Paediatrics Flashcards
When is the 6 in 1 vaccine given?
2, 3 and 4 months
When is the pneumococcus vaccine given?
2, 4 and 12 months
When is the Men B vaccine given?
2, 4 and 12 months
When is the rotavirus vaccine given?
2 and 3 months
When is the Hib/MenC booster given?
1 year
When is the MMR given?
1 year and 3 years 4 months
When is the HPV vaccine given?
12-13 years
When is the Men ACWY vaccine given?
14 years
New university students aged 19-25
Outline the management of DDH.
If < 2 months, observation and serial examination and ultrasound is recommended (every months)
If it persists/worsens, hip abduction orthosis (splint) or Pavlik harness are recommended (serial follow-up and plain X-ray at 6 months)
Outline how hearing is tested in the neonate.
1st: evoked otoacoustic emission (EOEA) testing
If this is abnormal –> automated auditory brain stem (AABR) audiometry
Briefly outline the steps in the management of necrotising enterocolitis.
Stop oral feeding
Broad spectrum antibiotics (ceftriaxone and vancomycin)
Surgery if perforation/necrosis
TPN
What can be used to close a PDA?
IV indomethacin
Prostacyclin synthetase inhibitor
Ibuprofen
How is the bilirubin concentration measured in neonatal jaundice?
If < 24 hours or < 35 weeks gestation = serum bilirubin
If > 24 hours or > 35 weeks gestation = transcutaneous bilirubin (if this is > 250 µmol/L - check serum bilirubin)
What serum bilirubin levels suggests increased risk of developing kernicterus?
> 340 µmol/L in babies > 37 weeks
or rising rapidly > 8.5 µmol/L/hr
How often should serum bilirubin be measured in a neonate with jaundice?
Every 6 hours until it drops below the treatment threshold
Which investigations should be performed in a neonate who developed jaundice within 24 hours of birth?
Haematocrit Blood group of mother and baby DAT test FBC and blood film Blood G6PD level Blood/urine/CSF culture
Which antibiotics are used to treat meconium aspiration?
IV ampicillin and gentamicin
Which antibiotics may be used in the treatment of early-onset sepsis?
Benzylpenicillin and gentamicin
Which organism most commonly causes late-onset sepsis?
Coagulase-negative staphylococcus (e.g. Staphylococcus epidermidis)
How is neonatal meningitis treated?
3rd generation cephalosporin + amoxicillin/ampicillin
What is the paediatric sepsis 6?
- Supplemental oxygen
- Gain IV or IO access and order blood cultures, blood glucose and arterial/capillary/venous gasses
- IV/IO broad-spectrum antibiotics
- IV fluids (be cautious about fluid overload)
- Experienced senior clinicians should be involved early
- Vasoactive inotropic support (e.g. adrenaline) should be considered early
a. Considered if normal physiological parameters are NOT achieved after > 40 ml/kg of fluid resuscitation
How should neonatal conjunctivitis be treated?
Discharge and redness (staph or strep) - topical ointment (e.g. neomycin)
Gonococcus - 3rd generation cephalosporin
Chlamydia - erythromycin (2 weeks)
What should babies at risk of vertical hepatitis B transmission receive?
Hepatitis B immunoglobulin AND Hep B vaccine
How is gastro-oesophageal reflux in a breastfed infant treated?
1st line: Breastfeeding assessment
2nd line: trial of alginate therapy for 1-2 weeks
How is gastro-oesophageal reflux in a formula fed infant treated?
1st line: review feeding history (check for overfeeding)
2nd line: offer trial of smaller more frequent feeds
3rd line: offer trial of thickened formula
4th line: offer trial of alginate therapy
If conservative measures to treat GOR in an infant fail, what should you do?
Consider a 4-week trial of a PPI or histamine antagonist
State an example of an antibiotic regimen that may be used to eliminate H. pylori.
Amoxicillin + metronidazole/clarithromycin
This is given as a 7-day triple therapy with a PPI
How are the maintenance fluid values for children calculated?
0-10 kg = 100 ml/kg/day
10-20 kg = 1000 mL + 50 ml/kg/day
20+ kg = 1500 mL + 20 ml/kg/day
How is the amount of fluid required when giving a bolus to a child calculated?
20 ml/kg of NaCl in < 10 mins
NOTE: use 10 mL/kg if DKA, trauma, fluid overload or heart failure
What precaution must be taken when rehydrating a child with hypernatraemic dehydration?
Replace fluid deficit over 48 hours and measure plasma sodium regularly
Rapid reduction in plasma sodium can lead to seizures and cerebral oedema
What should be monitored in children with Coeliac disease?
Annual review Weight, height and BMI Review symptoms Review diet and adherence Consider blood tests
What are the management options in a UC patient with:
Mild proctitis
Mild left-sided and extensive disease
Maintainin remission
Mild proctitis
- Oral/topical aminosalicylates
Mild left-sided and extensive disease
- Oral aminosalicylates (consider topical aminosalicylate or oral steroid)
Maintaining remission
- Aminosalicylates
- Consider oral azathioprine or mercaptopurine
NOTE: if aminosalicylates are ineffective after 4 weeks, consider adding oral prednisolone (if this is ineffective, consider oral tacrolimus)
How is severe fulminating disease in UC managed?
IV corticosteroids (induce remission)
Consider IV ciclosporin
Surgery - colectomy with ileostomy or IJ pouch
What is a major risk of UC and how are patient’s monitored for it?
UC is associated with bowel cancer
Regular colonoscopic screening performed after 10 years of diagnosis
How is constipation with faecal impaction treated?
1 - DISIMPACTION REGIME
Movicol Paediatric Plain
If not effective - senna
If not tolerated - senna + lactulose
2 - MAINTENANCE LAXATIVES
Movicol with or without senna (carry on for several months and titrate dose based on stools )
3 - BEHAVIOURAL METHODS (e.g. star charts)
How are anal fissures in children treated?
Ensure ease of passing stool (consider constipation treatment, advise increase in fluid intake and dietary fibre)
Offer simple analgesia
Advise sitting in a shallow, warm bath to reduce discomfort
Adult treatments (topical diltiazem or GTN)
How is threadworm infection treated?
If > 6 months: single dose mebendazole for child and all household contacts and hygiene measures (for 2 weeks)
If < 6 months: 6 weeks of hygiene measures
Which antibiotic is used in the management of bacterial meningitis in hospital?
IV ceftriaxone
N. meningitidis - 7 days
H. influenzae - 10 days
S. pneumoniae - 14 days
Which antibiotics might you use in a patient with bacterial meningitis who has a severe beta-lactam allergy?
Vancomycin and moxifloxacin
How should a patient with bacterial meningitis be followed-up?
Discuss potential long-term effects and pattern of recovery (e.g. hearing problems)
Offer formal audiological assessment
Consider testing for complement deficiency if more than one episode of meningococcal septicaemia
How is HSV encephalitis treated?
High-dose IV aciclovir for 3 weeks
How is toxic shock syndrome managed?
ICU Surgical debridement of infected tissue Clindamycin (stops toxin production) Vancomycin or meropenem IVIG (neutralise the toxin)
How is impetigo treated?
Localised infection = topical fusidic acid (3-4/day for 7 days)
Extensive Infection = oral flucloxacillin (QDS for 7 days)
Clarithromycin if penicillin allergy
How is periorbital cellulitis treated?
High-dose IV ceftriaxone
When is a child with chickenpox considered infectious?
Most infectious 1-2 days before the rash
Infectious until all the lesions have crusted over (usually 5 days after onset)
Which groups of patients should children with chickenpox avoid?
Pregnant women
People who are immunocompromised
Infants < 4 weeks old
NOTE: avoid school until lesions have crusted over
What must young people with EBV avoid doing?
Contact sports
Which medications are occasionally used to treat CMV infection?
IV ganciclovir
Oral valganciclovir
Foscarnet
How long should a child stay away from school for after measles infection?
4 days after rash onset
How long should a child stay away from school for after mumps infection?
5 days after the development of parotitis
How are mumps and rubella diagnosed?
Oral fluid sample
How is Kawasaki disease managed?
High-dose aspirin (7.5-12.5 mg/kg QDS for 2 weeks or until afebrile, then 2-5 mg/kg once daily for 6-8 weeks)
IVIG (2 g/kg daily for 1 dose)
Echocardiogram (check for coronary artery aneurysms)
What steps can be taken to reduce the risk of vertical transmission of HIV?
Intrapartum zidovudine infusion
Elective C-section (if high viral load)
Zidovudine treatment for neonate (up to 6 weeks)
Avoidance of breastfeeding
Outline the management of food allergy.
Avoidance
Provide an allergy action plan for managing an allergic attack
Mild reactions - non-sedating antihistamine (e.g. fexofenadine)
Severe reactions - provide an EpiPen
How is Cow’s milk protein allergy managed?
Breastfed - advise mother to exclude dairy from her diet (consider prescribing vitamin D and calcium supplements)
Formula-fed - use extensively hydrolysed formula
Trial for at least 6 months, and consider gradually reintroducing dairy following a milk ladder under medical supervision
Which tests can you do to further investigate suspected cow’s milk protein allergy?
Skin prick testing
Specific IgE
What PRN treatment may be appropriate for patients with allergic rhinitis?
Aged 2-5: oral antihistamine
Everyone else: intranasal azelastine
What preventative treatment may be used in patients with allergic rhinitis?
if main issue is nasal blockage or polyps - intranasal corticosteroid (e.g. beclometasone)
If main issue is sneezing/nasal discharge - oral antihistamine or intranasal corticosteroid
How would you treat urticaria?
Identify and manage triggers
Oral antihistamine for up to 6 weeks
Severe - oral corticosteroid
Refractory - IgE antibody or LTRA
How is bacterial tonsillitis treated?
Penicillin V (10 days) Allergy: clarithromycin
Which medication should be avoided in tonsillitis?
Amoxicillin
Causes a widespread maculopapular rash in infectious mononucleosis
How is scarlet fever treated?
Penicillin V QDS for 10 days
Allergy: azithromycin, clarithromycin
How long should patients with strep throat/scarlet fever stay away from school?
24 hours after starting antibiotics
What is the first-line medical management for acute otitis media?
Amoxicillin 5-7 days
How should sinusitis be managed?
< 10 days: reassure that it is usually viral and self-resolving
> 10 days: high-dose intranasal steroids (if > 12 years)
Consider back-up antibiotic prescription if not improved by 7 days (pen V)
Which severity of croup requires admission?
Anything worse than mild
I.e. anything worse than a barking cough on its own
How is croup treated?
0.15 mg/kg dexamethasone stat
This can be repeated after 12 hours if necessary
How is severe croup treated in an emergency?
High-flow oxygen
Nebulised adrenaline
How is acute epiglottitis managed?
Urgent hospital admission (ICU) Secure airway and supplemental oxygen Take blood culture IV cefuroxime Rifampicin prophylaxis for entire household
How is bronchiolitis treated?
Conservative
Supplemental oxygen if < 92%
Nasogastric/orogastric tube feeding if poor intake
Consider nebulised 3% saline
What are the first and second line treatment options for viral-induced wheeze?
1st line: SABA (up to 10 puffs every 4 hours)
2nd line: Intermittent LTRA or ICS
How is multiple trigger wheeze treated?
ICS or LTRA for 4-8 weeks
Outline the management steps for asthma in someone < 5 years.
1) SABA
2) 8-week trial of moderate-dose ICS
After 8 weeks:
- If symptoms resolve but recur < 4 weeks = restart low-dose ICS
- If symptoms resolve but recur > 4 weeks = repeat 8-week trial of moderate-dose
3) Add LTRA
4) Refer to specialist
Outline the management steps for asthma in someone > 5 years.
1) SABA
2) Low-dose ICS
3) Add LTRA (review in 4-8 weeks)
4) Stop LTRA, add LABA
5) Change to MART
6) Increase ICS to moderate-dose
7) Refer to specialist
List some non-pharmacological aspects of asthma management.
Assess impact on life
Provide personalised asthma action plan (Asthma UK)
Advise about trigger avoidance
Ensure clear explanation of peak flow and inhaler technique
Which investigations would you request in a patient having an asthma attack?
Obs (HR and RR are particularly important)
PEFR
SaO2
VBG/ABG
Examine for signs of increased respiratory effort
Outline the management of an acute asthma attack.
Supplemental oxygen
Nebulised SABA
If ineffective, add nebulised ipratropium bromide
Monitor PEFR and SaO2
NOTE: if mild-to-moderate, SABA can be given through a large volume spacer
Which medication should a patient be given to take home after an acute asthma attack?
Oral prednisolone (3-7 days)
When should a patient with an asthma attack treated in hospital be followed-up?
Within 2 working days of discharge
How is foreign body inhalation treated in a conscious patient?
ABCDE
Encourage coughing
Back blows
Heimlich manoeuvre (NOT in very young children)
Remove object (rigid/flexible bronchoscopy)
How is foreign body inhalation treated in an unconscious patient?
ABCDE
Secure the airway
Remove the foreign body (rigid/flexible bronchoscopy)
Which patients with whooping cough should be admitted?
< 6 months
Significant breathing difficulties
Outline the pharmacological treatment of whooping cough.
< 21 days after onset of cough: macrolide
(clarithromycin/azithromycin)
NOTE: use erythromycin in pregnant women
How is pneumonia in children treated?
1st line: amoxicillin 7-14 days
2nd line: add macrolide
ALL children with a clinical diagnosis of pneumonia should be treated with antibiotics
What are some treatment approaches for bronchiectasis?
Airway clearance techniques (physiotherapy)
Inhaled bronchodilator
Inhaled hypertonic saline
Antibiotic prophylaxis (e.g. azithromycin)
What are the aspects of managing the respiratory issues in cystic fibrosis?
Pulmonary monitoring (every 2 months in children, every 3 months in adults)
Airway clearance techniques (physiotherapy)
Mucoactive agents
What is the first-line mucoactive agent for cystic fibrosis?
rhDNAse
2nd line: add hypertonic saline
Alternative: mannitol dry powder inhalation
What are the management approaches to the infection risk associated with cystic fibrosis?
Continuous prophylactic antibiotics (flucloxacillin and macrolides)
Prompt and vigorous IV therapy for infections
End-stage disease: bilateral lung transplantation
What are the management approaches to the nutritional problems in CF?
Oral enteric-coated pancreatic replacement therapy
High calorie diet
Fat-soluble vitamin supplements
What are the main domains of management in cystic fibrosis?
Pulmonary management (regular chest physiotherapy)
Infection management
Nutritional management (high calorie and high fat, vitamin supplementation, enzymes)
Psychological management
What is a treatment option for severe sleep disordered breathing in a child?
Adenotonsillectomy
What is some general conservative advice given to parents of an infant with a nappy rash?
Use high absorbency nappy
Leave nappy off as much as possible to help the skin dry
Clean the skin/change the nappy every 3-4 hours and ASAP after soiling/wetting
Bath the child gently
Use barrier protection (e.g. sudocrem)
How should an inflamed nappy rash that is causing discomfort be treated?
Hydrocortisone 1% cream OD (max 7 days)
How should a nappy rash caused by candida be treated?
Do NOT use barrier protection
Prescribe topical imidazole (e.g clotrimazole)
How should a nappy rash caused by bacterial infection be treated?
Oral flucloxacillin for 7 days
What is the first-line treatment of seborrhoeic dermatitis?
Regular washing of the scalp with baby oils and baby shampoo (gently brush to remove the scales)
What treatments for seborrhoeic dermatitis could be used if conservative measures fail?
Topical imidazole cream
Hydrocortisone cream
What advice would you give a patient regarding emollient use for eczema?
Use in large amounts and often
Apply on the whole body
Use as a soap substitute
What advice would you give regarding how to apply topical steroids for eczema?
Use once or twice daily and only apply to areas of active eczema
Give an example of a mild, moderate and potent topical steroid used for eczema.
Mild - hydrocortisone 1%
Moderate - betamethasone valerate 0.025% or clobetasone butyrate 0.05%
Potent - betamethasone valerate 0.1%
Which treatment would be recommended for children > 2 years with eczema that has failed to respond to topical steroids?
Topical calcineurin inhibitors (e.g. pimecrolimus)
Under which circumstances do bandages tend to be used in eczema?
For areas of chronically lichenified skin
When are antihistamines used in eczema?
1 month trial of non-sedating antihistamine (e.g. fexofenadine) if severe itching or urticaria
1-2 week trial of sedating antihistamine (e.g. promethazine) if flare is disturbing sleep
How should infected eczema be treated?
Swab the affected area
Advice on good hygiene when using emollients
Flucloxacillin
How is eczema herpeticum managed?
Refer for same-day dermatology advice
Oral aciclovir
Consider ophthalmological review if around the eyes
How are viral warts treated?
Daily administration of salicylic acid, lactic acid paint or glutaraldehyde lotion
Cryotherapy
How is molluscum contagiosum managed?
Spontaneous resolution by 18 months
Avoid squeezing lesions
Avoid sharing towels/clothes
What is the first-line treatment option for mild ringworm?
Topical antifungals (terbinafine cream)
NOTE: hydrocortisone 1% may be added if there is extensive inflammation
How are more severe ringworm infections managed?
Oral antifungals
1st line: terbinafine
2nd line: itraconazole
What is the first-line management option for tinea capitis?
Oral griseofulvin (or oral terbinafine)
NOTE: any animal source of the infection would also need treatment
What is the first line treatment option for scabies?
Topical permethrin 5% cream
Apply on the whole body (chin downwards) and was off after 8-12 hours
Second application is required 1 week later
2nd line: malathion aqueous 0.5%
What advice should be given to patients with scabies?
Members of the household and close contacts should be treated
Bedding and clothes should be washed at high temperature
Treat post-scabeitic itch with crotamiton 10% cream
Nighttime sedative anti-histamine may be useful to help sleep
How should head lice be treated?
Wet combing with a fine-tooth comp every 3-4 days for 2 weeks
Dimeticone 4% lotion
Alternative: malathione 0.5% lotion
List some agents that are used in the treatment of guttate psoriasis.
Coal tar preparations
Dithranol
Calcipotriol
What are the treatment options for mild-to-moderate acne?
Benzoyl peroxide
Duac (benzol peroxide + clindamycin)
Adapalene (topical retinoid - CI in pregnancy and breastfeeding)
Azelaic acid
Outline the treatment options for moderate acne.
Consider oral antibiotics (lymecycline or doxycycline) for a maximum of 3 months
Change to alternative antibiotic after 3 months if no improvement
NOTE: topical benzoyl peroxide or retinoid should be co-prescribed to reduce the risk of antibiotic resistance
What can be used as an alternative to oral antibiotics in girls with acne?
COCP
NOTE: POPs and progestin implants can worsen acne
When might you consider dermatology referral for a patient with acne?
If not responding to 2 courses of antibiotics or if there is scarring, refer to dermatology for consideration of isotretinoin
When should a patient undergoing treatment for acne be reviewed?
At 8-12 weeks
How is heart failure in an infant managed?
Diuretics such as frusemide (reduce preload Enhance contractility (e.g. dopamine) Reduce afterload (e.g. ACEi) Improve oxygen delivery (beta-blockers)
How are ASDs managed?
Secundum - percutaneous closure (cardiac catheterisation with insertion of an occlusive device)
Partial AVSD - surgical correction
When are symptomatic ASDs usually treated?
3-5 years
When do large VSDs and AVSD tend to be treated surgically?
3-6 months
How can a PDA be closed?
Medical: indomethacin (or other NSAID)
Surgical: cardiac catheterisation and coil/occlusive device insertion
NOTE: surgical management usually happens at around 1 year
How should a cyanosed neonate presenting within the 1st week of life be managed?
Stabilise the airway, breathing and circulation
Artificial ventilation if necessary
Start prostaglandin infusion
Surgery
What murmur is associated with ASD?
Ejection systolic murmur best heard at the upper left sternal edge and fixed wide split second heart sound
What murmur is associated with VSD?
Loud pansystolic murmur at the lower left sternal edge, quiet pulmonary second heart sound
Which defects require surgical correction in tetralogy of Fallot?
Close the VSD
Relive the right ventricular outflow obstruction
How may hypercyanotic spells in tetralogy of Fallot be treated?
Sedation and pain relief
IV propranolol
IV fluids
Which life-saving procedure may be performed for patients with transposition of the great arteries to enhance mixing of the blood?
Balloon atrial septostomy
How is tricuspid atresia treated?
Blalock-Taussig shunt
How is aortic stenosis treated?
Balloon valvulotomy
Aortic valve replacement
NOTE: same for pulmonary stenosis
How is SVT managed?
1 - vagal manoeuvres
2 - IV adenosine (DC cardioversion if this fails)
3 - maintenance therapy with fleicainide or sotalol
90% of children have no further attacks
How is acute rheumatic fever treated?
Bed rest and anti-inflammatory agents (e.g. aspirin)
Penicillin V if evidence of persistent infection
What is the most effective prophylaxis for rheumatic fever?
Monthly injections of benzathine penicillin
Alternative: oral penicillin OD
NOTE: prophylaxis recommended for 10 years after last episode of rheumatic fever or until 21 years old
How is infective endocarditis treated?
Beta-lactam and gentamicin
Usually for 6 weeks
How would you treat an umbilical granuloma?
Regular application of salt to the wound
Cauterise with silver nitrate
List some contraindications for MMR.
Severe immunosuppression (high dose steroids leave you immunocompromised for 3 months)
Allergy to neomycin
Received another live vaccine by injection within 4 weeks
Pregnancy should be avoided for at least 1 month afterwards
IG therapy within the past 3 months
How should children < 3 months with a UTI be managed?
Admit to hospital immediately IV antibiotics (e.g. amoxicillin) for at least 5-7 days
Which clinical features are suggestive of an upper UTI?
Bacteriuria + fever
Bacteriuria + loin pain
How should an upper UTI be treated?
Oral antibiotics (e.g. trimethoprim for 7 days) If this cannot be used, give IV antibiotics (e.g. coamoxiclav) for 2-4 days and discharge with oral antibiotics
How should simple cystitis be treated?
Oral antibiotics (e.g. trimethoprim) for 3 days
Which children should have an ultrasound after a UTI?
Children who have had an atypical UTI
Children < 6 months
Which children should have a DMSA and MCUG after a UTI?
< 6 months old presenting with atypical or recurrent UTI
How should enuresis in < 5 year olds be managed?
Reassure that this usually resolves without investigation
Ensure easy access to the toilet at night
Encourage bladder emptying before bed
How should enuresis in > 5 year olds be managed?
If infrequent (< 2 weeks) reassure and watch-and-wait
1st line if < 7: enuresis alarm and positive reward system
2nd line: desmopressin
Desmopressin may be used first line if rapid short-term control is necessary, or if > 7 years old
List some causes of secondary enuresis.
UTI
Constipation
Diabetes
Psychological/Family problems
How is nephrotic syndrome treated?
Oral prednisolone for 4 weeks
Wean and stop after 4 weeks
If the child does not respond or has atypical features, consider renal biopsy
List some complications of nephrotic syndrome.
Hypovolaemia
Thrombosis
Infection
Hypercholesterolaemia
How is Henoch-Schonlein purpura managed?
Most resolve spontaneously within 4 weeks
Joint pain can be managed with paracetamol/ibuprofen
IV corticosteroids are recommended for nephrotic-range proteinuria or declining renal function
Oral prednisolone may be given for severe scrotal oedema or abdominal pain
How are urinary tract calculi managed?
Conservative - fluids, analgesia, antiemetics
Bacterial infection - co-trimoxazole/nitrofurantoin or surgical decompression
Small stones - tamsulosin
Large stones - ESWL or uteroscopy
What are the most common causes of AKI in children?
HUS
ATN
How is haemolytic uraemic syndrome managed?
Admit to hospital Monitor urine output and fluid balance Maintain adequate hydration status Monitor BP (treat with CCB if necessary) Some will need dialysis
What long-term follow-up should be offered to patients with HUS?
Check for persistent proteinuria, the development of hypertension and progressive CKD
Outline the aspects of managing CKD in a child.
Diet - calorie supplements often necessary
Prevention of renal osteodystrophy - phosphate restriction, calcium and vitamin D supplements
Control of salt and water balance
Anaemia - recombinant EPO
Hormonal - human GH for GH resistance
How does CKD affect the growth of a child?
Delayed puberty
Subnormal pubertal growth spurt
How are hydroceles in children managed?
< 2 years = most resolve spontaneously
2-11 year = open/laparoscopic repair
11-18 years = conservative or surgical
How should unilateral undescended testicles be managed?
Undescended at birth –> review at 6-8 weeks
Undescended at 6-8 weeks –> review at 3 months
Undescended at 3 months –> seen by urologist by 6 months
NOTE: if descended but retractile at 3 months, advise annual follow up due to risk of ascending testes through childhood
How should bilateral undescended testicles at birth be managed?
Urgent referral to a senior paediatrician within 24 hours (genetic or endocrine testing may be necessary)
How is testicular torsion managed?
Urgent exploratory surgery (with orchidopexy/orchidectomy)
How is torsion of the appendix testis managed?
Exploratory surgery is often performed because it may be difficult to distinguish from testicular torsion
Otherwise conservative
How are hypospadias managed?
May not require treatment
May require surgery (from 3 months) for cosmetic/functional purposes
IMPORTANT: do NOT circumcise any child with a hypospadia
How are labial adhesions treated?
Topical steroids or oestrogens