Non-Neoplastic Male GU - Fremont-Smith

Question 1

embryo of male

Answer 1

not on exam

Question 2

phimosis

Answer 2

cannot retract foreskin over penis

congenital and acquired

acquired - recurrent infection uncircumcised adult males

Question 3

hypospadias

Answer 3

more common

opening bottom of penis

Question 4

epispadias

Answer 4

rare**

opening top of penis

associated with bladder exstrophy**

Question 5

undescended testicles

Answer 5

cryptorchidism

usually before 6 months old

Question 6

hydrocele

Answer 6

fluid collection around teste
-usually resolve spontaneously

transillumination

Question 7

firm nontender testicle with discoloration

Answer 7

testicular torsion - prenatal

Question 8

foreskin

Answer 8

in newborn - tight and adherent

white sebaceous cyst at tip - normal

Question 9

paraphimosis

Answer 9

excessive retraction of foreskin
-CANNOT be returned to normal

strangulation of venous flow

Question 10

physiologic phimosis

Answer 10

congenital
-resolves with age

adhesions epithelial layer of skin

Question 11

acquired phimosis

Answer 11

pathologic

secondary - balantic, malignancy, etc.

poor hygiene

forceful retraction

Question 12

tx phimosis

Answer 12

weak topical corticosteroid cream
surgery

circumcision - only permanent cure

Question 13

smegma

Answer 13

extruded as part of normal separation process of glans penis and foreskin

Question 14

majority of penile conditions

Answer 14

traumatic

Question 15

swelling of penis and penile pain

Answer 15

paraphimosis

Question 16

urinary obstruction

Answer 16

need to reduce paraphimosis

Question 17

cause of hypospadias

Answer 17

unknown

possible hormonal imbalance

Question 18

as hypospadias go further down shaft

Answer 18

more complications

Question 19

extrophy of bladder

Answer 19

failure of cloacal membrane development

bladder connects to surface

requires surgical repair

with epispadias

Question 20

testicular descent

Answer 20

form in abdomen - urogenital ridge

coelomic cavity envaginates through abdomen wall to scrotal swelling

over time testis drawn in processus vaginalis (coelomic cavity) pulled by caudal genital ligament

descent into scrotum - guided by gubernaculum - forms inguinal canal

processus vaginalis - obliterates after birth

testes and spermatic cord descend

Question 21

lining of peritoneum

Answer 21

to scrotal sac

-communication with peritoneum

Question 22

muscles of inguinal canal

Answer 22

form direct path for descent to occur

• over time - muscles overlap
• less communication with peritoneum

will obliterate eventually

Question 23

hydrocele

Answer 23

communicating or non-communicating

communicating - sac communicates with peritoneal fluid**

• can be narrow or wide
• can reduce sac - push fluid up

non-communicating - with partial obstruction

Question 24

communicating hydrocele

Answer 24

bulging scrotal mass in infant

normal and common

with increased intraabdominal pressure - pushes fluid into scrotum

more common right**

Question 25

right testicle

Answer 25

descends after left

-so processus vaginalis obliteration behind left side

Question 26

patent processus vaginalis

Answer 26

communicating hydrocele

increase with valsalva

Question 27

fluid from mesothelial lining of tunica vaginalis

Answer 27

non-communicating hydrocele

Question 28

transillumination of cyst in scrotum

Answer 28

hydrocele

Question 29

hydrocele

Answer 29

must be distinguished from testicular mass

Question 30

varicocele

Answer 30

collection of dilated and tortuous veins in pampiniform plexus in spermatic cord

increased pressure and incompetent valves

more on left** - left renal vein enters at 90 degree - less continuous flow

Question 31

dull ache in scrotum with standing, bag of worms on PE

Answer 31

varicocele

Question 32

varicocele primary vs. secondary

Answer 32

primary - idiopathic - more in upright position

secondary - no change with positional change

Question 33

varicocele and fertility

Answer 33

can reduce it

Question 34

spermatocele

Answer 34

epididymal cyst

painless fluid filled cyst of head of epididymis

palpated as distinct from tetis - do transilluminate**

can drain

testicular tumor - does not transilluminate

Question 35

direct hernia

Answer 35

more medial

Question 36

indirect hernia

Answer 36

majority

pass lateral to epigastric vessels

widely patent processus vaginalis
-bowel through inguinal canal

Question 37

inguinal canal

Answer 37

infants - external ring over internal ring
-higher risk for inguinal hernia

adults - oblique angled opening

Question 38

male trichomonas

Answer 38

asymptomatic or very sympatomatic

urethral smear - wet mount - motile organisms

Question 39

condyloma

Answer 39

HPV 6 >11

Question 40

cancer of penis

Answer 40

not usually with HPV

-50/50

Question 41

balanitis

Answer 41

inflammation of glans

usually with those who have been circumcised

Question 42

balanoposthitis

Answer 42

foreskin and glans inflamed together

Question 43

posthitis

Answer 43

inflammation of prepuce

Question 44

frenular artery and vein

Answer 44

frenulum - ridge of tissue base of prepuce at coronal sulcus of penis

significant bleeding during circumcision

Question 45

group A strep

Answer 45

toxic shock syndrome in males

Question 46

reiter syndrome association

Answer 46

reactive arthritis
-joints, eyes, GU tract
with chlamydia trachomatis

circinate balanitis
shallow ulcers - painless
goes away few months

Question 47

circinate balanitis

Answer 47

shallow ulcer on glans penis and shaft

painless

chlamydia - reiter syndrome

Question 48

lichen sclerosis et atrophicus

Answer 48

white lesion on penis

painful erection

possibly premalignant

can ulcerate - bleeding, painful

thick epidermis atrophic with follicular hyperkeratosis