Peds - GU and GYN

Question 1

Define primary enuresis

Answer 1

bladder control has never been established (in a child old enough that it is expected)

Question 2

Define secondary enuresis

Answer 2

had bladder control for 6-12 months or more and then lost it

Question 3

Define nocturnal enuresis

Answer 3

incontinence during sleep

Question 4

Define diurnal enuresis

Answer 4

incontinence during waking hours

Question 5

What percentage of 10 year olds have enuresis?

Answer 5

up to 3%

Question 6

What percentage of enuresis is functional in orgin (in other words there is no underlying cause)?

Answer 6

95%

Question 7

What diagnostic tests are important to perform in children with enuresis?

Answer 7

urinalysis and urine culture to rule out UTI

Question 8

What is the most effective treatment for enuresis?

Answer 8

Hypnosis and self-hypnosis

Question 9

What medications can be used for enuresis?

Answer 9

o  imipramine (Tofranil) -- anti-dep also used in migraine
o  Desmopressin (DDAVP)
o  oxybutinin (Ditropan)

Question 10

What are important considerations to keep in mind if using medications for enuresis?

Answer 10

o must give drug holiday

o when not on the medication, recurrence is expected

Question 11

What organism is most likely implicated in “uncomplicated” UTI?

Answer 11

E. coli in 80-90% of cases

Question 12

What organism is most likely implicated in “complicated” UTI?

Answer 12

Staph aureus

often seen with catheterization in hospital

Question 13

Predisposing factors for UTI (6)

Answer 13

o  urinary STASIS
o  OBSTRUCTIVE lesions
o  NEUROGENIC bladder
o  poor HYGIENE
o  CONSTIPATION
o  INTERCOURSE

Question 14

Signs of UTI in infants (3)

Answer 14

o may be asypmtomatic
o irritability
o failure to thrive

Question 15

What might urinalysis show in UTI? (3)

Answer 15

o leukocytes
o erythrocytes
o nitrites

Question 16

What might CBC show in UTI? (1)

Answer 16

leukocytosis

Question 17

Duration of antibiotic therapy for younger children with UTI?

Answer 17

7-10 days

Question 18

Antibiotics used for UTI in children (4)

Answer 18

o trimethoprim/sulfamethoxazole - TMP/SMX (Bactrim)
o cephalosporins
o amoxicillin
o nitrofurantoin (Macrobid)

Question 19

Follow up after initiation of therapy in UTI

Answer 19

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

Question 20

What is the treatment of UTI in children < 2 months of age?

Answer 20

Hospitalization

parenteral antibiotics

Question 21

When is a renal ultrasound indicated?

Answer 21

After first UTI in febrile children 2 - 24 months of age

Question 22

When is a VCUG indicated?

Answer 22

If ultrasound is reflective of renal abnormalities

Question 23

What is prime age for hypospadias repair?

Answer 23

6 - 12 months

Question 24

Management of cryptorchidism

Answer 24

o if undescended at 1 year, refer to urology

o teach testicular self examination due to increased testicular cancer probability

Question 25

Define primary dysmenorrhea

Answer 25

pain associated with menses with absence of any pelvic pathology

Question 26

Define secondary dysmenorrhea

Answer 26

pain associated with menses related to an underlying cause such as PID or endometriosis

Question 27

Why is ibuprofen effective for menstrual cramps?

Answer 27

It decreases prostaglandins which are responsible for cramping

Question 28

Most common STD in adolescents (and adults)?

Answer 28

chlamydia