Inability to reduce the proximal foreskin over the glans penis is most likely which of the following?
Answers:
A. Balanitis
This question forces you to parse precise anatomic phrasing. The stem gives a single, technical physical‑exam finding. It looks simple. But the options are near‑synonyms that often get mixed up under test pressure. This is a classic boards “word‑choice” gotcha that weeds out fast guessers.
| Option | What It Tests / Implies | Why It’s Wrong Here |
|---|---|---|
| Balanitis | Recognizes inflammation limited to the glans. Tests knowledge of inflammatory vs mechanical causes of penile symptoms. | Balanitis is inflammation of the glans only; it does not describe inability to manipulate the foreskin. |
| Balanoposthitis | Tests recognition of combined glans + foreskin inflammation. | Balanoposthitis involves infection/inflammation of glans and prepuce; it does not cause a mechanical inability to return the foreskin after retraction. |
| Paraphimosis | Tests precise anatomic definition: a retracted foreskin that cannot be returned, causing venous congestion — a urologic emergency. | Correct — fits the stem exactly: proximal foreskin cannot be reduced over the glans, leading to distal congestion. |
| Phimosis | Tests knowledge of inability to retract the foreskin (often physiologic in children). | Stem describes inability to reduce a retracted foreskin back over the glans — the opposite of phimosis, which prevents retraction. |
| Priapism | Tests recognition of penile vascular emergencies unrelated to foreskin/foreskin position. | Priapism is prolonged erections due to corpora cavernosa engorgement, not a foreskin positioning problem. |
Paraphimosis = retracted, nonreducible foreskin causing constriction and distal edema — treat immediately (manual compression ± reduction; dorsal slit if unsuccessful).
This item relies on near‑synonymous vocabulary and reversal of action: “cannot reduce” vs “cannot retract.” Under time pressure, examinees frequently latch onto “foreskin” + “cannot” and misremember whether the problem is retracting or returning the prepuce. The exam tests exact anatomical verbs rather than broader clinical context.
A 7‑year‑old uncircumcised boy presents with sudden penile pain after being examined for phimosis earlier in the day. On exam the glans is erythematous, swollen, and the preputial ring is retracted behind the coronal sulcus and cannot be pulled forward over the glans. Which is the most likely diagnosis?
A. Balanitis
B. Balanoposthitis
C. Phimosis
D. Paraphimosis
E. Priapism
An adolescent presents with a painful, swollen distal penis after his caregiver forcibly retracted the foreskin for cleaning. On exam there is a tight, constricting ring at the proximal shaft with a tense edematous glans. What is the most appropriate immediate next step?
A. Oral antibiotics and outpatient follow‑up in 48 hours
B. Immediate urology consultation for dorsal slit only
C. Warm water soaks and topical steroids at home
D. Manual reduction after analgesia and compression; if unsuccessful, dorsal slit
E. Intracavernosal phenylephrine injection
A 5‑year‑old boy has persistent inability to pull back his foreskin over the glans. There are no signs of inflammation, infection, or pain. Parents report he has never had the foreskin retracted. What is the best initial management?
A. Emergency manual reduction under anesthesia
B. Reassurance and observation; most cases are physiologic and resolve with time
C. Immediate circumcision
D. Oral antifungals and hygiene instruction
E. Topical phenylephrine application
A 16‑year‑old male presents with a painful, rigid erection lasting 6 hours after pelvic trauma. The glans is soft and the shaft is rigid. Which statement is true?
A. This is paraphimosis and can be managed with manual reduction of the foreskin.
B. This is balanitis — treat with topical antifungals.
C. This is ischemic priapism requiring emergent decompression (aspiration ± phenylephrine).
D. This is phimosis and needs topical steroids.
E. This is balanoposthitis and requires oral antibiotics.
A 9‑year‑old uncircumcised boy presents with painful unitary swelling of the glans and prepuce after poor hygiene. The foreskin is not retracted and the preputial opening is tight, but the prepuce can’t be pulled back because of edema and pain. There is no history of prior attempts to retract. What is the best descriptor for this presentation?
A. Paraphimosis
B. Balanoposthitis
C. Phimosis (physiologic)
D. Priapism
E. Balanitis
Compare the acute management priorities and time sensitivity between paraphimosis and ischemic priapism. How does bedside technique differ, and when do you escalate to surgical intervention?
This question appears in Med-Challenger Pediatric Medicine Exam Review with CME
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