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Clin Med/Spec > Peds Exam 1 Lecture 6: Renal/GU > Flashcards

Peds Exam 1 Lecture 6: Renal/GU Flashcards

1
Q

Young male patient comes in:
mother says he has been tolerating feeds, is still consolable but she has noticed a painless, somewhat mobile mass around the testicle/scrotum, what is the Dx?

A

Hydrocele

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2
Q

What is typically seen w/Hydrocele with transillumination?

A

Bilateral Illumination

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3
Q

What population, sex, age range and side are MC for inguinal hernias?

A

MC in

  • premature infants
  • Boys > girls
  • < 1 yr
  • R side
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4
Q

Young male patient comes in w/a firm, discrete mass that is tender and surrounded by erythema and edema overlying the skin. His mother says he has been vomiting and has not had a BM in awhile, what is the Dx?

A

Incarcerated Inguinal Hernia

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5
Q

What is a common PE finding for Incarcerated inguinal hernia?

A

Testicle appears blue

pressure on spermatic cord–> venous congestion

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6
Q

Dx test to differentiate hydrocele from inguinal hernia

What is major difference b/t two diseases?

A

US

Inguinal Hernia = Painful
Hydrocele = Painless

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7
Q

What are Tx steps for incarcerated inguinal hernia?

A
  1. Try to manually reduce

2. Do elective surgical repair

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8
Q

When should a manual reduction of an incarcerated inguinal hernia NOT be attempted?

A

child appears ill, signs of peritonitis, obstruction or toxicity

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9
Q

When should an emergent surgical repair of an incarcerated inguinal hernia be performed?

A

Child is ill or hernia cant be manually reduced

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10
Q

Tx for hydrocele w/no mass or reducible mass?

A

Refer for surgery (not emergent) but do promptly to prevent progression to incarceration

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11
Q

Dilation of pampiniform plexus

A

Variocele

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12
Q

What dz is MC on L side, uncommon in boys under 10, is a cause of “subfertility”, is typically painless and described as a “bag of worms”

A

Variocele

note: if on R side need imaging

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13
Q

List 3 Grades of Variocele

A
  1. Present only w/Valsalva
  2. Present w/out Valsalva but not visible
  3. Visibly present (most risk of arrested testicular growth)
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14
Q

When retractile testes occur in boys > 1 what is it often caused by?

What are boys w/retractile testes at risk for?

A

Brisk cremasteric reflex

at risk for developing undescended testes

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15
Q

MC d/o of sexual differentiation in boys

A

Cryptochidism

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16
Q

Timeframe for testicular descent

A

7-8 months gestation

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17
Q

At what age is Cryptochidism likely permanent?

A

4 months

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18
Q

4 consequences of Cryptochidism?

A
  1. Torsion
  2. Testicular malignancy
  3. Indirect hernia
  4. Infertility

“Tommy’s Testicle Is Indiscernible”

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19
Q

What imaging is recommended for Cryptochidism?

A

NONE - routine imaging not recommended

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20
Q

Timeframe for surgery w/Cryptochidism

A

6 months = earliest

no later than 9-15 months

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21
Q

What is concerning for ambiguous genitalia?

A

Bilateral undescended testes

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22
Q

Definition of micropenis

A

< 2.5 SD for gestational age

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23
Q

What is micropenis due to?

A

Testicular failure during fetal life after morphogenesis is complete

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24
Q

What two things together are concerning for congenital hypopituitarism?

A

Hypoglycemia + Micropenis

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25
Q

What 4 things are part of the evaluation for Micropenis?

A
  1. Karyotype
  2. Assess anterior pituitary function
  3. Assess testicular function
  4. MRI –> assess pituitary, hypothalamus, other CNS midline structures
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26
Q

Why is Tx w/androgens controversial for boys w/micropenis?

A

May limit their growth potential

but good news… most boys w/micropenis have satisfactory sexual function (yay)

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27
Q

4 potential benefits of circumcision

A
  1. Reduction in UTIs, STIs (HIV)
  2. Reduction in phimosis/paraphysmosis
  3. Prevent penile SCC
  4. Easier Hygiene
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28
Q

Before circumcision is done what 3 things should be confirmed?

A
  1. infant at least 12 hrs old (24 preferred)
  2. infant voided
  3. no CIs
29
Q

Objectives said we need to know the CIs to Circumcision so there’s a lonnggg list on the flip side…learn it, live it, love it

(note most are not absolute CIs)

A
  1. Hypospadias
  2. Chordee w/out Hypospadias
  3. Dorsal hood deformity
  4. Micropenis
  5. Wandering/crooked raphe
  6. bilat undescended testes
  7. Ambiguous genitalia
  8. Bleeding diathesis
30
Q

Risks a/w Circumcision?

A
  1. Pain

2. Penile Injury (fistula, glans injury, excess skin removal, adhesions)

31
Q

What should NOT be given during circumcision?

A

Epi

32
Q

Post Circumcision:
Why should you use petroleum jelly?
What size of blood is okay to see on diaper?

A

Jelly: prevent adhesion to diaper

Blood < quarter size okay

33
Q

What congenital defect occurs when the opening of the urethra is on the underside of the penis rather than at the tip?

A

Hypospasdias

34
Q

Two clues for Hypospadias

A
  1. downward curvature of penis

2. “dorsal hood” - foreskin only on top 1/2 of penis

35
Q

What is MC degree for Hypospadias and location?

A

MC = 1st degree

location: meatus = distal

36
Q

What is the Tx for all 2nd & 3rd degree Hypospadias?

A

Surgical repair (must correct functional abnormalities)

37
Q

Why do you consider a VCUG in 3rd degree Hypospadias (proximal)?

A

some pts have dilated prostatic utricle

38
Q

Inability to retract prepuce at age when it should be retractable

What is typical age that prepuce becomes retractable?

A

Phismosis

Age 3 - normally prepuce is retractable

39
Q

How does physiologic phismosis differ from pathologic phismosis?

A

Physio - natural in newborns

Pathologic - previously retractable or occurs after puberty

40
Q

How does phismosis differ from paraphismosis?

A

Phismosis - prepuce cant be retracted

Paraphismosis

  • prepuce can retract but then it cant be extended
  • EMERGENCY (could have loss of blood supply to glans)
41
Q

Preferred position for genital exam (both sexes)

A

Supine w/hips elevated & frog leg position

42
Q

3 contributing factors for non-specific vulvovaginitis

A
  1. Lack of estrogenization, protective hair & labial fat pad
  2. Proximity of vagina to anus
  3. Poor hygiene, irritants, contamination
43
Q

3 main Tx concepts for non-specific

vulvovaginitis

A
  1. Keep area dry/aerated
  2. Decrease irritants
  3. Sitz bath
44
Q

How often/ingredient of sitz bath?

A

2x daily w/ 3 tbsp of baking soda

45
Q

3 main clinical findings of labial adhesions

A
  1. Fusion of labia minor
  2. interference w/voiding
  3. Recurrent UTIs
46
Q

3 Tx options for Labial adhesions

A
  1. Gentle traction (separates labia) –> 3-5 days of estrogen cream
  2. Hormonal cream (no traction) for several weeks
  3. Occasionally need surg
47
Q

When should you consider febrile UTI?

A

When fever of unknown source

48
Q

Although most Febrile UTIs resolve on own what complications can result from delaying Tx?

A

Urosepsis
Abscess Formation
Renal scarring –> HTN & CKD

49
Q

What signs/Sxs increase the suspicion for pyelonephrititis?

A

All Sxs assoc w/cystitis plus:

  1. Higher fever
  2. chills
  3. N/V
  4. Flank pain/tenderness
50
Q

What age group must you ALWAYS consider UTI in febrile children?

A

< 24 months

51
Q

What factors are a/w incr risk of febrile UTI specifically in girls?

A

White, Fever 2+ days, Age < 12 mo

52
Q

What factors are a/w incr risk of febrile UTI specifically in boys?

A

non-black, fever 1+ day, uncircumscribed

53
Q

What 2 factors of the Hx significantly increase the risk of febrile UTIs?

A
  1. Hx of UTI

2. Hx of congenital GU anomaly

54
Q

What three factors when combined on UA have a high specificity for UTI?

A
  1. Leuk esterase
  2. Nitrites
  3. WBC

All three negative –> unlikely UTI

Note: if Urine culture negative also unlikely UTI

55
Q

What are the requirements for UTI Dx?

A

Positive UA and least 50 cfu of urinary pathogen

56
Q

Length of Tx for febrile UTI

A

oral or IV ABX 7-14 days

57
Q

When should a US be preformed after a febrile UTI to r/o anatomic abnormalities?

A
  1. All kids not toilet trained
  2. ALL BOYS
  3. Toilet trained girls w/recurrent UTIs
58
Q

When is VCUG recommended in kids not toilet trained?

A
  1. Urinary dilatation or scarring
  2. Recurrent febrile UTI
  3. Urosepsis
  4. UTI d/t organism other than E. coli
  5. Fam Hx of congenital GU anomalies or reflux
59
Q

Tx for reflux?

A

ABX +/- surg

Higher stage –> less likely to resolve on own

60
Q

Why is VUR important?

A
  • identifies RF for recurrent UTI

- identifies risk for VUR nephropathy (can monitor/tx them)

61
Q

Why is ABX ppx used in VUR? What ABX used? What does ABX ppx in VUR not effect?

A
  • Used to decrease risk of recurrent febrile UTI
  • Bactrim = ABX for ppx
  • NO effect on renal scarring nephropathy
62
Q

Major RF for enuresis?

A

Fam Hx of nighttime bedwetting

63
Q

Difference b/t primary and secondary enuresis?

A

Primary - child hasnt had 6 mo of dry nights

2ndary - child previously had 6 mo of dry nights, most often a/w stress or underlying condition

64
Q

Sxs of Non-monosymptomatic enuresis?

What can Non-monosymptomatic enuresis suggest?

A

daytime incontinence or daytime lower urinary tract sxs

could suggest overactive bladder, dysfxtional voiding or something more serious

65
Q

How old must a child be for nocturnal enuresis?

A

5

66
Q

Common comorbidity a/w enuresis?

A

Constipation

Others: UTI, OSA, overactive bladder, ADHD. DM, DI, Sickle cell anemia

67
Q

Initial Tx for Enuresis

A

Behavioral modifications

68
Q

Most effective Tx for enuresis

A

Bed Alarm therapy

69
Q

How old must be to start pharmacotherapy for enuresis? what drug MC used?

A

Kids must be age 7 or older

MC used = DDAVP (Desmopressin)

Clin Med/Spec (11 decks)

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