Pedi genitourinary

Question 1

Hypospadias define

severity

Answer 1

congenital anomaly
uretheral opening abdormal on VENTRAL side

1st degree- glans or subcurona
2nd- penile shaft
3rd- scrotum perineum

Question 2

Management hypospadias

Answer 2

surgical repair by 6 months (ESPECIALLY BEFORE 18 months)
outpatient
AVOID circumcision- used in surgery

Question 3

Cryptorchidism aka

Answer 3

undescended testes: does not descend by 4 months of age

-may be unilateral or bilateral

Question 4

most common congenital anomaly of genitourinary tract

Answer 4

cryptochordism

Question 5

Exam cryptorchidism

Answer 5

empty scrotum poorly rugated scrotum, teste cannot be manipulated

Question 6

Most common location for undescended teste in order

Answer 6

1- external ring (suprascrotal)
2- inguinal canal
3- abdomen

Question 7

Complications of cryptochordism

Answer 7

• inguinal hernia
• testicular torsion
• testicular trauma (compression against pubic bone)
• malignancy

Question 8

Retractile testes

Answer 8

descended but retracts out of scrotum, most will descend spontaneously by 6 months
-look for hypospadias and or/cryptochordism

Question 9

Retractile testes occurence

Answer 9

30% of premature males; LEFT-side predominane

Question 10

Orchiopexy

Answer 10

referral to urologist if not descended by 6-12 months of age

testicle sutured in place

Question 11

Inguinal hernia differential

Answer 11

• hydrocele

- testicular torsion

Question 12

Define
hernia-
incarceration-
strangulation-

Answer 12

hernia- protrusion of portion of organ or tissue through opening in wall
incarceration- hernia cannot be reduced by manipulation (may be strangulated) ER- uncomfortable, crying
strangulation- vascular compromise of incacercerated hernia, can occur within 2 hours and leads to necrosis

Question 13

Inguinal hernia
higher incidence in?
most common?

Answer 13

higher incidence in premature

most commonly performed surgical procedure in children

Question 14

Inguinal hernia presentation

Answer 14

• intermittent bulge in groin (possibly at times at straining, crying)
• asymptomatic, no pain

Question 15

Incarcerated mass presentation

Answer 15

irritable crying, vomiting, abdominal distention

red inflamed

Question 16

Hydrocele define

Answer 16

fluid filled collection occurs along testes or ovary

• no mass palpated
• usually scrotal swelling
• no pain
• DOES NOT CHANGE in size or shape with crying or straining
• transilluminate
• IRREDUCIBLE

Question 17

Testicular torsion presentation

Answer 17

• pain-vomiting
• swollen tender
• retracted
• cremasteric reflex absent on affected side (stroke inner thigh- should pull up teste)

Question 18

Treatment
inguinal hernia
hydrocele

Answer 18

hernia: surgical repair (HERNIORRHAPY)
hydrocele: resolves spontaneously by 1 yr of age. no surgery.

Question 19

Urinary tract infection presentation in young child

Answer 19

irritability lack of appetite fever difficult to console

may only have fever esp

Question 20

School age children UTI

Answer 20

fever, dysuria, urgency, frequency, incontinence, macroscopic hematuria, abdominal pain

fever chills flank pain (pyelonephritis)

females- dysuria, no fever- bubble baths

Question 21

UTI prevalence
boys
girls

Answer 21

boys- most common

Question 22

Imaging and indication UTI

Answer 22

RB U/S age 2-24 months with first febrile UTI

Question 23

Imaging and indication for VUR

Answer 23

• 2 or more febrile UTIs
• children of any age with a first febrile UTI

delay until second children 2-24 months unless atypical or complex (hydronephrosis, scarring)

Question 24

Imaging done for UTI to

Answer 24

reduce risk of subsequent renal damage

Question 25

Grade 2/3 VUR | Grade 4/5 VUR

Answer 25

2/3- abx | 4/5- surgery

Question 26

UTI urine diagnosis

Answer 26

pyuria and significant bacteriuria necessary growth >100,000; catheterized >50,000 E.coli most common (klebsiella, proteus, enterobacter) catheter, suprapubic aspiration, clean catch for toilet trained

Question 27

UTI treatment

Answer 27

Early aggressive antibiotic within 72 hours Empiric therapy immediately with suspected UTI and positive urinalysis

Question 28

``` UTI medication choices 1st line ____ should not be used 50% resistant to____ Other ```

Answer 28

Third generation cephalosporin- Cefixime, cefdinir, ceftibuten) Cipro should not be used (affects osteocytes) 50% resistant to amoxicillin- augmentin may be used Other: bactrim

Question 29

Repeat urine?

Answer 29

not necessary

Question 30

Testicular cancer most common cancer in males age __ to ___ Presentation

Answer 30

15-35 one of most curable presentation: mass, with or without tenderness, testicular firmness, scrotal heaviness

Question 31

Testicular cancer screening

Answer 31

AAFP do not recommend screening in asymptomatic males or SE