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Pediatrics > Lecture 16: Pediatric Urology > Flashcards

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

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2
Q

A Fully developed scrotum should have (shallow/deep) rugae and testes bilaterally

A

Deep

Shallow = preemie, empty scrotum = cryptorchidism

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3
Q

The average age range of normal penile development is…

A

9-14 years

11.5 average

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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.

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5
Q

Male menarche is characterized by having () in urine and () dreams

A
  • Sperm in urine
  • Wet dreams (nocturnal emissions)
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6
Q

The first tanner stage that corresponds to penile enlargement is…

A

Stage 2

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7
Q

By late puberty, you would expect a normal penis to be around () cm in length

A

9.5 cm

+/- 1.12 cm

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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.

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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.

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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
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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

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12
Q

The STDs that are NOT reduced in incidence by circumcision are () and ()

A
  • Gonorrhea
  • Chlamydia
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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

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14
Q

T/F: You can retract the foreskin forcibly post-circumcision

A

False, only do it gently!

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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%

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16
Q

T/F: Most phimosis is physiological

A

True!

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17
Q

T/F: Smegma under the foreskin forming pearls requires intervention

A

False.

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18
Q

Phimosis in general is caused by ….

A

Constant irritation

Prob gunna need surgery

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19
Q

First-line pharm tx for phimosis is

A

6 weeks of topical betamethasone + stretching

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20
Q

Why might we use creams for phimosis tx?

A
  • Less invasive
  • Avoid risks of surgery
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21
Q

The surgeries done to correct phimosis are either () or ()

A

Dorsal slit surgery
circumcision

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22
Q

T/F: Paraphimosis is an emergency

A

True!!!!!

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23
Q

What is paraphimosis?

A

Swelling of glans with a collar of swollen foreskin at coronal sulcus

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24
Q

Early on, paraphimosis can be treated with….

A

Manual compression

Otherwise, dorsal slit and/or punctures

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25
Q

Balanoposthitis is specifically inflammation of…

A

Glans penis AND foreskin

Balanitis is penis only

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26
Q

Generally, older adolescents with balanoposthitis got it due to….

A

STDs

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27
Q

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….

A

Balanoposthitis

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28
Q

Your patient with balanoposthitis does not want to use any medications. You advise him that he can use….

A

Sitz baths

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29
Q

what are the tx options for the various etiologies of balanoposthitis

A
  • nonspecific - bacitracin/mupirocin
  • irritant - topical low potency steroids
  • candidial - topical antifungal or 1 dose PO fluconazole
  • bacterial - topical abx or oral abx if severe
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30
Q

The MC penile abnormality is…

A

Hypospadias

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31
Q

Hypospadias is generally characterized by the opening of the urethral meatus on the (ventral/dorsal) surface of the penis.

A

Ventral

Dorsal = epispadias

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32
Q

Generally, hypospadias is located most commonly on the (proximal/distal) shaft of the penis.

A

Distal

60%

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33
Q

T/F: You can perform a circumcision on someone with hypospadias

A

False.

Send to urology to surgical repair!

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34
Q

Hypospadias should be corrected when a boy is () months to () months old.

A

6-12 months old

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35
Q

Epispadias is characterized by the urethral meatus opening on the (ventral/dorsal) side of the penis

A

Dorsal side

Like a dolphin’s dorsal fin

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36
Q

A more proximal epispadias is associated with urinary ()

A

incontinence

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37
Q

The MC congenital abnormality of the GU tract is…

in boys

A

Cryptorchidism

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38
Q

T/F: Your 2 month old boy currently has cryptorchidism still. You should refer him to urology ASAP.

A

False, you would expect it to spontaneously descend by 4-6 months.

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39
Q

The MC side to experience cryptorchidism is…

A

Left testicle

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40
Q

3 locations describe abnormal descent of the testicles and 3 describe ectopic.

  • Abdominal
  • Inguinal
  • Suprascrotal
  • Suprapubic
  • Femoral
  • Perineal
A

Abnormal: abd, inguinal, suprascrotal.
Ectopic: Suprapubic, femoral, perineal

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41
Q

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 ()

A

4

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42
Q

A patient presents with suspected cryptorchidism. You first order (imaging), along with (genetic test), (hormones), and (gonadatropins)

A
  • Pelvic US
  • Karyotyping of sex
  • Adrenal hormones and metabolites to check for CAH
  • LH, FSH, Mullerian inhibiting substance

CAH = congenital adrenal hyperplasia?

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43
Q

Orchiopexy should be done in a boy by ()

A

1 year of age

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44
Q

hCG is best with helping to descend testes that are (higher/lower) positioned

A

Lower positioned

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45
Q

The biggest risk we are concerned about with untreated cryptorchidism is…

A

Testicular cancer

5-10x increased risk

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46
Q

The MCC of DSD (disorder of sex development) is ….

A

Congenital adrenal hyperplasia

Resulting in ambiguous genitalia

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47
Q

At around week () of gestation, external genitalia become sexually differentiated

A

Week 9

48
Q

In a phenotypic female with ambiguous genitalia, you would expect a () clitoris, fused labial folds, and () gonads

A
  • Enlarged clitoris
  • Palpable gonads
49
Q

The initial workup of ambiguous genitalia consists of 4 hormones and 1 test, which are….

A
  • FSH
  • LH
  • Testosterone/DHT
  • Anti-mullerian hormone
  • Karyotyping
50
Q

The adrenal steroid lab test you would check for in workup of ambiguous genitalia is…

A

17-hydroxyprogesterone

seems important

51
Q

The most medically important thing that could potentially occur in patients with ambiguous genitalia is…

A

Adrenal crisis due to CAH

52
Q

A communicating hydrocele is characterized by fluid flowing into the ()

A

tunica vaginalis

53
Q

Physical exam of a hydrocele that is Noncommunicating should show that is (reducible/not) and (changes/not changes) in size/shape with crying straining.

A

Non reducible and non-changing

54
Q

A hydrocele is peritoneal fluid in between the layers of the…

A

tunica vaginalis

55
Q

Generally, a patient with a hydrocele will experience ()

A

No symptoms

56
Q

In order to check for a hydrocele, you can do () or ()

A
  • Scrotal illumination
  • Scrotal US

Lightbulb balls

57
Q

Tx of a hydrocele is () if not resolved by 1-2 years of age.

A

Surgery

also if symptomatic or compromising skin integrity.

58
Q

Inguinal hernias are MC in boys and children less than () months old.

A

10 months old

Usually indirect.

59
Q

A inguinal hernia is a mass that is (spontaneously reducible vs manual) and is (timing)

A
  • Manual reduction is possible
  • Intermittent bulge in the groin

Painless swelling

60
Q

Your patient has an indirect inguinal hernia that you attempt manual reduction on and it fails. You suspect…

A

Its incarcerated and may end up strangulated

61
Q

If you diagnose an inguinal hernia, you should immediately ()

A

Refer for surgery so it doesn’t end up incarcerated

62
Q

The Dx of a testicular torsion is made via…

A

Doppler US

63
Q

Detorsion within () hours will allow for 100% viability still.

A

4-6 hours

64
Q

You attempt manual detorsion of testicular torsion and there is a return of blood flow and pain relief. Your next step is to…

A

Still send them to surgery?

I wrote this in, someone confirm

65
Q

The MCC of acute epididymitis in a sexually active person is…

A

Chlamydia

66
Q

Acute epididymitis is characterized by a () cremasteric reflex and () prehn’s sign

A
  • Normal cremasteric reflex
  • Positive prehn sign

Prehn sign = pain relief with elevation of testis

Differentiates this from torsion!

67
Q

If a patient presenting with high-likelihood STD epididymitis, you must order (3) labs

A
  • Gram Stain + culture OR NAATs of gonorrhea and chlamydia
  • Urine culture/first void urine for leukocytes
  • Syphilis and HIV testing
68
Q

Doppler US of acute epididymitis would show () blood flow to the affected epididymis

A

Increased blood flow

69
Q

Tx of enteric organism epididymitis is…

A

Levofloxacin 500mg for 10 days

70
Q

In younger children, UTI is the usual suspect for acute epididymitis. Therefore, they are treated with () or ()

A

Cefdinir or Bactrim

71
Q

STD epididymitis is treated with () + ()

A

Rocephin + Doxy

72
Q

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

A

3 days

73
Q

The most dominant feature of vulvovaginitis is…

A

Pruiritis

Burning, soreness, irritation

74
Q

Your patient with vulvovaginitis has a vaginal swab showing a pH of 4.2. She probably does not have ()

A

Bacterial vaginosis

75
Q

Candidial vaginitis is treated first-line with…

A

Fluconazole oral

One dose

76
Q

Bacterial vaginosis is treated with () or ()

A

Metronidazole or clinda

77
Q

For a child younger than 12, the preferred topical treatment for vulvovaginitis is…

A

Topical nystatin

78
Q

Labial adhesions most commonly occur in the first () years of life

A

First 5 years of life.

79
Q

Labial adhesions are diagnosed via

A

Visual inspection of the vulva

80
Q

What S/S make labial adhesions complicated?

A
  • Pain on urination/ambulation
  • Altered stream
  • Retention
  • Hx of UTI
81
Q

First-line tx of complicated labial adhesions is

A

Topical estrogen for 2 weeks.

82
Q

Once the labia are separated in labial adhesions, the next step is to…

A

Apply topical lubricant for a month.

83
Q

Unsuccessful labial adhesions treatment is characterized by lack of separation by () weeks with topical estrogen

A

8 weeks

84
Q

Minor penile adhesions are typically seen after ()

A

Circumcisions

Most are self-resolving.

85
Q

Your patient has penile adhesions. You first attempt (), but since that failed, you try ()

A
  • Start with gentle traction
  • Low-potency topical steroids
86
Q

A penile skin bridge should be referred to ()

A

Pediatric urology

87
Q

Girls older than () months have UTIs more commonly than boys.

A

6 months

88
Q

Uncircumcised boys () months have more UTIs

A

less than 3 months

89
Q

The MCC of UTI in young children is ()

A

E. coli

90
Q

Generally, the classic signs of frequency, dysuria, and urgency are seen in UTIs once a child is ()

A

School-aged

Although can occur in preschool still.

91
Q

In order to evaluate for a UTI and get cultures, you must get a () sample from a child

A

Clean catch

Cannot use a bag specimen for cultures

UA can use just a bag.

92
Q

The two recommended ways of getting urine from a non-toilet trained child for UTI eval per the AAP are () and ()

A
  • Transurethral bladder catheterization
  • Suprapubic aspiration
93
Q

In order to diagnose a UTI in a child, you must obtain a ()

A

Urine culture

94
Q

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.

A
  • Clean-void: 100k or more CFUs
  • Catheter: 50k or more CFUs
95
Q

A child less than () must be hospitalized/IV therapy for a UTI.

A

2 months

96
Q

The #1 treatment for children with UTIs is

A

Third gen cephalosporins: Cefdinir, Cefpodoxime, Ceftriaxone, Cefotaxime

97
Q

If a child has a UTI due to pseudomonas, you might switch the preferred ABX to…

A

Ciprofloxacin

Instead of 3rd gen cephalos

98
Q

Febrile children with UTIs require tx for () days

A

10 days.

99
Q

If a child with a UTI fails to improve/worsens after () hours, you should consider renal US or broader ABX.

A

48 hours

100
Q

Renal/Bladder US is recommended in UTI for… (4)

A
  • 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
Q

Voiding cystourethrograms are only done for a child meeting 1 of 2 indications.

A
  • 2+ febrile UTIs
  • First febrile UTI + abnormal renal US or 102.2F + non-E coli or poor growth or HTN
102
Q

Vesicouretral reflux can be ruled out by (imaging)

A

Voiding cystourethrogram

103
Q

What prenatal US finding can suggest vesicouretal reflux?

A

Hydronephrosis

104
Q

Grade 3 VUR is characterized mainly by ()

A

dilation of the ureter

105
Q

Grade 5 VUR is characterized by

A

Moderate/severe blunting of renal calyces

106
Q

Grades 1-2 VUR can be treated via…

A

Watchful waiting. ABX if not potty-trained.

107
Q

Surgery is indicated usually for grades () VUR

A

4-5

3 if non-compliant.

108
Q

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.

A
  • twice a week
  • 3 consecutive months
  • 5 years old
109
Q

Diurnal enuresis is…

A

Wetting in daytime

110
Q

Your patient has daytime enuresis. You would characterize it as (mono/polysymptomatic)

A

Polysymptomatic

111
Q

Generally, monosympatomtic nocturnal enuresis occurs because a child has urine that ()

A

exceeds bladder capacity

112
Q

Generally, monosymptomatic enuresis is worked up with (2)

A
  • Urinanalysis
  • Urine culture
113
Q

Your patient has both day and nighttime symptoms for enuresis. Your priorty for treatment is (day/nighttime)

A

Daytime symptoms

114
Q

The two mainstays of enuresis treatment are…

A
  • Alarm therapy
  • CBT

3 months at least

115
Q

The drug mainly used to treat nighttime enuresis is…

A

DDAVP

116
Q

The anticholingergic that can help treat daytime enuresis is…

A

Oxybutynin-ditropan

Pediatrics (41 decks)

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