Page 1 of 3: Shall we discuss case scenarios????

anand_parsns · Credits: 615 My Scrapbook

This is Anand.C....Is anyone interested to discuss case scenarios of various disorders......with explanations....and comments???

i

rmh · Credits: 3587 My Scrapbook

Hi, this is rashmila...7th sem....

would like to join this thread

anand_parsns · Credits: 615 My Scrapbook

A 3yr old boy is found to be lacking a right testicle in his scrotum . An orchidoplexy is done immediately. He is not seen until the age of 12 when he complaints of a swelling in his right groin . The most likely cause of the mass is ????

anand_parsns · Credits: 615 My Scrapbook

RMH....any guesses........i will post the answer after a ffew guesses are made so that we can discuss "why not the other resposes are correct , too"....

rmh · Credits: 3587 My Scrapbook

The mass is probably due to hernia.. caused by persistence of processus vaginalis sac.

Well Anand that was just a guess..

anand_parsns · Credits: 615 My Scrapbook

Nope Rashmila , the answer is not a Hernia.....The answer i expected was a testicular seminoma.....The case histrory though short was a typical one and had a few clues to be interpreted....
RATIONALE:
1.cryptorchidism occurs in 1 of every 20 full-term infants and 1 of 5 premature infants...
2.if the testis has not descended by 1 month(in fullterm infants) and by 3 months (in premature infants) then there is least probability that it would descend.
3.An orchidopexy should be done before active differentiation of spermatocytic series begins(ie[b].., before the age of 2 years[/b])
4.After the age of 5 the testis may become permanantly sterile
5. intraabdominal testis has 11 TIMES GREATER RISK OF DEVELOPING TESTICULAR NEOPLASMS than the scrotal testis.
6.AN INCREASED LABILITY TO MALIGNANT DISEASE IS NOT CORRECTED BY ORCHIDOPEXY but early diagnosis is made easier.(MOST IMPORTANT POINT TO REMEMBER IN THE CASE)
7.SEMINOMAS are the most common type of neoplasms which occur with undescended testis.

A hernia would not be probable in this case......RATIONALE(what i feel)
Coz the hernia u said is a indirect congenital type.....The mass for which the boy presented was on right side.....
1.Actually yhe boy had an undesended right testis in childhood ....so there is no question of a patent processus vaginalis....Since it is present only if the testis descends....
2.Congenital indirect hernia IS ACTUALLY COMMON IN ADULTS(refer Surgery Das or any other surgery book) AND NOT IN CHILDREN.

OTHER POINTS:
1.Undescended testis is commonest on right side(50%) more than Left(30%)

anand_parsns · Credits: 615 My Scrapbook

ARE U Satisfied with the Answer???

anand_parsns · Credits: 615 My Scrapbook

Another point to remember is that------a cryptorchidism is associated with an indirect inguinal hernia in 80-90% of cases....so an orchidopexy is always done with an accompanying herniotomy......So no chances of future hernia

hugepuppy · Credits: 651 My Scrapbook

a middle aged patient comes to the OPD with history of tiredness and sudden blurring of vision during episode of tiredness. when the BP was measured it was 210/140. the patient was immediately admitted but was normal by the time the sister came to administer the anti hypertensive drug. the patient's BP was rechecked and kept under observation for 24hrs when he had another attack of high BP of 200/146. What is the probable diagnosis???

NB: this was a case in our college...

anand_parsns · Credits: 615 My Scrapbook

my diagnosis would be MALIGNANT HYPERTENSION!
probably the blurring of vision is related to Papilledema...
Whats the answer???

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