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Flashcards in pediatric GU/ GYN Deck (40):
1

Definition of secondary enuresis

dry for more than 6-12 months and begin wetting

2

management of functional enuresis and medications

enuresis alarm
positive reinforcement (star chart)
Bladder control training (geared to bladder holding more urine)
Medications- imipramine one hour before bedtime x one week
Desmopressin
Oxybutynin
hypnosis
parent education

3

Organisms typical for UTI

E.coli (uncomplicated)
Staphyloccus (complicated)

4

Predisposing factors to UTI

Urinary stasis, congenital or acquired obstructive lesions, non-obstructive causes (e.g. neurogenic bladder, poor hygiene, constipation, and sex)

5

s/sx of UTI in infants

May have no s/sx, weight loss, FTT, dehydration, irritability

6

labs/diagnostics for UTI

a straight cath or bladder tap for c&s is indicated in those who cannot void voluntarily (clean catch may be used for mild symptoms or follow-up_
UA: leukocytes, erythrocytes, nitrates
Leukocytosis in the complete blood count

7

What oral anx do you use for UTI

ORAL ANTIBIOTICS FOR 10-14 days
trimethoprim/sulfa is first choice
cephalosporins
amoxicillin
sulfisoxazole
nitrofurantoin

8

When do you follow up after initiating treatment for UTI

follow up in 2 days, change antibiotic if no improvement seen
Follow up with UA in 1-2 weeks, then every one to three months for 1 year

9

What do you do for infant with UTI

hospitalized

10

a renal u/s after first UTI is indicated if

febrile infants
children 2-24 months old

11

What can high-grade vesicoureteral reflux (VUR) result in?

renal scarring, eventual hypertension, and renal failure

12

What age is best for surgery for hydrospadias

6-12 months

13

what kind of testicular abnormality is common in premature infants?

cryptorchidism (undescended testes)

14

What is crytorshidism?

absense of 1 or more testes from the scrotal sac due to failure to descend from abdomen in utero

15

When do you refer to urology for cryptochidism?

at 1 year old

16

What age do you teach males about testicular self-exam?

at 11/12 yo

17

What is testicular torsion

Twisting and strangulation of the spermatic cord characterized by acute pain; constitutes a surgical emergency to prevent necrotic testicle and infertility

18

s/sx of testicular torsion

acute profound pain
lack of irritating voiding symptoms
no infx/fever,
the affected tested may have a high lie
PAIN IS NOT RELIEVED By ELEVATING THE SCROTUM

19

Management of dysmenorrhea

1) education
2)proper diet
Heat application
psychological support
OTC analgesics (ibuprofen) 400mg every 4-6 hours beginning at onset of menstrual cycle and continuing for 24-72 hours
Stronger NSAIDS for moderate/severe
ORAL CONTRACEPTIVES
referral as needed

20

What is secondary dysmenorrhea?

results from underlying cause such as pregnancy, PID, endometriosis

21

When might primary dysmenorrhea begin?

6-12 months after menarche

22

How do you diagnose chlamydia

Culture is the most definitive but takes 3-9 says
Urine enzyme immunoassay EIA for screening: REsults in 30-120 minutes, low cost

23

treatment of chlamydia

azithromycin (zithromax) 1 gram orally in a single dose or
doxycycline (vibramycin) 100mg orally BID for 7 days

24

Hallmark of gonorrhea infection

mucopurulent vaginal discharge

25

diagnostics for gonorrhea

gram stain of discharge whose gram negative diplococci and WBCs, cervical culture using thayer-martin or transgrow media

26

treatment of gonorrhea

Ceftriaxone (rocephin) IM x1
Azithromycin (Zithromax) 1 gram orally x1 to cover chlamydia
doxycycline 100mg orally BID for 7 days
co-treat for chlamydia
all contacts should be treated
Report to HD

27

Syphilis organism

treponema pallidum; a spirochete

28

Stage I of syphilis

Primary; Chancre present at site of inoculation 2-6 weeks after exposure, CHANCRE INDURATED AND PAINLESS, regional lymphadenopathy

29

secondary stage of syphilis

secondary: occurs 6-8 weeks after primary, flu-like symptoms, generalized lymphadenopathy, generalized muculopapular rash especially on hand and soles

30

latent syphilis

seropositive by asymptomatic, about 1/2 of untreated cases develop tertiary

31

Tertiary syphilis

leukoplakia, cardiac insufficiency; aortitis, aneurysms, aortic regurgitation
infiltrative tumors of the skin, bones and liver
CNS involvement: meningitis, hemiparesis, hemiplegia, others

32

serological testing for syphilis

screening with non-treponemal antibody tests: Venereal disease research lab (VDRL) and or the RPR
CONFIRMED by treponemal tests: Fluorescent treponemal antibody absorption (FTA-ABS) or microhemagglutination assay for antibody to trepnema palladium (MHA-TP)

33

Management of syphilis

PCN or doxy or erythromycin for PCN allergic, report

34

BV diagnostics

wet mount shows Clue cells: epithelial cells covered with bacteria appear stippled with poorly defined borders
Positive amine "whiff" test when KOH added

35

BV treatment

metronidazole or clindamycin PO or intravaginal

36

Herpes s/sx

Initial: Fever, malaise, dysuria, painful/pruritic ulcers for 12 days
Recurrent: less painful puristic ulcers for 5 days

37

diagnostics for herpes

PAP or tzanck stain
Viral culture is most definitive

38

Treatment options for herpes

acyclovir topical oral or IV, pregnancy category b, can use as young as 6 months old
Valacyclovir- especially for the asymptomatic viral shedding of HSV-2

39

What tests do you use for infants vs older children for HIV

infants- HIV PCR
For older children- the enzyme linked immunosorbent assay (ELISA)

40

What is the confirmatory test for HIV

The western blot test is confirmatory