Pediatric

Question 1

testicular torsion
age distribution
classification

Answer 1

bimodal

vaginal

Question 2

testicular torsion

salvage rates

Answer 2

parabola

Question 3

Regarding circumcision to prevent UTI in boys:
NNT if:
normal boys
hx of recurrent UTI
hx of high grade VUR

Answer 3

111
11
4

Question 4

incidence of hypospadias

Answer 4

1 in 300 male births

Question 5

risk factors of hypospadias

Answer 5

FHx
LBW
IVF

Question 6

when does genital ridge form?

Answer 6

5th week

Question 7

when does primitive sex chords form?

Answer 7

6th week

Question 8

when does paramesonephric ducts form?

Answer 8

6th week

Question 9

when does Sertoli cells form?

Answer 9

7th week

Question 10

when does Sertoli cells release AMH?

Answer 10

8 - 10th week

Question 11

when does Leydig cells form?

Answer 11

10th week

Question 12

Timeline for testicular descent

Answer 12

8 - 12th: urogenital ridge to internal ring

24 - 30th: to scrotum

Question 13

Among true UDT:
palpable ___%
non-palpable ___%: among which ___% intraabdominal

Answer 13

80%

20% ; 40%

Question 14

UDT incidence in = ?
Full term: _
Pre-term: _

Answer 14

3.7%

30%

Question 15

How many of UDT will descend after birth?

Answer 15

70% will descend by 3 months (i.e. 1 % at 3m)

Question 16

UDT - risk factors

Answer 16

preterm
LBW
NM disorders
hypospadias
FHx (14% has)

Question 17

what is Prentiss maneuver?

Answer 17

divide inferior epigastric vessels

transpose the spermatic cord for a straighter course

Question 18

Cutoff for bladder capacity : age 4 - 12

Answer 18

(age + 1 ) x 30

Question 19

Cutoff for PVRU
age 4 - 6
age 7 - 12

Answer 19

4 - 6: < 20ml

7 - 12: < 10ml

Question 20

what is associated with bifid clitoris wrt incontinence?

Answer 20

epispadias

Question 21

Nocturnal enuresis: T / F
More common in boys
Patients have normal sleep architectures

Answer 21

TRUE

TRUE

Question 22

incidence of CAKUT congenital anomalies of kidney and urinary tract

Answer 22

1 in 500

Question 23

Prune belly syndrome:
incidence
triad = ?
urinary tract anomalies = ?

Answer 23

1 in 40,000
absent abd wall musculature, urinary tract anomalies, bilateral UDT
hypoplastic prostate, megalourethra, distended bladder/ureters, renal dysplasia

Question 24

postulated cause of prune belly syndrome?

Answer 24

in utero posterior urethra obstruction

Question 25

natural hx of PUJO in children

Answer 25

GOSH 60% stable RFT despite obstruction 25% resolves 15% pyeloplasty

Question 26

PUJO: chance of requiring surgery based on AP diameter >5cm >3cm <2cm

Answer 26

100% 55% 1%

Question 27

incidence of duplex

Answer 27

1 in 125

Question 28

F : M ratio for VUR

Answer 28

5 : 1

Question 29

what is Paquin's law

Answer 29

submucosal length : diameter = at least 5 : 1

Question 30

what is ICVUR

Answer 30

international classification of VUR

Question 31

``` Natural history of VUR: Most common grade: __ Spontaneous resolution of grade III: _ Spontaneous resolution of grade IV: _ Spontaneous resolution of grade V: _ ```

Answer 31

II 46% 9% 0%

Question 32

Regarding CAP for VUR: what dose and how to take? what drug?

Answer 32

1/4 therapeutic dose taken nocte < 6wk: augmentin > 6wk: septrin

Question 33

Result of RIVUR study

Answer 33

septrin reduces risk of recurrent febrile UTIs by 45%

Question 34

Result of Swedish Reflux Trial

Answer 34

CAP reduces new renal dmg

Question 35

Result of International Reflux Study on Children IRSC

Answer 35

surgery more effective than CAP in preventing pyelonephritis (10% vs 20%)

Question 36

what is the technique for Deflux injection?

Answer 36

Double HIT hydrodistension implantation technique

Question 37

what ureteric implantation techniques?

Answer 37

extra-vesical (Lich Gregoir) | intra-vesical (cross trigonal - Cohen) (high medial - Leadbetter)

Question 38

embryology for posterior urethral valve

Answer 38

abnormal confluence of mesonephric duct and urogenital sinus

Question 39

Poor prognostic factors for PUV: pre-natal post-natal

Answer 39

pre: early present, oligohydramnios, high fetal urine B2-microglobulin post: high Cr, bilateral VUR, proteinuria, poor complaince bladder

Question 40

incidence of horshoe kidney

Answer 40

1 in 400

Question 41

horseshoe kidney : T / F | More common in male

Answer 41

TRUE

Question 42

horsehoe kidney: associated with ___ embryology : ?

Answer 42

Turner syndrome | abnormal medial fusion of metanephric blastema

Question 43

what is bladder exstrophy

Answer 43

failure development of lower abd wall | resulting from failure of mesoderm to migrate into cloacal membrane

Question 44

features of bladder exstrophy

Answer 44

``` bladder plate, adjacent to umbilicus pubic diastasis rectus divarication separated corpora / bifid clitoris Not associated with other anomalies ```

Question 45

Congenital adrenal hyperplasia: what enzyme problem? what specific test?

Answer 45

21-hydroxylase deficiency | 17-hydroxy progesterone (high)

Question 46

Incidence of Wilms tumor HK UK

Answer 46

2.3 / mil | 5 / mil

Question 47

WAGR syndrome component

Answer 47

WT Aniridia GU abnormalities Retardation

Question 48

WT1: Ch = ? Associations = ?

Answer 48

11p WAGR Denys-Drash syndrome

Question 49

WT2: Ch = ? Association = ?

Answer 49

11p | BWS

Question 50

Pathology of WT = ?

Answer 50

Blastema Epithelial Stroma

Question 51

WT: unfavourable histological subtypes

Answer 51

anaplastic clear cell rhabdoid

Question 52

WT: most common site of mets calcification on imaging: _

Answer 52

Lung | 15% only (vs. 90% in neuroblastoma)