Peds Emergency: Gu/gyn

Front 1

what are the painless scrotal lesions?

Back 1

hydrocele, speratocele, varicocele, hernia, testicular tumor, idiopathic scrotal edema

Front 2

what are the painful scrotal lesions?

Back 2

torsion of the spermatic cord or appendix of the testis, epididymitis, orchitis, trauma, hernia, HSP, cellulitis, folliculitis

Front 3

how does epididymitis occur?

Back 3

pathogens reach epididymis thru lumen of the vas deferens from infected urine, posterior urethra, or seminal vesicles

Front 4

what are the etiologies of epididymitis?>

Back 4

infants/young children, GU tract abnormalities, STIs (GC, Chlamydia, e coli)

Front 5

ToF: epididymitis is always from an STI

Back 5

FALSE

Front 6

ToF: epididymitis is common from trauma

Back 6

FALSE

Front 7

what is the clinical presentation of epididymitis?

Back 7

(+) history of sex, associated urethritis, gradual onset of pain and tenderness, dysruia, urethral d/c, fever (50%), NV are not common

Front 8

what is seen on exam for epididymitis?

Back 8

discharge, tender scrotum, hydrocele, palpable swelling,

Front 9

what are the uncommon complications of epididymitis?

Back 9

testicular necrosis or atrophy, infertility

Front 10

how is epididymitis dx?

Back 10

UA and U c&s, urethral cultures, GU eval, sonogram and radionuclear scanning

Front 11

what is the tx for epididymitis?

Back 11

bactrim, STI tx if that is the cause, cephalosporin if enteric organism idenitified

Front 12

what is testicular torsion?

Back 12

twisting of the spermaticord

Front 13

how does testicular torsion occur?

Back 13

when free-floating testis rotates on the spermatic cord and occludes blood supply, may be spontaneous or after trauma

Front 14

when are the common times for testicular torsion?

Back 14

newborn period and at puberty

Front 15

ToF: a significant number of men > 21 get testicular torsion

Back 15

TRUE

Front 16

what are the perinatal symptoms of testicular torsion?

Back 16

scrotum appears swollen and erythematous or bluish, typically non-tender mass is palpable in afffected hemiscrotum

Front 17

what are the symps of testicular torsion in older children?>

Back 17

sudden onset of testicular pain, little swelling or tenderness, lower abdominal pain, NV, no fever dysuria or discharge

Front 18

what are the PE aspects for testicular torsion?

Back 18

rapid exam, skin usually erythematous and taut w/o normal rugae, testes high in scrotum, epididymis will not be in typical posistion, vas deferens is tender, CREMASTERIC REFLEX ABSENT!

Front 19

what are the dx tests for testicular torsion?

Back 19

UA (90% are normal), doppler US (absent testicular arterial pulsations), nuclear scan (decreased perfusion), scrotal US (does not differentiate epididymitis from torsion)

Front 20

ToF: a scrotal US can differentiate epididymitis from torsion

Back 20

FALSE

Front 21

what is the exam of choice to assess for torsion?

Back 21

Doppler

Front 22

ToF: testicular torsion is a urologic emergency

Back 22

TRUE

Front 23

ToF: most testicular tumors are germ cell and malignant

Back 23

TRUE

Front 24

what is the most common testicular tumor in prepubertal males

Back 24

teratomas

Front 25

what are the most common testicular tumors in males after puberty?

Back 25

seminomas

Front 26

what are the other forms of testicular tumors?

Back 26

embryonal cell carcinomas, choriocarcinomas, sertoli cell tumors and leydig cell tumors

Front 27

what should be considered in any male w/ firm, painless mass associated with testis?

Back 27

tumor

Front 28

how will a testicular tumor appear with transillumination?

Back 28

solid

Front 29

what is a varicocele?

Back 29

dilated plexus of scrotal veins situated above the testes in the scrotum

Front 30

what is the pathogenesis of varicocele?

Back 30

due to valvular incompetence of the speratic vein

Front 31

a varicocele occuring on the __ side does not need a work up?

Back 31

left

Front 32

what does a varicocele on the right mean?

Back 32

may represent acute venous obstruction from a tumor or intra abdominal pathology

Front 33

ToF: bilateral varicocele are completely rare

Back 33

false, more common than thought

Front 34

how does a varicocele feel?

Back 34

a bag of worms

Front 35

what does a varicocele look like?

Back 35

bluish discoloration which is visible thru the scrotum, prominent when pt is standing, collapses when sitting or supine,

Front 36

tof: varicocele is asymptomatic and testis is non tender

Back 36

TRUE

Front 37

how might a varicocele feel

Back 37

mild pain with heaviness of the scrotum

Front 38

how do you dx varicocele?

Back 38

have pt valsalva while standing, palpate testes, rectal exam: prostate size may shrink w/ testoterone deficiency occurs at times w/ varicocele. US,

Front 39

what is the work up for right sided varicocele?

Back 39

Venography: gold standard, doppler, consult specialist regarding fertility

Front 40

describe a speramatocele.

Back 40

painless, cystic mass containing sperm, located in upp portion of epidiymis, usually smooth, cystic sac and located above and posterior to testis

Front 41

what is the tx for spermatocele

Back 41

none, not needed

Front 42

what is DUB?

Back 42

Dysfunctional uterine bleeding: painless irregular vaginal bleeding that is anovulatory in nature, occurs more often than menses and stays for prolonged period,

Front 43

what is the criteria for dx of DUB?

Back 43

must be painless vaginal bleeding

Front 44

what is the tx for mild DUB?

Back 44

hgb > 11: reassure, educate, offer iron and low dose OCP, reevaluate in 3 months

Front 45

what is the tx for moderate DUB?

Back 45

hgb 9-11: educated, rule out STD and coagulopathy, offer iron and low dose OCP taper, reeval in 2 months

Front 46

what is the st for severe DUB?

Back 46

hgb 7-9: r/o coagulopathy. Offer iron and high dose OCP taper, reeval in 4 weeks

Front 47

what is the tx for DUB with hypovolemic shock?

Back 47

hgb <5-6: stabilize, r/o coag. Offer transfusion, admit for high dose hormones until VB stops (IV or po route). D&C or balloon tamponade in extreme cases

Front 48

ToF: you can get DUB again following a balloon tamponade tx

Back 48

TRUE

Front 49

what are the symptoms of an ectopic?

Back 49

severe LLQ pain, abdominal pain, vomiting, dizziness, and vaginal bleeding, sexually active female, occurs 6-8 weeks from LMP

Front 50

what are the symptoms of a threatened abortion?

Back 50

hx compatible with early pregnancy, bleeding w/ or w/o cramping, and Os is closed

Front 51

what is a complete abortion?

Back 51

embryo and placenta are completely expelled from uterus

Front 52

what is an incomplete abortion?

Back 52

fragments of placenta remain in uterus, prolonged bleeding and cervical dilation, continued cramping

Front 53

what is a missed abortion?

Back 53

fetal death in utero before 20th week, pregnancy is retained, no bleeding, Pt is amenorrheic w/ or w/o uterine growth, requires removal

Front 54

what are the risk factors for ectopic?

Back 54

hx of PID in past, previous ectopic, getting pregnant while on OCPs

Front 55

what is seen on PE for ectopic?

Back 55

abdominal, pelvic and cervical motion tenderness, adnexal mass may be felt, discrepancy b/w uterine size and expected size based on LMP or BHCG

Front 56

what is the ED management of ectopic?

Back 56

must ID it, CBC, BHCG, type and cross, 2 large bore Ivs, get blood hung asap, get to OR asap

Front 57

ToF: zithromax is used often in PID treatment

Back 57

FALSE

Front 58

PID is an ___ microbial genital infection that occurs in sexually active females

Back 58

ascending

Front 59

What are the usual causes of PID?

Back 59

GC and chlamydia, but the micro flora from vagina and bowel may contribute

Front 60

what are the risk factors for PID?

Back 60

child and adolescents due to antamoy and physiology, # of partners, new partners w/I 3 months, # of STDs, Past hx of PID, IUDs, Douching, early in monthly menses

Front 61

what are the protective factors against PID?

Back 61

pregnancy, use of barrier method contraception, OCPs

Front 62

ToF: PID is largely dx clinically

Back 62

TRUE

Front 63

what are the minimum criteria for PID?

Back 63

lower abdominal tenderness, adnexal tenderness, cervical motion tenderness

Front 64

what are the additional criteria for PID dx?

Back 64

oral temp 38.3 (100.9), lab documentation of cervical infection w/ GC or chlamydia

Front 65

what is the definitive dx criteria for PID?

Back 65

histopathologic evidence of endometriosis on biopsy, transvaginal US or imaging study showing thickened, fluid filled tubes w/ or w/o free fluid, tubo ovarian complex/abscess or laproscopic abnormalities consisten w/ PID

Front 66

what is the management for PID?

Back 66

broad spec abx, consider hospitalization, no azith

Front 67

what is the parentarel regimen A guideline for PID?

Back 67

cefotetan 2G IV q 12 h or Cefoxitin 2g IV q 6 PLUS doxy 100mg IV or oral q12

Front 68

what is the parenteral regimen B for PID?

Back 68

clinda 900mg IV q8 PLUS gent loading 2mg/kg followed by 1.5mg/kg q8 maintenance

Front 69

what is the PO regimen A for PID?

Back 69

ofloxacin 400 mg BID x 14 days PLUS metronidazole 500mg BID x 14 days

Front 70

what is the regimen B PO for PID?

Back 70

cetriaxone 250 mg IM or cefoxitin 2gm IM + probenecid 1g orally x one PLUS doxy 100mg BID x 14 days

Front 71

what is the reg C PO for PID?

Back 71

3rd gen ceph plus doxy 100mg BID x 14 days

Front 72

what is reg C IV for PID?

Back 72

Ofloxacin 400mg IV q 12 PLUS metronid 500mg IV q8 OR Amp/sulbactacm 3g IV q6h

Front 73

what can you give a pregnant woman with PID?

Back 73

erythro PO for 14 days

Front 74

how long must a pt be afebrile to be discharged?

Back 74

48 hours