Peds

Question 1

What are some risk factors for an undescended testicles?

Answer 1

Prematurity
Low birth weight
Genetic susceptibility
Maternal exposure to estrogens
Maternal smoking
Maternal alcohol consumption
Maternal analgesic consumption

Question 2

What should you tell her family about the timing of surgery for an undescended testicles?

Answer 2

It should occur between six and 18 months as many undescended testes will descend within the first 6 months of life, but rarely descends after 6
Months

Question 3

What do you do if you transect the vas deferens during a pediatric inguinal orchiopexy?

Answer 3

Attempt a re-anastomosis and cancel the family

Question 4

Does orchiopexy completely reduce the risk of testicular cancer?

Answer 4

No, the risk is reduced but it is not back down to normal. These patients should be counseled regarding testicular self exam beginning of puberty.

Question 5

Does orchiopexy restore fertility to normal levels?

Answer 5

Almost, but not completely. There is a slightly increased risk of infertility although fertility rates are still approximately 90%.

Question 6

What are possible findings during diagnostic laparoscopy of non-palpable testis?

Answer 6

Atretic vessels going to closed inguinal ring suggesting a vanishing testis (died 2/2 no blood supply)

A small hypoplastic testis (orch)

(In both cases can consider contralateral pexy)

Intraabdominal testis and will have to then determine if you can do a pexy or if you will have to divide the vessels (and then need to decide between 1 and 2 stage division)

Second stage happens 6 months later

Question 7

Which hypospadias babies need a karyotype and hormonal panel?

Answer 7

This with a perineal hypospadias, or a proximal hypospadias with UDT, or some major congenital abnormality

Question 8

What is the recommended timing of hypospadias repair?

Answer 8

6-12 months

Question 9

What is recommendation regarding abx in baby with VUR<1 year old?

Answer 9

Need prophylaxis except if no history of UTI and VUR is grade 1-2

Question 10

What is recommendation for abx prophylaxis in a kid >1 year?

Answer 10

They can be off it only if no BBD, recurrent UTIs, or scarring, but it remains an option

Question 11

What is recommended followup for kids with VUR?

Answer 11

Annual BP, height, weight, UA, ultrasound

Repeat VCUG 1 year

Nuclear renogram only for cause (worsening hydro, suspicion for scarring)

Question 12

What are absolute indications for surgical treatment of VUR?

Answer 12

Breakthrough UTI on prophylaxis
Noncompliance with prophylaxis
Progressive renal scarring

Question 13

What testing is required after all surgeries for VUR?

Answer 13

RUS 1 month later

Question 14

What is the incidence of VUR in siblings and when is screening warranted?

Answer 14

Any suggestion of reflux:

• UTI
• RUS with abormalities to suggest reflux, hydro, scarring
• nuclear renogram with scar

Question 15

Indications for operating on a MCDK?

Answer 15

Respiratory distress or difficulty with feeding due to mass effect

Question 16

Differential diagnosis for renal mass in a child?

Answer 16

Wilms Tumor
Neuroblastoma
Congenital mesoblastic nephroma
Clear cell sarcoma
Rhabdoid tumor
AML
RCC

Question 17

What are important things to ask about when considering a prenatal ultrasound?

Answer 17

• Were the kidneys appropriate size for gestational age?
• Were the ureters seen and were they dilated?
• does the bladder cycle?
• does any hydro relate to bladder filling
• is the rest of anatomy normal?