Urology/Renal

Question 1

A 4-year-old boy is brought to the office by his mother for a painless lump on his left testicle. On physical exam, the lump is about 2 centimeters in diameter, round, painless, and soft to touch. It increases in size with Valsalva maneuver. Transillumination of the scrotum shows homogenous tissue without any dark shadows. Which of the following is the most likely diagnosis?

A. Hydrocele
B. Spermatocele
C. Testicular tumor
D. Varicocele

Answer 1

Hydrocele

A hydrocele is a collection of fluid that accumulates within the tunica vaginalis that surrounds the testicle within the scrotum or anywhere along the spermatic cord.

Question 2

A 2-year-old boy is brought in to the office by his mother due to inability to retract his foreskin while changing his diaper today. She had been able to retract the foreskin prior to this occasion without difficulty. Upon physical exam, there is a contracted white fibrous ring visible around the preputial orifice. Which of the following is the most likely diagnosis?

A. Balanitis
B. Paraphimosis
C. Pathologic phimosis
D. Physiologic phimosis

Answer 2

Pathologic phimosis

Pathologic phimosis is the inability to retract the foreskin after it had been previously retractable. Pathologic phimosis usually occurs due to distal scarring of the foreskin secondary to poor hygiene or recurrent balanitis (inflammation of the glans penis). Patients with physiologic phimosis are usually brought in by a parent who notices that the foreskin is unable to be retracted during routine cleaning or bathing.