genitalia

Question 1

why does inguinal hernia form

Answer 1

patent processus vaginalis

comes from deep ring

Question 2

what are the consequences of an incarcerated hernia

Answer 2

intestinal obstruction, strangulation of testes

Question 3

how do you distinguish between hernia and hydrocele

Answer 3

can get above hydrocele

Question 4

mx of hydrocele

Answer 4

<2 watch and wait (most resolve spontaneously as processus vaginalis closes within months)
2-11 - (hydrocele persists beyond 2 years) open surgical repair
11-18 -
idiopathic - watch and wait unless uncomfortable
post-varciocelectomy - watch and wait, surgery if they don’t recover
post - filarial - surgical excision of tunica vaginalis

Question 5

what are the 2 types of undesended testes

Answer 5

palpable - this means that they’re in groin
ectopic testes - palpable testes below external ring but not in scrotum
impalpable - may be intra abdominal or absent. if impalpable bilaterally do karyotyping (exclude disorder of sexual development - emergency)

Question 6

mx undescended testes

Answer 6

< 3 months
if possibility of disorder of sexual development (ambiguous genitalia) or bilateral impalpable - refer to paediatrician in 24 hours
if unilateral undescended at birth
review in 6-8 weeks
if still undescended review at 3 months
both descended that’s fine
one/both in scrotum but one/both retractile arrange annual follow up (risk of ascending testes)
if still undescended at this appointmetn refer to surgeon before 6 months of age

surgical mx of undescended testes:
palpable - orchidopexy
impalpable - laparascopic exploration

Question 7

complications of undescended testes

Answer 7

fertility
risk of torsion and trauma
malignancy

Question 8

mx of testicular torsion

Answer 8

if suspected immediate referral, IV fluids, NBM, antiemetics, analgesia
non-neonates - immediate surgery, fix contralateral testicle
neonates - if born with torsion discuss risks vs benefits of surgery (anaesthesia), if they develop it operate

Question 9

which side is varicocele more common on

Answer 9

Left

left gonadal drains into left renal which receives catecholamines from left adrenal so is at higher pressure

Question 10

what is torsion of appendix of testes

Answer 10

torsion of hydatid of morgan
pain develops over days not hours
not as dangerous

Question 11

mx of epipdidymo-orchitis

Answer 11

admit if systemically unwell, diabetes, immunocompromised
symptomatic relief: bed rest, scrotal elevation

empirical Abx:
STI (gonorrhea + chlamydia) - don’t wait for results, 1 IM ceftriaxone and 2 weeks doxycycline
enteric organisms - quinolone (levofloxacin)
mumps - supportive

Question 12

caueses of epididymo-orchitis

Answer 12

STI:
age <35
urethral discharge
more than 1 sexual partner in last month

gonorrheal:
previous gonorrheal infection
purulent urethral discharge
MSM

enteric:
low risk sexual hx
penetrative anal sex
recent catheter

Question 13

phimosis vs paraphimosis

Answer 13

Phimosis caused by balanitis xerotica obliterans (scarring)

paraphimosis - tight band of skin (do puncture therapy)