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Question 1
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A 14 year old boy is taken to the emergency room after complaining of sudden onset of pain in the left hemiscrotum despite not having any other urinary symptoms. The superior pole of the testis is tender on examination and the cremasteric reflex is particularly marked. What would be the underlying diagnosis?
Your Answer: Torsion of a testicular hydatid
Explanation:Answer: Torsion of a testicular hydatidThe appendix testis (or hydatid of Morgagni) is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time. The appendix of testis can, occasionally, undergo torsion (i.e. become twisted), causing acute one-sided testicular pain and may require surgical excision to achieve relief. One third of patients present with a palpable blue dot discoloration on the scrotum. This is nearly diagnostic of this condition. If clinical suspicion is high for the serious differential diagnosis of testicular torsion, a surgical exploration of the scrotum is warranted. Torsion of the appendix of testis occurs at ages 0-15 years, with a mean at 10 years, which is similar to that of testicular torsion.Occasionally a torsion of the hydatid of Morgagni can produce symptoms mimicking those created by a testicular torsion| a torsion of the hydatid, however, does not lead to any impairment of testicular function.Absence of the cremasteric reflex is a sign of testicular torsion. This therefore confirms that the diagnosis is Torsion of a testicular hydatid.
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This question is part of the following fields:
- Genitourinary
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Question 2
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A 3 year old girl is brought to the clinic by her mother due to burning micturition, frequency and urgency. She is also experiencing some suprapubic tenderness. Which of the following investigations should be done initially?
Your Answer: Clean catch of urine for Culture &Sensitivity
Explanation:Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.
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This question is part of the following fields:
- Genitourinary
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Question 3
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A 13-year-old girl is complaining of severe acne. She does not have her period yet and her BMI is 37. She has high insulin levels on her lab results. What is the most likely diagnosis?
Your Answer: Polycystic Ovarian Syndrome (PCOS)
Explanation:The best answer is Polycystic Ovarian Syndrome (PCOS), supported by amenorrhea, obesity and acne. High insulin levels are indicative of PCOS and exclude Cushing syndrome (as this is associated with low insulin levels).
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This question is part of the following fields:
- Genitourinary
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Question 4
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A 14-year-old girl complains of a paravaginal mass. Biopsy was taken which confirmed a diagnosis of rhabdomyosarcoma. The likely cell of origin is a?
Your Answer: Skeletal muscle cell
Explanation:Rhabdomyosarcoma originates from skeletal muscle cells. A biopsy is needed for grading according to microscopy. Most patients are adult females.
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This question is part of the following fields:
- Genitourinary
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Question 5
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A 16 year old male complained of scrotal pain following a game of football. He couldn't recall any trauma to groin. Which of the following is the best investigation to confirm the diagnosis?
Your Answer: USG of the scrotum
Explanation:USG of the scrotum is important to exclude any abnormality with testicles, epididymis and scrotum. This presentation can be acute epididymo-orchitis or testicular torsion. USG of the scrotum will help to confirm the diagnosis.
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This question is part of the following fields:
- Genitourinary
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Question 6
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An 8-year-old girl presents with a history of a bright red bloodstain in her underpants one day prior to consultation. Her mother reports that the girl started cycling lessons one week ago. How will you proceed with the investigation in this case?
Your Answer: Examination under Anaesthesia
Explanation:A local exam might not help in locating the cause of the bleeding because it might be underneath the superficial structures. A thorough examination should be done under GA to accurately locate the source of bleeding.
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This question is part of the following fields:
- Genitourinary
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Question 7
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A 7 year old boy who had significant dry spells in the past presented with a recent history of wetting himself. Which of the following is the most appropriate management?
Your Answer: Desmopressin
Explanation:As this boy has experienced significant dry spells in the past, it is unlikely that a structural abnormality is causing the enuresis. The only therapies that have been shown to be effective in randomized trials are alarm therapy and treatment with desmopressin acetate or imipramine. Bladder training exercises are not recommended. Desmopressin acetate is the preferred medication for treating children with enuresis.
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This question is part of the following fields:
- Genitourinary
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Question 8
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A 1 year old baby boy is taken to the doctor by his mother who is concerned that she cannot feel his testis. On examination by the doctor, his testis are not palpable either in the scrotum or the inguinal region and cannot be seen on ultrasound either. Which of the following is the most appropriate next stage in management?
Your Answer: Laparoscopy
Explanation:Answer: LaparoscopyThe diagnostic accuracy of laparoscopy for impalpable testis is well recognized. Approximately 20% of undescended testes are truly impalpable, and laparoscopy is actually regarded as the gold standard for their localization| none of the currently available imaging techniques (ultrasound, computerized tomography, or magnetic resonance imaging) has proven to be 100% reliable in predicting the presence or absence of a testis.In this respect, not only can laparoscopy be considered the most reliable tool to provide information on the location of the testis but also to confirm its absence.Undescended testes in boys is a very common congenital abnormality in which one or both testes does not reach the bottom of the scrotum prior to birth. The incidence of the condition is 3–5% among all boys at birth, and decreases to 0.8–1% after 6 months of age.Males with undescended testes have a lower sperm count, poorer quality sperm, and lower fertility rate, compared to males whose testicles descend normally| the rate of subfertility increases with bilateral involvement and increasing age at the time of orchidopexy.
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This question is part of the following fields:
- Genitourinary
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Question 9
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Question 10
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A 17-year-old female was given an antibiotic for a urinary tract infection. After taking the medication the patient developed Steven-Johnson syndrome. Which particular antibiotic usually causes Steven-Johnson syndrome?
Your Answer: Sulphonamides
Explanation:Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. The most common cause is certain medications such as lamotrigine, carbamazepine, allopurinol, sulphonamide antibiotics, and nevirapine.
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This question is part of the following fields:
- Genitourinary
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