A 5-year-old boy develops the acute onset of testicular pain. There is no fever or history of trauma. You are considering both testicular torsion and orchitis.
Which of the following is false?
Correct Answer B:
Torsion is much more common than orchitis in childhood and this should be kept in mind when considering the diagnosis of testicular pain.
A. Elevation of the testicle results in pain relief in epididymitis and orchids but not improve torsional pain.
C. Only a few hours remain for intervention before irreversible damage occurs.
D. In this patient orchitis is most likely caused by viral infections, which would not respond to antibiotic treatment.
(In mumps orchitis, 4 out of 5 cases occur in prepubertal males (younger than 10 years). In bacterial orchitis, most cases are associated with epididymitis (epididymo-orchitis), and they occur in sexually active males older than 15 years or in men older than 50 years with benign prostatic hypertrophy)
E. As mumps is a primary cause of orchitis, the widespread use of this vaccine has decreased the number of cases of orchitis.
A 9-year-old boy has been referred to you for evaluation of bedwetting. He is dry during the day but wets every night. His physical examination and urinalysis are normal.
Which one of the following is the most appropriate initial method for managing this child?
Correct Answer E: Nocturnal enuresis is urinary incontinence during sleep. The child is counseled about the etiology and prognosis of enuresis, the aim of which is to remove blame and guilt. The child assumes an active role, including talking to the physician, urinating before going to bed, recording wet and dry nights, and changing wet clothing and bedding himself.
The child should not consume fluids during the 2 to 3 hours before bedtime, and caffeinated beverages should be strictly limited. Positive reinforcement is given for dry nights (eg, a star calendar, other age-appropriate rewards).
In addition to counseling, enuresis alarms are effective and often recommended simultaneously. Drug therapy can be effective in patients unresponsive to counseling and alarms. Short-term treatment (4 to 6 weeks) with desmopressin acetate nasal spray (a synthetic analog of ADH) is typically used in patients ≥ 6 years with persistent, frequent nocturnal enuresis.
A 5-year-old boy is brought to the office by his mother because of recurrence of bed-wetting at night. He has a 3-month-old sister who is healthy. Physical examination is normal. Urinalysis shows:
Which of the following is the most important information to share with his parents?
In the absence of an organic etiology, emotional stress (possibly arising from the arrival of a new sibling) is the most likely etiology of this child’s secondary enuresis. Complete urinalysis is essential in eliminating disorders such as urinary tract infections, diabetes mellitus, and diabetes insipidus. Most episodes of nocturnal enuresis are self-limited, and may not require additional therapy.
The timing of the boy’s bed-wetting is significant. He has just suffered a major disruption to his world, the birth of a sibling, and may be regressing in reaction to this event. Certainly this behavior is likely to refocus his parent’s attention on him, which may be what he is seeking at an unconscious level. At any rate, the most logical advice from the physician should be reassurance that the bed-wetting will go away, especially if the parents reassure the boy of their continuing love for him.
A 5-year-old boy frequently wets his bed with foul smelling urine. His parents are concerned and would like to know what they can do to prevent this. After obtaining a complete history and physical examination, which were both unremarkable, which of the following is an appropriate next step?
Correct Answer A:
Nocturnal enuresis is a common problem that can be troubling for children and their families. Recent studies indicate that nocturnal enuresis is best regarded as a group of conditions with different etiologies. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion.
During the second year of life, children start to develop the ability to voluntarily relax the external urethral sphincter and initiate voiding, even in the absence of the desire to void. By approximately age 4 years, all children with normal bladder function should have acquired this ability.
The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis. Urinalysis is the most important screening test in a child with enuresis. If the findings of the physical examination and urinalysis are negative and the history does not suggest a secondary cause of nocturnal enuresis, no further work-up is needed. If urinalysis reveals evidence of infection, the child should be evaluated for vesicoureteral reflux. Given our patient's history of present illness (foul smelling urine), UA (choice A) would be the best answer.
Treatment options include nonpharmacologic and pharmacologic measures. Continence training should be incorporated into the treatment regimen. Use of a bed-wetting alarm has the highest cure rate and the lowest relapse rate; however, some families may have difficulty with this treatment approach. Desmopressin and imipramine are the primary medications used to treat nocturnal enuresis, but both are associated with relatively high relapse rates.
An 8-year-old boy who has been continent of urine between the ages of 4 and 5 years comes in because of recent onset of enuresis.
Which of the following statements is false?
Correct Answer B: Nocturnal enuresis is a common problem that can be troubling for children and their families. A genetic component is likely in many affected children. Research also indicates the possibility of two subtypes of patients with nocturnal enuresis: those with a functional bladder disorder and those with a maturational delay in nocturnal arginine vasopressin secretion. The evaluation of nocturnal enuresis requires a thorough history, a complete physical examination, and urinalysis.
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