Common Pediatric Disorders- Villanueva

Question 1

When is recommended time to do surgery for undescended testicles?

Answer 1

after 6 mo.

Question 2

Reason for surgery of undescended testicle

Answer 2

Fertility (Same fertility if unilateral, but bilateral is 50% fertility) and cancer risk.

Question 3

When is the best time in life to do a scrotal exam

Answer 3

At birth

Question 4

Most reliable way to identify an undescended testicle

Answer 4

1) Physical exam **
2) MRI
3) Scrotal US with doppler
4) Scrotal US
5) CT scan

Question 5

Non palpable testicle has compensatory _________ >1.8cm. When kid has non palpable testicle must do a _________?

Answer 5

Hypertrophy, laparoscopy

Question 6

Most hernias in kids are ____________ while in adults they are _______

Answer 6

Indirect, direct

Question 7

Risks of hernias in kids

Answer 7

1) Incarceration (Premature 40%, overall 12%)
2) <10% can be redced
3) Bowel necrosis and strangulation is rare

Question 8

2 types of hydroceles

Answer 8

1) Communicating: risks 2% hernias 0% incarceration. 85% spontaneous resolution by 18 mos.
2) Non-communicating: risks=nil

Question 9

Febrile UTI characteristics

Answer 9

1) Younger child
2) Temp >38.5
3) Sick, back pain
4) Usually anatomic problem present
5) Workup: Renal US and in some a VCUG

Question 10

Non-febrile UTI characteristics

Answer 10

1) Older child
2) No fever
3) No constitutional symptoms
4) Usually has dysfunctional elimination syndrome with normal anatomy
5) Work-up: KUB, voiding diary

Question 11

What has surgical of vesicoureteral reflux been proven to decrease

Answer 11

1) Febrile UTIs- No other things

Question 12

Antibiotic prophylaxis after a UTI decreases the risk of recurrent UTI by…

Answer 12

8%- Antibiotics can causes resistance in bowel flora

Question 13

Classification of Hydronephrosis (SFU)

Answer 13

SFU 0= Normal 
SFU 1= Black (urine) at renal pelvis
SFU 2= If you see calyces
SFU 3= see all calyces
SFU 4= Complete obstruction

Question 14

Which children require immediate eval of hydronephrosis after birth

Answer 14

1) boy, history of oligodramnios (little amniotic fluid), bilateral grade 2 hydro
2) Girl, bilateral ureteroceles
3) Boy, bilateral grade 2 or more hydro

Question 15

The diagnosis and treatment of vesicoureteral reflux in an asymptomatic child with prenatal hydro and no history of UTIs:

Answer 15

Has no proven benefits

Question 16

Immediate postnatal evaluation

Answer 16

Bladder outlet obstruction, bilateral obstruction (SFU 4)

Question 17

What is Mag 3

Answer 17

For SFU 3 and 4. Radiotracer study to show blockage

Question 18

Causes of TRUE fecal incontinence (3)

Answer 18

1) Myelomeningocele
2) Hirshprung disease
3) Anorectal malformations

Question 19

Cause of PSEUDO-fecal Incontinence

Answer 19

Due to constipation

Question 20

Treatment of Encopresis

Answer 20

1) Desimpaction
2) Maintenance
3) Lifelong disease

Question 21

Daytime urinary incontenence- what should you do?

Answer 21

In older kids consider Renal US to rule out neurogenic bladder, valves, anatomic problems
RX: Constipation, timed voiding and double voiding regimen
-Anticholinergics? (relax bladder)

Question 22

Monosymptomatic nocturnal enuresis treatment

Answer 22

1) General measures (Restrict fluids, go to bathroom before bed)
2) Medicines (Don’t cure, and only 30% effective and <10% cure rate)
3) Bedwetting alarm (80% success)

Question 23

How are labial adhesions treated?

Answer 23

1) Observation
2) Estrogen cream
3) Break adhesion surgically

Question 24

What is the recommended care of an uncircumcised penis from age 0 to age 8

Answer 24

Once the foreskin becomes retractable, teach children to retract their own foreskin during voiding or bathing

-Phimosis- cannot retract foreskin

Question 25

Soft penile adhesions involves what anatomically? What treatment is needed?

Answer 25

Do not involve the circumcision.

Disappear on their own without treatment

Question 26

Penile bridge involves what anatomically? What treatment is needed?

Answer 26

Usually involve circumcision. Require surgical treatment

Question 27

Hypospadius

Answer 27

Dorsal hood. Hole on VENTRAL side