Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics Exam 1 > Lecture 6 - Peds Renal/GU > Flashcards

Lecture 6 - Peds Renal/GU Flashcards

1
Q

Inguinal Hernia

A

1-5% of all newborns
9-11% of premature infants (higher in premies due to time of testicular decent)

boys > girls
R > L

highest incidence in 1st year of life (peak at 1 month of life)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can you tell the difference between incarcerated inguinal hernia and hydrocele?

A

hernia might have signs of bowel obstruction and testicle may appear blue

hydrocele stools appropriately, and may be consolable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Incarcerated Inguinal Hernia

A

Signs of bowel obstruction
mass typically firm, discrete
tender
often surrounded by erythema and edema of overlying skin

testicle may appear blue
pressure on spermatic cord –> venous congestion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hydrocele

A

uncomfortable, but consolable
tolerates feeds (stools appropriately)
mass may be somewhat mobile, irreducible, non-tender
transillumination (bowel will also transilluminate – so this can be misleading)
area of “swelling” does typically involve only the scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Incarcerated Inguinal Hernia

A

Not reducible

12-15% of inguinal hernias

if left untreated may progress to strangulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the treatment for an inguinal hernia?

A

depends on if it is incarcerated are not

if it is NOT:
-refer to surgeon, not emergent but should be taken care of promptly
(repair should be made promptly since 13% of children awaiting elective repair progress to strangulation)

If it IS incarcerated:
- emergently reduced
manual attempts unless child appears ill or has signs of peritonitis, obstruction, or toxicity
-emergent surgical repair if ill or not manually reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the treatment for an incarcerated inguinal hernia?

A

emergently reduced
manual attempts unless child appears ill or has signs of peritonitis, obstruction, or toxicity
-emergent surgical repair if ill or not manually reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which side is more commonly involved for inguinal hernias?

A

right side MC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Blue dot sign

A

tender nodule with blue discoloration on the upper pole of the testis seen with torsion of appendix testis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is hydrocele painful or painless?

A

painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Is inguinal mass painful or painless?

A

painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is inguinal hernia painful or painless?

A

painful if incarcerated

otherwise painless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Variocele

A

dilation of pampiniform plexus

typically painless but may cause “dull ache’

“bag of worms” - most always on left side

may not be obvious when supine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bag of Worms

A

seen with varicocele d/t dilation of pampiniform plexus

most common on the LEFT SIDE

if seen on the right sing you best get some imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Grade 1 Varicocele?

A

present only with valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Grade 2 varicocele?

A

present without valsalva but not visible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Grade 3 varicocele?

A

visible with inspection

carries the greatest risk of arrested testicular growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 3 causes of an empty scrotum?

A

undescended (1 testicle is much less worrisome than 2)
absent
retractile (hyperactive creamasteric reflex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do you do for retractile testes?

A

often due to brisk creamasteric reflex in boys >1 year

monitor for 6 - 12 months for fear of it being permanent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cryptorchidism

A

MC disorder of sexual differentiation in boys

failure of testicles to drop into scrotum –typically resolves spontaneously in first 3 months of life

if undescended by 4 months –likely permanent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the MC disorder of sexual differentiation in boys?

A

cryptorchidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When to testicles typically descend?

A

7-8 months gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the potential consequences of cryptorchidism?

A

infertility
testicular malignancy
associated hernia
torsion of cryptorchid testis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the management of cryptorchidism?

A

surgery at 6 months of age

NO later than 9-15 months of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What referrals do you make for a pt with ambiguous genitalia?

A

endocrine
genetics
urology

these referrals are done immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is micropenis defined as?

A

<2.5 SD for gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the cause of micropenis?

A

result of primary or secondary testicular failure during fetal life after morphogenesis is complete

28
Q

What should you suspect if you have a pt with micropenis and hypoglycemia?

A

hypopituitarism

29
Q

What is the evaluation of micropenis?

A

karyotype
assessment of anterior pituitary function
assessment of testicular function
MRI to assess pituitary, hypothalamus and other midline CNS structures

30
Q

What are the potential benefits of circumcision?

A 
reduction in UTIs 
reduction in STIs 
easier hygiene 
reduced phimosis and paraphimosis 
squamous cell penis cancer
31
Q

What are the risks of circumcision?

A

really just related to the procedure

32
Q

When is it preferred to have circumcision?

A

24 hours old (can be as soon as 12 hour)

infant must have voided at least once since birth

33
Q

What are the contraindications of circumcision?

A

hypospadias
chordee without hypospadias
dorsal hood derformity
micropenis (delay until urology consult)
wandering raphe (RELATIVE contraindication)
bilateral undescended tests (until after eval)
ambiguous genitalia
known bleeding diathesis (until post heme consult)

34
Q

What is the post circumcision care?

A

some swelling expected
blood on diaper should be less than a quarter in size
clean with mild soap and water if soiled
petroleum jelly to precent adhesion to diaper

35
Q

What is the second most common congenital defect of male genitalia?

A

hypospadias

36
Q

Hypospadias

A

congenital defect in which opening of urethra is on underside of penis rather than at the top

incidence 1/150-300 newborns

37
Q

What are the different degrees of hypospadias?

A

first degree (distal) - 50%

second degree (midpenile) - 20%

third degree (proximal) - 50%

38
Q

Of the different locations for hypospadias, which might have prostatic utricle?

A

3rd degree – consider VGUG - voiding cystourethrogram

2nd and 3rd degree may indicate disorder of sexual differentiation

2nd and 3rd degree get surgical repair for functional and cosmetic deformities

39
Q

Phimosis/Paraphimosis

A

inability to retract the prepuce at an age when it should be retractable

normally: (physiologic phimosis)
in infant you can NOT retract the foreskin until around age of 3

40
Q

When should you be able to retract the foreskin of the penis?

A

age 3

until then it should NOT be retracted

41
Q

Pathologic phimosis?

A

if previously retractable, or after puberty

42
Q

Paraphimosis

A

retract but then cannot extend —EMERGENCY – loss of blood supply to the glans

43
Q

Non-specific vulvovaginits

A

accounts for 25-75% of vulvovaginitis cases

contributing factors:

  • lack of estrogenization
  • lack of protective hair and labial fat pad
  • proximity of vagina to anus
  • poor hygiene/chemical irritants
44
Q

What is the treatment for non-specific vulvovaginitis?

A

keep area dry and aerated
cotton underpants
loose fitting clothing
avoid prolonged exposure to moisture from bathing suits
leave underwear off for periods of time (bedtime)

decrease irritants

Sitz baths twice daily with 3 tablespoons of baking soda while symptomatic

45
Q

Labial Adhesions

A

affects 2% of girls

peak incidence is 2 years of life

46
Q

What are the clinical findings of labial adhesions?

A

fusion of labia minora
often no sxs
recurrent UTIs

47
Q

How do you treat labial adhesions?

A

often resolves spontaneously
gentle traction to separate labia
followed by 3-5 days of topical estrogen cream

hormonal cream used 1-2 times a day for several weeks

occasionally surgery by pediatric urologist

48
Q

Febrile UTI

A

F >M

slightly more common <12 months

49
Q

What are the sxs of UTI?

A

older children:

  • cystitis:
  • -dysuria
  • -frequency, urgency
  • -enuresis
  • -suprapubic pain
  • pyelonephritis:
  • -all of the above plus fever, chills, N/V, flank pain

infants/toddlers: (less specific)
fever, irritability, vomiting, decrease appetite, lethargy, hyperbilirubinemia, failure to thrive

CONSIDER UTI IN ALL FEBRILE CHILDREN < 24 MONTHS

50
Q

What are important complications associated with UTI?

A

renal scarring with resulting HTN and chronic kidney disease

difficult to distinguish cystitis from pyelonephritis in young children (fever is often used to increase suspicion for pyelonephritis)

51
Q

Many febrile UTIs resolve on their own, but delay in treatment might be associated with what complication?

A

urosepsis
abscess formation
renal scarring

52
Q

How do you dx UTI?

A

urinalysis

urine culture

53
Q

What is the treatment for UTI in 2-24 month old?

A

oral ABX (or IV —equal efficacy)

cephalosporin, amoxicllin, augmentin, bactrim

7-14 days
(3 days if child is older)

54
Q

What kind of follow up is recommended for children with UTIs?

A

US to identify anatomic abnormalities

this includes all boys
kids not yet potty trained
girls potty trained with recurrent UTIs

55
Q

When is VCUG recommended?

A

urinary dilation, scarring, or findings suggestive of vesicoureteral reflux or bladder outlet obstruction on US

recurrent febrile UTI (even if normal US)

“atypical” or “complex” clinical circumstances (basically clinical judgment)

56
Q

What is the grading for VUR?

A

Vesicoureteral reflex

Graded 1 -5

1 and 2 typically resolve spontaneously

4 and 5 less likely to resolve

57
Q

What is the treatment for VUR?

A

ABX prophylaxis

+/- surgery

58
Q

Why is VUR important?

A

identifies risk for recurrent UTI - treatment can prevent URI

risk for VUR nephropathy –children can be monitored for signs of progressing CKD such has HTN and proteinuria

59
Q

What is the recommended prophylaxis for VUR?

A

Bactrim

60
Q

Enuresis

A

Primary
- children who have not had 6 months of dry nights

Secondary

  • children who previously attained 6 months of dry nights
  • most likely caused by stressors or medical conditions
61
Q

What are the different types of enuresis?

A

Monosymptomatic
–only sx is nighttime bed wetting

Nonmonosymptomatic
–daytime incontinence or daytime lower urinary tract infections

62
Q

At what age group is it considered nocturnal enuresis?

A

5 years of age

63
Q

Primary vs secondary nocturnal enuresis?

A

primary
-inability to awaken from sleep in response to full bladder

secondary

  • recurrent UTI
  • urinary tract malformations
  • neurologic disorders
64
Q

How do you evaluate enuresis?

A

ask about:

  • frequency
  • timing
  • volume
  • daytime lower urinary tract sxs
65
Q

What is the treatment for enuresis treatment?

A

behavioral modification
limit fluid intake before bed
dry bed training - waking child at night to urinate
bladder stretching exercises – hold urine for longer periods of time

Bed alarm therapy –most effective treatment –moisture sensory underneath child so they stop urinating and go to the toilet

pharmocotherapy –should be reserved for children >7 years –if other therapies were unsuccessful
-Desmopressin (DDVAP) most commonly used

66
Q

Child with fever of no source, what needs to be high on your ddx?

A

febrile UTI

Pediatrics Exam 1 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions