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Renal / Urology > Benign / Lumps in the Groin > Flashcards

Benign / Lumps in the Groin Flashcards

1
Q

What is testicular torsion

A

Spermatic cord which supplies blood to the testicles becomes twisted

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2
Q

How does testicular torsion present

A 
Painful scrotum - acute, usually unilateral 
Tender
Painful to walk or move
Vomitnig
Redness
Transverse lie
Not relieved by lifting 
Thick cord
Firm testis 
Retracted / elevated testis
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3
Q

What happens to cremaster reflex in torsion of testis

A

Absent on side

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4
Q

Who is at risk

A

Young men
Congenital bell clapper - allows testis to rotate within tunica as not fixed to tunica vaginalis
Cryptochordism
Exertion / minor trauma

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5
Q

How do you treat

A 
SURGICAL EMERGENCY 
Clinical Dx 
Urine dip and bloods normal 
Inform senior and prep surgery 
NBM, analgesia
Pre-op blood - FBC, U+E, G+S 
Bilateral orchidopexy - fix both testis 
If >6 hours ischaemia is often irreversible causing infertility 
Orchiectomy if dead - consent for this 
Fix both as higher risk of othe
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6
Q

What Is DDX

A

Epididymitis - pain / discharge / urine
- +ve trans sign - elevating testis removes pain
- Abnormal dip / bloods
Torsion appendix
Trauma

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7
Q

What happens if don’t remove necrotic tissue

A

Atrophy

Anti-sperm Ab attacks contralateral side

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8
Q

What causes torsion appendix testis

A

Remnant of duct

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9
Q

How does it present

A

Unilateral scrotal pain
Could be on tender
Blue dot

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10
Q

What happens to cremaster reflex

A

Preserved and marked

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11
Q

How do you treat

A

Diathermy

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12
Q

What causes prostatitis

A

E.coli
S. faecalis
Chlamydia + G
Previous TB

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13
Q

How does prostatitis present

A 
UTI
Acute retention
Pain
Haematospermia
Swollen prostate on DRE
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14
Q

How do you Dx and Rx

A

Rectal swab
Analgesia
Ax

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15
Q

What is balantits

A

Inflammation of foreskin and glands

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16
Q

What causes balantitis

A 
Strep
Staph
Candida
STI
Dermatitis - contact, eczema, psoriasis
BXO 
Zoon's
- Persistent erythematous plaque on glands of penis - orange / red 
- Causes foreskin malfunction 
- Chronic and benign 
Circante
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17
Q

When is balantitis common

A

DM
Young children with tight foreskins / phismosis
Poor hygiene
Eczema / psoriasis

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18
Q

What is phimosis

A

Foreskin occludes the meatus and cannot be retracted

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19
Q

How does phimosis present

A

Recurrent balantitis in children
Painful intercourse
Infection
Ulceration

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20
Q

What is associated with balantiis and how does it present

A

BXO (male equivalent of lichen sclerosis

  • Painful itchy white spots
  • Tight white ring
  • Dysuria
  • Reduced sensation

Complications

  • Phismosis due to scarring
  • Balantitis
  • SCC
  • Infection
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21
Q

What is paraphismosis

A

Tight foreskin is retracted and becomes irreplaceable
Prevents venous return
Oedema
Possible ischaemia

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22
Q

How do you treat paraphismosis

A 
Return foreskin after catheter
Squeeze glands
Apply glucose swab or lidocaine gel 
Aspiration
Circumcision
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23
Q

How do you Dx balantitis

A

Swab if unclear or suspect bacterial

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24
Q

How do you Rx

A

Saline bath
Rx underlyin
Topical Ax or anti-fungal
Topical hydrocortisone

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25
Q

What do you do for recurrent balantitis / Zoons

A

Circumcision

Hygiene advice

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26
Q

What are reasons for circumcision

A 
Religious
Recurrent balantitis
BXO 
Pharphismosis
Phismosis
Reduce risk of penile cancer / STI / UTI
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27
Q

What do you do prior to circumcision

A

Hydrospadia as risk of stricture

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28
Q

What suggests an organic cause of erectile dysfunction and what causes this

A 
Normal libido
Ability to ejaculate
Vascular = most common
Neurogenic
Structural
Hormonal
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29
Q

What suggests a psychogenic cause

A 
Sudden onset
Decreased libido
Self-erection
Major life event
Previous psych 
Problems in relationship 
History premature ejaculation
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30
Q

What are the RF for erectile dysfunction

A 
Age 
Obesity
DM
Dyslipidaemia
Metabolic
HYpertension
Alcohol 
Drugs
TURP / pelvic surgery 
RT
Endocrine
Neuro
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31
Q

What drugs can cause

A

SSRI
BB
5 alpha reductase

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32
Q

How do you investigate erectile dysfunction

A

CVS risk / examine system
Free testesterone hypogonadism + HbA1c and lipid profile
FSH, LH prolactin if low
Refer to endocrine if abnormal

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33
Q

How do you treat erectile dysfunction

A

PDE-5 inhibitor - SIldenafil (Viagra)
- Cause vasodilation in blood vessel supplying corpus cavernosum
Regardless of cause
Vacuum erection if not appropriate

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34
Q

When is Viagra CI and what are SE

A

CI

  • Patients taking nitrates
  • Hypotension
  • Recent stroke or MI

SE

  • Blue visual disturbance due to ischaemic neuropathy
  • Flushing
  • GI
  • Headache
35
Q

What do you do if never had an erection

A

Refer to urology

36
Q

What other advise

A

Stop cycling

37
Q

Differential of lumps in the groin

A 
Epididymal cyst 
Hydrocele
Varicocele
Haematocele 
Epididymo-orchitis
Inquinal heria
Testicular torsion
Tumour
38
Q

What is 1st line investigation for ANY lump in the groin

A

USS

39
Q

What is it if you CAN’T get above it

A

Inguinal hernia

Proximal extending hydroceles

40
Q

What is it if separate from testis and cystic

A

Epididymal cyst - most common cause of lump

41
Q

What is it if separate from tests and solid

A

Epididymitis

Varicocele

42
Q

What is it If inside testis and cystic

A

Hydrocele

43
Q

What is it if inside testis and solid

A

Tumour
Haemaocele
Granauloma
Orchitis

44
Q

What is an epididymal cyst

A

Above and behind testis
Separate
Contains clear milky fluid

45
Q

How do you Rx and Rx

A

USS

Remove if causing symptoms

46
Q

What is a hydrocele

A

Accumulation of fluid in tuna vaginalis of testis caused by patenty of PPV in children or excess
Anterior and below
Can get above
May be difficult to palpate testis if large
Soft
Non tender
Transilluminates

47
Q

What should you always do with hydrocele

A

USS to exclude tumour as can be secondary to testicular tumour

48
Q

What else can cause hydrocele

A 
Primary in young to PPV drawing fluid in = communicating 
Trauma
Torsion
Infection - epidido-orchitis 
Malignancy - testicular
49
Q

How do you treat

A

Resolve spontensous
Aspiration
Repair in the young by age 1 or 2 as due to PPV

50
Q

What is a varicocele

A

Dilated veins of pampinoform plexus

51
Q

How does it present

A

Bag of worms in scortum

Dull ache

52
Q

What is varicocele associated with and what do you do to look for this

A

Infertility - serum parameters

If L could be RCC so do renal USS

53
Q

How do you Rx

A

Conservative if mild

Surgery if symptomatic / abnormal semen parameters as affects fertility

54
Q

What is haematocele

A

Blood in tunica vaginalis following trauma

55
Q

How do you Rx

A

Drainage

Excision

56
Q

What can cause epidymo-orchitis
Infection of epididymis - epididymitis
Infection of testis - orchitis

A 
C+G
E.coli
Mumps
TB
Usually spreads from urethra or bladder
57
Q

What is non-infective cause

A

Amiadarone

58
Q

How does it present

A 
Sudden onset
Swelling
Dysuria
Erythema 
Sweats
Fever 
Relieved by lifting 
Discharge suggests C+G
May have hydrocele 
Pain confined to epididymis where as in torsion it is the whole scrotum
59
Q

How do you Dx

A

1st catch urine
Look for discharge
STI screen
USS can confirm

60
Q

How do you treat

A

DONT MISS TORSION
Ax
Drain
Warn of infertility

61
Q

What is priaprism

A

Persistent painful erection in absence of sexual stimulation

62
Q

What are two types

A

Ischaemic

Non-ischaemia

63
Q

What causes ischaemic

A

Impaired vasorelaxation
Reduced vascular outflow
Congestion and trapping of deoxygenated blood

64
Q

What causes non-ishcameic

A

High arterial inflow e.g. due to a fistula / congenital malformation

65
Q

What is more suggestive of non-ischaemic

A

Not painful
Not fully rigid
Hx trauma

66
Q

What are RF

A 
Erectile dysfunction meds
Recreational drugs - cocaine / ectasy
Prescribed drugs - anti-hypertensive / coagulant / depressant 
Sickle cell / haemoglobinopathy 
Trauma
67
Q

How do you Dx / investigate for cause

A 
Clinical 
Cavernous blood gas analysis
Doppler USS 
FBC
Tox screen
68
Q

What suggest sischaemia

A

Low O2

High CO2

69
Q

How do you treat

A 
Ischaemic = emergency
If >4 hours = aspiration of blood + injection saline flush
Inject vasoconstriction agent if fails
Surgery
Non-ischaemia = watch and waste
70
Q

What are complications

A

Permanent tissue damage

Persistent erectile dysfunction

71
Q

What does intermittent testicular torsion require

A

Emergency surgery

72
Q

If can’t get above what is it

A

Inguinal hernia

73
Q

If can get above it what do you ask

A

Is it separates from testis

74
Q

If it is NOT separate

A

Does it transilluinate
YES = hydrocele
No = tumour

75
Q

If it IS separate

A

Does it feel like worms
Yes = varicocele
No = epidiymal cyst

76
Q

For any L scrotal mass or any torturous vein what must you rule out

A

Testicular or renal malignancy

77
Q

Hydrocele in young

A

Malignancy till proven otherwise

78
Q

Red and swollen

A

Torsion till proven otherwise

79
Q

What is Fournier gangrene

A

NF of perineum

80
Q

What causes

A

E.coli
Staph
Anoerobe - clostridium

81
Q

Who is it common in

A

Immunocompromsied
Type II DM
ALcohl

82
Q

How do you Rx

A 
ABCDE
Sepsis 6
NBM
Fluid
Broad spec Ax (tax and gent) 
Surgical debirdmenet
83
Q

Peyronies disease

A

Scar tissue in penis makes it bend
Can be painful and lead to ED
Should recover in 12 months

Renal / Urology (16 decks)

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