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Pediatrics > Peds GU > Flashcards

Peds GU Flashcards

1
Q

When should a patient with cryptorchidism be referred to urology?

  1. 3 months of age
  2. 6 months of age
  3. 1 year of age
  4. At diagnosis
A
  1. 6 months of age (spontaneous descend rarely occurs after 6 months).
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2
Q

What does cryptorchidism or undescended testes increase the risk for?

  1. Epididymitis
  2. prostate cancer
  3. Testicular cancer
  4. Penile cancer
A
  1. Testicular cancer
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3
Q

What is cryptorchidism and what is retractile testes?

A

Cryptorchidism: testes not in scrotum and can’t be manipulated there (found in infants).
Retractile Testes: move between the scrotum and the inguinal ring by cresmasteric reflex. (older infants to 5-6 years old).

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4
Q

Noncommunicating hydrocele is

a. tunica vaginalis is closed, limiting fluid collection to scrotum; size of hydrocele is constant
b. tunica vaginalis remains open, allowing fluid to flow between peritoneum and hydrocele sac; often associ- ated with hernia

A

a. tunica vaginalis is closed, limiting fluid collection to scrotum; size of hydrocele is constant, so there is no change in scrotal size with position in change, same time at bedtime and on awakening.

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5
Q

Communicating type Hydrocele is —

a. tunica vaginalis is closed, limiting fluid collection to scrotum; size of hydrocele is constant
b. tunica vaginalis remains open, allowing fluid to flow between peritoneum and hydrocele sac; often associ- ated with hernia

A

b. tunica vaginalis remains open, allowing fluid to flow between peritoneum and hydrocele sac; often associated with hernia

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6
Q

Which hydrocele has scrotal size changing with position?

a. Communicating Hydrocele
b. Non communicating Hydrocele

A

Communicating Hydrocele

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7
Q

Which hydrocele has risk of Hernia?

a. Communicating Hydrocele
b. Non communicating Hydrocele

A

Communicating Hydrocele

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8
Q

Which hydrocele transilluminates?

a. Communicating Hydrocele
b. Non communicating Hydrocele

A

a. Communicating Hydrocele

b. Non communicating Hydrocele

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9
Q

Which hydrocele needs urologist surgery recommendation?

a. Communicating Hydrocele
b. Non communicating Hydrocele

A

Communicating Hydrocele due to hernia risk.

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10
Q 
When would you refer a non-communicating hydrocele?
Check all that apply: 
a. Persists beyond one year
b. significant increase in size
c. Causes discomfort
d. Causes Hernia
A

a. Persists beyond one year
b. significant increase in size
c. Causes discomfort

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11
Q

Is scrotal swelling painful or not in hydrocele generally?

A

Not painful

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12
Q

Hypospadias definition

A

Congenital defect with urethral meatus (the tube which drains urine during voiding) is located on the ventral surface (underside) of the penis, instead of at the tip of the penis.

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13
Q

What is CHORDEE and what condition is it found in?

A

CHORDEE is ventral curvature or bowing of penis due to fibrous band of tissue and is found in Hypospadias.

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14
Q

Hypospadias signs and symptoms:

A
  1. Penile chordee : A downward curve of the penis
  2. Dorsally hooded foreskin: The penile foreskin covers only the top of the penis giving a hooded appearance
  3. Abnormal stream of urine: Urine may spray down or the urinary stream may not be straight
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15
Q

How do you manage hypospadias?

A

Referral to Urologist at birth. Surgery best done around 6 to 12 months of age.

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16
Q

Do you circumcise if child has hypospadias and why or why not?

A

Do NOT circumcise child with hypospadias as the foreskin is needed for surgical repair.

17
Q

What is Phimosis?

A

Phimosis is defined as the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis. Phimosis may appear as a tight ring or “rubber band” of foreskin around the tip of the penis, preventing full retraction. Phimosis is divided into two forms: physiologic and pathologic.

Physiologic phimosis: Children are born with tight foreskin at birth and separation occurs naturally over time. Phimosis is normal for the uncircumcised infant/child and usually resolves around 5-7 years of age, however the child may be older.

Pathologic phimosis: Phimosis that occurs due to scarring, infection or inflammation. Forceful foreskin retraction can lead to bleeding, scarring, and psychological trauma for the child and parent. If there is ballooning of the foreskin during urination, difficulty with urination, or infection, then treatment may be warranted.

18
Q

Care of Uncircumcised Penis:

A

No special care is required for foreskin in infancy. The foreskin should not be forcibly retracted, however gentle retraction is okay. IN MOST INSTANCES, FORESKIN IS NOT EASILY RETRACTIBLE UNTIL THE CHILD IS ABOUT 3 YEARS OLD.
In the first few years of life, gentle retraction with cleansing underneath the foreskin is sufficient during diaper changes or bathing and will result in progressive retraction over time. After retraction, the foreskin should be pulled back over the head of the penis and returned to the normal position.

19
Q

What is Balanitis

A

Inflammation of glans penis which may occur if foreskin is retracted forcefully.

20
Q

What is Paraphimosis?

A

inability to replace foreskin over glans after retraction, may be due to forcible retraction of foreskin for “cleaning” purposes.

21
Q

Management of Phimosis

A

Management/Treatment
1. Maintain good hygiene
2. Gentle stretch of foreskin during bath—advise
family against forceful retraction; scarring and
balanitis may occur

22
Q

Management of paraphimosis

A

Paraphimosis—urologic emergency,
goal is reduction of swelling to reduce foreskin; may be accomplished with ice, application of granulated sugar to the penis for osmosis to reduce swelling, or wrapping distal penis in saline soaked gauze and applying pressure for 5 to 10 minutes; will occasionally inject hyaluronidase beneath the band to release it; rarely a surgical emergency
Surgery—circumcision in phimosis with urinary obstruction

23
Q

TESTICULAR TORSION

• Definition

A

TESTICULAR TORSION
• Definition: Torsion of the spermatic cord; can
result in gangrene of testes (emergency)
• Etiology/Incidence
1. Abnormal fixation of testis to scrotum—
permits testis to twist/rotate; impedes
lymphatic and blood flow
2. Not unusual to awaken with pain, but can
also develop after scrotal trauma or increased
activity
3. Most common in adolescent males

• Physical Findings
1. Enlarged, highly tender testis
2. Scrotum on involved side edematous, warm,
erythematous
3. Anxious patient, resistant to movement
4. Lifting testis does not relieve pain (Prehn’s
sign)
5. Solid mass may be visualized with
transillumination

• Diagnostic Tests/Findings
1. Complete blood count (CBC)—may see slight
increase in white blood count
2. Doppler ultrasound—reveals diminished
blood flow
3. U/A—often normal, but leukocytosis may
develop rapidly

24
Q

What is the management treatment for testicular torsion?

A

Management/Treatment: Immediate referral for surgery to prevent necrotic testicle and infertility

25
Q

What is the most common age for testicular torsion?

A

Young boys age 10 -20 years old.

26
Q

What are the signs and symptoms for testicular torsion?

A

• Signs and Symptoms

  1. Acute, painful swelling of scrotum
  2. Affected testes may have a “high lie”, High position of the testicle and Transverse lie of the affected testis
  3. No systemic symptoms and no fever
  4. Lack of irritative urinary voiding symptoms is the norm
  5. Abnormal cresmaterix reflex.
27
Q

Is pain relieved by elevating scrotum in testicular torsion?

A

No, pain is not relieved by elevating scrotum, medical emergency.

28
Q

What is the cremasteric reflex and what does it indicate?

A

The cremasteric reflex is a type of superficial reflex that is present only in the human male. It involves the involuntary contraction of the cremaster muscle when the inner portion of the thigh is lightly stroked. This causes the scrotum and testicle to be pulled into an upward direction.
While the reflex is often overactive during early adolescence, its absence indicate health concerns such as Testicular TORSION, spinal injury, or a variety of motor neuron disorders.

29
Q

Pediatric UTI: how long do you treat if child is afebrile?

A

3rd generation cephalasporins for 3-5 days

30
Q

Pediatric UTI: how long do you treat if child is febrile?

A

3rd generation cephalasporins for 10 days

31
Q

What imaging is needed to test for FIRST FEBRILE UTI in ALL infants 2 - 24 months.

a. Voiding Cystourethrogam
b. Renal and bladder ultrasound (RBUS)

A

b. Renal and bladder ultrasound (RBUS)

32
Q

What test might quickly help determine which antibiotic tx is most appropriate in a pediatric patient with a UTI?

  1. Urinalysis
  2. Culture
  3. Gram stain
  4. In/out catheterization
A
  1. Gram stain
33
Q

What pharmacological interventions for Pediatric UTI for febrile child 2 - 24 months?

A

ABC 3
Amoxicillin
Bactrim
Cephalosporins 3rd generation.

34
Q

What pharmacological interventions for Pediatric UTI for febrile child under 2 months?

A

Hospitalized for parenteral antibiotics.

35
Q

What is the follow up protocol for UTI?

A

Follow up in 48-72 hrs for second culture, change antibiotic if no improvement is seen.
Follow up in 1 week for culture after completion of treatment when “test of cure” is indicated.

Pediatrics (9 decks)

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