GU

Question 1

What is the most common form of Ambiguous genitalia?

Answer 1

46 XX DSD - Pseudohermaphroditism - Female inside and out but doesn’t look right

Question 2

What is the common cause of Female Pseudohermaphroditism:

Answer 2

Congenital adrenal hyperplasia - enzyme def. cannot make cortisol and aldosterone from cholesterol - High levels of androgens

Question 3

A baby with CAH and ambiguous genitalia can present to the ER in:

Answer 3

Shock - after birth (low aldosterone –> increased sodium resorption in the renal = hyponatremia and hyperkalemia)

Question 4

What is the most common enzyme deficiency for CAH?

Answer 4

21-hydroxylase deficiency

Question 5

What do you treat the CAH ambiguous genitalia with?

Answer 5

CAH-cortisol + mineralocorticoid (then testosterone or estrogen at puberty)

Question 6

What is hypospadias, when is it corrected?

Answer 6

Ventral placement of urethra; corrected 4-18 months

Question 7

What is commonly associated with hypospadias?

Answer 7

• Ventral curvature (chorded)

- Undescended testes (9-30%)

Question 8

How do you want to look for Crytochidism?

Answer 8

US but surgery is better - could be done before US

Question 9

When is an orchiopexy done to get the undescended testicle and bring it down?

Answer 9

4-6 months

Question 10

What are three complications of Cryptochidism?

Answer 10

Infertility, testicular cancer, torsion

Question 11

What are the THREE acute issues with the testicle?

Answer 11

• Testicular torsion
• Torsion of the appendix testis
• Incarcerated hernia

Question 12

Most common surgical procedure in kids:

Answer 12

Hernia/hydrocele repair

Question 13

What is the formation of a hydrocele?

Answer 13

Fluid within the tunica vaginalis - can be communicating or non-communciating

Question 14

How do you differentiate between the hernia and the hydrocele?

Answer 14

US

Question 15

A hydrocele does not need to be repaired unless:

Answer 15

It has persisted for over 1 year

Question 16

When is the peak incidence for testicular torsion? Most common age!

Answer 16

• Perinatal
• Puberty

7-12 is the most common

Question 17

Bell Clapper deformity:

Answer 17

When the tunica vaginalis is attached to the spermatic cord up top

Question 18

If there is still a positive cremasteric reflex, what can you be dealing with?

Answer 18

• Appendix wrong

- Nothing wrong

Question 19

A blue dot on the pole of the testes can indicated:

Answer 19

Appendix testicular torsion

Question 20

If you have a testicular torsion, how long do you have to get to the operating room?

Answer 20

6-8 hours to save the testes

Question 21

If you know it is testicular torsion you can proceed to the:

Answer 21

OR (US is not needed first)

Question 22

Treatment for the torsion of the appendix testes and when should the pain resolve?

Answer 22

• ICE and NSAIDS (tight/whiteies)

- Pain resolves in 5-10 d

Question 23

In early infancy, who are UTIs more common in:

Answer 23

Boys - uncircumcised (4-8x more)

Question 24

After three months, UTIs are more common in:

Answer 24

Girls

Question 25

A baby with a fever, check a:

Answer 25

UA!!!!!

Question 26

What bacteria accounts for 80-90% of first UTI infections?

Answer 26

E. coli

Question 27

What is the anatomical abnormality with Vesicoureteral reflux?

Answer 27

Uterovesical junction abnormality

Question 28

VUR patients are at higher risks for ___ d/t ___ but it should ___

Answer 28

UTIS due to urine left in the bladder; should spontaneously resolve

Question 29

You can rule out a UTI only if bag urine on an infant is:

Answer 29

Negative - positive test does not rule in

Question 30

If an infant is under two months and the child is vomiting with a UTI, how do you treat?

Answer 30

IV ABX and admission to hospital - 3rd gen cephalosporin

Question 31

If a child is over 2 months and not vomiting but has a fever you treat with:

Answer 31

Oral ABX for 10 days - 3rd gen cephalosporin

Question 32

If a child is over 2 months and not vomiting and does not have a fever, you treat with:

Answer 32

Oral ABX for 5 days - 3rd gen cephalosporin

Question 33

What do you image with on a child's first and second febrile UTI:

Answer 33

First: Renal and bladder ultrasound Second: Voiding Cystourethrogram

Question 34

What is the most common complaint of prepubescent girls?

Answer 34

Vulvovaginitis

Question 35

What is the bacterial cause of vulvovaginitis 20% of the time?

Answer 35

Group A Hemolytic strep

Question 36

When is leukorrhea common in girls?

Answer 36

6-12 months before their period; after tanner stage III is hit

Question 37

What type of discharge is seen with Group A strep infection in the vagina?

Answer 37

Serosanguinous

Question 38

For UTI management, what guidance can you give for baths?

Answer 38

Warm sitz; BID, pretzel legged, no washcloth

Question 39

You can treat vaginal labial adhesions with:

Answer 39

Topical estrogen if it is painful or deflects the stream of urine

Question 40

When do you see labial adhesions?

Answer 40

Young children and 2 years - Poor perineal hygiene with inflammation