Genit XVII
Terms
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- balantitis
- inflammation of glans, usually from phimosis
- phimosis, paraphimosis
-
phimosis: tight distal foreskin precluding retraction
paraphimosis: retracted phimosis which is stuck with glans exposed. - epididimitis
-
Chlamydia > Gonorrhea
unilateral scrotal pain. Urethral discharge (white, grey, clear). Urinalysis: looks like mildly + UTI. - Orchitis
- Same sx as epididimitis but no dysuria
- Anogenital warts
- Prior to 1yr consider perinatal acquisition. After, sexual abuse is common, though autoinocculation may occur.
- painless scrotal mass diff dx
-
spermatocele: mass on epididimis
hydrocele: mass on epididimis
varicocele: bag of worms L spermatic cord. venous congestion in plexus above testes.
inguinal hernia: mass that is reducible adn worsens with strain
testicular tumor: mass on testis - Varicocele
- venous engorgement of plexus above testes (physiologic favor of L side where vein enters Renal vein.) bag of worms. worsens with valsalva, lessens when lying down.
- Hydrocele
- painless. fluid surrounds testes may slowly accumalate more by evening, not position dependent.
- Spermatocele
- heavy draggin feeling. Mass stuck to top pole of testicle. transilluminates.
- neuro complications of HSV
- primary infection 1/3 of females have self limited aseptic meningitis (Fever, headache, photophobia. Sacral anesthesia, urinary retension.
- Dx of genital HSV
- viral culture.
- Age by which uncircumcised penis should be able to retract
- 3yrs
- Age to watch and wait till for hydrocele
- 1 yr. If still present, may be a small hernia.
- ovarian torsion
- pain in lower abdomen, radiates down ipsi leg. associated with vomiting. U/S shows ovarian mass. surgical exploration usually needed.
- Age by which testicles must be in sac
- 1 yr. If not, orchipexy should be performed. This will not lower risk of malignancy but will prevent torsion and make exams possible.
- Perihepititis
- Common complication of PID from GC or Chlamyd. RUQ pain along with or following PID sx. LFTs normal, not a hepatitis.
- vulvovaginitis
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infection: pinworm, GAS, Staph, Candida
STDs
in nonsexually active: usually culture neg or mixed flora.
Foreign body = WBCs or foul discharge. - condyloma accuminata
- genital warts from HPV. Can manifest 4 wks- yrs after the infection. Different from condyloma lata which are large white plaques of secondary syphillis.
- Rx for mild hypospadius
- No further workup needed. Can be corrected without U/S of kidneys or VCUG. If severe , may need to rule out syndrome and to mroe anatomical workup
- mucocolpos
- imperforate hymen presents in neonatal period with mucous bulge from maternal estrogens increasing vaginal secretion.
- Reiter Syndrome
- reaction to STD usually Chlamydia. conjunctivitis, arthritis, non bacterial uretrhitis or cervicitis,mucocutaneous lesions (balantitis (inf of glans or clitoris), painless ulcers of oropharynx, rash.
- Uterine bleeding in newborn
- Estrogen withdrawal.
- micropenis, hypotonia, poor feeding.
- Prader-Willi. hypogonadotropin hypogonadism
- Diff dx of micropenis
- less than 2 SD. mean penile length is 3.5cm for newborn. if isolated micropenis, most are due to hypothalamic-pit disorders. hypoglycemia or midliine CNS defect common. Kallman and septo-optic dysplasia (no septum pellucidum)
- diff dx vaginal bleeding, prepubertal
- foreign body, lichen sclerosis, vulvovaginitis, trauma, precocious puberty, urethral prolapse.
- Torsion of testicular appendix
- most common cause of scrotal pain 2-11yrs. Vestigial structure. gradual onset. Self-resolves, give NSAIDS, rest. If unable to rule out testicular torsion, U/S and refer.