Urology Flashcards
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9
Q
Which of the following conditions is NOT typically addressed in pediatric urology?
A) Bedwetting
B) Appendicitis
C) Hypospadias
D) Vesicoureteral reflux
A
Answer: B) Appendicitis**
Explanation: Appendicitis is a gastrointestinal emergency, not primarily addressed by pediatric urology.
10
Q
A child experiencing both daytime and nighttime wetting might be evaluated for which of the following conditions?
A) Neurogenic bladder
B) Phimosis
C) Ovarian cyst
D) Meckel’s diverticulum
A
A) Neurogenic bladder**
Explanation: Neurogenic bladder can lead to incontinence, including daytime and nighttime wetting.
11
Q
Which of the following conditions involves the abnormal placement of the urethral opening on the underside of the penis?
A) Epispadias
B) Hypospadias
C) Phimosis
D) Cryptorchidism
A
B) Hypospadias**
*Explanation: Hypospadias involves the urethral opening on the underside of the penis.
12
Q
Which management strategy could be recommended to a parent of a child experiencing constipation associated with urinary difficulties?
A) Strict fluid restriction
B) Increased fiber intake
C) Delayed potty training
D) Decreased physical activity
A
B) Increased fiber intake**
Explanation: Increasing fiber can help alleviate constipation, which can be related to urinary difficulties.
13
Q
In pediatric urology, what does the term “megaureter” refer to?
A) Enlargement of the ureter
B) Blockage of the urethra
C) Inflammation of the bladder
D) Stone formation in the kidney
A
) Enlargement of the ureter**
Explanation: A megaureter refers to an enlarged ureter, which can result from various conditions, including obstruction or reflux.
14
Q
Which of the following conditions is characterized by fluid accumulation around the testicle?
A) Hydrocele
B) Varicocele
C) Epispadias
D) Cryptorchidism
A
Answer: A) Hydrocele**
*Explanation: A hydrocele is a fluid-filled sac around a testicle, often resulting in swelling.
15
Q
Which of the following birth abnormalities involves the intestines protruding into the inguinal canal and may cause an asymptomatic groin bulge?
A) Inguinal hernia
B) Hypospadias
C) Ureteropelvic junction obstruction
D) Phimosis
A
Inguinal hernia**
*Explanation: An inguinal hernia occurs when intestines or other tissues protrude into the groin area through a weakness in the abdominal muscles
16
Q
Hypospadias is a common congenital abnormality concerning which part of the male anatomy?
A) Testicles
B) Penis
C) Bladder
D) Prostate
A
Answer: B) Penis**
*Explanation: Hypospadias involves the penis, where the urethral opening is located on its underside
17
Q
Approximately how often does hypospadias occur in male births?
A) 1 in 100
B) 1 in 300
C) 1 in 200
D) 1 in 250
A
C) 1 in 200**
*Explanation: Hypospadias occurs in approximately 1 out of every 200 male births
18
Q
In cases of hypospadias, where is the urethral meatus typically located?
A) On the tip of the glans
B) On the underside of the penis
C) Inside the bladder
D) On the upper side of the penis
A
B) On the underside of the penis**
*Explanation: The urethral meatus is located on the underside of the penis in hypospadias
19
Q
What is a key indication that may suggest the presence of hypospadias during a physical examination?
A) The presence of a firm mass
B) A straight urinary stream
C) Upward curvature of the penis
D) Urine stream directed downward
A
Answer: D) Urine stream directed downward**
*Explanation: A downward-directed urine stream can be indicative of hypospadias.
20
Q
What is a critical management step to consider if hypospadias is suspected in a newborn?
A) Immediate antibiotic therapy
B) Performing a circumcision
C) Avoid circumcision
D) Immediate referral to a nephrologist
A
Answer: C) Avoid circumcision**
Explanation: Circumcision should be avoided if hypospadias is suspected as the foreskin may be needed for surgical repair.
21
Q
What is a potential risk associated with surgical repair of hypospadias?
A) Infection
B) Fistula formation
C) Loss of bladder control
D) Kidney failure
A
Answer: B) Fistula formation**
*Explanation: A potential complication of hypospadias surgery is the formation of a fistula.
22
Q
What is chordee primarily defined as?
A) Lateral curvature of the penis
B) Dorsal bowing of the penis
C) Ventral bowing of the penis
D) Absence of the urethral opening
A
Ventral bowing of the penis**
Explanation: Chordee is characterized by ventral bowing, or curvature, of the penis.
23
Q
At what age is surgical intervention typically recommended for chordee?
A) 3 months
B) 6 months
C) 12 months
D) 2 years
A
6 months**
*Explanation: Surgical intervention for chordee is recommended at 6 months of age or older.
24
Q
How is follow-up commonly scheduled after chordee surgery?
A) Weekly for 6 months
B) Monthly for 6 months
C) 1-2 months after surgery
D) Annually
A
C) 1-2 months after surgery**
*Explanation: Follow-up is typically scheduled 1-2 months after chordee surgery
25
What is phimosis characterized by?
A) The absence of a foreskin
B) Inability to void properly
C) Inability to retract the foreskin
D) Complete absence of the glans
C) Inability to retract the foreskin**
*Explanation: Phimosis is the condition where the foreskin cannot be easily retracted to expose the glans.*
26
Which of the following is part of the non-surgical management of phimosis during early childhood?
A) Immediate circumcision
B) Gentle retraction during voids and bathing
C) Strict avoidance of any foreskin manipulation
D) Application of antibiotics
Answer: B) Gentle retraction during voids and bathing**
*Explanation: Gentle retraction of the foreskin with returning to its normal position is recommended during voids and bathing starting at potty training age.*
27
In which situation is circumcision required for phimosis?
A) If the child experiences minor irritation
B) If scarring or ballooning of the foreskin occurs or if retractability is not achieved by puberty
C) If the foreskin becomes too elastic
D) At birth, regardless of other conditions
B) If scarring or ballooning of the foreskin occurs or if retractability is not achieved by puberty**
*Explanation: Circumcision is required if scarring or ballooning of the foreskin occurs, or if the foreskin cannot be retracted by puberty.*
28
Which topical treatment is commonly prescribed for phimosis and how is it applied?
A) Betamethasone 0.1% lotion applied twice daily for 1-2 months
B) Hydrocortisone cream applied once daily
C) Antibiotic ointment applied after each diaper change
D) Aloe vera gel applied as needed
A) Betamethasone 0.1% lotion applied twice daily for 1-2 months**
*Explanation: Betamethasone 0.1% lotion is applied twice daily for 1-2 months as a treatment for phimosis
29
What is paraphimosis primarily characterized by?
A) A completely circumcised penis
B) Retraction of the foreskin without any complications
C) Foreskin that cannot be returned to its original position, entrapping the glans
D) Enlarged glans with foreskin covering it fully
C) Foreskin that cannot be returned to its original position, entrapping the glans**
*Explanation: Paraphimosis occurs when the foreskin is retracted behind the glans and cannot be moved back to its normal position.
30
Which of the following is NOT a physical examination finding of paraphimosis?
A) Edema
B) Bluish discoloration of the glans and foreskin
C) Severe necrosis of the glans
D) Decrease in penis size
D) Decrease in penis size**
*Explanation: Paraphimosis is typically associated with swelling, discoloration, and potential necrosis, not a decrease in penis size.
31
What is a critical component of managing paraphimosis?
A) Use of antibiotics regardless of symptoms
B) Immediate circumcision in all cases
C) Reduction of swelling and repositioning of the glans
D) Complete immobilization of the patient
C) Reduction of swelling and repositioning of the glans**
*Explanation: Management involves reducing the swelling, often with ice, and pushing the glans back under the foreskin to avoid necrosis.*
32
Meatal stenosis primarily affects which part of the urinary system?
A) Ureter
B) Bladder neck
C) Urethral meatus
D) Renal pelvis
C) Urethral meatus**
*Explanation: Meatal stenosis is the narrowing of the urinary meatus.
33
Which age group is most commonly affected by meatal stenosis?
A) Infants under 1 year
B) Males aged 3-7 years
C) Females aged 10-15 years
D) Males over 50 years
B) Males aged 3-7 years**
*Explanation: Meatal stenosis is most commonly seen in males between the ages of 3 and 7 years.
34
What is a definitive management strategy for meatal stenosis?
A) Antibiotic therapy
B) Meatotomy
C) Pelvic exercises
D) Watchful waiting
B) Meatotomy**
*Explanation: A meatotomy is often performed if there is an abnormal urinary stream
35
Which of the following statements about labial adhesions is correct?
A) They always require surgical intervention
B) They primarily occur in females aged 10-13 years
C) Most cases require no treatment and resolve on their own
D) They often present with excessive vaginal secretion
C) Most cases require no treatment and resolve on their own**
*Explanation: Labial adhesions often do not require treatment and can resolve spontaneously, especially in young children
36
John, a 16-year-old male, is brought to your clinic by his mother because of severe swelling and pain in his penis. He mentions that the foreskin was retracted during cleaning two days ago and has not been reducible. On examination, you find the glans to be swollen, bluish, and there is significant edema of the foreskin.
**Questions:**
1. **What is the most likely diagnosis for John's condition?**
- Paraphimosis.
Explain the initial steps in managing John's condition.**
- Apply ice or a cold compress to reduce swelling. Then attempt manual reduction by squeezing the glans gently while pushing it back under the foreskin. If manual reduction fails, surgical intervention may be required
37
John, a 16-year-old male, is brought to your clinic by his mother because of severe swelling and pain in his penis. He mentions that the foreskin was retracted during cleaning two days ago and has not been reducible. On examination, you find the glans to be swollen, bluish, and there is significant edema of the foreskin.
Explain the initial steps in managing John's condition.
Apply ice or a cold compress to reduce swelling. Then attempt manual reduction by squeezing the glans gently while pushing it back under the foreskin. If manual reduction fails, surgical intervention may be required.
38
John, a 16-year-old male, is brought to your clinic by his mother because of severe swelling and pain in his penis. He mentions that the foreskin was retracted during cleaning two days ago and has not been reducible. On examination, you find the glans to be swollen, bluish, and there is significant edema of the foreskin.
What are the possible complications if John's condition is not managed promptly?
Complications include ischemia, necrosis of the glans, and potential permanent damage to the penis.
39
Lucas, a 5-year-old boy, presents to your clinic with difficulty urinating and a thin, deflected urinary stream. His parents report that he's been straining and taking longer to urinate. Lucas underwent circumcision at birth.
**Questions:**
1. **Based on Lucas's symptoms, what condition might you suspect?*
Meatal stenosis.
40
Lucas, a 5-year-old boy, presents to your clinic with difficulty urinating and a thin, deflected urinary stream. His parents report that he's been straining and taking longer to urinate. Lucas underwent circumcision at birth.
How would you confirm this diagnosis in Lucas?*
Perform a physical examination to assess the size and appearance of the urinary meatus, and potentially refer for a uroflowmetry test to measure the rate of urine flow.
41
Lucas, a 5-year-old boy, presents to your clinic with difficulty urinating and a thin, deflected urinary stream. His parents report that he's been straining and taking longer to urinate. Lucas underwent circumcision at birth.
*What is the recommended treatment for Lucas's condition?
Depending on the severity, a meatotomy may be indicated to resolve the symptoms by widening the urethral opening.
42
Melissa, a 9-month-old girl, is brought in for her routine check-up. On physical examination, you note partial adhesion of the labia minora. Her parents mention no urinary issues or infections, and she's in otherwise good health.
**Questions:**
1. **What condition are Melissa's symptoms indicative of, and is treatment necessary at this stage?
Labial adhesions. Treatment may not be necessary as many cases resolve spontaneously without intervention.
43
Melissa, a 9-month-old girl, is brought in for her routine check-up. On physical examination, you note partial adhesion of the labia minora. Her parents mention no urinary issues or infections, and she's in otherwise good health.
Discuss a possible treatment approach if the labial adhesions do not resolve or cause symptoms.
For symptomatic cases or those that don't resolve, topical estrogen creams can be applied. In some instances, manual separation under topical anesthesia may be performed
44
Melissa, a 9-month-old girl, is brought in for her routine check-up. On physical examination, you note partial adhesion of the labia minora. Her parents mention no urinary issues or infections, and she's in otherwise good health.
What advice would you give Melissa's parents regarding the care of these adhesions?*
Advise them on the signs of urinary tract infections and the importance of maintaining gentle hygiene without forcibly retracting the labia. Encourage routine diaper changes and inform them that the condition often resolves as estrogen levels naturally increase with age
45
A 17-year-old male presents with pain and swelling of the penis after keeping his foreskin retracted for a prolonged period. What is the most appropriate immediate management?**
a) Prescribe antibiotics
b) Refer to a urologist urgently
c) Apply ice and attempt manual reduction
d) Begin corticosteroid therapy
Answer: c) Apply ice and attempt manual reduction
Explanation**: The initial management of paraphimosis involves reducing edema with ice and attempting manual reduction. If this is unsuccessful, surgical intervention may be necessary.
46
What is a potential complication of untreated paraphimosis?**
a) Hypospadias
b) Ischemic necrosis of the glans
c) Testicular torsion
d) Epididymitis
Answer: b) Ischemic necrosis of the glans**
**Explanation**: If paraphimosis remains untreated, the constriction can lead to impaired blood flow, causing ischemia and possible necrosis of the glans.
47
A 6-year-old boy with a history of circumcision presents with a narrowed urinary stream and straining during urination. Which diagnosis is most likely?**
a) Hypospadias
b) Phimosis
c) Meatal stenosis
d) Urethral stricture
Answer: c) Meatal stenosis**
**Explanation**: Meatal stenosis is characterized by a thin, deflected urinary stream and is a common complication following circumcision.
48
What is a commonly recommended treatment for meatal stenosis?**
a) Antibiotic therapy
b) Circumcision
c) Balloon dilation
d) Meatotomy
Answer: d) Meatotomy**
**Explanation**: Meatotomy is a surgical procedure to widen the urinary meatus and relieve symptoms of meatal stenosis.
49
n assessing a 10-month-old female infant, you note partial adhesion of the labia minora. She is asymptomatic with no infection. What is the best course of action?**
a) Immediate surgical intervention
b) Prescribe topical estrogen cream
c) Observe and reassure the parents
d) Apply topical antibiotic
Answer: c) Observe and reassure the parents**
**Explanation**: Many cases of labial adhesions resolve spontaneously, and observation with reassurance is appropriate if the child is asymptomatic.
50
When should intervention be considered in the case of labial adhesions?**
a) If the adhesion resolves before puberty
b) Only if there is a urinary tract infection
c) If the adhesions cause urinary symptoms or do not resolve over time
d) Whenever the parents express concern
Answer: c) If the adhesions cause urinary symptoms or do not resolve over time**
**Explanation**: Intervention, such as the application of topical estrogen, is considered when the adhesions cause symptoms or fail to resolve.
51
An 18-month-old boy presents with a swollen scrotum that has been gradually enlarging. The parents report that the swelling is present throughout the day and is not painful. Upon transillumination, the scrotum glows uniformly. What is the most likely diagnosis?**
a) Inguinal hernia
b) Varicocele
c) Communicating hydrocele
d) Non-communicating hydrocele
Answer: d) Non-communicating hydrocele**
**Explanation**: A non-communicating hydrocele typically presents as a painless swelling that transilluminates and does not fluctuate in size throughout the day.
52
In the evaluation of an inguinal hernia, which physical characteristic distinguishes it from a hydrocele?**
a) Ability to be transilluminated
b) Presence of bowel sounds in the affected area
c) The swelling is non-reducible
d) It remains in the scrotum permanently
Answer: b) Presence of bowel sounds in the affected area**
**Explanation**: Inguinal hernias can present with bowel sounds in the herniated section, which helps differentiate them from hydroceles that do not contain bowel.
53
A 6-month-old male infant is diagnosed with a communicating hydrocele. What is the recommended management plan?**
a) Immediate surgical repair
b) Monitoring until 18 months of age
c) Immediate referral for laparoscopic surgery
d) Prescribing diuretics for symptomatic relief
Answer: b) Monitoring until 18 months of age**
**Explanation**: Communicating hydroceles in infants may resolve spontaneously, so monitoring until around 12-18 months of age is standard unless complications arise.
54
A preschool-aged child has a bulge in the groin area that appears during crying and disappears when the child is calm and lying down. What is the classic description associated with this condition?**
a) Non-communicating hydrocele
b) Incarcerated hernia
c) Reducible hernia
d) Strangulated hernia
Answer: c) Reducible hernia**
**Explanation**: A reducible inguinal hernia appears with increased intra-abdominal pressure, such as crying, and disappears when relaxed.
55
After an attempt to reduce an incarcerated inguinal hernia fails in a hospital setting, what is the immediate next step in management?**
a) Send the patient home with monitoring instructions
b) Administer antibiotic prophylaxis and reevaluate in a week
c) Schedule surgical repair within 24-48 hours
d) Prescribe analgesics and dietary changes
Answer: c) Schedule surgical repair within 24-48 hours**
**Explanation**: An incarcerated hernia that cannot be reduced is at risk for strangulation, and surgical intervention is needed promptly.
56
Patient History:
- **Name**: Lucas
- **Age**: 2 years old
- **Sex**: Male
- **Presenting Complaint**: Swelling in the right groin noticed by parents approximately two weeks ago. The swelling becomes more prominent when Lucas is crying or straining, such as during bowel movements, and tends to reduce when he is calm and lying down.
Medical History:
- **Prenatal/Birth**: Full-term, normal vaginal delivery
- **Family History**: Father had a history of inguinal hernia in childhood, repaired surgically.
- **Immunizations**: Up to date
- **Medications**: None
Physical Examination:
- **Vital Signs**: Stable
- **Abdomen**: Soft, non-tender
- **Genitourinary**: A soft, non-tender mass is palpable in the right inguinal area. The swelling is reducible and no signs of erythema or discoloration are present. Testes are descended bilaterally. The right hemi-scrotum is mildly distended.
- **Transillumination Test**: Negative in the swollen area.
Assessment and Differential Diagnosis:
- Inguinal hernia
- Communicating hydrocele
- Lymphadenopathy
- Testicular torsion
Given Lucas's symptoms and history, what is the most likely diagnosis?**
- Provide reasoning for your diagnosis based on his presentation and physical examination.
2. **What diagnostic test might you consider to confirm your diagnosis if the physical exam leaves any uncertainty?**
3. **What is the initial management strategy for Lucas considering his age and the nature of the condition identified?**
4. **Under what circumstances would more urgent intervention be necessary for this condition?**
5. **List potential complications if this condition were to remain untreated.**
Answers:
1. **Most likely diagnosis: Inguinal Hernia**
- **Reasoning**: The reducible nature of the swelling, its location in the inguinal region, and the associated history of familial hernia suggest an inguinal hernia. The negative transillumination test helps distinguish it from a hydrocele.
2. **Diagnostic Test: Ultrasound**
- An ultrasound can help confirm the presence of a hernia by revealing bowel or other abdominal content within the scrotal sac, especially if there is uncertainty from the physical exam.
3. **Initial Management Strategy:**
- Referral to a pediatric surgeon for evaluation and potential surgical repair. Since the hernia is reducible and not currently incarcerated or strangulated, plan an elective repair.
4. **Urgent Intervention Circumstances:**
- Immediate intervention is required if the hernia becomes incarcerated (unable to reduce) or strangulated (compromised blood supply), indicated by symptoms such as vomiting, severe pain, discoloration, or a tender, irreducible mass.
5. **Potential Complications:**
- If untreated, complications include incarceration and strangulation, which can lead to bowel ischemia, necrosis, and potentially life-threatening conditions. Additionally, chronic irritation and increased size of the hernia can affect scrotal structures and cause discomfort.
This case study offers a comprehensive approach to understanding the management and complications associated with common pediatric issues like hydrocele and inguinal hernia.
57
A 16-year-old male presents with acute scrotal pain that started suddenly while playing basketball. He is in considerable distress and denies any recent urinary symptoms. Physical examination reveals a tender, swollen scrotum with no cremasteric reflex. What is the most likely diagnosis?**
- A) Epididymitis
- B) Testicular torsion
- C) Inguinal hernia
- D) Hydrocele
Answer:** B) Testicular torsion
- **Explanation:** The sudden onset of severe scrotal pain and absence of the cremasteric reflex are classic presentations of testicular torsion, which is a surgical emergency.
58
Which of the following diagnostic tests is the most appropriate to confirm the diagnosis of testicular torsion?**
- A) Urinalysis
- B) Scrotal ultrasound with Doppler flow
- C) CT scan of the abdomen
- D) X-ray of the pelvis
Answer:** B) Scrotal ultrasound with Doppler flow
- **Explanation:** This test is used to assess blood flow to the testes and can help confirm the diagnosis of testicular torsion, which shows reduced or absent blood flow.
59
An 18-year-old male with a recent history of dysuria and penile discharge presents with gradual scrotal swelling and pain. Physical examination suggests epididymitis. What is the most likely causative organism?**
- A) Escherichia coli
- B) Staphylococcus aureus
- C) Neisseria gonorrhoeae
- D) Streptococcus pyogenes
Answer:** C) Neisseria gonorrhoeae
- **Explanation:** In sexually active males, epididymitis is often caused by sexually transmitted organisms like Neisseria gonorrhoeae or Chlamydia trachomatis.
60
What is the recommended initial treatment for epididymitis in sexually active males under 35 years of age?**
- A) NSAIDs only
- B) Ceftriaxone and doxycycline
- C) Amoxicillin
- D) Ciprofloxacin and metronidazole
Answer:** B) Ceftriaxone and doxycycline
- **Explanation:** These antibiotics are recommended for cases likely caused by sexually transmitted infections, such as gonorrhea or chlamydia.
61
Which of the following complications is most concerning if testicular torsion is not treated promptly?**
- A) Increased fertility
- B) Epididymitis
- C) Testicular necrosis and atrophy
- D) Increased urinary frequency
*Answer:** C) Testicular necrosis and atrophy
- **Explanation:** Without timely intervention, the lack of blood supply can cause necrosis and atrophy of the testicle, potentially leading to infertility or loss of the testicle.
62
A 22-year-old male presents to the emergency department with complaints of gradual onset of scrotal pain over the last three days. He reports painful urination and a yellowish discharge from the penis. The patient is sexually active and currently has multiple partners. On physical examination, the scrotum is swollen and tender, particularly at the posterior aspect of the testicle. A urinalysis showed leukocytes, and a urine culture was pending at the time of discharge.
**Questions:**
1. **What is the most likely diagnosis?**
- A) Epididymitis
- B) Testicular torsion
- C) Orchitis
- D) Inguinal hernia
Answer:** A) Epididymitis
- **Explanation:** The gradual onset of pain, urinary symptoms, and discharge, along with tenderness on the posterior part of the scrotum, suggest epididymitis.
63
A 22-year-old male presents to the emergency department with complaints of gradual onset of scrotal pain over the last three days. He reports painful urination and a yellowish discharge from the penis. The patient is sexually active and currently has multiple partners. On physical examination, the scrotum is swollen and tender, particularly at the posterior aspect of the testicle. A urinalysis showed leukocytes, and a urine culture was pending at the time of discharge.
Which infectious organisms are commonly involved in cases like this?**
- A) Escherichia coli
- B) Neisseria gonorrhoeae or Chlamydia trachomatis
- C) Staphylococcus aureus
- D) Candida albicans
Answer:** B) Neisseria gonorrhoeae or Chlamydia trachomatis
- **Explanation:** In sexually active young adults, especially those with multiple partners, these sexually transmitted bacteria are common causes of epididymitis.
64
A 22-year-old male presents to the emergency department with complaints of gradual onset of scrotal pain over the last three days. He reports painful urination and a yellowish discharge from the penis. The patient is sexually active and currently has multiple partners. On physical examination, the scrotum is swollen and tender, particularly at the posterior aspect of the testicle. A urinalysis showed leukocytes, and a urine culture was pending at the time of discharge.
What combination of antibiotics is recommended for this case?**
- A) Ciprofloxacin and metronidazole
- B) Amoxicillin and clavulanic acid
- C) Ceftriaxone and doxycycline
- D) Erythromycin and tetracycline
Answer:** C) Ceftriaxone and doxycycline
- **Explanation:** Ceftriaxone targets Neisseria gonorrhoeae and doxycycline covers Chlamydia trachomatis, addressing the most likely causes.
65
*What is the most likely diagnosis?**
- A) Epididymitis
- B) Testicular torsion
- C) Orchitis
- D) Inguinal hernia
Answer:** A) Epididymitis
- **Explanation:** The gradual onset of pain, urinary symptoms, and discharge, along with tenderness on the posterior part of the scrotum, suggest epididymitis.
66
What combination of antibiotics is recommended for this case?**
- A) Ciprofloxacin and metronidazole
- B) Amoxicillin and clavulanic acid
- C) Ceftriaxone and doxycycline
- D) Erythromycin and tetracycline
Ceftriaxone and doxycycline
- **Explanation:** Ceftriaxone targets Neisseria gonorrhoeae and doxycycline covers Chlamydia trachomatis, addressing the most likely causes.
67
A 15-year-old male comes into the clinic with sudden onset of severe right-sided scrotal pain. He reports the pain started while he was in gym class. He states there is nausea but no fever or urinary symptoms. Examination reveals a high-riding right testis with significant tenderness and an absent cremasteric reflex.
**Questions:**
1. **What is the most likely diagnosis?**
- A) Epididymitis
- B) Testicular torsion
- C) Hydrocele
- D) Varicocele
Answer:** B) Testicular torsion
- **Explanation:** Sudden severe pain, high-riding testicle, and absence of the cremasteric reflex are classic signs of testicular torsion.
68
What is the next step in management?**
- A) Administer NSAIDs and apply ice packs
- B) Perform a scrotal ultrasound with Doppler
- C) Prepare for surgical intervention
- D) Prescribe antibiotics
testicular torsion
B) Perform a scrotal ultrasound with Doppler
- **Explanation:** An urgent ultrasound with Doppler is necessary to confirm reduced blood flow indicative of torsion, but given the high suspicion clinically, the answer C (Prepare for surgical intervention) is also valid given surgical exploration is urgent.
69
What complication may arise from delayed treatment of this condition?**
- A) Increased testicular volume
- B) Orchitis
- C) Testicular necrosis and potential infertility
- D) Persistent varicocele
C) Testicular necrosis and potential infertility
- **Explanation:** If not treated rapidly (within 6 hours), the testicular tissue can necrose due to lack of blood supply, potentially resulting in infertility or loss of the testicle.
70
What condition is characterized by a painless scrotal mass that feels like a "bag of worms" and commonly occurs on the left side?**
A) Hydrocele
B) Testicular torsion
C) Epididymitis
D) Varicocele
D) Varicocele
- **Explanation:** A varicocele is a dilation of the testicular veins leading to a "bag of worms" feeling, typically occurring on the left side due to anatomical reasons
71
Under what circumstances should a varicocele be referred to a surgeon for evaluation?**
A) Grade 1, left-sided without symptoms
B) Grade 3, painful with a significant difference in testicular volume
C) Small, right-sided with no symptoms
D) Grade 2, pain resolves with lying down
Answer:** B) Grade 3, painful with a significant difference in testicular volume
- **Explanation:** A surgical referral is warranted for Grade 2 or 3 varicoceles that are painful, cause a notable difference in testicular volume, or occur on the right side.
72
Which diagnostic study is most relevant to evaluate kidney stones in a child?**
A) Voiding cystourethrogram (VCUG)
B) CT Stone Study
C) Renal ultrasound
D) 24-hour urine collection
CT Stone Study
- **Explanation:** A CT Stone Study is the most effective diagnostic tool for identifying and evaluating kidney stones.
73
Which of the following is important when taking a history for a child presenting with urinary symptoms?**
A) Abdominal pain
B) History of family urinary tract infections (UTIs)
C) Menstruation history (if applicable)
D) All of the above
D) All of the above
- **Explanation:** A comprehensive history includes collecting data on various symptoms, family history, and personal health history, including menstruation, if relevant.
74
What combination of diagnostic studies would be most useful for diagnosing a urinary tract infection in a child?**
A) Voiding cystourethrogram and CT Stone Study
B) Renal ultrasound and Mag-3 (Renal Scan)
C) Urinalysis and urine culture with sensitivity
D) 24-hour urine collection and microscopic urine examination
C) Urinalysis and urine culture with sensitivity
- **Explanation:** Urinalysis and urine culture are standard tests to identify bacteria and guide treatment for UTIs.
75
James, a 15-year-old adolescent, presents to the clinic reporting a noticeable mass in his scrotum that feels like a "bag of worms." He states that it is painless but seems to enlarge when he stands up and reduces when he lies down. This is his first visit addressing this issue, and it's noticed on his left side.
**Questions:**
1. **What is the most likely diagnosis for James's condition?**
- A) Epididymitis
- B) Hydrocele
- C) Varicocele
- D) Testicular torsion
C) Varicocele
- **Explanation:** The presenting symptoms of a "bag of worms" appearance, painless nature, and location on the left side are characteristic of a varicocele
76
What is the appropriate next step in managing James's condition?**
- A) Immediate surgical intervention
- B) Scrotal ultrasound for further evaluation
- C) Prescribing antibiotics
- D) Regular observation without further diagnostics
B) Scrotal ultrasound for further evaluation
- **Explanation:** A scrotal ultrasound helps confirm the diagnosis and assess any complications that may require surgical intervention.
77
Under what condition could James's varicocele warrant a referral to a surgeon?**
- A) Presence of mild discomfort and normal testicular volume
- B) Grade 3 size with a significant difference in testicular volume
- C) Existing only when standing without symptoms
- D) Improves promptly with lying down
B) Grade 3 size with a significant difference in testicular volume
- **Explanation:** Surgical referral is indicated for Grade 2 or 3 varicoceles if they are associated with symptoms or impacts on testicular volume.
78
Sophie, a 9-year-old girl, comes to your practice complaining of frequent urination, pain when urinating, and a fever. Her parents mention she has a history of UTIs.
**Questions:**
1. **What initial diagnostic tests would you order to confirm a urinary tract infection in Sophie?**
- A) Voiding cystourethrogram and renal ultrasound
- B) Urinalysis and urine culture with sensitivity
- C) CT Stone Study and 24-hour urine collection
- D) Mag-3 (Renal Scan) and blood tests
) Urinalysis and urine culture with sensitivity
- **Explanation:** These are the standard tests to identify and confirm a urinary tract infection, determining the presence of bacteria.
79
What symptoms warrant further imaging investigations such as renal ultrasound in Sophie’s case?**
- A) Fever persistence despite antibiotic treatment
- B) All previous history of UTIs reported
- C) First occurrence of frequent urination
- D) Rapid resolution of symptoms with hydration
A) Fever persistence despite antibiotic treatment
- **Explanation:** Persistent symptoms may suggest potentially complicated UTIs or an underlying structural issue, warranting further imaging.
80
Besides medications, what important historical information should you gather during this visit?**
- A) Dietary preferences
- B) Physical activity habits
- C) Recent changes in toilet training
- D) Family history of urological disorders
D) Family history of urological disorders
- **Explanation:** Understanding family history can provide insights into possible hereditary conditions contributing to recurring UTIs.
