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EOR 3 - Peds > GU > Flashcards

GU Flashcards

1
Q

Hypospadias

A

urethral opening is not at the tip of the penis

2nd most common congenital defect of male genitalia (following cryptorchidism)

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2
Q

What is the tx for hypospadias?

A

surgical repair for 2nd and 3rd degree

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3
Q

Phimosis

A

inability to retract the prepuce at an age when it should be retractable (typically around 3 yo)

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4
Q

Paraphimosis

A

prepuce is retracted but cannot be extended

boys <4yo are at increased risk d/t non fully mobile foreskin
catheterizations puts them at risk too

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5
Q

What is the treatment for paraphimosis?

A

manual reduction

if unsuccessful –> dorsal slit procedure 00> circumcision should be performed at a later time

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6
Q

What is the MC pathogen of vaginitis?

A

S. pyogenes

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7
Q

What is the tx for vaginitis?

A

keep area aerate and dry
decrease irritants
Sitz bath twice daily with 3 tbsps of baking soda

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8
Q

Strawberry cervix

A

seen with trichomoniasis
frothy, green/yellow discharge

ph < 5
flagellated, pear shaped motile organisms

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9
Q

What is the tx for trichomoniasis?

A

metronidazole

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10
Q

When should you suspect pyelonephritis over UTI in a child?

A

when they have a fever

its difficult to distinguish pyelo from cystitis otherwise

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11
Q

How is a UTI dx?

A

+ nitrates in urine (most specific, not most sensitive)

leukocyte esterase, WBC in UA

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12
Q

What is the tx for UTI/cystitis?

A

Amoxicillin, Augmentin, Bactrim
Cefdinir
x 7-14 days

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13
Q

When do testicles descend?

A

7-8 monts gestation

if not descended at birth, should be by 4 months of age

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14
Q

Cryptorchidism

A

MC disorder of sexual differentiation of males

undescended testicles

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15
Q

What is the tx for cryptorchidism?

A

orchiopexy (surgery) at 6 months (no later than 9-15 months)

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16
Q

Hydrocele

A

fluid filled remains of tunica vaginalis

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17
Q

How does hydrocele present?

A

soft, non tender fullness of the hemiscrotum
TRANSILLUMINATES
size may wax and wane

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18
Q

What is the tx for hydrocele?

A

usually watch and wait

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19
Q

Testicular torsion

A

twisting of the spermatic cord - MC d/t an anatomical defect (such as anchoring of the testicle within the tunica vaginalis)

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20
Q

When is testicular torsion MC?

A

during first year of life
AND
during puberty

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21
Q

How does testicular torsion present?

A

acute onset of unilateral testicular of abdominal pain

Absence of CREMASTERIC reflex (most sensitive finding)

22
Q

How is testicular torsion dx?

A

US with doppler –> blue dot sign on US

23
Q

What is the tx for testicular torsion?

A

EMERGENCY surgery within 6 hours from sx onset

24
Q

What are the benefits of circumcision?

A

reduce risk of UTI, STDs, and penile cancer
easier hygiene
reduce risk of phimosis and paraphimosis

25
Q

What is the minimum age at which a child can get a circumcision?

A

12 hours
but ideally 24 hours
the infant must have voided at least ONCE

26
Q

What are contraindications to circumcision?

A

bilateral undescended testes
hypospadias
micropenis
known bleeding diathesis

27
Q

Nephroblastoma

A

Wilms tumor

asymptomatic abdominal mass - usually doesnt cross the midline
MC 4yo

28
Q

What is the tx for Wilms tumor?

A

surgery + chemotherapy

29
Q

What is the difference between primary and secondary enuresis?

A

primary: child who HAS NOT had 6 months of dry nights
secondary: child who previously had 6 months of dry nights

30
Q

What is the tx for enuresis?

A

MOST effective = bed alarm therapy

medications should be limited to children >7 yo
DDAVP is most commonly used (risk of hyponatremia and seizures)

31
Q

What is vesicuourethral reflux?

A

retrograde flow of urine from bladder into the ureter

32
Q

How do pts with VUR present?

A

hydronephrosis (often identified prenatally via US)

UTIs

33
Q

How is VUR dx?

A

UA
VCUG - voiding cystourethrography

imaging after 1st UTI is indicated in all children <5yo, in all boys, in all toilet trained girls with recurrent UTIs.

34
Q

When is US and VCUG recommended for UTIs?

A

after 1s UTI in all children <5yo
in all males
in toilet trained girls with recurrent UTIs

35
Q

What is the tx for VUR?

A

ABX prophylaxis (bactrim 2-4mg/kg daily) +/-surgery

36
Q

HUS

A

hemolytic uremic syndrome
caused by shiga-toxin E. coli (STEC)
MC in children <5yo

microangiopathic hemolytic anemia + thrombocytopenia + renal impairment

37
Q

What is the clinical presentation of HUS and what labs would you expect to see?

A

anemia, bleeding (from thrombocytopenia)
decrease urine output (renal impairment)
irritability, seizures, encephalopathy

microangiopahtic hemolytic anemia - schistocytes

38
Q

What is the treatment for HUS?

A

supportive

platelet transfusions for severe bleeding

39
Q

How does HUS differ from aHUS?

A

HUS is caused by STEC

aHUS is not caused by STEC – associated with a chronic relapsing course and poor outcome

40
Q

What is the tx for aHUS?

A

plasma exchange

Eculizumab (blocks complement activation) - first line

41
Q

Brown granular casts

A

intrinsic renal glomerulonephritis

tubular disease MC (85%)

42
Q

Kernicterus

A

elevated unconjugated bilirubin complications

yellow staining of the basal ganglia and hippocampus –> widespread cerebral dysfunction

43
Q

Jaundice within the first 24 hours of life

A

PATHOLOGIC

  • hemolysis (immune mediated, membrane defects, sepsis)
  • cephalhematoma
  • polycythemia
44
Q

Is elevation in conjugated or unconjugated bilirubin always pathologic?

A

conjugated (direct) = pathologic

45
Q

What is the MC cause of unconjugated hyperbilirubinemia?

A

physiologic and hemolytic anemia

46
Q

What is the tx for hyperbilirubinemia?

A

phototherapy – helps break down bilirubin into water soluble products (recall that unconjugated bili is not water soluble — so this doesn’t help with elevated conjugated bili)

47
Q

Breast milk jaundice

A

exaggerated physiologic jaundice –>poss related to substance in breastmilk that inhibits glucuronyl transferase

peaks in 1-2 weeks of life
infants should continue to feed and grow normally

48
Q

Breastfeeding jaundice

A

poor enteral intake (poss d/t poor milk supply)

onset 2-4 days of life

CP: prolonged transitional stools
dehydrations - decreased urine output

49
Q

What is the MC cause of GI bleeding in a newborn and how can you be sure?

A

Swallowed maternal blood from delivery or cracked nipples during breastfeeding

Apt test –> differentiates maternal from fetal blood

50
Q

NEC

A

necrotizing entercolitis - acute inflammatory necrosis of the bowel

51
Q

What is the MC neonatal GI emergency?

A

NEC - more common in premature infants in the first few days of life

52
Q

How is NEC dx?

A

luekocytosis, thrombocytopenia, hyponatremia, metabolic acidosis

intramural air (pneumatosis intestinalis) on abdominal Xray 
football sign

EOR 3 - Peds (9 decks)

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