25. Scrotal Mass Flashcards

1
Q

What details of a scrotal lump should you find out?

A
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?
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2
Q

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

A

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

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3
Q

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

A

Epididymal cyst

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4
Q

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

A

Acute epididymitis

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5
Q

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

A

Hydrocele (collection of fluid in tunica vaginalis)

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6
Q

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

A

Tender: Torsion, orchitis, epididymo-orchitis

Non tender: cancer

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7
Q

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

A

Testicular torsion until proven otherwise

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8
Q

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

A

Testicular cancer

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9
Q

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

A

Inguinoscrotal hernia

can’t get above it

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10
Q

What does transillumination of a mass suggest?

A

Fluid contents

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11
Q

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

A

TB epididymitis

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12
Q

Where do the testes drain?

A

Para-aortal lymph nodes

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13
Q

Where does the scrotal skin drain?

A

Inguinal lymph nodes

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14
Q

Which tumour markers are commonly expressed in teratomas?

A

a-Fetoprotein (AFP)

b-HCG

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15
Q

Which tumour markers are more often raised in seminomas?

A

b-HCG

LDH

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16
Q

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

A

Varicocele

17
Q

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

A

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

18
Q

Who is most commonly affected by teratomas and seminomas?

A

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

19
Q

On which side are varicoceles more common?

A

Left

left gonadal vein drains into left renal vein at 90 degree angle

20
Q

What can cause sudden appearance of a left sided varicocele?

A

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

21
Q

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

A

< 35: STI: Chlamydia + Gonorrhoeae

> 35: UTI: E. coli