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General Surgery · Hernia and abdominal wall: communicating hydrocele in infants
Sample itemA 10-month-old boy has a painless scrotal swelling that is smaller in the morning and larger by evening. It transilluminates brilliantly and the examiner can get above it. What is the underlying cause?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. A patent processus vaginalis
A swelling that varies in size through the day indicates communication with the peritoneal cavity through a patent processus vaginalis. Peritoneal fluid tracks into the tunica vaginalis when the child is upright. Since the processus may close with time, many are observed, while persistence or a hernia component is treated by ligation.
Option by option
A. Filarial lymphatic obstruction
Filarial obstruction causes a hydrocele in endemic adults, not an infant with a diurnal change.
B. Defective absorption by the tunica vaginalis
Defective absorption causes a non-communicating hydrocele that does not vary through the day.
C. A patent processus vaginalis (correct)
Correct. A patent processus vaginalis lets peritoneal fluid pass into the scrotum, giving a size that changes with posture.
D. Excess fluid from a testicular tumour
A tumour does not give a brilliantly transilluminant swelling that varies in size.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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