urogenital

Question 1

urinary incontinence first line tx?

Answer 1

enuresis alarm

Question 2

urinary incontinence first line tx for >7 and need for short term control?

Answer 2

desmopressin but may relapse after

Question 3

urinary incontinence mx plan?

Answer 3

advice regarding fluid intake, diet, toileting patterns reward system for agreed behaviour e.g. star charts then enuresis alarm if needed

Question 4

advice re enuresis alarms?

Answer 4

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

Question 5

advice regarding desmopressin?

Answer 5

many will relapse when tx is withdrawn importance of fluid restriction from 1 hr before until 8h after taking desmopressin.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

Question 6

mx of simple obesity in children?

Answer 6

supportive envt lifestyle changes (parents take main responsibility) e.g. more exercise, dietician advice social causes of weight gain? (e.g. stress)

Question 7

IX of simple obesity in children?

Answer 7

Heigh weight BMI assess risk factors / comorbidities HbA1c, fasting lipid family history

Question 8

primary enuresis contributing factors?

Answer 8

constipation stress UTIs Diabetes Mellitus/ Insipidus

Question 9

primary enuresis neuro examination?

Answer 9

lower limb neuro exam to exclude neuro cause e.g. cerebral palsy

Question 10

inguinal mass

can get above the mass,

testis cannot be palpated separately

will not transmit a cough impulse

transilluminates

Answer 10

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

Question 11

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

Answer 11

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.

Question 12

‘bag of worms’

Answer 12

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

Question 13

Dx of varicocele

Answer 13

USS, showing venous dilatation > 2mm

Question 14

Mx of varicocele

Answer 14

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.

Question 15

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)

Answer 15

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.

Question 16

What does surgical mx of testicular torsion involve?

Answer 16

Surgery involves untwisting of the testicle and bilateral fixation of the testes to the tunica vaginalis to prevent further torsion.

Question 17

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

Answer 17

Torsion of the hydatid of Morgagni

Mx: reguires surgical excision.

Question 18

Prehns sign +ve – relief of pain on elevation of the testes

Painful, swollen testicle with consititutional symptoms such as pyrexia and malaise.

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

child with hypospadia and bilaterally impalpable testes?

most impt thing to rule out

Answer 20

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.

Question 21

Paediatric Basic life support

how many breaths: compressions

Answer 21

2 inflation breaths per 15 chest compressions