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Q1: Clinical examination (2 min)
"A patient has a scrotal swelling. How do you determine if it is a hydrocele or a hernia?"
- Can you get above it? Yes = scrotal (hydrocele). No = inguinal hernia.
- Transillumination — positive in hydrocele, negative in hernia.
- Cough impulse — absent in vaginal hydrocele, present in hernia and congenital hydrocele.
- Reducibility — hernia reduces, hydrocele does not.
Q2: Congenital hydrocele (2 min)
"A 6-month-old infant has a hydrocele. What do you do?"
- Most resolve by age 2 (processus vaginalis closes). Observe.
- If persistent after age 2 or clearly communicating: herniotomy (ligate processus at internal ring via inguinal incision).
- Do NOT aspirate (risks infection, does not address patent processus).
Q3: Adult surgical management (3 min)
"Describe the Jabouley and Lord procedures."
- Jabouley: open the sac, evacuate fluid, evert the tunica vaginalis, suture behind cord and epididymis.
- Lord: plicate (pleat) the tunica to the testis border without excision.
- Both have under 5% recurrence.
- Excision reserved for thick-walled fibrous sacs.
- Always ultrasound before surgery to exclude tumour.
Q4: Filarial hydrocele (2 min)
"A patient from Bihar has a large hydrocele with milky fluid. What is the organism and treatment?"
- Wuchereria bancrofti — lymphatic filariasis.
- Milky fluid = chylocele (lymph-rich).
- Treatment: DEC 6 mg/kg for 12 days + doxycycline for Wolbachia. Plus surgery.
- India's MDA programme: DEC + albendazole mass drug administration.