Lecture 16: Pediatric Urology Flashcards
1
Q
A neonate should expect to have their entire glans covered by their foreskin by around weeks ()-()
A
18-20 weeks
2
Q
A Fully developed scrotum should have (shallow/deep) rugae and testes bilaterally
A
Deep
Shallow = preemie, empty scrotum = cryptorchidism
3
Q
The average age range of normal penile development is…
A
9-14 years
11.5 average
4
Q
A parent wants to know what the first sign that shows their boy is hitting puberty. You tell them to look for…
A
Increased testicular size and volume.
5
Q
Male menarche is characterized by having () in urine and () dreams
A
- Sperm in urine
- Wet dreams (nocturnal emissions)
6
Q
The first tanner stage that corresponds to penile enlargement is…
A
Stage 2
7
Q
By late puberty, you would expect a normal penis to be around () cm in length
A
9.5 cm
+/- 1.12 cm
8
Q
T/F: Circumcision in the US is primarily a religious affair and not common.
A
False. Circumcision in the US is actually very common and its for non-religious reasons.
9
Q
The general age a circumcision is performed is around days () to ()
A
1-10 days
Its an elective procedure, so making sure infant is healthy first.
10
Q
What are the CI to circumcision?
A
- unstable/significantly premature
- penile abnormalities (hypospadias w foreskin abnormality, chordee/curvaturte of penis, concealed penis/buried or large suprapubic fat pad)
- Bleeding disorders or FHx of such should be managed in setting w clinicians who have experience w clotting abnormalities
11
Q
- Easier genital hygiene
- Lower UTI rates
- Lower viral STD rates
- Lower penile cancer rates
- Lower cervical cancer rates in female partners
All describe the benefits of what?
A
Circumcision
12
Q
The STDs that are NOT reduced in incidence by circumcision are () and ()
A
- Gonorrhea
- Chlamydia
13
Q
The blind technique for circumcision uses the () clamp. The risks of this technique includes ()
A
mogen
possible amputation of the glans (yikes)
You cut MOre in MOgen because you’re blind
14
Q
T/F: You can retract the foreskin forcibly post-circumcision
A
False, only do it gently!
15
Q
When is retractibility of foreskin 99%
A
Adolescent
age 1 - 50% of boys can retract foreskin
age 3 - 90%
age 6-7 -92%
adolescence 99%
16
Q
T/F: Most phimosis is physiological
A
True!
17
Q
T/F: Smegma under the foreskin forming pearls requires intervention
A
False.
18
Q
Phimosis in general is caused by ….
A
Constant irritation
Prob gunna need surgery
19
Q
First-line pharm tx for phimosis is
A
6 weeks of topical betamethasone + stretching
20
Q
Why might we use creams for phimosis tx?
A
- Less invasive
- Avoid risks of surgery
21
Q
The surgeries done to correct phimosis are either () or ()
A
Dorsal slit surgery
circumcision
22
Q
T/F: Paraphimosis is an emergency
A
True!!!!!
23
Q
What is paraphimosis?
A
Swelling of glans with a collar of swollen foreskin at coronal sulcus
24
Q
Early on, paraphimosis can be treated with….
A
Manual compression
Otherwise, dorsal slit and/or punctures
25
Balanoposthitis is specifically inflammation of...
Glans penis AND foreskin
| Balanitis is penis only
26
Generally, older adolescents with balanoposthitis got it due to....
STDs
27
Your 18yo patient presents with a complaint of penile swelling. He states he is **circumcised**, but it has been **swelling recently and smells bad**. He is sexually active. Upon examination, you notice some **scarring between the glans and prepuce**. You suspect he has....
Balanoposthitis
28
Your patient with balanoposthitis does not want to use any medications. You advise him that he can use....
Sitz baths
29
what are the tx options for the various etiologies of balanoposthitis
* nonspecific - bacitracin/mupirocin
* irritant - topical low potency steroids
* candidial - topical antifungal or 1 dose PO fluconazole
* bacterial - topical abx or oral abx if severe
30
The MC penile abnormality is...
Hypospadias
31
Hypospadias is generally characterized by the opening of the urethral meatus on the (ventral/dorsal) surface of the penis.
Ventral
| Dorsal = epispadias
32
Generally, hypospadias is located most commonly on the (proximal/distal) shaft of the penis.
Distal
| 60%
33
T/F: You can perform a circumcision on someone with hypospadias
False.
| Send to urology to surgical repair!
34
Hypospadias should be corrected when a boy is () months to () months old.
6-12 months old
35
Epispadias is characterized by the urethral meatus opening on the (ventral/dorsal) side of the penis
Dorsal side
| Like a dolphin's dorsal fin
36
A more proximal epispadias is associated with urinary ()
incontinence
37
The MC congenital abnormality of the GU tract is...
| in boys
Cryptorchidism
38
T/F: Your 2 month old boy currently has cryptorchidism still. You should refer him to urology ASAP.
False, you would expect it to spontaneously descend by 4-6 months.
39
The MC side to experience cryptorchidism is...
Left testicle
40
3 locations describe abnormal descent of the testicles and 3 describe ectopic.
* Abdominal
* Inguinal
* Suprascrotal
* Suprapubic
* Femoral
* Perineal
Abnormal: abd, inguinal, suprascrotal.
Ectopic: Suprapubic, femoral, perineal
41
You should start considering referral for cryptorchidism for **bilateral nonpalpable testes, unilateral non-palpable tests with hypospadias, sex development disorder, ascending testes, or lack of descent of testes** by the months of ()
4
42
A patient presents with suspected cryptorchidism. You first order (imaging), along with (genetic test), (hormones), and (gonadatropins)
* Pelvic US
* Karyotyping of sex
* Adrenal hormones and metabolites to check for CAH
* LH, FSH, Mullerian inhibiting substance
| CAH = congenital adrenal hyperplasia?
43
Orchiopexy should be done in a boy by ()
1 year of age
44
hCG is best with helping to descend testes that are (higher/lower) positioned
Lower positioned
45
The biggest risk we are concerned about with untreated cryptorchidism is...
Testicular cancer
| 5-10x increased risk
46
The MCC of DSD (disorder of sex development) is ....
Congenital adrenal hyperplasia
| Resulting in ambiguous genitalia
47
At around week () of gestation, external genitalia become sexually differentiated
Week 9
48
In a phenotypic female with ambiguous genitalia, you would expect a () clitoris, fused labial folds, and () gonads
* Enlarged clitoris
* Palpable gonads
49
The initial workup of ambiguous genitalia consists of 4 hormones and 1 test, which are....
* FSH
* LH
* Testosterone/DHT
* Anti-mullerian hormone
* Karyotyping
50
The adrenal steroid lab test you would check for in workup of ambiguous genitalia is...
17-hydroxyprogesterone
| seems important
51
The most medically important thing that could potentially occur in patients with ambiguous genitalia is...
Adrenal crisis due to CAH
52
A communicating hydrocele is characterized by fluid flowing into the ()
tunica vaginalis
53
Physical exam of a hydrocele that is Noncommunicating should show that is (reducible/not) and (changes/not changes) in size/shape with crying straining.
Non reducible and non-changing
54
A hydrocele is peritoneal fluid in between the layers of the...
tunica vaginalis
55
Generally, a patient with a hydrocele will experience ()
No symptoms
56
In order to check for a hydrocele, you can do () or ()
* Scrotal illumination
* Scrotal US
| Lightbulb balls
57
Tx of a hydrocele is () if not resolved by 1-2 years of age.
Surgery
| also if symptomatic or compromising skin integrity.
58
Inguinal hernias are MC in boys and children less than () months old.
10 months old
| Usually indirect.
59
A inguinal hernia is a mass that is (spontaneously reducible vs manual) and is (timing)
* Manual reduction is possible
* Intermittent bulge in the groin
| Painless swelling
60
Your patient has an indirect inguinal hernia that you attempt manual reduction on and it fails. You suspect...
Its incarcerated and may end up strangulated
61
If you diagnose an inguinal hernia, you should immediately ()
Refer for surgery so it doesn't end up incarcerated
62
The Dx of a testicular torsion is made via...
Doppler US
63
Detorsion within () hours will allow for 100% viability still.
4-6 hours
64
You attempt manual detorsion of testicular torsion and there is a return of blood flow and pain relief. Your next step is to...
Still send them to surgery?
| I wrote this in, someone confirm
65
The MCC of acute epididymitis in a sexually active person is...
Chlamydia
66
Acute epididymitis is characterized by a () cremasteric reflex and () prehn's sign
* Normal cremasteric reflex
* Positive prehn sign
| Prehn sign = pain relief with elevation of testis
## Footnote
Differentiates this from torsion!
67
If a patient presenting with high-likelihood STD epididymitis, you must order (3) labs
* Gram Stain + culture OR NAATs of gonorrhea and chlamydia
* Urine culture/first void urine for leukocytes
* Syphilis and HIV testing
68
Doppler US of acute epididymitis would show () blood flow to the affected epididymis
Increased blood flow
69
Tx of enteric organism epididymitis is...
Levofloxacin 500mg for 10 days
70
In younger children, UTI is the usual suspect for acute epididymitis. Therefore, they are treated with () or ()
Cefdinir or Bactrim
71
STD epididymitis is treated with () + ()
Rocephin + Doxy
72
Your patient with epididymitis is asking how long it should take them to improve once they start abx. You tell them it will take () days
3 days
73
The most dominant feature of vulvovaginitis is...
Pruiritis
| Burning, soreness, irritation
74
Your patient with vulvovaginitis has a vaginal swab showing a pH of 4.2. She probably does not have ()
Bacterial vaginosis
75
Candidial vaginitis is treated first-line with...
Fluconazole oral
| One dose
76
Bacterial vaginosis is treated with () or ()
Metronidazole or clinda
77
For a child younger than 12, the preferred topical treatment for vulvovaginitis is...
Topical nystatin
78
Labial adhesions most commonly occur in the first () years of life
First 5 years of life.
79
Labial adhesions are diagnosed via
Visual inspection of the vulva
80
What S/S make labial adhesions complicated?
* Pain on urination/ambulation
* Altered stream
* Retention
* Hx of UTI
81
First-line tx of complicated labial adhesions is
Topical estrogen for 2 weeks.
82
Once the labia are separated in labial adhesions, the next step is to...
Apply topical lubricant for a month.
83
Unsuccessful labial adhesions treatment is characterized by lack of separation by () weeks with topical estrogen
8 weeks
84
Minor penile adhesions are typically seen after ()
Circumcisions
| Most are self-resolving.
85
Your patient has penile adhesions. You first attempt (), but since that failed, you try ()
* Start with gentle traction
* Low-potency topical steroids
86
A penile skin bridge should be referred to ()
Pediatric urology
87
Girls older than () months have UTIs more commonly than boys.
6 months
88
Uncircumcised boys () months have more UTIs
less than 3 months
89
The MCC of UTI in young children is ()
E. coli
90
Generally, the classic signs of frequency, dysuria, and urgency are seen in UTIs once a child is ()
School-aged
| Although can occur in preschool still.
91
In order to evaluate for a UTI and get cultures, you must get a () sample from a child
Clean catch
| Cannot use a bag specimen for cultures
## Footnote
UA can use just a bag.
92
The two recommended ways of getting urine from a non-toilet trained child for UTI eval per the AAP are () and ()
* Transurethral bladder catheterization
* Suprapubic aspiration
93
In order to diagnose a UTI in a child, you must obtain a ()
Urine culture
94
In a clean void sample, a positive urine culture should show () CFU of a single pathogen, whereas a catheter sample should show () CFU of a single pathogen.
* Clean-void: 100k or more CFUs
* Catheter: 50k or more CFUs
95
A child less than () must be hospitalized/IV therapy for a UTI.
2 months
96
The #1 treatment for children with UTIs is
Third gen cephalosporins: Cefdinir, Cefpodoxime, Ceftriaxone, Cefotaxime
97
If a child has a UTI due to pseudomonas, you might switch the preferred ABX to...
Ciprofloxacin
| Instead of 3rd gen cephalos
98
Febrile children with UTIs require tx for () days
10 days.
99
If a child with a UTI fails to improve/worsens after () hours, you should consider renal US or broader ABX.
48 hours
100
Renal/Bladder US is recommended in UTI for... (4)
* Younger than 2 with first **febrile UTI**
* **Recurrent UTIs**
* **UTI + Fhx of renal/urologic dz, poor growth or htn**
* **not responding to normal abx**
101
Voiding cystourethrograms are only done for a child meeting 1 of 2 indications.
* 2+ febrile UTIs
* First febrile UTI + abnormal renal US or 102.2F + non-E coli or poor growth or HTN
102
Vesicouretral reflux can be ruled out by (imaging)
Voiding cystourethrogram
103
What prenatal US finding can suggest vesicouretal reflux?
Hydronephrosis
104
Grade 3 VUR is characterized mainly by ()
dilation of the ureter
105
Grade 5 VUR is characterized by
Moderate/severe blunting of renal calyces
106
Grades 1-2 VUR can be treated via...
Watchful waiting. ABX if not potty-trained.
107
Surgery is indicated usually for grades () VUR
4-5
| 3 if non-compliant.
108
Enuresis is defined as voiding in bed/clothes that occurs at least () per week for at least () months in a child aged at least () years.
* twice a week
* 3 consecutive months
* 5 years old
109
Diurnal enuresis is...
Wetting in daytime
110
Your patient has daytime enuresis. You would characterize it as (mono/polysymptomatic)
Polysymptomatic
111
Generally, monosympatomtic nocturnal enuresis occurs because a child has urine that ()
exceeds bladder capacity
112
Generally, monosymptomatic enuresis is worked up with (2)
* Urinanalysis
* Urine culture
113
Your patient has both day and nighttime symptoms for enuresis. Your priorty for treatment is (day/nighttime)
Daytime symptoms
114
The two mainstays of enuresis treatment are...
* Alarm therapy
* CBT
| 3 months at least
115
The drug mainly used to treat nighttime enuresis is...
DDAVP
116
The anticholingergic that can help treat daytime enuresis is...
Oxybutynin-ditropan
