1: Disorders Testes, Scrotum and Penis Flashcards by Grace Poole

What are 6 differential diagnosis of testicular pain

Testicular torsion
Epidiymo-orchitis
Hydatid of Morgagni
fournire gangrene
strangulated inguinal hernia
renal stones

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What is Hydatid of Morgagni

Testicular appendage

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What age does hydatid of morgagni occur in

3-5 year-olds

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what is a sign unique to hydatid or Morgagni

Blue discolouration of the scrotum

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what is testicular appendage

remnant of the mullerian duct

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how does strangulated inguinal hernia present clinically

Recurrent inguinal-scrotal swelling

- Sudden-onset pain

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what is testicular torsion

twisting of spermatic cord and its contents in the tunica vaginalis

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what is the peak incidence of testicular torsion

15 -25 year-olds

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aside from in adolescence, who may testicular torsion occur in

neonates (30d)

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what type of torsion occurs in adolescents

Intra-vaginal (Within tunica vaginalis)

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what are 4 RF for intra-vaginal torsion

FH
Previous torsion
Cryptorchidism
Bell clapper deformity

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what is bell clapper deformity

Spermatic cord joins higher on tunica vaginalis. This increases mobility of the testes and often means they lie horizontally

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what type of torsion is extra-vaginal torsion

Neonatal torsion

- Occurs as tunica vaginalis is not yet fully attached to the scrotum and therefore is susceptible to tort

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how does testicular torsion present clinically

Sudden-onset unilateral scrotal pain and swelling

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how will the testes present on examination

Erythematous and swollen

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what will be absent on testicular examination

Phren sign

Cremasteric reflex

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what is phren sign

where testicular pain is relieved by lifting the testes

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what is phren sign indicative of

epidiymo-orchitis

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what time frame can necrosis of testes occur post-torsion

6-12h

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how is testicular torsion diagnosed

clinically

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how should testicular torsion be managed

emergency surgical exploration and bilateral orchidpexy

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what is time frame for orchipexy

4-6h

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what should all patients undergoing orchiopexy be consented for

Orchidectomy

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what is epidiymitis

inflammation epididymis

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what is orchiditis

inflammation testis

what is epididymo-orchitis

inflammation epididymis and testis.

explain epidemiology of epididymo-orchitis

orchitis rarely ever occurs alone. Most cases of epididymo-orchitis turn out to be epididymitis

when is the peak incidence of epididymo-orchitis

15-30 year-olds | 60 year-olds

what causes epididymal-orchitis

STI UTI Gastroenteritis

what is the biggest cause of epididymal-orchitis in men under 35

STI: - Chlamydia - Gonorrhoea

what is the biggest cause of epididymal-orchitis in men over 35

UTI: | E.Coli

what causes just orchitis

Mumps

what are two complications of mumps

Testicular atrophy | Infertility

what is a risk factor or epididymal-orchitis

Unprotected sexual intercourse Multiple partners Bladder outlet obstruction Instrumentation Immunocompromised

how does epididymal-orchitis present clinically

Unilateral scrotal pain and swelling Fever, riggers Preceding dysuria or discharge

how does epididymal-orchitis present on examination

Tender, erythematous

what signs are positive in epididymal-orchitis

Phren | Cremasteric reflex

what is phren's sign

Pain is relieved on elevating testes

what investigations should be ordered in epididymal-orchitis

NAAT on first void urine sample (Chlamydia and Gonorrhoea) Urinalysis

how is epididymal-orchitis managed

Antibiotics Analgesia Bed-Rest

what antibiotic is given if suspected E.coli is cause of epididymal-orchitis

Oxafloxacin

what antibiotics are given if suspect STI as cause of epididymal-orchitis

Ceftriaxone and Doxycycline

what foes epididymal-orchitis increase risk of

Hydrocele | Abscess

how can scrotal swellings be divided

Extra-testicular | Intra-testicular

name 5 extra-testicular scrotal swellings

- Inguinal Hernia - Hydrocele - Epididymitis - Epididymal cyst - Varicocele

what age do epididymal cysts occur in

Middle-Age

how do epididymal cysts present clinically

Smooth fluctuant nodules above and separate to testis, may be multiple. Usually asymptomatic

what are features of epididymal cysts on examination

Transilluminable

what is one of the most common causes of scrotal pain in adults

epididymitis

what is a distinctive feature of inguinal hernias as a cause of scrotal swelling

cannot get above the swelling!

what can exacerbate scrotal swelling if an inguinal hernia

coughing

when may lump disappear if an inguinal hernia

lying down

what are 4 testicular lumps causing scrotal swellings

- Testicular cancer | - Torsion

how does testicular cancer present

painless irregular lump of testis

if suspecting testicular cancer describe investigations

- Testicular USS - AFP, LDH and bHCG do NOT, under no circumstances, biopsy! at this can seed the cancer

what is a varicocele

abnormal dilation of pampiniform plexus

what are the causes of varicocele

- Primary (Idiopathic) | - Secondary = lymphoma or RCC

what side do 90% of varicoceles occur on and why

Left | : left testicular vein drains into renal vein

how do varicoceles present clinically

Dull-ache sensation : worse on standing | Bag of worms - swelling that may disappear on lying down

what are 3 red flags of testicular varicocele

- Right sided - Acute - onset - Remains on lying flat

what does right sided testicular varicocele indicate

usually abdominal mass such as lymphoma or RCC

what should all individuals with varicocele be offered and why

abdominal exam - due to risk of RCC

what investigations are ordered in varicocele

USS | Semen analysis

why is a semen analysis offered in varicocele

As can compromise fertility

what are two management options for varicocele

Conservative | Embolisation

when is testicular embolisation offered

Pain | Infertility

what are two complications of varicocele

Testicular atrophy | Infertility

what is a hydrocele

collection fluid between visceral and parietal layers of tunica vaginalis

how does a hydrocele present

painless fluctuant swelling

how are hydrocele's and inguinal hernias differentiated

- hydroceles = can get above | - inguinal hernia = cannot get above

what is a key feature of hydroceles on examination

transilluminable

what causes congenital hydroceles

patent processus vaginalis

in patients 20-40 years with suspected hydrocele what should be done

USS - to exclude testicular cancer

if congenital hydrocele when do they typically resolve by

6-months

when are congenital hydroceles operated on

1-year

what is balanitis

inflammation glans penis

what is balanoposthitis

inflammation glans penis and foreskin

what are features of candiasis balanitis

Itching following intercourse | White discharge

what are features of contact or allergic dermatitis balanitis

Painful Itchy Clear discharge No other region affected

what are features of eczema or psoriais dermatitis balanitis

Itchy | Other regions skin affected

What usually causes bacterial balanitis

Staphylococcus

How does bacterial balanitis present

- Painful - Itchy - Yellow discharge

How does aerobic balanitis present

Offensive yellow discharge

What are features of lichen plants balanitis

- Wickhams striae | - Violaceous papules

What is lichen sclerosis balanitis called

Balanitis xerotica obliterans

How does balanitis xerotica obliterans present clinically

Itchy white plaques scarring

what can balanitis xerotica obliterans cause

urethral stricture

how does plasma cell balanitis of zoon present

well circumscribed erythematous lesions

what is circinate balanitis associated with

retir syndrome | - presents as painless erosions

what is used to manage balanitis

Saline wash out - was under foreskin | Topical hydrocortisone

how is balanitis xerotica obliterans managed

Circumscion | Topical corticosteroids

what are 4 indications for circumscision

- Recurrent balanitis - Balanitis xerotica obliterans - Phimosis - Paraphimosis

what are 3 advantages of circumscion

- Reduce risk penile cancer - Reduce risk UTI - Reduce risk STI

what organism is the most common cause of epididymo-orchitis

chlamydia

1: Disorders Testes, Scrotum and Penis Flashcards

(94 cards)