GU Flashcards
Hypospadias
urethral opening is not at the tip of the penis
2nd most common congenital defect of male genitalia (following cryptorchidism)
What is the tx for hypospadias?
surgical repair for 2nd and 3rd degree
Phimosis
inability to retract the prepuce at an age when it should be retractable (typically around 3 yo)
Paraphimosis
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
What is the treatment for paraphimosis?
manual reduction
if unsuccessful –> dorsal slit procedure 00> circumcision should be performed at a later time
What is the MC pathogen of vaginitis?
S. pyogenes
What is the tx for vaginitis?
keep area aerate and dry
decrease irritants
Sitz bath twice daily with 3 tbsps of baking soda
Strawberry cervix
seen with trichomoniasis
frothy, green/yellow discharge
ph < 5
flagellated, pear shaped motile organisms
What is the tx for trichomoniasis?
metronidazole
When should you suspect pyelonephritis over UTI in a child?
when they have a fever
its difficult to distinguish pyelo from cystitis otherwise
How is a UTI dx?
+ nitrates in urine (most specific, not most sensitive)
leukocyte esterase, WBC in UA
What is the tx for UTI/cystitis?
Amoxicillin, Augmentin, Bactrim
Cefdinir
x 7-14 days
When do testicles descend?
7-8 monts gestation
if not descended at birth, should be by 4 months of age
Cryptorchidism
MC disorder of sexual differentiation of males
undescended testicles
What is the tx for cryptorchidism?
orchiopexy (surgery) at 6 months (no later than 9-15 months)
Hydrocele
fluid filled remains of tunica vaginalis
How does hydrocele present?
soft, non tender fullness of the hemiscrotum
TRANSILLUMINATES
size may wax and wane
What is the tx for hydrocele?
usually watch and wait
Testicular torsion
twisting of the spermatic cord - MC d/t an anatomical defect (such as anchoring of the testicle within the tunica vaginalis)
When is testicular torsion MC?
during first year of life
AND
during puberty
How does testicular torsion present?
acute onset of unilateral testicular of abdominal pain
Absence of CREMASTERIC reflex (most sensitive finding)
How is testicular torsion dx?
US with doppler –> blue dot sign on US
What is the tx for testicular torsion?
EMERGENCY surgery within 6 hours from sx onset
What are the benefits of circumcision?
reduce risk of UTI, STDs, and penile cancer
easier hygiene
reduce risk of phimosis and paraphimosis
What is the minimum age at which a child can get a circumcision?
12 hours
but ideally 24 hours
the infant must have voided at least ONCE
What are contraindications to circumcision?
bilateral undescended testes
hypospadias
micropenis
known bleeding diathesis
Nephroblastoma
Wilms tumor
asymptomatic abdominal mass - usually doesnt cross the midline
MC 4yo
What is the tx for Wilms tumor?
surgery + chemotherapy
What is the difference between primary and secondary enuresis?
primary: child who HAS NOT had 6 months of dry nights
secondary: child who previously had 6 months of dry nights
What is the tx for enuresis?
MOST effective = bed alarm therapy
medications should be limited to children >7 yo
DDAVP is most commonly used (risk of hyponatremia and seizures)
What is vesicuourethral reflux?
retrograde flow of urine from bladder into the ureter
How do pts with VUR present?
hydronephrosis (often identified prenatally via US)
UTIs
How is VUR dx?
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.
When is US and VCUG recommended for UTIs?
after 1s UTI in all children <5yo
in all males
in toilet trained girls with recurrent UTIs
What is the tx for VUR?
ABX prophylaxis (bactrim 2-4mg/kg daily) +/-surgery
HUS
hemolytic uremic syndrome
caused by shiga-toxin E. coli (STEC)
MC in children <5yo
microangiopathic hemolytic anemia + thrombocytopenia + renal impairment
What is the clinical presentation of HUS and what labs would you expect to see?
anemia, bleeding (from thrombocytopenia)
decrease urine output (renal impairment)
irritability, seizures, encephalopathy
microangiopahtic hemolytic anemia - schistocytes
What is the treatment for HUS?
supportive
platelet transfusions for severe bleeding
How does HUS differ from aHUS?
HUS is caused by STEC
aHUS is not caused by STEC – associated with a chronic relapsing course and poor outcome
What is the tx for aHUS?
plasma exchange
Eculizumab (blocks complement activation) - first line
Brown granular casts
intrinsic renal glomerulonephritis
tubular disease MC (85%)
Kernicterus
elevated unconjugated bilirubin complications
yellow staining of the basal ganglia and hippocampus –> widespread cerebral dysfunction
Jaundice within the first 24 hours of life
PATHOLOGIC
- hemolysis (immune mediated, membrane defects, sepsis)
- cephalhematoma
- polycythemia
Is elevation in conjugated or unconjugated bilirubin always pathologic?
conjugated (direct) = pathologic
What is the MC cause of unconjugated hyperbilirubinemia?
physiologic and hemolytic anemia
What is the tx for hyperbilirubinemia?
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)
Breast milk jaundice
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
Breastfeeding jaundice
poor enteral intake (poss d/t poor milk supply)
onset 2-4 days of life
CP: prolonged transitional stools
dehydrations - decreased urine output
What is the MC cause of GI bleeding in a newborn and how can you be sure?
Swallowed maternal blood from delivery or cracked nipples during breastfeeding
Apt test –> differentiates maternal from fetal blood
NEC
necrotizing entercolitis - acute inflammatory necrosis of the bowel
What is the MC neonatal GI emergency?
NEC - more common in premature infants in the first few days of life
How is NEC dx?
luekocytosis, thrombocytopenia, hyponatremia, metabolic acidosis
intramural air (pneumatosis intestinalis) on abdominal Xray football sign
