Scrotal Disorders

Question 1

what is phimosis

Answer 1

foreskin unable to be retracted over glands of penis
normal in baby/todler

Question 2

what is paraphimosis

Answer 2

medical emergency
foreskin trapped in retracted position
entrapments becomes edematous and needs to be forcibly reduced

Question 3

what is a painless mass in the scrotum which tramsillumniates

Answer 3

hydrocele

Question 4

what is a fluid filled sac around tunica albuginea

Answer 4

hydrocele

Question 5

what usually causes hydrocele

Answer 5

inflammation, injury, infection, malignancy

Question 6

what diagnostic test is used for hydrocele

Answer 6

ultrasound necessary, especially age 18-35 (d/t risk of testicular CA)

Question 7

what is a “bag of worms” in scrotum

Answer 7

varicocele

Question 8

what side is most common to have varicocele in

Answer 8

left > Right
higher venous pressure in left scrotal veins causing retrograde reflux of blood into pampiniform plexus

Question 9

where are varicosities located with varicoceles

Answer 9

pampiniform plexus

Question 10

what is an abnormal cyst that develops in epididymis, separate from testes above upper ple

Answer 10

spermatocele

Question 11

what are the symptoms of spermatocele

Answer 11

usually asymptomatic
pain or discomfort in affected testicle
heaviness in testicle with spermatocele
fullness behind and above testicles

Question 12

how do you evaluate for spermatocele

Answer 12

US and/or transillumination

Question 13

what is epididymitis

Answer 13

inflammation of epididymis, occasionally accompanied by inflammation of testis

Question 14

how is epididymitis diagnosed

Answer 14

physical examination

Question 15

what is the treatment of epididymitis

Answer 15

antibiotics, analgesics, scrotal support

Question 16

what portions of the epididymis is involved with epididymitis

Answer 16

tail

Question 17

what age groups are epididymitis most common

Answer 17

18-35 yo

Question 18

what are the causes of epidiymitis

Answer 18

bacterial, non bacterial (viral and mycotic), non-infectious

Question 19

what is the presentation of epididymitis

Answer 19

present with gradual onset of scrotal pain and symptoms mimicking UTI that has progressed to:
severe unilateral scrotal pain
scrotal inflammation, redness, enlargement and/or reactive hydrocele
+/- urethral discharge
irritative voiding

Question 20

what is Prehn’s sign

Answer 20

decreased pain on elevation of testes

Question 21

what is the treatment of STD epididymitis

Answer 21

chlamydia and gonorrhea - most common
Ceftriaxone IM + Doxycycline 10 days

Question 22

what are complications of epididymitis if untreated

Answer 22

infertility
worsening ascending infection
rare: epididymal abscess
death of testicular tissue

Question 23

what is infection of tests, typically with mumps virus

Answer 23

orchitis

Question 24

what is the tx of orchitis

Answer 24

if symptomatic: abx are given only if bacterial infection is identified

Question 25

what is the presentation of orchitis

Answer 25

unilateral mumps orchitis develosp acutely 4-7 days after parotid swelling 3-%. - disease spreads to other tests in 1-9 days pain may be of any degree of severity systemic: malaise, fever, nausea, headache, myalgias

Question 26

what is seen on testicular exam with orchitis

Answer 26

exquisite tenderness, erythema, enlargement, induration of testis and edema and erythema of scrotal skin

Question 27

how is orchitis diagnosed/worked up

Answer 27

H&P color doppler US Mumps: serum immunofluorescence antibody testing

Question 28

what is the tx of orchitis

Answer 28

supportive care with analgesics and hot/cold packs if bacterial infection has been ruled out bacterial infection - abx urologic follow up highly recommended

Question 29

what is the most common side of cryptochidism

Answer 29

external inguinal ring

Question 30

when is descent of testicles completed

Answer 30

7 months gestation

Question 31

what is gubernaculum

Answer 31

a fibrous cord that connects that fetal tests with the bottom of the scrotum and by failing to elongate in proportion to the rest of the fetus causes the descent of testes

Question 32

how is cryptorchidism diagnosed

Answer 32

exam and sometimes US or laparoscopy

Question 33

what is the tx of cryptorchadism

Answer 33

surgical orchiopexy

Question 34

what is ectopic testis

Answer 34

descends normally through external ring but diverts to abnormal location and lies outside normal course of descent

Question 35

when should surgery be done for cryptorchidism

Answer 35

~6 months old; early intervention improves fertility potential and may reduce cancer risk

Question 36

what are complications of cryptorchadism

Answer 36

undescended testes may cause subfertility and are associated with testicular carcinoma intra-abdominal testes, testicular torsion may occur, manifesting as acute abdomen

Question 37

what is a strangulation of testes blood supply

Answer 37

testicular torsion - emergency condition

Question 38

what are symptoms of testicular torsion

Answer 38

acute scrotal pain and swelling, nausea and vomiting

Question 39

how is testicular torsion diagnosed

Answer 39

physical examination and confirmed by color Dopper US

Question 40

what is the treatment of testicular torsion

Answer 40

immediate manual detorsion followed by surgical intervention

Question 41

what side is more common to get a testicular torsion

Answer 41

left > right

Question 42

what is the clinical presentation of testicular torsion

Answer 42

rapid onset of severe local pain, nausea, vomiting, followed by scrotal edema and induration cremasteric reflex usually absent on affected side

Question 43

what is the preferred diagnostic study for testicular torsion

Answer 43

color doppler US of scrotum