urogenital Flashcards
urinary incontinence first line tx?
enuresis alarm
urinary incontinence first line tx for >7 and need for short term control?
desmopressin but may relapse after
urinary incontinence mx plan?
advice regarding fluid intake, diet, toileting patterns reward system for agreed behaviour e.g. star charts then enuresis alarm if needed
advice re enuresis alarms?
takes some time to work. may be a few weeks before dry nights achieved. assess response by 4 wks stop if achieved dry nights for 2 wks straight
advice regarding desmopressin?
many will relapse when tx is withdrawn importance of fluid restriction from 1 hr before until 8h after taking desmopressin. should be taken at bedtime
mx of simple obesity in children?
supportive envt lifestyle changes (parents take main responsibility) e.g. more exercise, dietician advice social causes of weight gain? (e.g. stress)
IX of simple obesity in children?
Heigh weight BMI assess risk factors / comorbidities HbA1c, fasting lipid family history
primary enuresis contributing factors?
constipation stress UTIs Diabetes Mellitus/ Insipidus
primary enuresis neuro examination?
lower limb neuro exam to exclude neuro cause e.g. cerebral palsy
inguinal mass
can get above the mass,
testis cannot be palpated separately
will not transmit a cough impulse
transilluminates
hydrocoele
collection of serous fluid in the tunical vaginalis, a membrane that covers the testis
hydroceles can be primary or secondary to an underlying cause.
Primary - tense, painless, fluctuant swellings that transilluminate
Severe dysphagia, earache and trismus (lockjaw)
Inspection of the pharynx shows a unilateral bulge of the soft palate, w deviation of the uvula to the opposite side.
Tonsils inflammed + halitosis
Peritonsillar Abscess (Quinsy)
Collection of pus outside the tonsil – complication of tonsillitis
rupture of the asbcess can result in aspiration pneumonia
tx: penicillin + drain abscess.
conventional to perform tonsillectomy after Quinsy.
‘bag of worms’
Varicocele
Varicosities in the pampiniform venous plexus, the network of veins that drains the testicle.
Usually occurs on the L side and present in 10% of males.
Present w scrotal swelling on standing that feels like a bag of worms, and they may experience a heavy, dragging sensation.
Usually harmless but may be assoc w defective spermatogenesis -> subferility
Dx of varicocele
USS, showing venous dilatation > 2mm
Mx of varicocele
Reassurance and wearing supportive underwear
If patient desires tx: radiological embolization of the L testicular vein, or ligation and division of the testicular veins, can be performed.
Sudden onset pain and swelling in testicle.
Pain extends into the lower abdomen and groin, + N+V
Testis riding high in the scrotum.
Cremasteric reflex –ve.
Prehn’s sign –ve (lifting the testicle to relieve the pain)
Testicular torsion
Surgical emergency
T10 n affected – abodomen + groin pain
Torsion occurs around the spermatic cord when there is an anatomically abnormal testicle, often following a hx of mild trauma.
Irreversible infarction of a torsioned testicle occurs within 6-12h, so need urgent surgical exploration without further ix.
What does surgical mx of testicular torsion involve?
Surgery involves untwisting of the testicle and bilateral fixation of the testes to the tunica vaginalis to prevent further torsion.
Torsion may affect boys just prior to puberty.
Often presents w pain that increases in intensity in over 1-2 days.
Blue dot sign positive: blue dot seen on the superior aspect of the scrotal skin
Torsion of the hydatid of Morgagni
Mx: reguires surgical excision.
Prehns sign +ve – relief of pain on elevation of the testes
Painful, swollen testicle with consititutional symptoms such as pyrexia and malaise.
Epididymo-orchitis
Inflammation of the epididymis and testis.
May exhibit a secondary hydrocele.
Usually a consequence of ascending infection e.g. UTI/ STI -> there may be dysuria/ urethral discharge
Mx: bed rest and long course of Abx (6 wks of oral ciprofloxacin)
If an abscess develops it requires drainage.
unvacinated child
trismus: lock jaw
grinning face due to facial muscle spasm (risus sardonicus)
arched body, hyperextended neck (opisthotonus)
tachycardia/ arrhythmais, low BP and sweating
Tetanus
gram + anaerobe clostridium tetani
neurotoxic exotoxin, tetanospasmin, that acts on motor cells in the CNS to cause muscle spasm
death due to aspiration, resp failure, cardiac failure or exhaustion.
child with hypospadia and bilaterally impalpable testes?
most impt thing to rule out
congenital adrenal hyperplasia
21 hydroxylase deficiency.
measure U+Es, chromosomal analysis and pelvic USS.
baby could be virilized female infant secondary to CAH.
or male w bilaterally undescended testes.
Paediatric Basic life support
how many breaths: compressions
2 inflation breaths per 15 chest compressions
