First one with correct answer with justification win.

 

[size=20px]A pediatrician calls you about an 18 month old in whom she could not palpate a testis in the left scrotum. On previous well child checks, she had documented that the patient had bilateral retractile testes that could be brought down to their normal positions in the scrotum. On your exam the left testis is palpable in the subcutaneous tissue distal to external inguinal ring but cannot be brought down into the scrotum. The next best step in management of this patient with an abnormally located testis is

 

A reassure the parents that the testis will descend during puberty.

 

B re-examine in six months.

 

C obtain an ultrasound.

 

D hormonal treatment.

 

E orchidopexy.[/size]

C

Think again my friend

(Untitled)

 

E

E

correct

 

Acquired cryptorchidism describes the situation when a testis previously noted to be in the normal position is no longer in scrotum and cannot be manipulated into a stable normal position. When this situation occurs spontaneously it is known as an ascending testis. If it occurs after an ipsilateral hernia repair or other groin operation it is known as an entrapped testis. The potential for a previously descended testis to ascend to an abnormal location is one reason why scrotal exams are recommended during well child checks.

 

An ascending testis may lose germ cells just as a congenital undescended testis so it is recommended that (1) any child older than six months (corrected) age with a testis that cannot be found in the scrotum be referred for surgical evaluation and (2) an orchidopexy be performed if the testis is confirmed to be in an abnormal position. Ultrasound and other imaging studies are rarely indicated in the evaluation of cryptorchidism since 70% of undescended testes are palpable by an experienced specialist and there is no imaging modality that can accurately predict the absence of an impalpable testis and eliminate the need for operative evaluation. Imaging may delay timely surgical treatment and also may provide false positive and negative findings.