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Core > Pediatrics: Reproductive > Flashcards

Pediatrics: Reproductive Flashcards

1
Q

Hydrometrocolpos

A

When the uterus and vagina are expanded with blood due to obstruction

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2
Q

Causes of hydrometrocolpos

A
  • Imperforate hymen (most common)
  • Vaginal stenosis
  • Lower vaginal atresia
  • Cervical stenosis
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3
Q

Complications of hydrometrocolpos

A

Hydronephrosis (due to mass effect from distended uterus)

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4
Q

Hydrometrocolpos is associated with which congenital uterine anomaly?

A

Uterine didelphys

Note: 75% of cases have a transverse vaginal septum.

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5
Q

RLQ pain in a young female with ultrasound demonstrating an enlarged right ovary with displaced follicles containing fluid-debris levels…

A

Think ovarian torsion

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6
Q

Is idiopathic ovarian torsion more common in kids or adults?

A

Kids (due to excessive mobility of the ovary in kids)

Note: Ovarian torsion in adults is usually due to a mass.

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7
Q

When should you consider an ovary to be enlarged enough to be suspicious of ovarian torsion in a kid?

A

When it is at least 3x larger than the contralateral ovary

Note: There is a lot of variability in ovarian size in the pediatric population.

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8
Q

What are the most common ovarian neoplasms in a child?

A
  • Benign dermoids/teratomas (67%)
  • Germ cell cancer (25%)
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9
Q

What imaging characteristics make an ovarian mass suspicious for cancer?

A
  • Mural nodules
  • Thick septations
  • Peritoneal implants
  • Ascites
  • Lymphadenopathy
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10
Q

Congenital hydrocele is due to…

A

A patent processus vaginalis, allowing peritoneal fluid into the scrotal sac

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11
Q

How can you differentiate a hematocele and pyocele?

A

Clinically

Note: Both hematoceles and pyoceles appear as complicated hydroceles with septations.

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12
Q

Varcicoceles are more common on which side?

A

Left

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13
Q

Next step if you identify an isolated right-sided varicocele…

A

Abdominal CT to look for pathology (e.g. extrinsic compression, renal vein thrombosis, portal hypertension with splenorenal shunting)

Note: Isolated right varicoceles are very rare without other pathology.

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14
Q

What is the most common cause of idiopathic scrotal edema?

A

IgA vasculitis (Henoch-Schonlein purpura)

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15
Q

Common causes of unilateral right-sided varicocele

A
  • Extrinsic compression of the right gonadal vein (e.g. nutcracker syndrome, renal cell carcinoma, retroperitoneal fibrosis)
  • Renal vein thrombosis
  • Portal hypertension (causing a splenorenal shunt)
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16
Q

Differential for acute scrotal pain in a kid

A
  • Torsion of the appendix testis
  • Testicular torsion
  • Epididymo-orchitis
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17
Q

Causes of orchitis

A
  • Progression of epididymitis (by far most common)
  • Mumps (rare)
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18
Q

10 y/o M with acute onset scrotal pain and a “blue dot sign” on physical exam…

A

Think torsion of the appendix testis (but exclude testicular torsion with scrotal ultrasound)

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19
Q

What is the most common cause of acute scrotal pain in males age 7-14?

A

Torsion of the appendix testis

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20
Q

What is the testicular appendage?

A

A vestigial remnant of a mesonephric duct

Note: Clinically significant because it can torse, causing acute scrotal pain.

21
Q

Classic imaging appearance of torsion of the appendix testis

A

Enlargement of the testicular appendage to greater than 5 mm WITHOUT evidence of testicular torsion

22
Q

Major risk factor for testicular torsion

A

Bell clapper deformity (failure of the tunica vaginalis to connect with the testis, allowing more testicular mobility than usual)

Note: This is often bilateral, so treatment is a bilateral orchiopexy in the setting of torsion.

23
Q

5 y/o M with afebrile, painless, scrotal swelling and a heterogeneous extra-testicular scrotal mass with internal vascularity on color doppler…

A

Think rhabdomyosarcoma

Note: These are usually embryonal from the spermatic cord or epididymis.

24
Q

Management of testicular microlithiasis

A

Follow-up screening ultrasounds in 6 months, then annually to look for germ cell tumors

Note: This is controversial.

25
Q

How can you differentiate different types of intratesticular masses on ultrasound?

A

You can’t, the best you can do is differentiating intratesticular from extratesticular masses and then guess based on epidemiology (not imaging)

26
Q

What are the major categories for testicular tumors?

A
  • Germ cell (90%)
  • Non germ cell (10%)
27
Q

What are the most common testicular germ cell tumors?

A
  • Seminoma (40%)
  • Non-seminoma (60%):
    • Teratoma
    • Yolk sac
    • Mixed germ cell (choriocarcinoma)
28
Q

What are the most common testicular non germ cell tumors?

A
  • Sertoli
  • Leydig
29
Q

What are the two most common testicular germ cell tumors seen in the first decade of life?

A
  • Yolk sac tumor
  • Teratoma
30
Q

1 y/o M with a heterogeneous testicular mass…

A

Think yolk sac tumor to teratoma

31
Q

How do testicular teratomas differ from ovarian teratomas?

A

Testicular teratomas tend to demonstrate aggressive biological behavior

32
Q

14 y/o with a highly vascular testicular mass and elevated b-hCG…

A

Think choriocarcinoma

Note: Look for hemorrhagic metastases.

33
Q

Which lab abnormality is classic in testicular choriocarcinoma?

A

Elevated beta-hCG

34
Q

Young male with bilateral testicular masses and multiple small, dark macules on their lips…

A

Bilateral Sertoli cell tumors (in the setting of Peutz-Jeghers syndrome)

35
Q

Bilateral testicular masses with dense echogenic foci centrally in a pt with Peutz-Jeghers syndrome…

A

Bilateral Sertoli cell tumors

Note: These tumors tend to “burn out” and form calcified scars.

36
Q

Bilateral Sertoli cell tumors are associated with…

A

Peutz-Jeghers syndrome

37
Q

Risk factors for testicular lymphoma

A

Immunosuppression

38
Q

Multiple hypoechoic vascular masses in the bilateral testes of an immunosuppressed child…

A

Think lymphoma

39
Q

Which testicular tumors are often bilateral?

A
  • Sertoli cell tumors
  • Testicular lymphoma
  • Metastases
40
Q

Why are the testes a common place for lymphoma/leukemia recurrence?

A

The blood-testes barrier prevents chemotherapy from being as effective in the testes

41
Q

Testicular mass with microlithiasis…

A

Think seminoma

Note: Large calcifications are more common in non-sminomatous germ cell tumors.

42
Q

Classic imaging appearance of testicular lymphoma

A

Multiple focal or diffuse hypoechoic vascular lesions within the testes with minimal mass effect (lymphomatous tissue “replaces” testicular parenchyma)

43
Q

What is the most common tumor of the fetus/infant?

A

Sacrococcygeal teratoma (usually benign)

44
Q

Large solid and/or cystic mass in the posterior pelvis of a newborn…

A

Think sacrococcygeal teratoma

45
Q

Complications of sacrococcygeal teratomas

A
  • GI obstruction
  • Hip dislocation
  • Nerve compression (possible incontinence)
46
Q

Treatment for sacrococcygeal teratoma

A

Surgical resection (with complete resection of the coccyx)

Note: Incomplete resection of the coccyx is associated with a high recurrence rate.

47
Q

Sacrococcygeal teratomas are more likely to be malignant if they are…

A
  • Totally intraabdominal
  • In an older infant
48
Q

Classification of sacrococcygeal teratomas by location

A
  • Type 1 (extra pelvic)
  • Type 2 (pelvis involvement without abdominal involvement)
  • Type 3 (abdominal involvement)
  • Type 4 (totally intraabdominal; highest risk of malignancy)

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