Inguino-scrotal

Question 1

common organisms that cause epididymoorchitis

Answer 1

N. gonorrhoea

Chlaymdia trachomatis

Question 2

what is epispadias

Answer 2

urethral opening is on top of the penis/above the clitoris

Question 3

complications of phimosis and paraphimosis

Answer 3

urinary obstruction

ballooning of the foreskin on micturition

Question 4

treatment of balanitis

Answer 4

topical or systemic antibiotics

Question 5

clinical presentation of testicular torsion in a baby

Answer 5

hard, painless, scrotal mass

Question 6

clinical presentation of torsion of the testicular appendage

Answer 6

• gradual onset of testicular pain

no nausea

Question 7

complications of hypospadias

Answer 7

difficulty direction urinary stream
infertility
poor sexual function

Question 8

treatment of testicular torsion

Answer 8

surgery

Question 9

what signs on examination points towards a varicocele

Answer 9

• feels like a bag of worms
• asymmetry - testes hanging at different positions
• no transillumination
• increases in size during Valsalva
• decreases in size if supine

Question 10

what causes a hydrocele

Answer 10

peritoneal fluid tracks down a narrow but patent processus vaginalis into the scrotum causing swelling

Question 11

3 complications of cryptorchidism

Answer 11

reduced fertility
increased malignancy risk
increased risk of testicular torsion

Question 12

typical clinical presentation of testicular torsion in a pubescent

Answer 12

sudden onset testicular pain and swelling
+/- nausea and vomiting
(pain may be in the iliac fossa)

Question 13

treatment of paraphimosis

Answer 13

external compression of the glans –> reduce the swelling –> push back through the constriction

Question 14

which testicle is more likely to have a varicocele? L or R

Answer 14

left

Question 15

what percentage of live births of boys have undescended testes

Answer 15

2%

Question 16

risk factors for epididymoorchitis

Answer 16

• UTI
• instrumentation/catheterization
• reflux
• other abnormalities of the urinary tract
• immunocompromise

Question 17

greatest risk factor for torsion of the testes

Answer 17

Bell-clapper deformity

Question 18

difference between direct and indirect inguinal hernias

Answer 18

direct - through the external ring due to abdominal wall weakness
indirect - through the internal inguinal ring

Question 19

when does descent of the testes usually start in utero

Answer 19

by 28 weeks

Question 20

history presentation of a varicocele

Answer 20

asymptomatic or may have scrotal pain or heaviness

Question 21

what signs on examination do you see for testicular torsion

Answer 21

• discolouration of the scrotum
• exquisitely tender testes
• swollen testis, riding high
• absent cremasteric reflex

Question 22

what signs of examination tell you that a scrotal swelling is a hydrocele and not an inguinal hernia

Answer 22

• transilluminates
• can get above it
• no impulse on crying/straining
• does not empty with compression

Question 23

3 components of hypospadias

Answer 23

• proximal meatus on the undersurface of the penis
• dorsal hood
• chordee

Question 24

what is the common cause of balanitis

Answer 24

infected urine pools under the foreskin due to phimosis

Question 25

what causes acquired undescended testis

Answer 25

result of the failure of elongation of the spermatic cord with age caused by the persistence of a fibrous remanent of the processes vaginalis

Question 26

what signs on examination do you see for torsion of the testicular appendage

Answer 26

• focal tenderness at upper pole of testes, but testis itself can be palpated without pain
• blue dot sign

Question 27

principles of management of epididymoorchitis

Answer 27

scrotal support, bed rest, ice
analgesia
alkalinisation of urine
antibiotics - ceftriaxone and doxycycine

Question 28

what is a bell-clapper deformity

Answer 28

when the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate

Question 29

what is smegma

Answer 29

a collection of shed skin cells and skin secretions under the foreskin of a penis in young boys due to adherence of the foreskin to the glans in early childhood (up to 5)

Question 30

most common age for torsion of the testicular appendage

Answer 30

under 11 years

Question 31

what causes a varicocele

Answer 31

Dilation of the pampiniform venous plexus and the internal spermatic vein within the scrotum due to incompetent valves in the testicular veins

Question 32

difference between phimosis and paraphimosis

Answer 32

• phimosis - inability to RETRACT foreskin over glans penis

- foreskin is caught behind the glans leading to oedema and the ability to REDUCE the foreskin

Question 33

when should you do surgery for a varicocele

Answer 33

if there is:

• pain
• testicular atrophy/delayed growth of ipsilateral testes

Question 34

treatment of phimosis

Answer 34

• mild-moderate = application of steroid ointment to the tight shiny part of the foreskin
• severe = circumcision

Question 35

clinical presentation of a hydrocele

Answer 35

PAINLESS cystic swelling around the testis in the scrotum

Question 36

pathophysiology of paraphimosis

Answer 36

when a tight foreskin is forcibly retracted –> forms a constricting ring around the coronal groove of the glans –> venous engorgement –> painful swelling of the glans –> unable to reduce foreskin over the swelling

Question 37

clinical presentation of epididymoorchitis

Answer 37

• sudden onset bilateral scrotal pain and swelling
• fever
• purulent discharge
• secondary reactive hydrocoele

Question 38

detail the urgency of surgery for inguinal hernias

Answer 38

more urgent the younger the child

Question 39

typical age group for torsion of the testes

Answer 39

• babies

- >13 years (most commonly between the ages of 13-16)