Sexual Flashcards
Signs of testicular torsion
High-riding testicle
Absent cremasteric reflex
Scrotal pain that doesn’t resolve with elevation (negative Prehn sign)
Swollen, erythematous scrotum without transillumination
Which side is varicocele more common?
Left - left renal vein is vulnerable to compression where it passes between superior mesenteric artery and aorta
Right is rare and should raise suspicion for thrombosis or malignant compression
What is suggested by a varicocele that doesn’t decompress when supine, is on the right side and is in a prepubertal boy?
Secondary varicocele - perform abdominal ultrasound to evaluate for cause
- Extrinsic compression (renal [Wilms tumor] or retroperitoneal mass) of IVC
- Venous thrombus
What is purpose of testing cremasteric reflex?
Absent with testicular torsion
Positive Prehn sign (relief of pain with elevation of scrotum)
Epididymitis
Appendix testis torsion vs testicular torsion
Appendix testis torsion has localized, tender mass with possible blue discoloration
Doppler ultrasound would show normal or increased blood flow
Treat with pain management and scrotal elevation
Breast mass - FNA, core, or excisional biopsy?
FNA: small or cystic
Core: solid, acellular
Excisional: large, suspicious
Hydrocele appearance on US
Uniform fluid without vascularity anterior to testis
Testicular cancer - where does it metastasize?
Retroperitoneal LN, lungs, liver
Watch out for this in young man
What nerves regulate erection?
Sympathetic: T11-T12
Parasympathetic: S2-S4
Reflex erection: S2-S4
Which testicular cancer is in 40-50s (vs 15-30 yo)?
Seminoma
What testicular cancer should involve retroperitoneal lymph node dissection?
Non-seminomatous germ cell tumors
bHCG is seen from which testicular cancers?
Primarily choriocarcinoma
Possibly teratoma (which can also have AFP)
Rarely seminoma
Do Sertoli cell tumors produce anything?
No - Leydig cell tumors produce testosterone and estrogen
