Hernias and Male GU Dermatology

Question 1

What is a groin hernia? What are 2 types?

Answer 1

a protrusion of abdominal-cavity contents through the inguinal canal

inguinal or femoral

Question 2

What body landmark divides inguinal and femoral hernia?

Answer 2

inguinal ligament

inguinal above
femoral below

Question 3

Location of ventral hernia

Answer 3

above umbilicus

Question 4

Which type of groin hernia is more rare? Which is more common in men?

Answer 4

femoral (rare, more in women)

inguinal (common, more in men)

Question 5

Ages that are most affected by groin hernias

Answer 5

< 1 yo and > 50 yo

Question 6

Most common abdominal wall hernias

Answer 6

inguinal

Question 7

Risk factors for groin hernias

Answer 7

Older age 
Male 
Caucasian 
Smoking 
Chronic cough
Chronic constipation
Abd wall injury
H/O Cryptorchidism
H/O or FHX hernia

Question 8

Location of indirect vs direct inguinal hernias

Answer 8

indirect: through natural weakness of deep inguinal ring; LATERAL to inferior epigastric artery
direct: directly through abdominal wall - posterior/floor of inguinal canal; MEDIAL to inferior epigastric artery

Question 9

congenital and acquired etiologies of groin hernias

Answer 9

due to failure of the processus vaginalis to obliterate and internal ring to close

due to a weakening or disruption of the fibromuscular tissues of the abdominal wall

Question 10

Risks with cryptorchidism

Answer 10

groin hernias, testicular torsion, sterility

Question 11

Hesselbach’s triangle

Answer 11

inferior epigastric artery, inguinal ligament, rectus abdominis muscle

contains inguinal canal

where direct inguinal hernias protrude

Question 12

Most common: indirect or direct?

Answer 12

indirect

Question 13

Which type of inguinal hernia is found more in children?

Answer 13

indirect

*direct more in adults

Question 14

Which groin hernias are congenital?

Answer 14

indirect and direct inguinal hernias

*femoral is acquired

Question 15

How is hernia best seen on exam?

Answer 15

patient standing and Valsalva maneuver

Question 16

Differences of indirect and direct inguinal hernia on PE

Answer 16

bulge shape: direct more rounded; indirect more oval

location: direct medial; indirect lateral
palpation: indirect more pointy

Question 17

Complications of inguinal hernia if painful on palpation

Answer 17

incarceration - trapping of hernia contents (localized pain)

strangulation - ischemia, decreased blood flow, and necrosis of hernia contents (erythema, greater pain)

bowel obstruction - blocked passage of stool/gas through hernia (N/V and diffuse abd pain)

Question 18

Findings on palpation of uncomplicated hernia

Answer 18

• usually non-tender

- may not be visible externally

Question 19

When should you get U/S for hernia?

Answer 19

occult (hidden) hernia

differentiating inguinal from femoral

Question 20

When should you get CT for hernia?

Answer 20

complicated

differentiating hernia from other causes of pain

Question 21

incarcerated vs unincarcerated hernia

Answer 21

incarcerated is painful and unincarcerated is not

Question 22

4-6 hrs of strangulation. next step?

Answer 22

refer

Question 23

Treatment of uncomplicated hernias with minimal symptoms

Answer 23

watchful waiting

Question 24

When is elective repair an option for patient with hernia?

Answer 24

uncomplicated hernias with significant symptoms or femoral hernia

Question 25

Treatment for acutely incarcerated hernias who do not have sx of strangulation

Answer 25

Manual reduction

Question 26

Treatment for unreducible incarcerated hernias and/or strangulated hernias

Answer 26

Emergent repair

Question 27

Benign dome-shaped subcutaneous papules on scrotum

Answer 27

Follicular or sebaceous cysts

Question 28

Follicular or sebaceous cysts treatment

Answer 28

Reassurance Surgical removal if unsightly, painful, infected

Question 29

Man comes in thinking he has STI because small dome-shaped flesh-colored papules on coronal margin or sulcus of glans penis

Answer 29

Pearly penile papules

Question 30

Pearly penile papules treatment

Answer 30

Reassurance | Laser ablation for cosmetic reasons if desired

Question 31

Well-demarcated scaly erythematous plaques Frequently accompanied by perianal & intergluteal cleft plaques

Answer 31

psoriasis

Question 32

Psoriasis treatment

Answer 32

Hydrocortisone during symptomatic periods Calcipotriene (vit D3 analog) cream for prevention Recurrences are normal

Question 33

black, blue, or dark red, dome-shaped papules ranging from 1-6 mm in diameter on the scrotum May bleed if scratched May be present elsewhere on the body

Answer 33

Angiokeratomas of Fordyce

Question 34

Angiokeratomas of Fordyce treatment

Answer 34

Reassurance (benign) | Laser ablation, electrocautery, or cryotherapy for cosmetic reason if desired

Question 35

When do Angiokeratomas of Fordyce usually occur?

Answer 35

after puberty

Question 36

Violet, flat-topped lesions usually seen on glans & shaft May develop pruritic or painful erosive lesions

Answer 36

Lichen planus

Question 37

Lichen planus

Answer 37

Reassurance – usually resolves spontaneously after several years (possibly decades) Papular Lesions - tx with topical corticosteroids Erosive Lesions - tx with intralesional steroid injection

Question 38

Progression of Lichen sclerosis symptoms

Answer 38

Early: Atrophic Pruritic white plaques/papules Progressing: dysuria, painful erection Later: phymosis, meatal stenosis

Question 39

How is Lichen sclerosis dx'd?

Answer 39

biopsy

Question 40

Lichen sclerosis also called ________.

Answer 40

Balanitis xerotica obliterans (BXO)

Question 41

Treatment of Lichen sclerosis

Answer 41

Early stages = High potency topical Later stages = High potency intralesional corticosteroids Long term use may cause epidermal atrophy Circumcision may be necessary if foreskin affected

Question 42

Uncircumsized boy under 5 yo with small red erosions and swelling of glans and foreskin. Started to have discharge.

Answer 42

balanitis

Question 43

Balanitis treatment

Answer 43

Antibiotics, Antifungal, or Steroid depending on suspected underlying cause

Question 44

Collection of thick whitish discharge under the foreskin

Answer 44

smegma

Question 45

Smegma treatment

Answer 45

Retract foreskin and clean regularly