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53 Cards in this Set
- Front
- Back
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What else do you suspect in a girl with an ectopic urethra?
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Vesicouretral reflux
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What does VACTERLS stand for?
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V -- vertebral anomalies / dysgenesis, vascular anomalies
A -- anal atresia C -- Cardiac anomalies T -- tracheo-esophageal (T-E) fistula E -- esophageal atresia R -- renal anomalies, radial dysplasia L -- Limb anomalies S - Single umbilical artery |
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A 7yo has had microscopic hematuria and back pain for 3 months. Renal U/S revealed a 2mm stone in her right renal pelvis. His urine calcium is 6.7mg/kg/day (Normal is < 4mg/kg/day)
Of the following what would be beneficial in addition to hydration A)amilioride B) furosemide C) nothing D) spironolactone E) thiazide |
E. It blocks sodium chloride transport in the distal tubule and thus promotes sodium excretion, and hypovolemia which induces increased reabsorption of other substances like calcium, and thereby decreases stone formation.
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A one month old boy has a painless inguinal mass that transilluminates on exam. What is your suspected diagnosis?
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Hydrocele
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A six month old boy has a tender inguinal mass that appears red and is warm to touch. His urinalysis has 25-30 WBC, positive LE and positive Nitrates. What is the mass?
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Lymphadenitis
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A 2 month old boy is brought to the ED b/c mom noted a bulge in the baby's groin that increases with crying. On exam, the baby has a tender abdomen and attempts to press the mass in are unsuccessful. What is your next step?
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Call the pediatric surgeon, as this may be an incarcerated hernia.
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A 5yo is brought in because his father noted that the child has a mass in the left side of his groin. On exam your medical student describes the left testicle as a "heavy" What is this?
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Varicoclele
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A 2yo girl on peritoneal dialysis with progressive abdominal pain has some crusted edges around the catheter site and you note a large mass on the left lower abdomen just lateral to the catheter but no guarding or rebound. What is the most likely cause of her symptoms?
A) Bacterial peritonitis B) Cellulitis C) Hernia D) Incarcerated omentum E) Incarcerated hernia |
C. She is afebrile with benign exam!
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When does gynecomastia of newborns typically resolve?
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3 weeks
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A 3 month old is noted to have vaginal adhesions on exam. She was brought in because she complained that it hurt when she peed. She has no other abnormal findings. What should you do?
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Give estrogen cream.
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A 3 month old is noted to have vaginal adhesions on well child exam. She has no other abnormal findings. What should you do?
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Nothing.
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A 16yo comes in because she remains amenorrheic. Her HCG is negative. She does describe cyclic abdominal pain and a palpable bulge in the middle of her belly. On pelvic exam, she is noted to have a bluish bulging hymen. What is her diagnosis?
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Imperforate hymen
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How do you differentiate imperforate hymen from TOA?
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Imperforate hymen has palpable mass. TOA does not.
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What is hydrometrocolpos?
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It is the collection of fluid in the uterus that builds up due to an imperforate hymen.
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A 10yo girl presents with vaginal itching, pain and irritation. She also notes a nasty odor. What is the most likely cause?
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A foreign body, such as tissue paper
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True or False.
Pre pubescent girls do not present with candida infections. |
False. They can and it is usually due to recent antibiotic use.
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A 16yo girl comes in with vaginal itching. She is sexually active with one partner. She has a negative HCG. She describes green discharge. Her gonorrhea test is negative. What is this?
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Beta-hemolytic strep infection.
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A 17yo girl has recurrence of a fluid filled soft tissue mass in her vaginal area. She has no vaginal discharge or bleeding. What is this?
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Bartholin's cyst.
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How do you distinguish a bartholin's cyst from a sebaceous cyst?
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Sebaceous cysts are flesh colored, and arise from the skin while bartholin's cysts are not.
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By when should a child with an undescended testes undergo surgery?
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Before his first birthday.
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True or False.
Orchipexy for an undescended testicle will reduce infertility risk and malignancy risk. |
False. It will decrease infertility risk, but not malignancy risk.
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What is the relative risk of malignancy in the descended testicle to the undescended testicle of a boy with one undescended testicle?
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The descended has an increased risk of malignancy, but not as high as the undescended testicle.
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A 3yo is here for his first visit with you. You are unable to palpate his right testicle. You review his record and note that he has had bilaterally descended testicles. What is the best next step?
A) Let him warm up and re-examine the patient. B) Testicular U/S C) Obtain family history D) Pelvic U/S E) Genetic studies |
A) Reexamine in the cross-legged or tailor position.
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What is hypospadias?
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Displaced urethra in a male
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What are four syndromes associated with hypospadias?
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Silver Russell Syndrome
Laurence Moon Biedl Syndrome Opitz syndrome Beckwith Widemann syndrome SLOB |
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A 9mos old boy is brought to you because his father is concerned about the size of his son's penis. The mother is concerned of his poor feeding, and they are both concerned about his being realtively floppy. What is the most likely diagnosis?
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Prader-Willi Syndrome.
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A 17yo comes in because he was rejected as a call boy. The women were complaining that he has a tiny penis. He was also rejected as a food critic because he can't smell anything. He also has hypoglycemic events and has vision problems. What is his diagnosis?
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Kallman syndrome.
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For what penile length would you pursue endocrine and genetic workup of micropenis of a newborn?
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Less than 2.5cm
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A 16yo sexually active male comes in with left sided groin pain, dysuria and fever. He has not noted any testicular masses or any urethral discharge. His U/A is normal. What is the most likely diagnosis and underlying cause?
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Epididymitis due to chlamydia or neisseria gonorrhea.
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How do you distinguish orchitis and epididymitis?
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Orchitis will not present with dysuria
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A 16yo boy from Panama presents with 2 days of fever and testicular pain. The right testicle is swollen and diffusely tender with erythema of the overlying skin. There is no urethral discharge or history of dysuria. He is tanner stage 4 and denies sexual history. The testicular ultrasound reveals normal flow. What is your next step?
A) CBC and ESR B) CBC and Blood culture C) Mumps serology D) CBC E) Chlamydia culture |
C. Remember he is from abroad and may not have been immunized!
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How do you distinguish epididymitis from testicular torsion in the following categories?
1. Cremaster reflex 2. Position of the testicles 3. WBC in urine 4. Treatment |
1. Cremaster is maintained in epididymitis but not in testicular torsion.
2. Testicles are low in epididymitis but high in torsion 3. WBC are absent in torsion 4. Epididymitis requires Ceftriaxone and PO doxycycline. Torsion requires surgery. |
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What is phimosis?
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It is where tightness of the foreskin prevents retraction after the age of 3.
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What is balanitis?
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Inflammation of the penis associated with phimosis.
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A 4yo boy who is not circumcised is brought to the office because his dad noticed tiny white bumps on the tip of the boy's penis. What is the cause of these bumps?
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They are inclusion cysts which require no treatment.
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By what age should foreskin be retractable?
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Age 3yo.
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True or False.
Gram negative discharge from the urethra confirms gonococcal urethritis. |
False. Chlamydia can also present with gram negative urethritis.
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A 15yo boy who has recently had unprotected sex complains of dysuria and swelling of his foreskin. His U/A is positive for 3+ WBC and Gram stain is negative. You also note conjunctivitis on exam. What additional finding would you expect on exam? What is the underlying cause?
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Arthritis. This is Reiter's syndrome due to chlamydia.
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A 16yo girl has flesh-colored, non-tender, verrucous lesions that bleed with minor trauma. See the image.
What is she at risk for? |
This is condyloma acuminata. It is due to HPV. She is at risk for cervical cancer.
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What is the cremasteric reflex?
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It is the natural tendency of the scrotum and testicles to rise upon stroking the inner thigh.
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What are these smooth, flesh colored lesions?
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Molluscum. They are caused by a pox virus and last up to 5 years and are contagious but are completely benign.
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What are these whitish gray papules. What causes them?
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Condyloma lata caused by syphillis
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A 4yo is noted to have anogenital warts on well visit exam. What is your suspicion?
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Child abuse
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A 2yo is noted to have anogenital warts on well visit exam. What is your suspicion?
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Congenital transmitted condyloma acuminata. This can be attributed to birth canal exposure upto age 3yo.
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A 14yo boy has a painful penile ulcerative lesion and tender inguinal lymph nodes. What is the most likely diagnosis and treatment?
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HSV. Treat with po acyclovir.
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A 14yo boy has a painful recurrent oral vesicular lesions What is the most likely diagnosis and treatment?
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HSV. Treat with po acyclovir.
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A sexually active 17yo has multiple vesicular painful penile lesions. What is your best diagnostic step?
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Viral culture for HSV
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A 7yo is brought in with red, crusted suprapubic macules and blue-gray dots. This is the image. What is this?
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Pediculosis pubis. Crabs.
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True or False.
Pubic lice in any child should raise suspicion of abuse. |
True
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What are the three criteria for PID?
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Adenexal tenderness
Cervical motion tenderness Lower abdominal pain. |
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A 14yo has RUQ pain and nausea and vomiting. OCPs are her only medication. What is the best first step in making a diagnosis?
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Pelvic exam for cervical cancer.
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A 17yo girl has left sided abdominal discomfort. There is a ovarian cyst, not abscess, on the left ovary. What do you do if the cyst is > 6cm? What if it is < 6cm?
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If< 6cm follow with ultrasounds. If > 6cm > laproscopic cyst aspiration.
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A 15yo has suddent lower abdominal pain radiating to her back and left leg. She also has nausea and vomiting. What do you suspect is her problem? What is your diagnostic test and management?
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Ovarian torsion. Get a doppler pelvic ultrasound and then surgically remove.
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