PEDIATRIC Section 12: Reproductive

Question 1

Essentially the vagina won’t drain the uterus.

Answer 1

Hydrometrocolpos

Question 2

Hydrometrocolpos on US

Answer 2

expanded fluid-filled vaginal cavity with associated distention of the uterus.

Question 3

How is Hydrometrocolpos presented?

Answer 3

infant + mass in the uterus

teenager + delayerd menarche

“Midline pelvic mass” + hydroneprhosis (mass effect)

Question 4

Most common cause of Hydrometrocolpos

Answer 4

Imperforate hvmen (most common’)
vaginal - cervical stenosis
lower vaginal atresia

Question 5

Hydrometrocolpos is associated with what condition?

Answer 5

Uterus Didelphys (75% has a transverse vaginal septum)

Question 6

In an adult, ovarian torsion is almost always due to a mass. In a child, torsion can occur with a normal ovary,
secondary to?

Answer 6

excessive mobility of the ovary.

Question 7

What will you see in ovarian torsion?

Answer 7

you are going to see an enlarged (swollen) ovary, with peripheral follicles, with or without arterial flow.

Question 8

How do you know if the ovaries are enlarged in Peds?

Answer 8

compare the ovary in question to the contralateral size.

Suspect torsion if ovary = 3x the size of the opposite “normal” ovary.

Question 9

Give an adolescent ovarian torsion finding

Answer 9

Fluid-Debris Levels within the displaced follicles

Question 10

2/3 of ovarian neoplasms are?

1/3 is cancer - Most common?

Answer 10

Benign - Dermoids/teratomas

Cacner - germ cells (75%)

Question 11

You suspect cancer in the ovary if you see these

Answer 11

Nodules and thick septations

+ ascites
+ lymphadenopathy

Question 12

the most common cause of painless scrotal swelling.

Answer 12

Collection of serous fluid = hydrocele

Question 13

result from a patent processus vaginalis that permits entry of peritoneal fluid into the scrotal sac.

Answer 13

Hydrocele

Question 14

It is a complicated hydrocele if you see what?

Answer 14

Septations

Question 15

Varicocele

Answer 15

Most of these are idiopathic and found in adolescents and young adults.

More frequent on the LEFT.

Question 16

Next step:

Isolated right sided varicocele =

Answer 16

Abdomen CT - Exclude extrinsic mass, renal vein thrombus, or portal hypertension causing a splenorenal shunt

should stir suspicion for abdominal pathology (nutcracker syndrome, RCC, retroperitoneal fibrosis)

Question 17

the most common cause of idiopathic scrotal edema

Answer 17

HSP (henoch schonlein purpura)

Question 18

The top three considerations in a child with acute scrotal pain are:

Answer 18

(1) torsion of the testicular appendage
(2) testicular torsion
(3) epididymo-orchitis.

Question 19

Isolated orchitis =

Answer 19

Mumps

Nearly always occurs as a progressed epididymitis.

Question 20

most common cause of acute scrotal pain in age 7-14.

Answer 20

Torsion of the Testicular Appendages

Question 21

vestigial remnant of a mesonephric duct.

Answer 21

testicular appendage

Question 22

Sudden onset of pain + Blue dot sign on PE

Answer 22

Torsion of the Testicular Appendages

Question 23

What is the best indicator of Torsion of the Testicular Appendages?

Answer 23

> 5mm enlargement

Question 24

Results from the testis and spermatic cord twisting within the serosal space leading to ISCHEMIA

Answer 24

Torsion of the Testicle

Question 25

Cause of Testicular Torsion?

Answer 25

ailure ofthe tunica vaginalis and testis to connect

Question 26

“Bell Clapper Deformity”

Answer 26

Torsion of the Testicle

Question 27

Torsion of the Testicle findings

Answer 27

Findings will be absent or asymmetrically decreased flow, asymmetric enlargement, and slightly decreased echogenicity of the involved ball.

Question 28

Testicular Masses can be thought of as?

Answer 28

Extra and Intra

Question 29

If the mass is extratesticular, the most likely diagnosis is?

Answer 29

embryonal rhabdomyosarcoma

from the spermatic cord or epididymis.

Question 30

Age: 5

Hx: Painless scrotal swelling + afebrile + `US: Heterogeneous Vascular EXTRA-testicualr mass =

Answer 30

embryonal rhabdomyosarcoma

Question 31

This appears as multiple small echogenic foci within the testes.

Answer 31

Testicular Mircolithiasis

Question 32

Testicular Mircolithiasis have a relationship with what tumor?

Answer 32

Germ Cell Tumors (controversiaP

Question 33

Testicular cancers in PEDs are likley?

Answer 33

Germ Cell (90%)

Non Germ Cell (10%)
- Sertoli
- Leydig

Question 34

Testicular Germ Cell tumors are likely?

Answer 34

Seminoma (40%) - 4th decade

Non-Sminoma (60%)
- Teratoma
- Yolk Sac
- Mixed GCT (Choriocarcinoma)

Question 35

The two Germ Cell Tumors seen in the first decade of life

Answer 35

Yolk Sac Tumor
Teratoma

Question 36

Heterogeneous Testicular Mass in < 2 year old + elevated AFP

Answer 36

Yolk Sac Tumor

Question 37

< 2 y.o + Testicular mass + aggressive (unlike ovarian)

Answer 37

Teratoma

Question 38

2nd decade + Testicular mass + Agressive (High mortality) + inc b-HCG

Answer 38

Choriocarcinoma

Question 39

“Multiple hypoechoic masses of the testicle”

Answer 39

Testicular lymphoma

Question 40

Testicular calcifications

Microcalc = ?

Macrocals = ?

Answer 40

Microcalc = Seminoma

Macrocals = Germ Cell Tumor

Question 41

This is the most common tumor of the fetus or infant

Answer 41

Sacrococcygeal Teratoma

Question 42

These soUd and/or cystic masses are typically large and found either on prenatal imaging or birth

Answer 42

Sacrococcygeal Teratoma

Question 43

Mass effects of Sacrococcygeal teratoma?

Answer 43

effect on the GI system
hip dislocation
nerve compression leading to incontinence.

Question 44

Sacrococcygeal Teratoma Types

Answer 44

-Type 1 - Totally extra pelvic
-Type 2 - Barely pelvic, but not abdominal
-Type 3 - Some abdominal

-Type 4 - Totally inside abdomen
** this one has the highest rate o f malignancy.