Peds - GU and GYN Flashcards
Define primary enuresis
bladder control has never been established (in a child old enough that it is expected)
Define secondary enuresis
had bladder control for 6-12 months or more and then lost it
Define nocturnal enuresis
incontinence during sleep
Define diurnal enuresis
incontinence during waking hours
What percentage of 10 year olds have enuresis?
up to 3%
What percentage of enuresis is functional in orgin (in other words there is no underlying cause)?
95%
What diagnostic tests are important to perform in children with enuresis?
urinalysis and urine culture to rule out UTI
What is the most effective treatment for enuresis?
Hypnosis and self-hypnosis
What medications can be used for enuresis?
o imipramine (Tofranil) -- anti-dep also used in migraine o Desmopressin (DDAVP) o oxybutinin (Ditropan)
What are important considerations to keep in mind if using medications for enuresis?
o must give drug holiday
o when not on the medication, recurrence is expected
What organism is most likely implicated in “uncomplicated” UTI?
E. coli in 80-90% of cases
What organism is most likely implicated in “complicated” UTI?
Staph aureus
often seen with catheterization in hospital
Predisposing factors for UTI (6)
o urinary STASIS o OBSTRUCTIVE lesions o NEUROGENIC bladder o poor HYGIENE o CONSTIPATION o INTERCOURSE
Signs of UTI in infants (3)
o may be asypmtomatic
o irritability
o failure to thrive
What might urinalysis show in UTI? (3)
o leukocytes
o erythrocytes
o nitrites
What might CBC show in UTI? (1)
leukocytosis
Duration of antibiotic therapy for younger children with UTI?
7-10 days
Antibiotics used for UTI in children (4)
o trimethoprim/sulfamethoxazole - TMP/SMX (Bactrim)
o cephalosporins
o amoxicillin
o nitrofurantoin (Macrobid)
Follow up after initiation of therapy in UTI
o follow-up in 2 days and change antibiotic if no improvement
o follow-up in 1-2 weeks
o then every 1-3 months x 1 year
What is the treatment of UTI in children < 2 months of age?
Hospitalization
parenteral antibiotics
When is a renal ultrasound indicated?
After first UTI in febrile children 2 - 24 months of age
When is a VCUG indicated?
If ultrasound is reflective of renal abnormalities
What is prime age for hypospadias repair?
6 - 12 months
Management of cryptorchidism
o if undescended at 1 year, refer to urology
o teach testicular self examination due to increased testicular cancer probability
Define primary dysmenorrhea
pain associated with menses with absence of any pelvic pathology
Define secondary dysmenorrhea
pain associated with menses related to an underlying cause such as PID or endometriosis
Why is ibuprofen effective for menstrual cramps?
It decreases prostaglandins which are responsible for cramping
Most common STD in adolescents (and adults)?
chlamydia
