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EOR 3 - Peds > GU > Flashcards

GU Flashcards

1
Q

Hypospadias

A

urethral opening is not at the tip of the penis

2nd most common congenital defect of male genitalia (following cryptorchidism)

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2
Q

What is the tx for hypospadias?

A

surgical repair for 2nd and 3rd degree

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3
Q

Phimosis

A

inability to retract the prepuce at an age when it should be retractable (typically around 3 yo)

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4
Q

Paraphimosis

A

prepuce is retracted but cannot be extended

boys <4yo are at increased risk d/t non fully mobile foreskin
catheterizations puts them at risk too

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5
Q

What is the treatment for paraphimosis?

A

manual reduction

if unsuccessful –> dorsal slit procedure 00> circumcision should be performed at a later time

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6
Q

What is the MC pathogen of vaginitis?

A

S. pyogenes

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7
Q

What is the tx for vaginitis?

A

keep area aerate and dry
decrease irritants
Sitz bath twice daily with 3 tbsps of baking soda

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8
Q

Strawberry cervix

A

seen with trichomoniasis
frothy, green/yellow discharge

ph < 5
flagellated, pear shaped motile organisms

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9
Q

What is the tx for trichomoniasis?

A

metronidazole

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10
Q

When should you suspect pyelonephritis over UTI in a child?

A

when they have a fever

its difficult to distinguish pyelo from cystitis otherwise

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11
Q

How is a UTI dx?

A

+ nitrates in urine (most specific, not most sensitive)

leukocyte esterase, WBC in UA

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12
Q

What is the tx for UTI/cystitis?

A

Amoxicillin, Augmentin, Bactrim
Cefdinir
x 7-14 days

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13
Q

When do testicles descend?

A

7-8 monts gestation

if not descended at birth, should be by 4 months of age

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14
Q

Cryptorchidism

A

MC disorder of sexual differentiation of males

undescended testicles

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15
Q

What is the tx for cryptorchidism?

A

orchiopexy (surgery) at 6 months (no later than 9-15 months)

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16
Q

Hydrocele

A

fluid filled remains of tunica vaginalis

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17
Q

How does hydrocele present?

A

soft, non tender fullness of the hemiscrotum
TRANSILLUMINATES
size may wax and wane

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18
Q

What is the tx for hydrocele?

A

usually watch and wait

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19
Q

Testicular torsion

A

twisting of the spermatic cord - MC d/t an anatomical defect (such as anchoring of the testicle within the tunica vaginalis)

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20
Q

When is testicular torsion MC?

A

during first year of life
AND
during puberty

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21
Q

How does testicular torsion present?

A

acute onset of unilateral testicular of abdominal pain

Absence of CREMASTERIC reflex (most sensitive finding)

22
Q

How is testicular torsion dx?

A

US with doppler –> blue dot sign on US

23
Q

What is the tx for testicular torsion?

A

EMERGENCY surgery within 6 hours from sx onset

24
Q

What are the benefits of circumcision?

A

reduce risk of UTI, STDs, and penile cancer
easier hygiene
reduce risk of phimosis and paraphimosis

25
What is the minimum age at which a child can get a circumcision?
12 hours but ideally 24 hours the infant must have voided at least ONCE
26
What are contraindications to circumcision?
bilateral undescended testes hypospadias micropenis known bleeding diathesis
27
Nephroblastoma
Wilms tumor asymptomatic abdominal mass - usually doesnt cross the midline MC 4yo
28
What is the tx for Wilms tumor?
surgery + chemotherapy
29
What is the difference between primary and secondary enuresis?
primary: child who HAS NOT had 6 months of dry nights secondary: child who previously had 6 months of dry nights
30
What is the tx for enuresis?
MOST effective = bed alarm therapy medications should be limited to children >7 yo DDAVP is most commonly used (risk of hyponatremia and seizures)
31
What is vesicuourethral reflux?
retrograde flow of urine from bladder into the ureter
32
How do pts with VUR present?
hydronephrosis (often identified prenatally via US) UTIs
33
How is VUR dx?
UA VCUG - voiding cystourethrography imaging after 1st UTI is indicated in all children <5yo, in all boys, in all toilet trained girls with recurrent UTIs.
34
When is US and VCUG recommended for UTIs?
after 1s UTI in all children <5yo in all males in toilet trained girls with recurrent UTIs
35
What is the tx for VUR?
ABX prophylaxis (bactrim 2-4mg/kg daily) +/-surgery
36
HUS
hemolytic uremic syndrome caused by shiga-toxin E. coli (STEC) MC in children <5yo microangiopathic hemolytic anemia + thrombocytopenia + renal impairment
37
What is the clinical presentation of HUS and what labs would you expect to see?
anemia, bleeding (from thrombocytopenia) decrease urine output (renal impairment) irritability, seizures, encephalopathy microangiopahtic hemolytic anemia - schistocytes
38
What is the treatment for HUS?
supportive | platelet transfusions for severe bleeding
39
How does HUS differ from aHUS?
HUS is caused by STEC | aHUS is not caused by STEC -- associated with a chronic relapsing course and poor outcome
40
What is the tx for aHUS?
plasma exchange | Eculizumab (blocks complement activation) - first line
41
Brown granular casts
intrinsic renal glomerulonephritis tubular disease MC (85%)
42
Kernicterus
elevated unconjugated bilirubin complications | yellow staining of the basal ganglia and hippocampus --> widespread cerebral dysfunction
43
Jaundice within the first 24 hours of life
PATHOLOGIC - hemolysis (immune mediated, membrane defects, sepsis) - cephalhematoma - polycythemia
44
Is elevation in conjugated or unconjugated bilirubin always pathologic?
conjugated (direct) = pathologic
45
What is the MC cause of unconjugated hyperbilirubinemia?
physiologic and hemolytic anemia
46
What is the tx for hyperbilirubinemia?
phototherapy -- helps break down bilirubin into water soluble products (recall that unconjugated bili is not water soluble --- so this doesn't help with elevated conjugated bili)
47
Breast milk jaundice
exaggerated physiologic jaundice -->poss related to substance in breastmilk that inhibits glucuronyl transferase peaks in 1-2 weeks of life infants should continue to feed and grow normally
48
Breastfeeding jaundice
poor enteral intake (poss d/t poor milk supply) onset 2-4 days of life CP: prolonged transitional stools dehydrations - decreased urine output
49
What is the MC cause of GI bleeding in a newborn and how can you be sure?
Swallowed maternal blood from delivery or cracked nipples during breastfeeding Apt test --> differentiates maternal from fetal blood
50
NEC
necrotizing entercolitis - acute inflammatory necrosis of the bowel
51
What is the MC neonatal GI emergency?
NEC - more common in premature infants in the first few days of life
52
How is NEC dx?
luekocytosis, thrombocytopenia, hyponatremia, metabolic acidosis ``` intramural air (pneumatosis intestinalis) on abdominal Xray football sign ```

EOR 3 - Peds (9 decks)

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