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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
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.

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