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Question 1
Correct
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A neonate is diagnosed with cryptorchidism of the right side (undescended testis). Which is the LEAST likely place to find the testis?
Your Answer: Perineum
Explanation:Embryologically the testes are retroperitoneal structures in the posterior abdominal wall, attached to the anterolateral abdominal wall by the gubernaculum. The gubernaculum ‘pulls’ the testes through the deep inguinal ring, inguinal canal and superficial inguinal ring and over the pelvic brim. The gubernaculum is preceded by the processus vaginalis that is derived from the peritoneum anterior to the testes. The processus vaginalis pushes the muscle and fascial layers. These eventually make up the canal and the spermatic cord, into the scrotum. The gubernaculum persists as the scrotal ligament while part of the processus vaginalis remains as a bursa-like sac i.e. the tunica vaginalis testes. The testes therefore could be caught in any one of these places along its path of descending. The testes are never in the perineum.
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This question is part of the following fields:
- Genitourinary
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Question 2
Correct
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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 3
Incorrect
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A 15-year-old boy observed a bluish painless swelling in his left scrotum. It is soft and can be compressed. What would you do next?
Your Answer: Immediate surgery
Correct Answer: Reassurance
Explanation:The boy seems to have a varicocele so the most appropriate next step would be reassurance. A varicocele is an enlargement of the veins within the scrotum called the pampiniform plexus. A varicocele only occurs in the scrotum and is very similar to varicose veins that can occur in the leg. Because a varicocele usually causes no symptoms, it often requires no treatment.
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This question is part of the following fields:
- Genitourinary
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Question 4
Incorrect
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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: Sleep alarms
Correct 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 5
Incorrect
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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 the testis
Correct 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 6
Correct
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A 7-year-old boys undergoes a testicular biopsy after a tumour is found in his right testis. Elements similar to hair and teeth are found in it. What kind of tumour is this?
Your Answer: Teratoma
Explanation:A teratoma is a tumour containing tissue elements that are similar to normal derivatives of more than one germ layer. They usually contain skin, hair, teeth and bone tissue and are more common in children, behaving as a benign tumour. After puberty, they are regarded as malignant and can metastasise.
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This question is part of the following fields:
- Genitourinary
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Question 7
Incorrect
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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: Continue Regular Child Care
Correct 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 8
Correct
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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 9
Correct
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Question 10
Correct
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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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SESSION STATS - PERFORMANCE PER SPECIALTY
