Gu

Question 1

UA normal , edema and warmth of testicle and pain. Elevation increases pain

Answer 1

Testicular torsion

Question 2

Elevation of testicle relieves pain

Answer 2

Epididmytis

Question 3

Prehn sign

Answer 3

Elevation relieves pain in epididymitis not seen in testicular torsion

Question 4

Causes of epididmytis

Answer 4

Gonorrhea/ chlamydia
Sexually active teen or sex Truama common risk factors
Chemical irritant
Structural abnormalities

Question 5

Epididmytis s/s

Answer 5

scrotum pain SLOW BUT WORSENS
OBSTRUCTIVE VOIDING
dysuria
Can have blood in urine
Abnormal Ua could be or uti
Fever 
N/v 
Edema and erythema 
Tender spermatic cord 
Normal cremation reflex
Urethra discharge

Question 6

Epididmytis dx

Answer 6

Ua : pyuria or bacteruria can be present
CBC: wbc increased
VCUG if urogenital issue or + Ua
STI/Std testing

Question 7

Epididmytis management

Answer 7

Ice pack
Elevation 
NSAIDS
1st: ceftriaxone 
250 IM x1 dose & Doxycycline 100mg BID x10 days 

Alternative:
Ofloxcin 300 mg BID X10 days
cephlexin 40 mg /kg/day x dose

Treat sex partners
Referral if only unilateral involvement
Avoid sex until cured

Question 8

Testicular torsion management

Answer 8

EMERGENCY

SURGERY 6-12 hours

Question 9

Hypospadias

Answer 9

Congenital abnormality urethra located in abnormal position or even ventral surface underside of penis

Question 10

10% also have undescended testes , Inguinal hernia or hydrocele

Answer 10

Hypospadias

Question 11

Dorsally hooded foreskin in newborn , and chordee

Answer 11

Chordee=bowing of penis

Hypospadias

Question 12

Management of hypospadias

Answer 12

NO CIRCUMCISION
refer Peds urologist
Done at 6-12 months

Question 13

Testicular decent occurs when

Answer 13

At 7 to 8 months gestation

Undescended testes is common and preterm at 30% low birth weight and twin infants

Question 15

Cryptorchidism

Answer 15

Undescended testes
Cannot be manipulated into the scrotum

Understand a testes after birth can occur spontaneously in the first 3 -6 months

Bilateral is rare 10% cases

Question 16

Retractable testes

Answer 16

A retractable testes is out of the scrotum but can be brought into the scrotum and remains there

Bilateral more common 5-6 year old boys

Question 17

Gliding testes

Answer 17

Can be brought into the screen and returns to a high position once released

Question 18

Etopic testes

Answer 18

Lies outside the normal path of descent

Question 19

Risk factors Cryptorchidism

Answer 19

Family history
Testicular malignancy
Prematurity, hypospadias, low birth weight, down syndrome, Klinefelter syndrome

Question 20

Cryptorchidism dx &mangement

Answer 20

Frog leg position

Refer at 6 months for surgical intervention

Question 21

Hydrocele

Answer 21

Painless scrotal swelling with a collection of serous fluid in the scrotal sac

Scrotal size increases with activity and decreases with rest
Testes descended

Question 22

Noncommunicating hydrocele

Answer 22

Collection of fluid is only in the scrotum

No treatment fluid is absorbed unless persists >1 heat or painful

Question 23

Communicating hydrocele

Answer 23

Fluid moves from the abdomen to the scrotum is more likely associated with hernia

Can Resolved without surgery if hernia persist more than one year referral for surgical intervention

Question 24

Phimosis

Answer 24

Foreskin that’s too tight to be retracted over the glans penis

can be physiologic over the first six years of life or pathologic when the foreskin cannot be retracted after previously being retracted after puberty

Can have urinary obstruction or ballooning of the foreskin

Question 25

Phimosis mangement

Answer 25

Normal cleansing with gentle stretching of the foreskin can retract by five or six years old never forcefully retract the foreskin

Can get a circumcision

Persistent phimosis can be treated with corticosteroid cream TID for a month

Question 26

Paraphimosis

Answer 26

More common and adolescents it is a retracted foreskin that cannot be reduced to the normal position causes constriction on the penis and result in pain Adema of the glands and possible necrosis Seen in sexually active adolescences sexual abuse and forceful retraction

Question 27

Paraphimosis management

Answer 27

Reduction by lubricating the foreskin and pulling back the glands if not successful may need surgery

Question 28

Wilms tumor

Answer 28

Mass in the abdomen or flank Can have fever, dyspnea, diarrhea, vomiting, weight loss, or malaise, pain if mass has undergone rapid growth or hemorrhage

Question 29

Ascended testes

Answer 29

Testicles that have fully descended but has spontaneously re-ascended and lies outside the scrotum

Question 30

Pain and cramping with the absence of any pelvic pathology

Answer 30

Primary dysmenorrhea Occurs 6 to 12 months after first menses ovulation is needed Primarily in adolescence

Question 31

Painful menses, lore of Domino pain, back pain, nausea, vomiting, fatigue, headache, and diarrhea

Answer 31

Symptoms of dysmenorrhea

Question 32

Painful menses results from my underlying cause such as pelvic disease ,pregnancy, PID, and Endometriosis, cyst, tumors

Answer 32

Secondary dysmenorrhea

Question 33

treatment for mild dysmenorrhea

Answer 33

``` Heat application exercise Tylenol good diet Motrin 400 mg Q6 to 8 hours, 1 to 3 days ```

Question 34

Primary dysmenorrhea moderate

Answer 34

NSAIDS inhibit prostaglandin synthesis Naproxen sodium 500 mg PO then 250 mg Q6 to 8 hr mefenamic 500 mg PO, 250 mg every 6-8 h Assess 2 to 3 cycles if effective NSAID Tx No NSAIDS for clotting disorders, renal, or peptic ulcer‘s, preop, or allergy

Question 35

Primary severe dysmenorrhea treatment

Answer 35

If unresponsive to inserts and mild treatments start with OCP‘s Check in 3 to 4 cycles to see improvement A continuous >4 months GYN referral

Question 36

Hydronephrosis

Answer 36

Blocks urine from the kidney S/S: nausea; flank pain; decreased urine TX: surgery

Question 37

Bacterial infection of the urinary tract

Answer 37

UTI

Question 38

UTIs are greater in_____In the first year of life ____ especially if they are _______. Then it’s more common in______.

Answer 38

Males in the first year of life especially if they are uncircumcised and then more common in females

Question 39

Biggest pathogen of a UTI

Answer 39

E. coli 80 to 90% of cases

Question 40

Pathogens of UTI

Answer 40

Viral but rare adenovirus E. coli 80 to 90% Staphylococcus aureus Klebsiella Staphsaprophyticus

Question 41

Infants have a weight loss, failure to thrive, irritable | Teens experience dysuria, nocturia, frequency, urgency, hematuria, fever, abdominal pain

Answer 41

s/s uti

Question 42

Cath culture sensitivity

Answer 42

Positive > 1000 CFU Single or multiple organism

Question 43

Clean catch sensitivity is performed when

Answer 43

Done with mild symptoms or follow up

Question 44

Positive UTI for a clean catch specimen

Answer 44

Positive at 50,000 to 100,000 CFU single organism

Question 45

A positive UTI on a UA shows what

Answer 45

Leukocytes, erythrocytes, nitrates, Estrace, leukocytosis in a CBC

Question 46

When should Reno or bladder ultrasound be performed in a UTI

Answer 46

Febrile infants First UTI, children 2 to 24 months Symptoms of pyelonephritis at any age UTI <3 months —hospital

Question 47

When should a VCUG be performed

Answer 47

If abnormal ultrasound | Increase blood pressure symptoms

Question 48

Anabiotic for UTI

Answer 48

Bactrim/cephalosporin/nitrofurtin/Augmentin 10 to 14 days; follow up to days if no improvement change antibiotic

Question 49

Common history for primary nocturnal enuresis

Answer 49

Positive family history, related to maturational delay, some nighttime winters can stop wetting without treatment

Question 50

Common in enuresis type for school-age children

Answer 50

Primary diurnal enuresis