Pediatric Flashcards
testicular torsion
age distribution
classification
bimodal
vaginal
testicular torsion
salvage rates
parabola
Regarding circumcision to prevent UTI in boys: NNT if: normal boys hx of recurrent UTI hx of high grade VUR
111
11
4
incidence of hypospadias
1 in 300 male births
risk factors of hypospadias
FHx
LBW
IVF
when does genital ridge form?
5th week
when does primitive sex chords form?
6th week
when does paramesonephric ducts form?
6th week
when does Sertoli cells form?
7th week
when does Sertoli cells release AMH?
8 - 10th week
when does Leydig cells form?
10th week
Timeline for testicular descent
8 - 12th: urogenital ridge to internal ring
24 - 30th: to scrotum
Among true UDT:
palpable ___%
non-palpable ___%: among which ___% intraabdominal
80%
20% ; 40%
UDT incidence in = ?
Full term: _
Pre-term: _
3.7%
30%
How many of UDT will descend after birth?
70% will descend by 3 months (i.e. 1 % at 3m)
UDT - risk factors
preterm LBW NM disorders hypospadias FHx (14% has)
what is Prentiss maneuver?
divide inferior epigastric vessels
transpose the spermatic cord for a straighter course
Cutoff for bladder capacity : age 4 - 12
(age + 1 ) x 30
Cutoff for PVRU
age 4 - 6
age 7 - 12
4 - 6: < 20ml
7 - 12: < 10ml
what is associated with bifid clitoris wrt incontinence?
epispadias
Nocturnal enuresis: T / F
More common in boys
Patients have normal sleep architectures
TRUE
TRUE
incidence of CAKUT congenital anomalies of kidney and urinary tract
1 in 500
Prune belly syndrome:
incidence
triad = ?
urinary tract anomalies = ?
1 in 40,000
absent abd wall musculature, urinary tract anomalies, bilateral UDT
hypoplastic prostate, megalourethra, distended bladder/ureters, renal dysplasia
postulated cause of prune belly syndrome?
in utero posterior urethra obstruction
natural hx of PUJO in children
GOSH
60% stable RFT despite obstruction
25% resolves
15% pyeloplasty
PUJO: chance of requiring surgery based on AP diameter
>5cm
>3cm
<2cm
100%
55%
1%
incidence of duplex
1 in 125
F : M ratio for VUR
5 : 1
what is Paquin’s law
submucosal length : diameter = at least 5 : 1
what is ICVUR
international classification of VUR
Natural history of VUR: Most common grade: \_\_ Spontaneous resolution of grade III: _ Spontaneous resolution of grade IV: _ Spontaneous resolution of grade V: _
II
46%
9%
0%
Regarding CAP for VUR:
what dose and how to take?
what drug?
1/4 therapeutic dose
taken nocte
< 6wk: augmentin
> 6wk: septrin
Result of RIVUR study
septrin reduces risk of recurrent febrile UTIs by 45%
Result of Swedish Reflux Trial
CAP reduces new renal dmg
Result of International Reflux Study on Children IRSC
surgery more effective than CAP in preventing pyelonephritis (10% vs 20%)
what is the technique for Deflux injection?
Double HIT hydrodistension implantation technique
what ureteric implantation techniques?
extra-vesical (Lich Gregoir)
intra-vesical (cross trigonal - Cohen) (high medial - Leadbetter)
embryology for posterior urethral valve
abnormal confluence of mesonephric duct and urogenital sinus
Poor prognostic factors for PUV:
pre-natal
post-natal
pre:
early present, oligohydramnios, high fetal urine B2-microglobulin
post:
high Cr, bilateral VUR, proteinuria, poor complaince bladder
incidence of horshoe kidney
1 in 400
horseshoe kidney : T / F
More common in male
TRUE
horsehoe kidney:
associated with ___
embryology : ?
Turner syndrome
abnormal medial fusion of metanephric blastema
what is bladder exstrophy
failure development of lower abd wall
resulting from failure of mesoderm to migrate into cloacal membrane
features of bladder exstrophy
bladder plate, adjacent to umbilicus pubic diastasis rectus divarication separated corpora / bifid clitoris Not associated with other anomalies
Congenital adrenal hyperplasia:
what enzyme problem?
what specific test?
21-hydroxylase deficiency
17-hydroxy progesterone (high)
Incidence of Wilms tumor
HK
UK
2.3 / mil
5 / mil
WAGR syndrome component
WT
Aniridia
GU abnormalities
Retardation
WT1:
Ch = ?
Associations = ?
11p
WAGR
Denys-Drash syndrome
WT2:
Ch = ?
Association = ?
11p
BWS
Pathology of WT = ?
Blastema
Epithelial
Stroma
WT: unfavourable histological subtypes
anaplastic
clear cell
rhabdoid
WT:
most common site of mets
calcification on imaging: _
Lung
15% only (vs. 90% in neuroblastoma)