Lumps In The Groin And Scrotum

Question 1

What is the it if you cant get above it

Answer 1

Inguinal hernia
Proximally extending hydrocele
Varicocele

Question 2

If it is separate from the tests and cystic what is it

Answer 2

Epididymal cyst

Question 3

If it is separate and sold what is it

Answer 3

Epididymitis/varicocele

Question 4

Testicular and Cystic what is it

Answer 4

Hydrocele

Question 5

If it is testicular and solid what is it

Answer 5

Tumour
Hametocele
Granuloma 
Orchitis
Gumma - tertiary syphilis

Question 6

What is a testicular lump until proven otherwise

Answer 6

Tumour

Question 7

What is acute tender enlargement of the testis until proven otherwise

Answer 7

Torsion

Question 8

What is a hydrocele

Answer 8

Fluid within he tunica vaginalis

Question 9

Types of hydrocele

Answer 9

Primary: Associated with patent processes vaginalis
Which typically resolves around 1 yo
Secondary: to a testes tumour.infection/trauma primary are more common larger and usually in younger men
Can resolve spontaneously

Question 10

Tx of hydroceles

Answer 10

Aspiration- which may need repeating
Surgery - plicating the tunica vaginalis - Lords repair
Or jaboulays repair - inverting the sac

Question 11

Causes of epididymoorchitis

Answer 11

Chlamydia <35yrs
E. coli, mumps,
N, gonorrhoea
TB

Question 12

Features of epididymorchits

Answer 12

Sudden onset tender swelling, dysuria, sweats/fever, urethral discharge

Question 13

Ix epididymitis-orchitis

Answer 13

First catch urine sample

STI screen

Question 14

Tx of epididymitis-orchitis

Answer 14

<35yrs doxycycline - chlamydia contact trace
Gonorrhoea is suspected add centric one
If >35 and non STI - UTI associations more common
So try ciprofloxacin 2-4 weeks ab
Also analgesia
Scrotal support
Drain any abscess

Question 15

What is a varicocele

Answer 15

Dilated veins of the pampiniform plexus 
Left side more commonly affected 
Often visible 
Feel like a bag of worms
May have a dull ache 
Associated with sub fertility 
Left side more commonly affected as connects to renal vein bot straight to IVC

Question 16

What is a haematocele

Answer 16

Blood in the tunica vaginalis
Follows trauma
May need drainage/excision

Question 17

Types of testicular tumours

Answer 17

Seminoma
Non seminomatous germ cell tumour
Mixed
Lymphoma

Question 18

Age range most commonly affected with testicular tumours

Answer 18

15-44 yrs

Question 19

Signs of test cancer

Answer 19

Painless testis lump 
Found after trauma+/- infection +/- haematospermia
Ecndary hydrocele
Aim
Dyspnoea - lung mets
Ado mass - enlarged nodes 
Or effects of secreted hormones

Question 20

Risk factors for test ca

Answer 20

Undescended testes
Infant hernia
Infertility

Question 21

What percentage of test ca present with mets

Answer 21

50% NTSGCC

25% seminoma

Question 22

Staging of test ca

Answer 22

1 - no mets
2- infradiagphragmairc node involvement
3- supradiaphragmatic node involvement
4 - lung involvement- haematogenous spread

Question 23

Tests tes ca

Answer 23

CXR
CT
Excision biopsy
Alpha FP
HCG
Useful tumour markers

Question 24

Tx test ca

Answer 24

Radical orchidectomy
Seminoma radiosensitive orchidectomy + radio 95% cure
NSGCT even with mets 3 cycles chemo - 5 years survival >90%