I pray someone reads this before my test Tuesday!

[HalcyonDays]

Just some last minute questions/conflicting sources that I hope can be sorted out before my exam.

1.)Cryptochidism - should the surgery take place at 6 months or 1 yr? I have seeing varying answers to this. World vignette says 6 months...Crush says 1 yr. Neither of which decreases the risk of future testicular cancer but Crush says wait because they could descend on their own while World seems to say they aren't going to descend if they haven't by 6 months.

2.)Anaphylactic Shock - World had a vignette where they ask you whether the epinephrine should be delivered IV or SubQ. The answer was IV I believe b/c you can control the levels better. However, I'm doubting that since I've seen SubQ in other sources.

Thanks!!

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[Blade28]

2.)Anaphylactic Shock - World had a vignette where they ask you whether the epinephrine should be delivered IV or SubQ. The answer was IV I believe b/c you can control the levels better. However, I'm doubting that since I've seen SubQ in other sources.

You mean IM, right?

The traditional method of delivering epinephrine for anaphylaxis is subcutaneously. Recently studies are looking at IM injections for quicker absorption and higher serum levels of epinephrine. But that's still being investigated now.

Bottom line: I'd pick the subcutaneous route. Remember that you want to give it immediately, and many people in anaphylactic shock don't have IV access readily available (e.g. someone with a bee or peanut allergy!).

If someone goes into anaphylaxis and you spend five minutes trying to place an IV first...well that's just bad.

 

[psychman]

for cryptochidism, you make the referral around 6 mos as the chances of testes descending diminish after 6 mos. Surgery is usually done anywhere between 1-2 years of age. CA risk remains high, but fertility is what one is trying to save. you will either get a case that patient is 3 mos old with undescended testes, what do you do...observe & recheck in few mos....or a 10 mos old with same situation...refer to urologist.

 

[Path or bust]

for cryptochidism, you make the referral around 6 mos as the chances of testes descending diminish after 6 mos. Surgery is usually done anywhere between 1-2 years of age. CA risk remains high, but fertility is what one is trying to save. you will either get a case that patient is 3 mos old with undescended testes, what do you do...observe & recheck in few mos....or a 10 mos old with same situation...refer to urologist.

Yup. Also, apparently even the normally descended testis in these individuals will have an increased risk for testicular cancer (most commonly seminomas). While orchioplexy will decrease their risk of infertility, its questionable whether it decreases their risk of cancer. These kiddos should do testicular self-exams most of their life.