Pediatric GU & GYN

Question 1

Enuresis

Answer 1

Primary- never established control
Secondary- restarted after 6 months of control
check UA, culture
Treat- enuresis alarm, bladder control training, hypnosis, medications (imipramine, desmopressin, oxybutynin)

Question 2

Treatment of UTI in kids

Answer 2

• Oral antibiotics for 10-14 days (Bactrim, cephalosporins)
• Hospitalize under 2mo old for IV antibiotics
• Follow up in 2 days: change antibiotic if no improvement, then follow up in 1-2 weeks, then every 1-3 months for one year
• Renal US after first UTI in febrile infants, or 2-24 months old

Question 3

Prehn’s sign

Answer 3

Relief of scrotal pain with elevation of the scrotum occurs with epididymitis, and no relief of pain with testicular torsion

Question 4

testicular torsion

Answer 4

acute severe pain, cremasteric reflex absent

emergent surgery

Question 5

Dysmenorrhea

Answer 5

Primary: no pathology
Secondary: underlying cause (pregnancy, PID, endometriosis)
Heat, ibuprofen, NSAID, OCPs, refer to GYN if needed

Question 6

Chlamydia

Answer 6

most common cause of cervicitis and urethritis in adolescents
S/sx: asymptomatic, dysuria, postcoital bleeding, discharge, pelvic pain, testicular pain
Dx: culture, or enzyme immunoassay (EIA) (quick urine test)
Tx: azithromycin 1 gm x1, OR doxycycline 100mg BID x7 days

Question 7

Gonorrhea

Answer 7

leading cause of infertility in females
S/sx: dysuria, urinary frequency, discharge, labial pain/swelling, lower abdominal pain, fever, dysmenorrhea, nausea/vomiting, penile discharge, testicular pain
Dx: Culture
Tx: Ceftriaxone (Rocephin), co-treat chlamydia

Question 8

Syphilis stages

Answer 8

Primary: painless chancre, adenopathy 2-6 weeks after exposure
Secondary: flu symptoms, adenopathy, rash (palms/soles/mouth) 6-8 weeks later
Latent: asymptomatic
Tertiary: leukoplakia, cardiac insufficiency, tumors, CNS involvement

Question 9

Syphilis

Answer 9

VDRL/RPR to screen, and confirm with treponemal tests

Pencillin G (or if allergic, doxycycline, or erythromycin)

Question 10

Herpes

Answer 10

initial- fever, malaise, dysuria, painful/pruritic ulcer for 12 days
recurrent- less painful/pruritic ulcer for 5 days
diagnose- viral culture
treat- acyclovir or valacyclovir

Question 11

HIV/AIDS

Answer 11

Screen with HIV PCR in infants, and ELISA in older kids
Western blot to confirm
Monitor CD4 and viral load
Refer to ID/HIV specialist

Question 12

CD4 count in HIV/AIDS management

Answer 12

Normal CD4 >800

Start antivirals and prophylactic drugs when CD4