Reproductive Flashcards

Question

What are the indications for surgery for benign prostate hyperplasia?

Answer 1

RUSHES Mnemonic - R - Recurrent or refractory urinary retention - U - recurrent UTIs - S - bladder Stone - H - Haematuria - E - Elevated creatinine - S - Symptom deterioration despite therapy

Answer 2

- Transurethral incision of the prostate (TUIP) - Transurethral resection of the prostate (TURP) - Holmium laser enucleation of the prostate (HoLEP) - Transurethral electro-vaporisation of the prostate (TUVP)

Answer 3

Prostate cancers most commonly refer to prostate adenocarcinomas but other prostate cancers include transitional cell carcinoma arising from cells in the transitional zone, and small cell prostate cancer arising from neuroendocrine cells.

Answer 4

- Increasing age: highest rates amongst men aged 75 to 79 years - Family history: 5-10% have a strong family history - Afro-Caribbean ethnicity - Being tall - Obesity and high-fat diet - Use of anabolic steroids - Cadmium exposure - BRCA1 and BRCA2

Answer 5

- Asymmetrical, hard, nodular prostate with loss of median sulcus on digital rectal examination - Urinary retention - Presents with lower abdominal pain and tenderness, inability to urinate and a palpable bladder - Palpable lymphadenopathy: indicates metastatic disease

Answer 6

- Frequency - Hesitancy - Terminal dribbling - Nocturia - Haematuria or haematospermia - Dysuria - Constitutional symptoms: e.g. weight loss, fatigue - Bone pain: e.g. lumbar back pain: suggests metastatic disease

Answer 7

- Digital rectal exam - first line - Prostate-specific antigen (PSA) - Liver profile - U&Es - Multiparametric MRI: first line for suspected localised cancer - TRUS was previously gold standard

Answer 8

- CT abdomen and pelvis / MRI: usually performed as part of staging - Bone scan: if symptoms, e.g. bone pain, or PSA trends are indicative of metastasis then an isotope bone scan must be performed

Answer 9

Used to grade prostate neoplasms following biopsy giving an overall score ranging from 2 - 10 - The most prevalent histological pattern is graded form 1-5, with grade 5 being the least differentiated - The second most prevalent histological pattern is graded in the same way, and the two scores are added together - Grade 1: Well differentiated cancer. - Grade 2: Moderately differentiated cancer. - Grade 3: Moderately differentiated cancer. - Grade 4: Poorly differentiated cancer. - Grade 5: Anaplastic (poorly differentiated) cancer.

Answer 10

- Benign prostatic hyperplasia - Chronic prostatitis

Answer 11

- Option 1: Active surveillance or observation - Option 2: Radical prostatectomy - Option 3: Radical radiotherapy or brachytherapy +/- anti-androgen therapy (flutamide, or LHRH agonists)

Answer 12

- Option 1: Radical prostatectomy - Option 2: Radical radiotherapy with anti-androgen therapy - Option 3: Radical radiotherapy with brachytherapy - Option 4: Docetaxel chemotherapy with anti-androgen therapy

Answer 13

- Treated with docetaxel chemotherapy and anti-androgen therapy - Bilateral orchidectomy (removal of testes to cause androgen deprivation) should be offered as an alternative to LHRH agonists

Answer 14

- Urinary retention - Metastasis: most commonly to bone

Answer 15

Breast cancer is an uncontrolled growth of epithelial cells within the breast.

Answer 16

- Female gender - Age - White ethnicity - Exposure to radiation - Alcohol - Obesity - Family history - Personal history of breast cancer - Genetic predispositions (e.g. BRCA 1, BRCA 2) - Oestrogen exposure: - Combined oral contraceptive (still debated, effect likely minimal if present) - Hormone replacement therapy - Early menarche and late menopause - Nulliparity (woman who has never given birth) - Increased age of first pregnancy

Answer 17

- May be asymptomatic in the early stages - Breast and/or axillary lump: - Often irregular - Typically hard/firm - May be fixed to skin or muscle - Breast pain - Breast skin: - Change to normal appearance - Skin tethering - Oedema - Peau d’orange: thickened and dimpled skin - Nipples: - Inversion: fibrosis of lactiferous ducts and suspensory ligament causes retraction - Discharge, especially if bloody - Dilated veins - Paget's disease: itching, redness, crusting and discharge from the nipple. - Features of metastatic spread: the bone (bone pain), liver (malaise, jaundice), lungs (shortness of breath, cough) and brain (confusion, seizures) are most commonly affected.

Answer 18

- In England, breast cancer screening runs from the ages of 50 to 71. - Screening involves a mammogram. The images are then reviewed by a consultant radiologist with several possible results. - Additional screening exists for those with family history and may involve genetic testing and imaging at a younger age.

Answer 19

- Satisfactory: no radiological evidence of breast cancer, approximately 96% will have a normal result - Abnormal: abnormality detected, further investigations needed. Around a quarter with an abnormal result will subsequently be found to have breast cancer. - Unclear: results or imaging unclear or inadequate. Further investigations required.

Answer 20

- History and examination - Imaging - Mammogram: utilises x-rays to image breast tissue. Findings suggestive of cancer include soft tissue masses and microcalcifications. - USS: modality of choice in women under the age of 40. It is also used in older women, particularly when mammography and clinical findings do not align. - Histopathology - This is usually in the form of a fine-needle aspiration (FNA) or core biopsy

Answer 21

- Imaging: - CXR - Breast tomosynthesis - MRI breast - CT chest, abdomen and pelvis - CT brain - Contrast-enhanced liver USS - Bone scan - PET/CT - Receptor testing - Oestrogen receptor (ER) status - Progesterone receptor (PR) status - Human epidermal growth receptor (HER2) status - Assessment of axilla: if abnormal lymph nodes are found, they may be sampled with ultrasound-guided needle sampling - Genetic testing e.g. for BRCA1

Answer 22

TNM system.

Answer 23

- Tumour resection - Breast conservation - Mastectomy - Lymph node assessment - Breast reconstruction

Answer 24

- Surgery - Chemotherapy e.g. Trastuzumab (Herceptin) - Endocrine therapy - Tamoxifen - Aromatase inhibitors (e.g. anastrozole) - GnRH analogue (e.g. goserelin) - Laparoscopic oophorectomy

Answer 25

- Other causes of breast lumps: - Fibroadenoma - Fibrocystic Breast Disease - Breast cysts - Breast abscess - Fat necrosis - Lipoma - Phyllodes tumour

Answer 26

- Unable to develop or maintain an erection during sex. - Also called impotence.

Answer 27

- International index of erectile dysfunction - abnormal - Sexual Health Inventory for Men - abnormal - Fasting blood glucose - diagnosing diabetes - Lipid profile - abnormal in hypercholesterolaemia - Duplex ultrasound - evaluate blood flow, look for atherosclerosis

Answer 28

- First line → Treatment of underlying condition. - Second line → PDE5 (Sildenafil, Tadalafil, Vardenafil) - Third line → Intra-cavernus injection (intra-cavernous alprostadil , papaverine) - Fourth line → Intraurethral suppository (alprostadil urethra) - Fifth line → Penile prothesis

Answer 29

- This is a common sexually transmitted infection in the UK and significant cause of infertility. - The causative organism is Chlamydia trachomatis - A gram-negative bacteria - It is an intracellular organism

Answer 30

- Unprotected sex - Young, sexually active etc - Multiple partners

Answer 31

- Abnormal vaginal discharge - cloudy or yellow discharge - Painful urination - dysuria - Pelvic pain - Abnormal vaginal bleeding (intermenstrual or post coital) - Painful sex - dyspareunia

Answer 32

- Urethral discharge or discomfort - Painful urination (dysuria) - Epididymo-orchitis - Reactive arthritis

Answer 33

- Trachoma & Neonatal Conjunctivitis - Swollen eyelids - Purpulent discharge - Pain - Photophobia - C. trachomatis pneumonia - Rapid breathing - Staccato cough - Short, repetitive cough with deep inspiration after each cough - LVG - Ulcerating papules on genitals - Swollen lymph nodes in inguinal region

Answer 34

NAAT (Nucleic acid amplification test) - In women can be performed on vulvovaginal swab, endocervical swab or first-catch urine sample - In men can be performed on first-catch urine sample or a urethral swab

Answer 35

- Anti-chlamydial antibiotics (first line) - Doxycycline 100mg twice for 7 days - Abstain from sex for seven days of treatment - Refer all patients to GUM - Test for and treat other STIs - Provide eduation on prevention - Consider safeguarding issues and sexual abuse in children and young people

Answer 36

- Doxycycline is contraindicated in pregnancy and breastfeeding - Alternatives are: - Azithromycin 1g stat then 500mg once a day for 2 days - Erythromycin 500mg four times daily for 7 days - Erythromycin 500mg twice daily for 14 days - Amoxicillin ****500mg three times daily for 7 days

Answer 37

- Pelvic inflammatory disease - Chronic pelvic pain - Infertility - Ectopic pregnancy - Epididymo-orchitis - Conjuctivitis - Reactive arthritis - Lymphogranuloma verenum

Answer 38

- This program aims to screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner. - Everyone that tests positive should have a re-test three months after treatment. - This re-testing is to ensure they have not contracted chlamydia again, rather than to check the treatment has worked. - Tests are for: - Chlamydia - Gonorrhoea - Syphilis (blood test) - HIV (blood test)

Answer 39

- A common STI caused by Neisseria gonorrhoeae, a gram-negative diplococcus bacterium.

Answer 40

- Unprotected sex - 15-24 years old - Black ancestry - Current or prior history of STIs - Multiple recent sexual partners - Inconsistent condom use - Men who have sex with men - History of sexual abuse

Answer 41

- Odourless purpulent discharge, possibly green or yellow - Dysuria - Pelvic pain (in women) - Testicular pain or swelling aka epididymo-orchitis (in men) - Rectal infection may cause anal or rectal discomfort or discharge but is often asymptomatic - Pharyngeal infection may cause a sore throat but is often asymptomatic - Prostatitis cause perineal pain, urinary symptoms and prostate tenderness on examination - Conjunctivitis cause erythema and a purulent discharge

Answer 42

- NAAT → Will be positive for gonorrhoea. - NAAT does not provide any information about the specific bacteria and their antibiotic sensitivities and resistance. - Charcoal swab - Taken for microscopy, culture and testing antibiotic sensitivities before initiating antibiotic therapy. - This is especially important given the high rates of antibiotic resistance.

Answer 43

Patient should be referred to GUM clinics to coordinate testing, treatment and contact tracing - Single dose IM Cefriaxone 1g - Single dose Oral Ciprofloxacin 500mg All patient should have a follow-up “test of cure” given the high antibiotic resistance.

Answer 44

- This is with NAAT testing if they are asymptomatic, or cultures where they are symptomatic. - BASHH recommend a test of cure at least: - 72 hours after treatment for culture - 7 days after treatment for RNA NAAT - 14 days after treatment for DNA NAAT

Answer 45

- Abstain from sex for seven days of treatment - Refer all patients to GUM - Test for and treat other STIs - Provide education on prevention - Consider safeguarding issues and sexual abuse in children and young people

Answer 46

- Pelvic inflammatory disease - Chronic pelvic pain - Infertility - Epididymo-orchitis (men) - Prostatitis (men) - Conjunctivitis - Urethral strictures - Disseminated gonococcal infection - Skin lesions - Fitz-Hugh-Curtis syndrome - Septic arthritis - Endocarditis

Answer 47

- A complication of untreated gonococcal infection - Where bacteria spreads to skin and joints - It causes - Various non-specific skin lesions - Polyarthralgia (joint aches and pains) - Migratory polyarthritis (arthritis that moves between joints) - Tenosynovitis - inflammation of synovial membrane around tendon - Systemic symptoms such as fever and fatigue

Answer 48

- In a neonate this means its contracted from the mother during birth - Neonatal conjunctivitis is called ophthalmia neonatorum - This is a medical emergency and is associated with sepsis, perforation of the eye and blindness

Answer 49

- A sexually transmitted infection caused by the spirochaetal bacterium Treponema pallidum. - It infects the skin and mucous membranes of the external genitalia and mouth.

Answer 50

- Contacted through: - Acquired syphilis: oral, vaginal or anal sex, , IV drug use, blood transfusions and other transplants. - Congenital syphilis: Vertical transmission (mother to child).

Answer 51

- Sexual contact with an infected person - MSM - Illicit drug use - Commercial sex workers - Multiple sex partners - Syphilis during pregnancy

Answer 52

- Painless genital ulcer (chancre) - Local lymphadenopathy

Answer 53

- Maculopapular rash - Condylomata lata (grey wart-like lesions around the genitals and anus) - Low-grade fever - Lymphadenopathy - Alopecia (localised hair loss) - Oral lesions

Answer 54

- Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones) - Aortic aneurysms - Neurosyphilis - Argyll-Robertson pupil (pupil loses the light reflex) - Headache - Altered behaviour - Dementia - Tabes dorsalis (demyelination affecting the spinal cord posterior columns) - Ocular syphilis (affecting the eyes) - Paralysis - Sensory impairment

Answer 55

- Dark field microscopy - Polymerase chain reaction (PCR) - Antibody testing

Answer 56

All patients must be followed up by a specialist service. - Standard treatment → Single deep IM dose of Benzathine benzylpenicillin. - If patient is allergic then give Doxycycline. - Alternative regimes and types of penicillin are used in different scenarios, for example, late syphilis and neurosyphilis. Ceftriaxone, amoxicillin and doxycycline are alternatives.

Answer 57

Jarisch-Herxheimer reaction for penicillin use

Answer 58

A varicocele refers to dilated testicular veins within the pampiniform plexus. The vast majority (around 90%) occur on the left side.

Answer 59

- Palpable veins (described as bag of worms) - Scrotum may hang lower on side of varicocele - Signs of testicular atrophy may be seen on the affected side.

Answer 60

- Painless testicular swelling - May reduce on lying and be exacerbated by a Valsalva manoeuvre (slow breathing) - Some patients develop symptoms: discomfort, pain or a dragging sensation.

Answer 61

- Testicular examination: demonstrates dilated veins (bag of worms) - Examination is conducted both standing and lying. - The size of each testicle should be evaluated. - Doppler USS may be used in cases of diagnostic uncertainty and to confirm diagnosis. - Fertility assessments may be completed. Semen analysis can be sent alongside FSH and testosterone levels.

Answer 62

- Sub-clinical: No clinical abnormality, only detected by Doppler ultrasound. - Grade I (small): Only clinically palpable with Valsalva manoeuvre. - Grade II (moderate): Palpable without Valsalva manoeuvre. - Grade III (large): Varicocele is visible through the scrotal skin, easily palpable.

Answer 63

- Inguinal / subinguinal approach - Retroperitoneal high ligation - Microsurgical inguinal - Laparoscopy

Answer 64

- Antegrade sclerotherapy - Retrograde sclerotherapy - Retrograde embolisation

Answer 65

- Testicular mass - Hydrocele - Inguinal hernia

Answer 66

- Testicular atrophy - Infertility/ subfertility

Answer 67

All testicular lumps = cancer until proven otherwise. Acute, tender enlargement of testis = testicular torsion until proven otherwise. 1. Can you get above it? 2. Is it separate from the testis? 3. Cystic or solid? - Cannot get above = inguinoscrotal hernia, hydrocele extending proximally - Separate and cystic = epididymal cyst - Separate and solid = epididymitis, varicocele - Testicular and cystic = hydrocele - Testicular and solid = tumour, haematocele, granuloma, orchitis, gumma (non cancerous growth)

Answer 68

- Testicular torsion is a urological emergency caused by twisting of the testicle on its spermatic cord, leading to ischaemia and eventually necrosis. - Germ cells are most susceptible to ischaemia. - “6 hour window” after onset before damage from ischaemia is irreversible.

Answer 69

- Young age - Bell clapper deformity: high riding testicle with a horizontal lie - Cryptorchidism: undescended testis increase the risk of torsion and would usually present in the first few months of life - Trauma: trauma-induced torsion accounts for less than 10% of cases

Answer 70

- Swollen, high-riding and tender testicle: skin may be erythematous - Abnormal lie - Horizontal lie - Rotated so that epididymis is not in normal posterior position - Elevated (retracted) testicle - Prehn’s negative: - Pain is not relieved on lifting the ipsilateral testicle, unlike in epididymitis - Absent cremasteric reflex - Swipe the superior and inner part of the thigh - A normal reflex contracts the cremaster muscle, pulling up the ipsilateral testis - Reflex almost always absent

Answer 71

- Usually unilateral, sudden onset and excruciatingly painful - Often triggered by activity - Pain may be severe, intermittent and self-limiting; intermittent pain does not rule out torsion - Nausea and vomiting secondary to pain is common - Lower abdominal pain: referred pain

Answer 72

- Imaging should not be considered if testicular torsion is suspected as it will delay surgery. - Surgical exploration: should be performed immediately if there is high clinical suspicion as it allows definitive diagnosis and management. Should be performed within 6 hours to prevent irreversible damage (90% salvageable at 6 hours and 10% salvageable at ≥24 hours)

Answer 73

- Testicular ultrasound: operator-dependent; ‘whirl-pool’ sign suggests torsion, as does decreased blood flow in the affected testicle on colour doppler - Urinalysis: an abnormal result such as the presence of leukocytes and nitrites may suggest an alternative diagnosis, e.g. epididymo-orchitis

Answer 74

- Epididymo-orchitis/ epididymitis - Torsion of the Hydatid of Morgagni (embryonic remnant of the Mullerian duct) - Hydrocele - Varicocele - Testicular cancer

Answer 75

Bilateral orchiopexy: the affected testicle is untwisted and fixed to the scrotal sac. The contralateral testicle should always be fixed to prevent contralateral torsion

Answer 76

Ipsilateral orchiectomy and contralateral orchiopexy: removal of the affected testis and fixation of the contralateral testis to the scrotal sac to prevent contralateral torsion

Answer 77

Manual de-torsion: a temporary measure that should only be performed if surgery is not available within 6 hours. Surgical exploration must be subsequently performed to ensure the viability of the testis

Answer 78

- Recurrent torsion - Infertility/ subfertility: torsion for 10-12 hours results in ischaemia and irreversible damage. Orchiectomy results in decreased spermatogenesis - Pubertal delay: may occur, particularly if bilateral orchiectomy is performed; hormone replacement may be required

Answer 79

- Inflammation of the epididymis (coiled tube that stores sperm and transports it from the testes) is referred to as epididymitis, whilst orchitis is inflammation of the testicle. - The two can co-exist and is referred to as epididymo-orchitis.

Answer 80

- STI-related: young, multiple partners, unprotected sex - Enteric-related: elderly, bladder outflow obstruction, structural/functional abnormality of urinary tract, instrumentation of urinary tract - Tuberculosis: can cause epididymo-orchitis - Mumps

Answer 81

- Tenderness and palpable swelling of the epididymis and testicles - Prehn’s sign positive - Pain relief with lifting the affected testicle - Prehn’s sign is negative in testicular torsion - Cremasteric reflex preserved (unlike torsion)

Answer 82

- Unilateral tender, red, and swollen testicle - Pain develops over a few days - Lower urinary tract symptoms e.g. dysuria - Urethral discharge: may and or may not be present - Urethritis: may or may not be present - Pyrexia may or may not be present

Answer 83

- Urinalysis: first void sample is most useful and should be sent for microscopy and culture. - Nucleic Acid Amplification Test (NAAT): first void urine sample for NAAT to detect the DNA/RNA of the causative organism - Swab of urethral secretions: less sensitive than NAAT ****but must also be performed in symptomatic men

Answer 84

- STD screening - Testicular ultrasound: if the diagnosis is uncertain - Surgical exploration: if torsion cannot be confidently excluded clinically and ultrasound is not available expediently

Answer 85

Testicular torsion

Answer 86

- First-line for STI: - Empirical: ceftriaxone and doxycycline - Additional management: no sex until review and partner notification - Test of cure: only done in cases where gonorrhoea is confirmed - First-line for enteric organisms: - Empirical: fluoroquinolone e.g. ofloxacin or ciprofloxacin - Analgesia - Scrotal support, if needed - Drainage, if abscess - Partner notification: for patients with a confirmed STI causing epididymo-orchitis.

Answer 87

- Musculoskeletal: reactive arthritis secondary to chlamydia or gonorrhoea - Infective: disseminated infection secondary to gonorrhoea - Reproductive: male subfertility or infertility - Urological: epidydimal obstruction and scarring secondary to poorly treated infection

Answer 88

- Testicular cancer is the most common malignancy in young males and usually presents with a firm, painless testicular lump. - Testicular cancer can be divided into germ cell tumours, which are by far the most common comprising 95% of cases, non-germ cell tumours (sex-cord stromal tumours), and lymphomas.

Answer 89

- Young males: seminoma > 35 years; non-seminoma < 35 years - Caucasian - Family history - Infertility: 3-fold increased risk - Cryptorchidism: highest risk in abdominal and bilateral undescended testes - Intersex conditions: e.g. Klinefelter’s syndrome (extra X chromosome = small undeveloped testicles) - In-utero exposure to pesticides or synthetic sex hormones - Mumps orchitis: pain and swelling in testicles after mumps - Testicular atrophy: often following trauma

Answer 90

- Firm non-tender testicular mass - Does not transilluminate - Hydrocele (swelling in scrotum) may be present - Supraclavicular lymphadenopathy

Answer 91

- Painless testicular lump - Sometimes sharp or dull testicular pain and lower abdominal pain - Symptoms related to raised β-hCG - Hyperthyroidism occurs as the alpha subunit of β-hCG mimics TSH - Gynaecomastia - Loss of libido - Erectile dysfunction - Testicle atrophy - Bone pain: indicates skeletal metastasis - Breathlessness, cough or haemoptysis: indicates lung metastasis - Back pain: indicative of lymph node metastasis

Answer 92

- Ultrasound testicular doppler: first-line and diagnostic in over 90% of cases - Tumour markers: β-hCG, AFP, and LDH must be measured prior to surgery. LDH is raised non specifically in most testicular cancers - CT Chest, abdomen, pelvis: performed as part of staging to assess for metastatic disease - NOTE: fine-needle aspiration or percutaneous needle biopsy must not be carried out due to the risk of introducing a new pathway by which the cancer can spread*

Answer 93

- Testicular torsion - Hydrocele - Epidydimal cyst

Answer 94

- Radical orchiectomy - Post-orchiectomy active surveillance: for patients with low-risk disease - Post-orchiectomy radiotherapy or chemotherapy: radiotherapy is offered in locally-invasive disease, however, carboplatin (chemo) can be used as an alternative

Answer 95

- Radical orchiectomy: some patients also undergo retroperitoneal lymph node dissection - Post-orchiectomy active surveillance: for patients with low-risk disease - Post-orchiectomy combination chemotherapy: for patients with high-risk disease

Answer 96

- Radical orchiectomy - Seminoma: adjuvant combination chemotherapy or radiotherapy - Non-seminoma: combination chemotherapy

Answer 97

- Metastasis: lung, liver, bones, brain, lymph nodes - Treatment-related: - Infertility secondary to orchiectomy/chemotherapy/radiotherapy - Secondary malignancy due to radiotherapy - Pulmonary or renal toxicity secondary to chemotherapy

Answer 98

Hydrocele refers to a collection of serous fluid between the parietal and visceral layers of the tunica vaginalis (membrane covering the testes).

Answer 99

- Scrotal swelling (in front and below testicle) - Smooth - Non-reducible - Demonstrating transillumination with pen-torch - Non-tender - Soft and fluctuant (communicating hydrocele) - Stays one size (non-communicating hydrocele) - Communicating hydroceles tend to change size and increase when standing for prolonged periods

Answer 100

Testicular ultrasound.

Answer 101

- Partially descended testes - Inguinal hernia - Testicular torsion - Varicocele - Epidydimal cyst - Haematoma - Tumours (rare)

Answer 102

- May resolve within first year of life - Patients should have ongoing observation to ensure resolution occurs and to identify the development of an inguinal hernia - If surgery is indicated, it is an open repair with high ligation of patent processus vaginalis (for communicating hydroceles)

Answer 103

- Non-communicating hydroceles may have spontaneous repair. - Scrotal support may help adults with symptoms of discomfort. - Late onset communicating hydrocele less likely to resolve - Aspiration of a hydrocele is simple and may give initial relief - Surgical options include: - Lord’s procedure: this involves plication (folding) of the sac. - Jaboulay procedure: the sac is opened drained, partially excised, everted and sutured behind the testicle.

Answer 104

Smooth, extra-testicular, spherical sac of fluid in the head of the epididymis (top of testicle). They are usually harmless.

Answer 105

- Not uncommon overall. - Usually develop in adulthood. - Rare in children.

Answer 106

Signs - Palpable lump (often multiple and bilateral) - Well defined and will transluminate since fluid-filled Symptoms Can cause dragging and soreness - May be pain if cysts are large

Answer 107

Scrotal ultrasound

Answer 108

- Hydrocele - Varicocele

Answer 109

- Usually not necessary - Removed, if symptomatic

Reproductive Flashcards

(133 cards)