GU Flashcards
What is the most common form of Ambiguous genitalia?
46 XX DSD - Pseudohermaphroditism - Female inside and out but doesn’t look right
What is the common cause of Female Pseudohermaphroditism:
Congenital adrenal hyperplasia - enzyme def. cannot make cortisol and aldosterone from cholesterol - High levels of androgens
A baby with CAH and ambiguous genitalia can present to the ER in:
Shock - after birth (low aldosterone –> increased sodium resorption in the renal = hyponatremia and hyperkalemia)
What is the most common enzyme deficiency for CAH?
21-hydroxylase deficiency
What do you treat the CAH ambiguous genitalia with?
CAH-cortisol + mineralocorticoid (then testosterone or estrogen at puberty)
What is hypospadias, when is it corrected?
Ventral placement of urethra; corrected 4-18 months
What is commonly associated with hypospadias?
- Ventral curvature (chorded)
- Undescended testes (9-30%)
How do you want to look for Crytochidism?
US but surgery is better - could be done before US
When is an orchiopexy done to get the undescended testicle and bring it down?
4-6 months
What are three complications of Cryptochidism?
Infertility, testicular cancer, torsion
What are the THREE acute issues with the testicle?
- Testicular torsion
- Torsion of the appendix testis
- Incarcerated hernia
Most common surgical procedure in kids:
Hernia/hydrocele repair
What is the formation of a hydrocele?
Fluid within the tunica vaginalis - can be communicating or non-communciating
How do you differentiate between the hernia and the hydrocele?
US
A hydrocele does not need to be repaired unless:
It has persisted for over 1 year
When is the peak incidence for testicular torsion? Most common age!
- Perinatal
- Puberty
7-12 is the most common
Bell Clapper deformity:
When the tunica vaginalis is attached to the spermatic cord up top
If there is still a positive cremasteric reflex, what can you be dealing with?
- Appendix wrong
- Nothing wrong
A blue dot on the pole of the testes can indicated:
Appendix testicular torsion
If you have a testicular torsion, how long do you have to get to the operating room?
6-8 hours to save the testes
If you know it is testicular torsion you can proceed to the:
OR (US is not needed first)
Treatment for the torsion of the appendix testes and when should the pain resolve?
- ICE and NSAIDS (tight/whiteies)
- Pain resolves in 5-10 d
In early infancy, who are UTIs more common in:
Boys - uncircumcised (4-8x more)
After three months, UTIs are more common in:
Girls
A baby with a fever, check a:
UA!!!!!
What bacteria accounts for 80-90% of first UTI infections?
E. coli
What is the anatomical abnormality with Vesicoureteral reflux?
Uterovesical junction abnormality
VUR patients are at higher risks for ___ d/t ___ but it should ___
UTIS due to urine left in the bladder; should spontaneously resolve
You can rule out a UTI only if bag urine on an infant is:
Negative - positive test does not rule in
If an infant is under two months and the child is vomiting with a UTI, how do you treat?
IV ABX and admission to hospital - 3rd gen cephalosporin
If a child is over 2 months and not vomiting but has a fever you treat with:
Oral ABX for 10 days - 3rd gen cephalosporin
If a child is over 2 months and not vomiting and does not have a fever, you treat with:
Oral ABX for 5 days - 3rd gen cephalosporin
What do you image with on a child’s first and second febrile UTI:
First: Renal and bladder ultrasound
Second: Voiding Cystourethrogram
What is the most common complaint of prepubescent girls?
Vulvovaginitis
What is the bacterial cause of vulvovaginitis 20% of the time?
Group A Hemolytic strep
When is leukorrhea common in girls?
6-12 months before their period; after tanner stage III is hit
What type of discharge is seen with Group A strep infection in the vagina?
Serosanguinous
For UTI management, what guidance can you give for baths?
Warm sitz; BID, pretzel legged, no washcloth
You can treat vaginal labial adhesions with:
Topical estrogen if it is painful or deflects the stream of urine
When do you see labial adhesions?
Young children and 2 years - Poor perineal hygiene with inflammation
