Renal/GU

Question 1

what is unilateral transilumination of an inguinal mass in a male infant mean?

Answer 1

testicular torsion is most likely

Question 2

how do you differentiate between a hyrdrocele and a incarcerated inguinal hernia?

Answer 2

In hernia:

• signs of bowel obstruction
• mass typically firm discrete, tender and surrounded by erythema and edema
• testicle may appear bluish

In hyrocele:

• baby tolerates feeds

Question 3

what’s the key differential of a scrotal mass in a boy or adolescent male?

Answer 3

painful vs. painless?

Question 4

what is cryptorchidism?

Answer 4

undescended testicle

most common disorder of sexual differentiation in males

Question 5

when there is bilateral cryptorchidism, what should you do?

Answer 5

do a genetic workup to determine if there is a genetic disorder

Question 6

how is micropenis defined?

Answer 6

penis length <2.5 SD for gestational age

Question 7

what is the prevalence of circumcision in the US?

Answer 7

about 80% for males 14-59 in the US

Question 8

what’s on the differential for girl with painful urination and vaginal pain, redness?

Answer 8

• non-specific vulvovaginitis
• specific vulvovaginiits (bacteria/yeast, but generally not the right environment in young girls)ych
• pinworms
• foreign body
• vulvar skin disease
• trauma/abuse
• psychosomatic vaginal complaints
• masturbation

Question 9

what needs to be high on the differential for children with a fever of unkown origin?

Answer 9

UTI

Question 10

what is the risk of UTI in children?

Answer 10

renal scarring with resulting HTN and CKD

Question 11

what is the epidemiology of UTI in peds?

Answer 11

approx. 5% among all infants with fever age 2-24 months

>2:1 female:male

slightly more common <12 months

Question 12

What are the risk factors for pediatric UTI?

Answer 12

• Girls
  
  • white race
  • age <12 months
  • temperature >39
  • fever of 2 or more days
  • no other source
• Boys
  
  • non-black race
  • temperature >39
  • fever of 2 or more days
  • no other source

Question 13

what is the treatment for enuresis if other therapies are unsuccessful?

Answer 13

Desmopressin (DDAVP)

risk of hyponatremia and seizures (reduce water consumption)

Question 14

what is hypospidiasis?

Answer 14

When the urethral meatus is located other than at the tip of the glans

usually located along the bottom of the tip, or along the shaft of the penis

Question 15

what frequently accompanies hypospidiasis?

Answer 15

chordee

and cryptorchidism

Question 16

how is hypospidiasis treated?

Answer 16

surgically

Question 17

what is hydrocele?

Answer 17

it is a fluid collection within the scrotum

caused by: congenital (develop); injury/trauma; infection

• if it communicates with the peritoneal cavity is it communicating and can re-fill
• if it is non-communicating the swelling and fluid is confined to the scrotum

Question 18

what is the treatment for hydrocele?

Answer 18

communicating - surgery

non-communicating - usually watchful waiting, but if tense and painful, then may require surgery to avoid impaired blood flow

Question 19

what is the peak age of testicular torsion and in whom is it more likely to occur?

Answer 19

12-18 years

bell clapper deformity

l>r

Question 20

What are the signs/sx of testicular torsion?

Answer 20

sudden onset of testicular pain

swollen and tender testicle

• Prehn’s sign
• absent cremasteric reflex on ipsilateral side

Question 21

how do you diagnose testicular torsion?

Answer 21

test of choice: venous doppler