146

Management of Abnormalities of the

External Genitalia in Boys

Lane S. Palmer; Jeffrey S. Palmer

Questions

1.In the male, which of the following stimulates the development of the external genitalia?

a.Testosterone

b.Human chorionic gonadotropin

c.Dihydrotestosterone

d.Luteinizing hormone and follicle-stimulating hormone

e.Maternal progesterone

2.What percentage of uncircumcised boys will have persistent phimosis by 17 years of age?

a.Less than 1%

b.5%

c.10%

d.15%

e.20%

3.Circumcision should not be performed in neonates with which condition of the genitalia?

a.Phimosis

b.Undescended testis

c.Inguinal hernia

d.Penile curvature

e.Testicular atrophy

4.What is the most common complication associated with circumcision?

a.Trauma to the glans

b.Bleeding

c.Meatal stenosis

d.Skin bridges

e.Balanitis xerotica obliterans (BXO)

5.A 4-year-old boy presents with phimosis and BXO of the prepuce. What is the preferred treatment?

a.Observation

b.Topical corticosteroids

c.Excision of BXO skin without circumcision

d.Warm baths

e.Circumcision

6.Penile agenesis is associated with all of the following malformations EXCEPT:

a.cryptorchidism.

b.vesicoureteral reflux.

c.horseshoe kidney.

d.ureteropelvic junction obstruction.

e.renal agenesis.

7.The etiology of the buried penis includes all of the following EXCEPT:

a.suprapubic fat pad.

b.small penis.

c.poor penopubic fixation of the penis.

d.obesity.

e.cicatricial scarring after surgery.

8.A 9-month-old boy who was previously circumcised presents with a buried penis resulting from cicatricial scarring. What is the most appropriate initial treatment?

a.Topical betamethasone and manual retraction

b.Revision of circumcision

c.Penopubic fixation of the penis

d.Liposuction of the suprapubic fat pad

e.Observation

9.What is the minimal normal stretched penile length of a full-term neonate?

a.1.2 cm

b.1.9 cm

c.2.5 cm

d.3.2 cm

e.4.5 cm

.Which of the following statements is TRUE regarding a micropenis in a term male neonate?

a.The testes are usually normal in size and not cryptorchid.

b.It is best managed by gender reassignment.

c.It has an abnormal ratio of the length of the penile shaft to circumference.

d.It is unlikely to respond to testosterone stimulation until puberty.

e.It is less than 1.9 cm in stretched length.

.What is the most common cause of micropenis?

a.Hypergonadotropic hypogonadism

b.Hypogonadotropic hypogonadism

c.Idiopathic

d.Growth hormone deficiency

e.Androgen insensitivity syndrome

.Which of the following statements regarding penile masses is FALSE?

a.The treatment of parameatal urethral cysts is complete excision of the cyst.

b.The most common acquired cystic lesion of the penis is smegma under the unretractable prepuce.

c.Congenital penile nevi tend to be malignant.

d.The initial management of juvenile xanthogranulomas is expectant monitoring.

e.Epidermal inclusion cysts may form after penile surgery.

.A 13-year-old African-American boy with sickle cell disease has a 6-hour painful erection. The initial management should include all of the following EXCEPT:

a.alkalization.

b.hydration.

c.intracavernous injections of β-adrenergic sympathomimetic agents.

d.analgesia.

e.transfusion to reduce hemoglobin S concentration.

.Which of the following statements is TRUE regarding high-flow priapism?

a.It is usually a drug-induced etiology.

b.The aspirated blood is similar to venous blood on blood gas analysis.

c.Color Doppler ultrasonography commonly demonstrates the fistula.

d.Surgical intervention is the initial management.

e.Sickle cell disease is the most common cause

.Penoscrotal transposition is associated with all of the following anomalies EXCEPT:

a.sex chromosome abnormalities.

b.distal shaft hypospadias with chordee.

c.autosomal chromosome abnormalities.

d.Aarskog syndrome.

e.caudal regression.

.All of the following are associated with patency of the processus vaginalis EXCEPT:

a.Transverse testicular ectopia

b.Epididymal anomalies

c.Cryptorchidism

d.Spermatic cord torsion

e.Polyorchidism

.Abdominoscrotal hydrocele is reported to be associated with all of the following features EXCEPT:

a.a closed processus vaginalis.

b.epididymal anomalies.

c.testicular dysmorphism.

d.hydronephrosis.

e.increased pressure within the tunica vaginalis.

.Irreversible ischemic injury of the testicular parenchyma may begin as early as how many hours after torsion of the spermatic cord?

a.1

b.2

c.4

d.6

e.8

.Which of the following is most specific in diagnosing spermatic cord torsion?

a.High-riding testis

b.Absence of the cremasteric reflex

c.Transverse lie of the testis

d.Spermatic cord twist on high-resolution Doppler ultrasonography

e.Acute severe pain

.After manual detorsion of the spermatic chord, which of the following is appropriate management?

a. Color Doppler ultrasonography

b.Radionuclide scan

c.Doppler examination of the testis and spermatic cord

d.Discharge from the hospital and arrangement for an office reevaluation in 1 week

e.Immediate scrotal exploration

.An adolescent is evaluated for a history of self-limited, intermittent episodes of severe unilateral scrotal pain. Physical examination findings are normal. What is the most appropriate course of action?

a.Color Doppler ultrasonography

b.Reassessment in 6 months

c.Elective scrotal exploration

d.Radionuclide scrotal imaging

e.Immediate scrotal exploration

.When the diagnosis of torsion of the appendix epididymis is made, which of the following is optimal management?

a.Observation

b.Color Doppler ultrasonography

c.Radionuclide scrotal imaging

d.Immediate scrotal exploration

e.Cord block and manual detorsion

.Which of the following is the most likely diagnosis in an infant with sterile urine and epididymitis?

a.Unilateral renal agenesis

b.Large prostatic utricle

c.Urethral stricture disease

d.Persistent vasoureteral fusion

e.Radiographically normal urinary tract

.What is the most appropriate course of action in an otherwise healthy neonate with perinatal testicular torsion?

a.Surgical exploration of the affected testis

b.Surgical exploration of the affected testis with contralateral scrotal orchidopexy

c.Color Doppler ultrasonography of the scrotum

d.Radionuclide testicular scan

e.Observation

.Most adolescent varicoceles evaluated by urologists are: a. painful.