genitalia

Question 1

in pregnancy, which hormone influences testicle descent in boys?

Answer 1

anti-Mullerian hormone

Question 2

what is the usual cause of an inguinal hernia in children (boys and girls)?

Answer 2

• patent processus vaginalis

- it’s meant to close in the womb after genital development

Question 3

a) which sex is more likely to develop an inguinal hernia?

b) which side?

Answer 3

a) males

b) right

Question 4

presentation of an inguinal hernia?

Answer 4

• intermittent groin/scrotal swelling
• appears on crying or straining
• infants might have vomiting too

Question 5

how to confirm an inguinal hernia on examination?

Answer 5

• apply pressure to the abdomen by pressing on it

- ask the child to cough

Question 6

management of inguinal hernia?

Answer 6

• surgical

- hernial sac is ligated and divided

Question 7

why is an inguinal hernia operation on a boy an emergency?

Answer 7

left untreated it will strangulate the testis

Question 8

cause of a hydrocoele?

Answer 8

patent processus vaginalis

Question 9

presentation of a hydrocoele?

Answer 9

• asymptomatic scrotal swelling
• bilateral
• bluish discolouration (sometimes)
• non-tender
• transilluminate

Question 10

age group for hydrocoeles?

Answer 10

• usually at birth

- in infants, appear post-infectious

Question 11

management of hydrocoele?

Answer 11

• most resolve w/o intervention

- surgery if persistent > 18 months of age

Question 12

what is a varicocoele made up of?

Answer 12

• dilated (varicose) testicular veins

Question 13

age demographic of varicocoeles?

Answer 13

teenage boys

Question 14

which side is more likely to develop a varicocoele?

Answer 14

left (because L gonadal vein drains into the L renal vein)

Question 15

presentation of a varicocoele?

Answer 15

• most are asymptomatic
• dull ache
• O/E: bluish, “bag of worms” feeling, testis is smaller / softer than usual

Question 16

management of a varicocoele?

Answer 16

• conservative if asymptomatic

- otherwise surgical ligation

Question 17

a) aetiology of undescended testis?

b) what does it increase the risk of?

Answer 17

a) testis gets arrested along normal path of descent embryologically
b) testicular torsion

Question 18

around which age do most undescended testis resolve themselves by?

Answer 18

• 3 months

- only 1% persist past this

Question 19

risk factor for undescended testis?

Answer 19

prematurity

Question 20

when would undescended testis usually be picked up?

Answer 20

examination of the newborn (NIPE)

Question 21

a) which investigation is done for bilateral, impalpable testes?
b) why?

Answer 21

a) karyotyping

b) to rule out disorders of sex development

Question 22

what causes retractile testis?

Answer 22

overaction of the cremasteric muscle reflex

Question 23

management of undescended testis?

Answer 23

orchidopexy

Question 24

where is the risk of malignancy in an undescended testis higher?

Answer 24

• bilateral

- intra-abdominal

Question 25

when should orchidopexy be perfomed?

Answer 25

before / around 1 year of age, in undescended testis

Question 26

a) what is the main genital emergency for boys?

b) which age?

Answer 26

a) testicular torsion

b) pre-pubescent

Question 27

presentation of testicular torsion?

Answer 27

• painful
• red, oedematous scrotal skin
• pain may localise to groin / lower abdomen

Question 28

management of testicular torsion?

Answer 28

• EMERGENCY !!!!
• must be surgically fixed within 4 hours
• fix the contralateral testis so this doesn’t get torsion too