Genitalia

Question 1

What is pathophysiology for inguinal hernia?

Answer 1

patent processus vaginalis

intestine emerges from deep inguinal ring through inguinal canal (indirect)

Question 2

Why are premature babies more likely to get inguinal hernia?

Answer 2

tissues are weaker and more friable

Question 3

what is the presentation of an inguinal hernia?

Answer 3

lump in the groin (extends onto scrotum/labia)

asymptomatic

Question 4

What is an incarcerated hernia?

Answer 4

hernia that cannot be reduced (irreducible)

Question 5

what is a strangulated hernia

Answer 5

intestine in hernia becomes ischaemic

Question 6

what is management of hernia

Answer 6

taxis (compression in line with inguinal canal) with good analgesia)
surgery (once oedema has settled and child is well)

Question 7

what is a hydrocele

Answer 7

patent processus vaginalis that allows peritoneal fluid to track down the testes

Question 8

What is the clinical difference between hydrocele and hernia

Answer 8

you can get above a hydrocele

hydrocele transilluminates

Question 9

What is management of hydrocoele under 2 yrs

Answer 9

NOTHING

should resolve spontaneously

Question 10

What is mx of hydrocele >2 years

Answer 10

surgical repair, laparoscopic exploration

Question 11

what is a varicocoele

Answer 11

scrotal swelling due to dilated testicular veins

Question 12

what side is varicocele most common on

Answer 12

LEFT

Question 13

what is the clinical presentation of varicocele

Answer 13

feels like BAG OF WORMS

dull ache

Question 14

how do you manage varicocele

Answer 14

conservative if asymptomatic

otherwise can use surgical ligation

Question 15

what is bilateral undescended testes

Answer 15

cryptorchidism

Question 16

why is bilateral impalpable testes a medical emergency

Answer 16

because the karyotype must be CHECKED to exclude disorders of sex development

Question 17

what are risk factors for testicular torsion

Answer 17

undescended / bell clapper testes

Question 18

what are differentials for testicular torsion

Answer 18

torsion of appendix testis

epididimo-orchitis

Question 19

what is a medical cause of circumcision

Answer 19

balanitis xerotica obliterates
recurrent balanoposthitis
prophylaxis of UTI
if access to urethra is required regularly e.g. spina bifidA CATHETERISATION

Question 20

what is phimosis

Answer 20

inability to retract foreskin/ ballooning of foreskin during micturition

Question 21

how do you manage phimosis over / under 2 yo?

Answer 21

UNDER 2: physiological, should resolve with time (do NOT forcibly retract as it can cause scar formation)

OVER 2 + recurrent balanoposthitis/UTI: consider surgery

Question 22

what is the only condition that can cause true phimosis

Answer 22

balanitis xerotica obliterans

Question 23

what is balanitis xerotica obliterans

Answer 23

progressive scarring that extends onto glans, meatus and urethra
IT IS AN INDICATION FOR CIRCUMCISION

Question 24

what is paraphimosis

Answer 24

retracted foreskin cannot be reduced

it is an EMERGENCY, as it may compromise blood supply to glans

Question 25

How do you manage paraphymosis

Answer 25

manipulation with topical analgesia puncture technique (perforating foreskin at multiple points to allow leakage of fluid) surgical reduction, the circumcision

Question 26

what is hypospadia

Answer 26

failure of develoipment of ventral tissues of pnis

Question 27

what are three key features of hypospadia

Answer 27

ventral urethral meatus ventral curvature of shaft of penis hooded appearance of foreskin

Question 28

how do you manage hypospadia

Answer 28

surgery of cosmetic / functional grounds ideally boys will be able to pass urine in straight line while standing and have a straight erection NO CIRCUMCISION BEFORE REPAIR, as skin is important for repair

Question 29

How do you manage testicular torsion

Answer 29

Admit immediately to urology/paeds surgery IV fluids, NBM, antiemetics, analgesia Surgery within 4-6 hours to salvage the testicle: orchidectomy vs orchidopexy + fix contralateral testicle to the posterior wall

Question 30

What is the medical term for underscended testes

Answer 30

cryptorchidism

Question 31

what do you do if neonate presemnts with bilat undescended testes (and impalpable)

Answer 31

refer URGENTLY (24j)to senior paediatrician for genetic /endocrine testes

Question 32

How do you manage unilat undescended testes

Answer 32

Birth: arrange review. at 6-8 weeks 6-8 weeks: arrange review in 3 months 3m: - descended but retractile > review annually as risk of ascending testes - one testis still undescended > refer to paeds for surgey BEFORE 6 MONTHS

Question 33

What surgery is done for undescended palpable testes

Answer 33

Orchidopexy (placement of testis in scrotum)

Question 34

Why must an orchidopexy be carried out

Answer 34

Cosmetic Reduced risk of trauma and torsion Fertility Malignancy (increased risk if undescended)

Question 35

What surgery is done for undescended NONPALPABLE tetes

Answer 35

laparoscopic inguinal surgical exploration

Question 36

How do you manage labial adhesions

Answer 36

Topical steroids / oestrogens to lyse the adhesions