Genital disorders, OB/GYN, STDs

Question 1

Dx and management of indirect inguinal hernia

Answer 1

• Inguinal or testicular mass
• Failure of processuus vaginalis in boys or canal of Nuck in girls to close
• Originates above inguinal ligament and extends to vulva in girls or hemiscrotum in boys
• If reducible, non-urgent but timely referral to surgery. If not reducible, emergent referral to surgery.

Question 2

Causes of inguinal mass

Answer 2

• Retractile or undescended testes in boys
• Lymph node(s)
• Tumor (rare)

Question 3

Most common cause of malodorous vaginal discharge in young girl

Answer 3

• Retained FB

- Exam under anesthesia often required

Question 4

Symptoms of rectovaginal fistula

Answer 4

• Malodorous vaginal discharge
• Recurrent UTI
• Passage of feces through vagina

Question 5

Physiologic phimosis

Answer 5

• Quite common up to 5-6 years

- No need to clean under prepuce until foreskin is retractile

Question 6

Penile epidermal inclusion cysts

Answer 6

• Small, white, benign bumps on glans

Question 7

Balanitis

Answer 7

• Inflammation/infection of the glans

- If occurs prior to age 3, associated with phimosis

Question 8

Signs/symptoms of testicular torsion

Answer 8

• Testicular pain
• Absence of cremasteric reflex
• Increased pain when scrotum elevated

Question 9

Torsion of appendix testes or epididymis

Answer 9

• Testicular pain
• Blue dot sign
• Benign
• Tx with NSAIDs

Question 10

Epididymitis

Answer 10

• S/S: dysuria, increased urinary frequency, fever, pain at epididymis, urethral discharge
• Causes: Prepubertal = postviral; may be caused by E.Coli from spread to urethra, though relatively uncommon. Sexually active males: chlamydia, gonorrhea, E. Coli (esp if history of anal sex).
• Tx: If sexually active, Rocephin + Azith (or doxy), scrotal support, rest, NSAIDs. If enteric, ofloxacin or levofloxacin.

Question 11

Orchitis

Answer 11

• S/S: testicular pain, possible fever. NO discharge or dysuria.
• Etiologies include MUMPS and other viruses. May be 2/2 epididymitis.
• If testicular atrophy is present, there is INCREASED RISK OF CANCER.
• If both sides involved, increased risk of infertility.