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Paediatrics > Paeds Pelvis > Flashcards

Paeds Pelvis Flashcards

1
Q

When should orchidopexy be done?

A

first year of life

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2
Q

What is an orchidopexy?

A

placement of testis into scrotum

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3
Q

6 month old boy comes into GP with bilateral impalpable testes. What do you do?

A

MEDICAL EMERGENCY

karyotype and laparoscopy

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4
Q

Sometimes testes are descended and sometimes not. What’s this?

A

retractile (‘vanishing’)

need warm env, can be manipulated down

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5
Q

Scrotal swelling due to dilated testicular veins. What’s this?

A

varicocoele

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6
Q

What is a varicocoele?

A

scrotal swelling due to dilated testicular veins

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7
Q

Hydroceole and inguinal hernia are both due to?

A

patent processus vaginalis

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8
Q

Who are inguinal hernias particularly common in?

A

boys + premature babies

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9
Q

Inguinal hernia presents as lump in groin, you can’t get above it. Where can this extend to ?

A

scrotum, labia

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10
Q

5 yr old boy who was premature presents to GP with reducible inguinal hernia, visible on coughing. What is management?

A

TAXIS (reduce it)

wait for herniotomy

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11
Q

If inguinal hernia is irreducible, strangulated, or incarcerated, what is the management?

A

EMERGENCY HERNIOTOMY

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12
Q

4 yr old boy presents to GP with lump in scrotum, which appears a bit blue. He feels well. Management?

A

Hydrocoele
he’s >2yrs surgery (cut + drain fluid out)

can transilluminate but weird thing to do

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13
Q

Excess fluid around the testis. What’s this?

A

hydrocoele

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14
Q

4 month old baby boy is brought to GP with mum complaining of lump in scrotum. Is doesn’t seem to be causing him any pain but appears blue. On examination, you can get above it. What is management?

A

hydrocoele

<2 yrs so expectant - wait for patent processus vaginalis to close

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15
Q

Do inguinal hernias in children tend to be direct or indirect?

A

indirect

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16
Q

When are varicocoeles common?

A

puberty

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17
Q

13 yr old boy presents to GP with dull ache in is left testicle, saying it looks like a bag of worms. Why is this condition more common on the left?

A

varicoele

- testicular vein drains straight into left renal vein with no valves

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18
Q

Give me 4 good reasons for orchidopexy.

A

cosmetic

reduce risk of:

  • torsion
  • infertility
  • malignancy
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19
Q

Management of varicocoele?

A

expectant, supportive pants

~~ surgical ligation of gonadal veins

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20
Q

14 yr old has varicocoele which has persisted for a year and is causing lots of discomfort depsite trying supportive underpants. What now?

A

surgical ligation of gonadal veins

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21
Q

Why are varicocoele more common on left?

A

left testicular vein drains straight into left renal vein with no valves

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22
Q

What percent of undescended testes are palpable somewhere in the groin?

A

80%

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23
Q

What percent undescended testes are impalpable?

A

20%

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24
Q

Why might testes be impalpable?

A

intra-abdominal or absent

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25
Q

When should orchidopexy for undescended testes be performed?

A

within first year of life

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26
Q

What is the treatment for undescended testes?

A

orchidopexy

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27
Q

What is taxis?

A

reducing hernia

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28
Q

16 yr old presents to A&E with scrotal swelling and sudden onset intense testicular pain on the right. On examination, scrotum is red and swollen. He has been vomiting. What is your course of action.

A

analgesia+antiemetics

straight to theatre for scrotal exploration and probably bilateral orchidopexy

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29
Q

What is actually twisting in testicular torsion?

A

spermatic cord twists within tunica vaginalis, compromising blood supply

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30
Q

spermatic cord twists within tunica vaginalis, compromising blood supply. What’s this?

A

testicular torsion

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31
Q

Testicular torsion is most common in boys aged 12-25. What other age group does it sometimes happen in?

A

newborns

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32
Q

negative Prehn’s sign is

A

cremasteric reflex absent

tesicular torsion

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33
Q

blue dot on scrotum makes you think of

A

torsion of hyatid appendage

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34
Q

Investigation for suspected testicular torsion?

A

go to theatre for scrotal exploration

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35
Q

In the operating theatre for a 16 yr old boy with testicular torsion. It’s been a few hours and the testis is no longer viable :( What needs to happen?

A

orchidectomy :(

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36
Q

Even if testicular torsion is untwisted and fixed with bilateral orchidopexy, bad things can happen to the testis later on. Name one.

A

testicular atrophy

chronic pain

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37
Q

When is a case of testicular torsion confirmed?

A

in theatre

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38
Q

17yr old boy presents with sudden onset unilateral testicular pain, says he has been feeling feverish over the past few days. On examination there a blue dot on the scrotum. You suspect torsion of Hyatid appendage. Investigations and treatment?

A

scrotal exploration in theatre

remove infarcted hyatid

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39
Q

What is phimosis?

A

phimosis = pathologically non retractile foreskin

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40
Q

When is it normal for the foreskin to be non-retractile?

A

infancy

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41
Q

pathologically non retractile foreskin. What’s this?

A

phimosis

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42
Q

In a 3 yr old, the preputial opening is red and sore, with purulent discharge. What’s this?

A

balanoposthitis

if recurrent - circumcision

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43
Q

Posh word for foreskin is?

A

prepuce

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44
Q

What is the main cause of phimosis (pathologically non-retractile foreksin)?

A

balanitis xerotica obliterans

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45
Q

What age boys are affected by balanitis xerotica obliterans (causing pathologically non retractile foreskin?)

A

older boys + young adults

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46
Q

What is the treatment for balanitis xerotica obliterans?

A

circumcision

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47
Q

Can retract foreskin but can’t return it back (reduce it). What’s this?

A

paraphimosis

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48
Q

What is paraphimosis?

A

can retract foreskin but can’t return it back over the glans penis

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49
Q

Give me four indications for circumcision.

A

recurrent balanoposthitis
balanitis xerotica obliterans
high risk for UTI
intermittent catheterization

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50
Q

What is female equivalent of balanitis xerotia obliterans?

A

lichen sclerosis !

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51
Q

What condition in childhood might need intermittent catheterization leading to need for circumcision?

A

spina bifida

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52
Q

If left untreated, paraphimosis can lead to what?

A

oedema of glans and maybe necrosis

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53
Q

What is the treatment for paraphimosis?

A

emergency reduction of prepuce

pull the foreskin back up with analgesia. ouch.

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54
Q

congenital defect causing ventral urethral meatus + penile curvature. What’s this?

A

Hypospadia

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55
Q

What is Hypospadia?

A

congenital defect causing ventral urethral meatus + penile curvature

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56
Q

Don’t circumcise if you suspect… what

A

hypospadia. Because you might need to use the prepuce for surgical repair of the hypospadia.

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57
Q

What is chordee?

A

ventral curvature of the penis

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58
Q

How common is hypospadia?

A

common. 1 in 200.

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59
Q

If you see a child with hypospadia and undescended testes, what might you suspect?

A

disorder of sexual development (eg CAH - could be ambiguous genitalia)

60
Q

What is the mainstay surgical treatment for hypospadia?

A

urethroplasty

61
Q

Vulvovaginitis in pre-pubertal girl could be due to…

A
  • thrush
  • nappy rash
  • vaginal rhabdomyosarcoma if bloody discharge
62
Q

UTIs in children are most common in boys or girls?

A

girls

half have strucutral abnormality of urinary tract

63
Q

Give me three examples of congenital kidney abnormalities, detected on antenatal US.

A
  • renal agenesis
  • ADPKD
  • horseshoe kidney

(need prophylactic Abx at birth)

64
Q

Obstruction to urine flow at PUJ causes unilateral or bilateral hydronephrosis?

A

PUJ obstruction = unilateral hydronephrosis

65
Q

Obstruction to urine flow at VUJ causes unilateral or bilateral hydronephrosis?

A

VUJ obstruction = unilateral hydronephrosis

66
Q

What does PUJ stand for?

A

pelvic uteric junction

67
Q

What does VUJ stand for?

A

vesico uteric junction

68
Q

Obstruction to urine flow at bladder neck causes unilateral or bilateral hydronephrosis?

A

bladder neck obstruction = bilateral hydronephrosis

69
Q

Obstruction to urine flow at posterior urethral valve causes unilateral or bilateral hydronephrosis?

A

posterior urethral valve obstruction = bilateral hydronephrosis

70
Q

2 yr old in nappies is brought in with fever, vomiting, poor feeding, and jaundice. You suspect UTI. What investigations ?

A

“clean catch” urine sample
…
dipstick
culture

71
Q

Investigation for atypical or recurrent UTIs for <1yr old?

A

US of kidneys + urinary tract

MCUG + DMSA

72
Q

what is MCUG?

A

micturating cystourethrogram (x ray)

73
Q

what is a DMSA?

A

dimercaptosuccinic acid (radionucleotide localises the renal cortex to see scarring in imaging)

74
Q

Investigation for atypical or recurrent UTIs in 1-3yr olds?

A

US of kidneys + urinary tract

DMSA

75
Q

Investigation for atypical or recurrent UTIs in >3yrs?

A

ultrasound of kidneys + urinary tract, if normal no further Ix

76
Q

which scan detects scars in kidneys

A

DMSA

77
Q

which scan detects obstruction / reflux

A

MCUG

78
Q

UTI treatment under 3 months

A

<3 months - refer to paed (admit, IV co-amox)

79
Q

UTI treatment for LOWER UTI >3months

A

trimethroprim / nitrofurantoin

80
Q

UTI treatment for UPPER UTI >3months

A

co-amox

81
Q

does potters syndrome cause

A

oligohydramnios, yes

82
Q

involuntary discharge of urine by day or night or both, in a child aged 5 years or older, in the absence of congenital or acquired defects of the nervous system or urinary tract’. What’s this?

A

enuresis

83
Q

what is enuresis?

A

involuntary discharge or urine by day or night or both in a child aged 5 yrs or older, in the absence of congenital or acquired defects of the nervous system or urinary tract

84
Q

management of enuresis?

A

advise of toileting, fluid intake
star charts e.g. wee before bed
<7yr - enuresis alarm
>7yrs - desmopressin

85
Q

difference between primary and secondary enuresis?

A

primary (the child has never achieved continence) secondary (the child has been dry for at least 6 months before)

86
Q

in secondary enuresis the child has been dry for at least 6 months before. what can be causes

A

emotional upset
UTI
diabetes !!

87
Q

in primary enuresis, the child has never achieved continence. what can be causes

A

detrusor instability
neuropathic bladder
UTI
constipation

88
Q

first step management of enuresis

A

advise on tolieting fluid intake

89
Q

second step managemnet of enuresis

A

star charts

90
Q

oral trimethoprim / nitrofuratnoin in treatment for

A

LOWER UTI in >3month old

91
Q

oral co-amox treatment for what utis

A

UPPER UTI in >3 month old

92
Q

IV co-amox is treatment ofr what utis

A

any <3month old

93
Q

2 causes of transient proteinuria

A

exercise

febrile

94
Q

4 causes of persistnet proteinuria

A

orthostatic proteinuria
hypertension
CKD
NEPHROTIC SYNDROME!

95
Q

leaky glomerulus = ?

A

nephrotic syndrome

96
Q

heavy proteinuria, hypoalbuminaemia, oedema is triad for?

A

nephrotic syndrome

97
Q

what is triad of nephrotic syndrome?

A

heavy proteinuria
hypoalbuminaemia
oedema

98
Q

two types of nephrotic syndrome in kids

A

steroid sensitive

steroid resistant

99
Q

where can oedema go in nephrotic syndrome

A

periorbital
scrotal / vulval
ankle

100
Q

triad of nephrotic syndrome is proteinuria, hypoabluminaemia, and oedema. what symptoms might there be apart from oedema?

A

breathlessness (effusion)

infection (sepsis!)

101
Q

which investigation in nephrotic syndrome tests for post-infectious strep glomeruloneprhitis

A

throat swab: anti-streptolysin O :)

102
Q

what protein:creatinine ratio is bad in first morn urine

A

> 20mg/mmol = nephrotic syndrome

103
Q

investigations for nephrotic syndrome?

A 
urine dipstick
first morn urine protein:creatinine ratio
serum albumin
FBC, U+Es, ESR etc
throat swab!
104
Q

4 complications of nephrotic syndrome

A

hypovolaemia
thrombosis
infection
hypercholesterolaemia

105
Q

hypovolaemia
thrombosis
infection
hypercholesterolaemia

are all complications of what

A

nephrotic syndrome

106
Q

90% of nephtoric syndromes are

A

… steroid sensitive

107
Q

10% of nephrtoic syndromes are

A

…. steroid resistant

108
Q

most steroid sensitive nephrotic syndrome is due to

A

MINIMAL CHANGE DISEASE

or henoch schonlein purpura

109
Q

most steroid resistant nephrotic syndrome is due to…..

A

FOCAL SEGMENTAL GLOMERULONEPHROPATHY

110
Q

focal segmental glomerulomephrotpathy causes what

A

steroid resistant nephrotic syndrome

111
Q

minimal change disease causes what

A

seroid sensitive nephrotic syndome

112
Q

what makes you think its steroid sesnitive

A

aged 1-10yrs
no macroscopic haematuria
normal BP

113
Q

what makes you think its steroid resistant

A

high BP

frank haematuria

114
Q

13 yr old boy presents with oedema, hypoalbuminaeia, and proteinuria. He has frank haematuria and high BP. What’s the likely diagnosis?

A

steroid resistant nephrotic syndrome

probs focal segmental glomerulonephropathy

115
Q

3 yr old boy from Indonesia presents with oedema, hypoablimnumaia, and proteinuira. He has microscopic haematuria and his BP is normal. What’s likely diagnosis.

A

steroid sensitive nehrotic syndrome

probs minimal change disease

116
Q

If nephrotic syndomre doesnt respond to steroids, you want to do renal biopsy. On histology, what would you see if its minimal change disease?

A

normal on light microscopy

then dodgy podocytes on electron microscopy

117
Q

dodgy podocytes on electron microscopy. whats this

A

minimal change disease

118
Q

what is treatment for steroid sentivie nephrotic syndrome (clue in name LOL)

A

oral prednisolone

daily for 4wks, then alternate days for 4wks, then wean

119
Q

what is treatment for steroid resistant nephrotic syndrome (clue, its just symptomatic at this point)

A

diuretics, salt restriction, ACE-i

120
Q

apart from nephrotic syndome, what are some other causes of generalzed oedema in kid?

A 
LOW ALBUMIN:
kwashiorkor malnutrition
malabsoprtion of protein
bad liver
nephrotic syndrome

SALT + WATER RETENTION:
kidney failure
heart failure

121
Q

positive urine dipstick for uti? what would this show

A

nitrites (good indicator)

leukocytes (just show febrile)

122
Q

how many colony forming units does urine culture have to have to be pos

A

> 10 to the power 5 colony forming units

123
Q

apart from e.coli, two uti culprits

A

proteus

klebsiella

124
Q

causes of childhood uti?

A 
incomplete bladder emptying (eg neuropathic bladder)
vesicouteric reflux (often familial)
125
Q

severe vesicouteric reflux causing recurrent utis merits..

A

surgery

126
Q

inflamed glomerulus = ?

A

nephritic syndrome

127
Q

what is nephritic syndrome

A

inflamed glomerulus

= less glomerular blood flow = less filtration

128
Q

what counts as haematuria on microscopy?

A

> 10 red cells per high power field

129
Q

serum albumin in nephrotic syndrome is

A

<25mg/mmol

130
Q

how long do you prescribe prednisolone for in steroid sensitive nephrotic ysndrome?

A

daily 4wks, alternate days next 4 wks, wean)

131
Q

what is prognosis for steroid sensitive nephrotic syndrome?

A

one third resolve
one third infrequent relapses
one third frequent relapses

132
Q

3 causes of nephritis

A

post-infectious
IgA nephropathy
vasculitis

133
Q

what is the management of acute nephritis? (if its not severe)

A

fluid + electrolye balance

? diuretics

134
Q

what is the management of severe acute nephritis?

A

renal biopsy
imm supp
plasma exchange

135
Q

suspect post-infectious glomerulonephritis? Ix?

A

culture (skin/throat)
anti-streptolysin O / ani-DNAase B titres
low C3 levels

136
Q

sudden reduction in renal function (potentially reversible) usually w oliguria = ?

A

acute kidney injury

137
Q

define acute kidney injury

A

sudden reduction in renal function (potentially reversible) usually with oliguria

138
Q

define oliguria

A

when you’re weeing less than 0.5ml / kg/hr

139
Q

AKI can be pre-renal, renal or post-renal. Which is most common in kids?

A

pre-renal

140
Q

what is pre-renal cause of AKI?

A

hypovolaemia (e.g. gastroenteritis, burns, haemorrhage)

141
Q

give one RENAL cause of AKI?

A

glomerulonephritis
haemolytic uraemic syndrome
pyelonephritis

142
Q

what’s the POST-RENAL cause of AKI?

A

obstruction of tuuubes

143
Q

what electrolyte imbalances do you get in renal AKI?

A

METABOLIC ACIDOSIS
HYPER PHOS
HYPER K

144
Q

treatment for pre-renal AKI?

A

fluid replacement + circulatory support

145
Q

treatment for hyperkalaemia in renal AKI?

A

glucose + insulin
calcium gluconate
salbutamol
…. dialysis if bad

Paediatrics (14 decks)

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