mal-odor. what is your first thought?

A

UTI

56
Q

Parents describe their 5 month old infant as irritable with poor appetite and occasional vomiting, and fever. what is your first thought?

A

UTI …maybe

57
Q

what is the duration of treatment (abx) for UTI?

A

7-14 days

58
Q

your pt is not responding to abx that you prescribed for UTI. What is your next action?

A

renal ultrasound to evaluate for perinephric abscess

59
Q

what dx study can evaluate for hydronephrosis/hydroureter when suspecting obstruction or VUR?

A

renal ultrasound

60
Q

what are indications to order radiologic studies?

A
  1. children <3 yrs w/first UTI
  2. males any age wit hfirst UTI
  3. kids w/recurrent UTI
  4. kids w/ recurrent UTI not responding to therapy
61
Q

what do you check for in PE in a pt complaining of Nocturnal enuresis?

A

Boys: meatal stenosis
girls: labial adhesions

62
Q

diurnal enuresis/ dysfunctional voiding is commonly seen with?

A

Hx of recurrent UTI/dysuria

63
Q

routine ua screening for protein/heme IS RECOMMENDED for pediatric pts with …

A 
HSP
DM
post infectious glomerulonephritis
acute renal injury or failure
sickle cell trait
strong FH of renal dz
64
Q

what is nephrotic syndrome?

A

MASSIVE renal PROTEIN LOSS.

65
Q

what are some symptoms of nephrotic syndrome?

A

proteinuria
edema. hyperlipidemia
hypoalbuminemia

66
Q

what are the DDX for painless hematuria?

A 
glomerular dz
post infec. glomerulonephritis
benign familial/thin membrane dz
HSP
HUS
67
Q

what do you need to r/o for painful hematuria?

A

direct injury to UT/

kidney/abd trauma

68
Q

what are PE findings for painful hematuria?

A

flank/CVS pain or masses
ecchymosis
suprapubic pain

69
Q

what are DDX for painful hematuria?

A 
wilm's tumor 
bladder/kidney stone
cystitis
pyelonephritis
urethritis

Peds (8 decks)

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