Reproductive 2

Question 1

What is hypospadias?

Answer 1

Common congenital malformation with incorrect positioning of the urethral meatus due to failure of urethral folds and foreskin to fuse on ventral penis

The meatus may be located centrally (penile shaft), anteriorly/distally (glans/corona), or posteriorly/proximally (scrotum or perineum)

Question 2

How may hypospadias present?

Answer 2

Abnormal foreskin - dorsal hood
Ventral penile curvature
Two meatal openings
Proximal hypospadias are associated with bifid scrotum and penoscrotal transposition
Associated with inguinal hernias and cryptorchidism

Question 3

What is the management of hypospadias?

Answer 3

Significant displacement or symptomatic micturition may need surgery:
- Reconstruction of urethra, penis and scrotum at 6 months of age (urethroplasty / orthoplasty)

Severe cases require two stage repair with correction of penile curvature first followed by urethroplasty at least 6 months later

Question 4

What are some complications of hypospadias repair?

Answer 4

Urethral fistula
Meatal stenosis
Urethral diverticulum
UTI

Question 5

What is meatal stenosis?

Answer 5

Stenosis of the opening of the urethra at the external meatus

Question 6

What is urethral diverticulum?

Answer 6

Distinct outpouching of the urethral mucosa that most frequently leads to dribbling, dysuria and dyspareunia

Question 7

What is contraindicated in hypospadias?

Answer 7

Circumcision

Question 8

What is cryptorchidism?

Answer 8

Failure of one or both testicles to descend to their natural position in the scrotum

Question 9

What are possible variations of cryptorchidism?

Answer 9

Inguinal
Intra-abdo
Ascending

Question 10

What is the management of cryptorchidism?

Answer 10

Surgery between 6-18 months

Orchidopexy - exposure and fastening of the testicle to the scrotum

If non-palpable, potentially therapeutic open or laparoscopic orchidopexy

Question 11

What is acute abdomen?

Answer 11

Severe abdominal pain lasting for ≤ 5 days

Question 12

List some genitourinary causes of an acute abdomen

Answer 12

Ruptured ectopic
Ovarian torsion
Testicular torsion
Acute pyelonephritis

Question 13

How would a ruptured ectopic present (symptoms)?

Answer 13

Sudden severe lower abdo pain
Vaginal bleeding or amenorrhoea (or symptoms of pregnancy)
Lower abdo guarding / tenderness
Tachycadia

Question 14

What signs may be noted on exam of a ruptured ectopic?

Answer 14

Cervical motion tenderness
Closed cervix
Enlarged uterus
Lower abdo guarding / tenderness
Hypotension
Tachycardia

Question 15

What investigations are diagnostic of a ruptured ectopic?

Answer 15

β-hCG

Transabdo / transvaginal US

Question 16

What may a transabdo / transvaginal US

Answer 16

Free fluid in hepatorenal recess (pouch or Morison) or in recto-uterine pouch (pouch of douglas)
Emtpy uterine cavity
Thickened endometrial lining
Adnexal mass
Tubal ring sign (shows trophoblastic tissue = early pregnancy)

Question 17

What could a sudden onset of unilateral lower abdo or pelvic pain in a woman suggest? What other feature may be present?

Answer 17

Ovarian torsion

N&V
Unilateral iliac fossa tenderness

Question 18

What investigations should be done for ovarian torsion?

Answer 18

Pelvic / transvaginal US

Pelvic CT with IV contrast

Question 19

What is fat necrosis of the breast?

Answer 19

Nonsuppurative inflammatory lesion affecting breast adipose tissue

Question 20

How does fat necrosis of the breast present?

Answer 20

Irregularly defined and dense breast mass
Generally periareolar
Causes skin retraction, erythema or ecchymosis

Question 21

What investigations may be done for fat necrosis of the breast?

Answer 21

Mammogram +/- US

Question 22

What may be the shown on mammogram of fat necrosis of the breast?

Answer 22

Fluid filled cyst

Course rim calcification

Question 23

If there is doubt about the findings on mammogram / US of fat necrosis of the breast, what should be performed? Why may you be alarmed?

Answer 23

May mimic breast cancer

Do biopsy

Question 24

What does biopsy show on fat necrosis of the breast?

Answer 24

Foam cells
Multinucleatued giant cells
Hemosiderin (iron storage complex)
Chronic inflammation

Question 25

What is the treatment of fat necrosis of the breast?

Answer 25

None
Can go away on its own
Occasionally can be removed by surgery