Gastrointestinal and Genitourinary Emergencies
This domain covers the common and the can't-miss: gastroenteritis and dehydration, intussusception, malrotation with volvulus, appendicitis, and the acute scrotum. Candidates must assess dehydration severity clinically and know the principles of oral versus intravenous rehydration. Recognize bilious vomiting in a neonate as a surgical emergency until proven otherwise.
Genitourinary content includes testicular torsion, which requires urgent surgical consultation, and the distinction between torsion and epididymitis. Understand urinary tract infection presentations by age and the approach to abdominal pain in adolescents, including pregnancy testing.
Traps: attributing bilious vomiting to gastroenteritis; delaying surgical consultation in testicular torsion; and missing dehydration in a child with normal-appearing vital signs. Another trap is failing to consider pregnancy in an adolescent with abdominal pain.
Worked example: a neonate with bilious emesis should be evaluated urgently for malrotation with volvulus, including imaging and surgical consultation, rather than observed for gastroenteritis. Rule of thumb: bilious vomiting in a neonate and acute scrotal pain are surgical emergencies until excluded. For dehydration, use clinical signs-capillary refill, mucous membranes, tears, mental status-to guide rehydration strategy.