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Flashcards in 25. Scrotal Mass Deck (21)
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1

What details of a scrotal lump should you find out?

Is it painful?
How long has it been there?
What made them first notice the lump?
Is the lump always there?
Any other lumps?
Other symptoms? (UTI/STI)
Trauma to the testes?

2

What are 4 key characteristics of a scrotal mass that will let you narrow your differential?

Can you get above it?
Can you palpate the testis separate from the swelling/ lump?
Does it transilluminate?
Is it tender?

3

What would you suspect if the scrotal mass is separate from the testis, fluctuant and transilluminable?

Epididymal cyst

4

What would you suspect if the scrotal mass is separate from the testis, non transilluminable and tender?

Acute epididymitis

5

What would you suspect if the scrotal mass is not separate from the testis and is transilluminable?

Hydrocele (collection of fluid in tunica vaginalis)

6

What would you suspect if the scrotal mass is not separate from the testis, not transilluminable and tender/ not tender?

Tender: Torsion, orchitis, epididymo-orchitis
Non tender: cancer

7

What is indicated by an acutely swollen and tender scrotum that has been present for a matter of hours?

Testicular torsion until proven otherwise

8

What is suggested by a feeling of heaviness in the testis?

Testicular cancer

9

What should you suspect in a swelling that extends into the groin?

Inguinoscrotal hernia
(can't get above it)

10

What does transillumination of a mass suggest?

Fluid contents

11

What would you suspect if the scrotal mass is separate from the testis, non transilluminable and non tender?

TB epididymitis

12

Where do the testes drain?

Para-aortal lymph nodes

13

Where does the scrotal skin drain?

Inguinal lymph nodes

14

Which tumour markers are commonly expressed in teratomas?

a-Fetoprotein (AFP)
b-HCG

15

Which tumour markers are more often raised in seminomas?

b-HCG
LDH

16

What may be described as a "bag of worms" on palpation of a scrotal mass?

Varicocele

17

Why is radical orchidectomy performed via an inguinal incision rather than a scrotal incision?

Scrotal incision would risk seeding malignant cells into the scrotum (separate lymph drainage)

18

Who is most commonly affected by teratomas and seminomas?

Teratomas: 20-30y
Seminomas: 30-50y

19

On which side are varicoceles more common?

Left
(left gonadal vein drains into left renal vein at 90 degree angle)

20

What can cause sudden appearance of a left sided varicocele?

Renal tumours (block left renal vein, impair gonadal drainage)

21

Which pathogens are most likely to cause epidiymo-orchitis in < 35s + >35s?

< 35: STI: Chlamydia + Gonorrhoeae
> 35: UTI: E. coli