Packet 2

Question 1

inguinal hernia

Answer 1

protrusion of tissue or an organ through a defect in the muscle wall

Question 2

reducible hernia

Answer 2

protrusion can be returned to normal position

Question 3

nonreducible hernia

Answer 3

protrusion cannot be returned to normal position

Question 4

incarcerated hernia

Answer 4

nonreducible with intact blood flow

Question 5

strangulated hernia

Answer 5

nonreducible with a lack of blood flow

Question 6

inguinal hernia risk factors

Answer 6

male, obesity, activities that increase intra-abdominal pressure, hx of hernia or abdominal surgery

Question 7

indirect inguinal hernia

Answer 7

most common type
congenital
hernia follows path of inguinal canal secondary to patent tunica vaginalis

Question 8

direct inguinal hernia

Answer 8

common in men >40
secondary to defect of the abdominal wall in the area of Hesselbach’s triangle usually at the transversalis muscle

Question 9

indirect hernia presentation and PE

Answer 9

palpable mass in groin or scrotum
dull, achy pain, heaviness in scrotum, scrotal swelling
digital exam: hernia evaluation, valsalva maneuver, hernia touches distal aspect of finger

Question 10

direct hernia presentation and PE

Answer 10

palpable mass in abdomen or groin
dull achy
digital exam: hernia evaluation, valsalva maneuver, hernia touches lateral aspect of finger

Question 11

treatment of inguinal hernia

Answer 11

referral to general surgery
observation with pt education
supportive devices- Truss
surgical repair with or without mesh

Question 12

hernia complications

Answer 12

extreme pain, sudden onset, changes in bowl movement, N/V, cyanosis, F/C

Question 13

hydrocele

Answer 13

a collection of fluid within the tunica vaginalis
unilateral or bilateral scrotal enlargement

Question 14

communicating hydrocele

Answer 14

congenital
patent tunica vaginalis permits fluid from peritoneum

Question 15

noncommunicating hydrocele

Answer 15

appears in adults
secondary to increase fluid production or decreased fluid absorption
causes: inflammation, infection, lymphatic fluid, cancer

Question 16

hydrocele presentation

Answer 16

nontender swelling of the scrotum
unilateral or bilateral
may c/o dull ache due to the heaviness of scrotum
palpable uniformly fluctuant swelling

Question 17

hydrocele PE and Dx evaluation

Answer 17

transillumination
labs to r/o infection
US
find underlying cause

Question 18

hydrocele tx

Answer 18

treat underlying cause and observation
aspiration and sclerotherapy
surgical intervention

Question 19

varicocele

Answer 19

enlargement and dilation of venous blood supply within the scrotum; spermatic vein or pampiniform plexus
L>R d/t anatomical variation and the angle of L to R
incompetent valves may also contribute

Question 20

varicocele presentation

Answer 20

asymptomatic, dull ache or heaviness sensation in scrotum that is worse with standing
infertility complaints d/t blood temp increase making sperm nonviable

Question 21

varicocele pe and dx evaluation

Answer 21

PE: “bag or worms” perform palpation while pt stands
Dx: doppler US; sudden onset means CT to r/o underlying cause

Question 22

varicocele tx

Answer 22

r/o underlying cause
surgical consultation: varicocelectomy vs percutaneous embolization

Question 23

epididymitis

Answer 23

inflammation of the epididymis secondary to infection of the GU tract often occurring with orchitis
acute (<6 days) or chronic (>3 months)

Question 24

epididymitis cause

Answer 24

age >39–enteric organism e. coli
age<39–chlamydia trachomatis and neisseria gonorrhoeae

Question 25

epididymitis risk factors

Answer 25

hx of UTI/STIs
anatomical anomalies
urologic surgery
trauma

Question 26

epididymitis presentation

Answer 26

sx: gradual onset of unilateral testicular pain
scrotal swelling, F/C, dysuria, urethral discharge
PE: tenderness to palpation specifically at epididymis
+ cremaster reflex and + prehn’s sign

Question 27

epididymitis dx workup

Answer 27

UA-r/o UTI
CBC-leukocytosis with left shift
urethral culture- r/o chlamydia trachomatis and neisseria gonorrhoeae
scrotal doppler us- thickening, enlargement increased blood flow to epididymis

Question 28

epididymitis tx–acute d/t chlamydia or gonorrhea

Answer 28

Ceftriaxone 500mg IM + doxycycline 100mg T tab po BID x 10 days

Question 29

epididymitis tx–chronic likely d/t enteric organism

Answer 29

levofloxacin 500 mg T tab po daily x 10 days

Question 30

epididymitis complication

Answer 30

orchitis, recurrence of epididymitis, abscess, testicular infarction or atrophy, fertility concers

Question 31

testicular torsion

Answer 31

twisting of the spermatic cord resulting in blood flow compromise to the ipsilateral testicle–medical emergency
more common in neonates and adolescents

Question 32

testicular torsion risk factors

Answer 32

bell clapper deformity- congenital absence of the gubernaculum
cryptorchidism
hx of testicular torsion
trauma

Question 33

testicular torsion presentation

Answer 33

sx: sudden onset of unilateral severe testicular pain; N/V; scrotal swelling
PE: tender of testicle to palpation
elevation of testicle on affected side
absent cremasteric reflex
negative prehn’s sign
color changes; cyanosis

Question 34

testicular torsion dx workup

Answer 34

high suspicion: immediate urologic surgical interventions
questionable: confirm with doppler US of scrotum

Question 35

testicular torsion tx

Answer 35

manual detorsion
surgery to revascularize testicle that must be done within six hours of onset for organ and fertility salvage
orchiopexy- make gubernaculum
orchiectomy- removal of testicle