PP3 - Male Genitalia (Clinical)

Question 1

what is hydrocele?

Answer 1

an abnormal accumulation of serous fluid, leads to swelling and discomfort

Question 2

where does fluid accumulate in a hydrocele of the testes?

Answer 2

within the cavity of the tunica vaginalis surrounding the testes

Question 3

common causes of hydrocele in the testes?

Answer 3

excessive secretion of serous fluid by the visceral layer of the tunica vaginalis - may be due to inflammation, injury, other pathological changes

Question 4

what differentiates a hydrocele of the spermatic cord from one of the testes?

Answer 4

hydrocele of the spermatic cord -fluid accumulates within a persistent processus vaginalis (didn’t fully close)

hydrocele of the testes - fluid accumulation around the testes IN the tunica vaginalis

Question 5

where does fluid accumulate in a hydrocele of the spermatic cord?

Answer 5

in the processus vaginalis if it remains partly open after foetal development

Question 6

what test is used to diagnose a hydrocele? how does it work?

Answer 6

transillumination test

light is shone through the scrotal sac - if light passes through it indicates the presence of serous fluid & confirms hydrocele

Question 7

if the testes is swollen but a transillumination test does not show light shining through the swollen scrotal sac - what might this indicate?

Answer 7

blood or solid mass causing swelling

Question 8

what is testicular torsion?

Answer 8

twisting of the testes and spermatic cord

Question 9

why is testicular torsion a medical emergency?

Answer 9

lack of blood supply to testes & spermatic cord can lead to ischaemia

Question 10

what are the primary treatments for testicular torsion?

Answer 10

1. manual rotation to untwist the testicle
2. surgical rotation to attach the testicle to the scrotum and prevent further twisting

Question 11

what is varicocele?

Answer 11

the dilation and twisting of the pampiniform plexus veins

Question 12

characteristic appearance of varicocele?

Answer 12

‘bag of worms’ appearance around the testes

Question 13

why is varicocele more commonly found on the left side?

Answer 13

the left testicular vein drains at a right angle into the left renal vein - causes slower blood flow and higher venous pressure

Question 14

in transurethral catheterization, how does the procedure differ for biological females compared to males?

Answer 14

females:
- urethra is shorter and straighter
- the external urethral meatus is located by moving posteriorly from the clitoris, making it a short and straight passage

males:
- natural bends of the penis require holding it at a right angle to the abdomen (holding it straight)

Question 15

considerations during transurethral catheterisation for biological females?

Answer 15

menopausal changes may make the the tissue around the urethra more delicate and the urethral meatus harder to locate

Question 16

potential complications of transurethral catheterization in biological males?

Answer 16

difficulty due to benign prostatic hyperplasia - enlarged prostate can obstruct the urethra

risk of creating a ‘false passage’ from excessive force

potential damage to the membranous urethra - it’s the least dilatable part of the urethra

Question 17

why is it important to insert a catheter gently during transurethral catheterization?

Answer 17

helps prevent trauma to the urethra and avoids creating a false passage, especially in the less dilatable membranous urethra

Question 18

A 14-year-old male presents with sudden onset testicular pain and an absent cremasteric reflex. What is the most likely diagnosis?
A) Epididymitis
B) Hydrocele
C) Testicular torsion
D) Varicocele

Answer 18

C) Testicular torsion - twisting of testes & spermatic cord may affect the genital branch of the genitofemoral nerve (innervates cremasteric muscle, travels within spermatic cord)

Question 19

What is the critical time window for surgical intervention in testicular torsion to maximize testicular viability?
A) 2 hours
B) 6 hours
C) 12 hours
D) 24 hours

Answer 19

B) 6 hours

Question 20

Which of the following clinical signs best helps differentiate hydrocele from a solid mass like testicular tumor?
A) Absent cremasteric reflex
B) Redness of overlying skin
C) Positive transillumination
D) Tenderness on palpation

Answer 20

C) Positive transillumination - light shines through swollen scrotal sac = serous fluid.

Question 21

Which condition is associated with a “bag of worms” feeling on scrotal palpation?
A) Hydrocele
B) Epididymitis
C) Varicocele
D) Inguinal hernia

Answer 21

C) Varicocele

Question 22

Why is varicocele more common on the left side?
A) Left testicular vein drains directly into IVC
B) Left renal vein is shorter
C) Left testicular vein drains at a right angle into the left renal vein
D) Left gonadal artery is longer than right

Answer 22

C) Left testicular vein drains at a right angle into the left renal vein - leads to slower & turbulent flow, higher venous pressure

Question 23

Which of the following is not typically associated with hydrocele?
A) Accumulation of serous fluid
B) Dilated venous plexus
C) Patent processus vaginalis
D) Positive transillumination

Answer 23

B) Dilated venous plexus - associated with varicocele

Question 24

Which of the following would most likely not transilluminate?
A) Hydrocele
B) Testicular tumour
C) Spermatocele
D) Epididymal cyst

Answer 24

B) Testicular tumour (and blood accumulation)

Question 25

Which zone of the prostate contains the highest concentration of glandular tissue and is most commonly associated with prostate cancer? A) Central zone B) Peripheral zone C) Transitional zone D) Anterior fibromuscular zone

Answer 25

B) Peripheral zone

Question 26

A digital rectal exam (DRE) that reveals a ‘rock hard’ prostate is most indicative of which condition? A) Benign Prostatic Hyperplasia (BPH) B) Acute prostatitis C) Prostate cancer D) Prostatic abscess

Answer 26

C) Prostate cancer

Question 27

Which prostate zone surrounds the urethra and is most commonly involved in benign prostatic hyperplasia (BPH)? A) Central zone B) Peripheral zone C) Transitional zone D) Anterior fibromuscular region

Answer 27

C) Transitional zone

Question 28

During a DRE, a 'bulky' prostate is most suggestive of which condition? A) Prostate cancer in the peripheral zone B) Aggressive cancer in the central zone C) BPH in the transitional zone D) Inflammation of the anterior zone

Answer 28

C) BPH in the transitional zone

Question 29

The central zone of the prostate surrounds which structure? A) Prostatic urethra B) Ejaculatory ducts C) Bladder neck D) External sphincter

Answer 29

A) Prostatic urethra

Question 30

Which zone is least likely to be involved in pathological processes like cancer or hyperplasia? A) Central zone B) Transitional zone C) Anterior fibromuscular zone D) Peripheral zone

Answer 30

C) Anterior fibromuscular zone - has minimal glandular tissue

Question 31

Prostate cancers arising from the central zone are: A) Benign and slow-growing B) Often asymptomatic C) Aggressive and rare D) Easily detected by DRE

Answer 31

C) Aggressive and rare - can easily spread to the ducts (ejaculatory, seminal vesicle) due to close proximity

Question 32

Which of the following statements is true regarding the transitional zone? A) It's the largest prostate zone. B) It has the highest malignancy rate. C) It enlarges in BPH, compressing the urethra. D) It cannot be palpated during DRE.

Answer 32

C) It enlarges in BPH, compressing the urethra.

Question 33

Why is the peripheral zone a key focus during DRE screening for prostate cancer? A) It's closest to the bladder neck. B) It contains the urethral opening. C) It’s easily palpable and commonly the site of malignancy. D) It regulates seminal fluid pH.

Answer 33

C) It’s easily palpable and commonly the site of malignancy.

Question 34

A 67-year-old male presents with nocturia, weak urinary stream, and hesitancy. A digital rectal exam reveals a smooth but enlarged prostate, described as 'bulky'. Which prostatic zone is most likely enlarged in this patient, and what is the most probable diagnosis? A) Peripheral zone; prostate cancer B) Central zone; prostate cancer C) Anterior zone; benign prostate hyperplasia D) Transitional zone; benign prostate hyperplasia

Answer 34

D) Transitional zone; benign prostate hyperplasia