Mehl. penile/testicular disorders nr. 1

Question 1

M. Urethral meatus opens on underside of penis (ventral aspect). Dx?

Answer 1

Hypospadias

Question 1

M. Urethral meatus opens on top of penis (dorsal aspect). Dx?

Answer 1

Epispadias

Question 2

M. Cannot retract the prepuce (foreskin). In other words, cannot pull it back to expose the glans. Dx?

Answer 2

Phimosis

Question 3

M. Cannot reduce the prepuce. In other words, once it is retracted, cannot replace it back over the glans. Dx.

Answer 3

Paraphimosis

Question 4

M. Paraphimosis Tx?

Answer 4

Just remember that paraphimosis is the bad one / emergency.

Question 5

M. Undescended testis. Dx?

Answer 5

Cryptorchidism

Question 6

M. Cryptorchidism. Definition?

Answer 6

Undescended testis.

Question 7

M. Cryptorchidism. incr risk for what? 2

Answer 7

Increased risk of infertility (­incr. temperature within abdomen -> decr. spermatogenesis).

Increased risk of testicular carcinoma.

Question 8

M. Cryptorchidism. Tx?

Answer 8

USMLE wants no treatment prior to age 6 months;

after 6 months, perform orchidopexy.

Question 9

M. Acutely painful testis; medical emergency; can lead to ischemia and loss of testis. Dx?

Answer 9

Testicular torsion

Question 10

M. Testicular torsion, definition?

Answer 10

Acutely painful testis; medical emergency; can lead to ischemia and loss of testis

Question 11

M. Can be caused by abnormality of the gubernaculum, which is a ligamentous cord that anchors the testis within the scrotum. This leads to “bell-clapper deformity,” where improper anchoring = ­ incr. risk of rotation. Dx?

Answer 11

Testicular torsion

Question 12

M. Testicular torsion, cause mechanism?

Answer 12

Can be caused by abnormality of the gubernaculum, which is a ligamentous cord that anchors the testis within the scrotum. This leads to “bell-clapper deformity,” where improper anchoring = ­ risk of rotation.

Question 13

M. Testicular torsion. Prehn sign?

Answer 13

Negative Prehn sign, which is failure of relief of pain upon lifting of the scrotum.

Apparently this is an unreliable test in real life, but NBME vignettes can still mention it. In contrast, a (+) Prehn (relief of pain upon lifting the scrotum) is more indicative of epididymitis.

Question 14

M. Testicular torsion. Cremasteric reflex?

Answer 14

Negative cremasteric reflex, which is failure of the scrotal skin to retract upon palpation of the medial thigh. In contrast, a (+) cremasteric reflex (scrotal skin retracts) is more indicative of epididymitis.

Normally, when the inner thigh is stroked, the cremaster muscle contracts and pulls up on the ipsilateral testis. In torsion, the twisted spermatic cord can impair the nerve fibers responsible for triggering the reflex

Question 15

M. Testicular torsion. next best step?

Answer 15

USMLE wants Doppler ultrasonography as next best step, followed by surgery.

Question 16

M. Testicular torsion. Tx?

Answer 16

USMLE wants Doppler ultrasonography as next best step, followed by surgery.

Question 17

M. Inflammation/infection of epididymis. Dx?

Answer 17

Epididymitis

Question 18

M. Epididymitis. Phren sign, cremasteric reflex?

Answer 18

(+) Prehn sign and (+) cremasteric reflex.

Question 19

M. Epididymitis. MCC in males < 35yo?

Answer 19

Chlamydia and gonorrhea are most common causes in males <35.

Question 20

M. Epididymitis. MCC in males > 35yo?

Answer 20

Over 35, E. coli is most likely.

Question 21

M. Epididymitis. The USMLE will not play games where they give you a borderline case and force you to guess. They will give you either a 25- or 45-year-old male.

This also goes for prostatitis (same organisms). There is an NBME Q of a 45-year-old where the answer is E. coli, and chlamydia is wrong.

Answer 21

.

Question 22

M. Curvature deformity of penis caused by fibrous plaque within tunica albuginea. Dx?

Answer 22

Peyronie disease

Question 23

M. Peyronie disease, Tx?

Answer 23

Doesn’t have to be treated unless causing functional impairment.