GU

Question 1

Inability to retract foreskin

Answer 1

phimosis

Question 2

At what age can you physiologic ability to retract foreskin

Answer 2

Birth(4%)
10yo(50%)
12yo(99%)

Question 3

Pathologic causes of retractable foreskin

Answer 3

• Early forcible retraction

* Fibrosis secondary to infection

Question 4

Sxs of phimosis

Answer 4

• Inability to retract foreskin after previously being retractable
• Painful erection
• Bleeding/irritation
• Dysuria
• Recurrent infections

Question 5

Tx phimosis

Answer 5

• Stretching exercises
• Topical corticosteroid
• Circumcision

Question 6

Phimosis pt educ

Answer 6

• Dont retract 6mo
• Clean w/ mild soap & water
• Return foreskin to natural position

Question 7

Retracted foreskin in uncircumcised male that can’t be returned to natural position

Answer 7

Paraphimosis (EMERGENT)

Question 8

Pathophys of paraphymosis

Answer 8

Entrapment -> impaired venous flow -> engorgement -> arterial compromise

Question 9

Causes of paraphimosis

Answer 9

• Forcible retraction
• Infection/inflammatin
• GU procedure
• Sexual activity/trauma

Question 10

Sxs paraphimosis

Answer 10

• Swelling
• Pain
• Irritability (infant)

Question 11

Exam findings paraphimosis

Answer 11

• Edema & tenderness of glans
• Painful swelling of retracted foreskin
• shaft unaffected
• color change if ischemia present

Question 12

Tx paraphimosis

Answer 12

• Manual reduction

* Surgical intervention by urology

Question 13

Surgical removal of foreskin

Answer 13

Circumcision

Question 14

6 step circumcision procedure that leaves glans exposed during recovery

Answer 14

Gomco

Question 15

3 step circumcision procedure that leaves plastic covering on glans during recovery

Answer 15

Plastibell (preferred by moms)

Question 16

Congenital ventral displacement of urethra (looks like it is sucked back in)

Answer 16

Hypospadias

Question 17

When is hypospadias Dx made

Answer 17

New born exam

Question 18

Exam findings

Answer 18

• Abn foreskin
• Abn penile curvature (chord)
• Second opening

Question 19

Further eval for hypospadias/chordee

Answer 19

• Family Hx
• Normal penile length (2.5-3.5cm)
• Check for penile curvature
• Look for disorders of sexual devt

Question 20

Tx Hypospadias/Chordee

Answer 20

• Urology (surgical repair at 6mo)

* DONT CIRCUMCISE DURING NEW BORN PERIOD

Question 21

Testes not within scrotum and hasn’t spontaneously descended by 4mo

Answer 21

Cryptorchidism

Question 22

Cryptorchidism increases risk of

Answer 22

• Testicular torsion
• Subfertility (correct by 1yo)
• Testicular cancer

Question 23

Cryptorchidism terminology

Answer 23

• Absent (agenesis/atrophy)
• Undescended (stopped short along path)
• Retractile (overactive cremasteric reflex)
• Ascending testes
• Ectopic

Question 24

Clinical presentation of cryptorchidism

Answer 24

Absent uni/bilat testicle w/ flat scrotum

Question 25

Cryptorchidism exam

Answer 25

* Check if unilat/bilat | * Check if testicle is palpable in canal (watch and wait)

Question 26

Cryporchidsm Tx

Answer 26

* Spontaneous decent 6mo * Refer if; - non-palpable undescended testes - Ascending testes beyond infancy - Atrophic testis - Difficulty differentiating bt undescended, retractile, ectopic

Question 27

Twisting of spermatic cord due to poorly anchored testicle -> vascular compromise

Answer 27

Testicular torsion (EMERGENT)

Question 28

Peak incidence of testicular torsion

Answer 28

Neonatal period, puberty

Question 29

Neonatal testicular torsion

Answer 29

Extravaginal

Question 30

Testicular torsion Sxs

Answer 30

* Abru and tept onset of severe scrotal pain (may radiate) * Constant pain * Nausea & vomiting

Question 31

Exam findings of testicular torsion

Answer 31

* Edematous erythematous scrotum * Slightly elevated & tender * Absent cremasteric reflex * Negative Prehn's sign (relief of pain when you elevate scrotum)

Question 32

Dx Testicular torsion

Answer 32

* Hx and physical | * Doppler ultrasound (confirmatory test)