27- groin pain

Question 1

Absence of the cremasteric reflex is a sensitive but non-specific finding for

Answer 1

testicular torsion.

Question 2

blue dot sign

Answer 2

A small bluish discoloration known as the “blue dot sign”, may be visible through the skin in the upper pole of the testes.

pathognomonic for appendiceal torsion when tenderness is also present.

Question 3

testicular torsion presentation

Answer 3

Swollen, tenderness limited to the upper pole of the testis, especially when a hard, tender nodule is palpable in this region.

abrupt severe pain, +/- N/V

Question 4

Prehn sign

Answer 4

physical lifting of the testicles relieves the pain caused by epididymitis but not pain caused by testicular torsion.

Question 5

Inguinal hernia

Answer 5

painless swelling in the inguinal region,

enhanced by maneuvers that raise intra-abdominal pressure, such as cough or Valsalva maneuver.

swelling becomes painful and tender when it is incarcerated.

types: direct vs indirect

Question 6

indirect hernia

Answer 6

result of a persistent process vaginalis.

content follows inguinal canal into sac
medial to inferior epigastric arteries

Question 7

direct hernia

Answer 7

defect or weakness in the transversalis fascia area of the Hesselbach triangle.

Question 8

Hesselbach triangle borders

Answer 8

The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoint tendon.

Question 9

hydrocele

Answer 9

Cystic painless scrotal fluid collection

Positive transillumination

generally asymptomatic unless associated with trauma or infection

Question 10

most common cause of painless scrotal swelling.

Answer 10

hydrocele

Question 11

Henoch-Schönlein purpura (HSP)

Answer 11

nonthrombocytopenic purpura, arthralgia, renal disease, abdominal pain, gastrointestinal bleeding, and occasionally scrotal pain.

The onset of scrotal pain may be acute or insidious.

Question 12

testicular tumor presentation

Answer 12

scrotal mass that is rarely accompanied by tenderness.

The swelling is solid so should not transilluminate.

A testicular tumor is usually non-tender to palpation.

Question 13

Varicocele

Answer 13

dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord in the scrotum

associated with infertility

can be asymptomatic or may complain of a dull ache or fullness of the scrotum upon standing.

mass-like and nontender or mildly tender to palpation

Question 14

referred pain travels through what 3 nerves

Answer 14

the genitofemoral, ilioinguinal, and posterior scrotal nerves.

Question 15

how many hours of window for surgery for testicular torsion

Answer 15

4-12 hrs

within 6 hrs apparently tho

Question 16

Torsion of the testicular appendages

Answer 16

less common, less morbid

age 7-14

abrupt pain, less severe, localized to appendix testis

Question 17

what is the Appendix testis

Answer 17

a small vestigial structure (embryonic remnant of Mullerian duct) located on the anterosuperior aspect of the testis.

Question 18

does Torsion of the testicular appendages have a pos o neg blue dot sign?

Answer 18

positive

Question 19

most frequent cause of sudden scrotal pain in adults.

Answer 19

Epididymitis

Question 20

time course of Epididymitis

Answer 20

slowly progressive over several days rather than abrupt.

Question 21

cause of Epididymitis

Answer 21

It is caused by bacterial infection of the epididymis, typically from a urinary tract or sexually-transmitted infection.

Question 22

Epididymitis presentation

Answer 22

The patient may appear comfortable except when examined.

Severe swelling and exquisite pain are present on the involved side, often accompanied by high fever, rigors, and irritative voiding symptoms.

scrotum is tender to palpation and edematous on the involved side. The cremasteric reflex is usually present, and the testis is in its normal location and position.

Question 23

Causes of Testicular Torsion

Answer 23

A. Congenital anomaly
B. Undescended testicle
C. Trauma
D. Exercise

Question 24

Congenital anomaly that would cause testicular torsion

Answer 24

Failure of normal posterior anchoring of the gubernaculum, epididymis, and testis is called a bell clapper deformity because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell, causing an intravaginal torsion.

A large mesentery between the epididymis and the testis can also predispose itself to torsion. Contraction of the muscles shortens the spermatic cord and may initiate testicular torsion.

Question 25

what can confirm testicular torsion if pain is less severe and the diagnosis is in question

Answer 25

Color Doppler ultrasonography

Question 26

Radionuclide scintigraphy

Answer 26

is a diagnostic test that uses a radioisotope to visualize testicular blood flow.

Patients with testicular torsion have decreased radiotracer in the ischemic testis, resulting in a photopenic lesion.

more sensitive than US but less available

Question 27

orchiopexy

Answer 27

surgical fixation of both testes to prevent retorsion

do on both sides when you get torsion

Question 28

Guidelines for Adolescent Preventive Services (GAPS)

Answer 28

GAPS recommendations are organized into four types of services that address 14 separate topics or health conditions. (everything but DM)

Question 29

most common malignancy affecting males between the ages 15 and 35

Answer 29

testicular cancer

Question 30

What are the risk factors for testicular tumors?

Answer 30

A. Genetics
B. Family history
C. Cryptorchidism
D. Environment
E. Prior testicular cancer

Question 31

disorders that are more likely to cause germ cell tumors

Answer 31

Klinefelter
Down syndrome, 
testicular feminizing syndrome, 
true hermaphrodites, 
persistent mullerian syndrome, 
 cutaneous ichthyosis

Question 32

Cryptorchidism is

Answer 32

the absence of one or both testes from the scrotum, usually as the result of an undescended testis.

Question 33

Germ cell tumor types

Answer 33

seminomas (45%)

nonseminomatous germ cell tumors (NSGCTs): 50%
Embryonal cell tumor (20%)
Mixed GCTs (40%)
Teratomas and teratocarcinomas (30%)
Yolk sac tumors (also known as endodermal sinus tumors)
Choriocarcinoma (1%)

Question 34

most common prepubertal germ cell tumor

Answer 34

Yolk sac tumors (also known as endodermal sinus tumors)

Question 35

prognosis of yolk sac tumors

Answer 35

benign but are most often malignant. Most affected patients require surgery and chemotherapy because of the aggressive nature of the tumors, but the overall prognosis is excellent.

Question 36

most lethal germ cell tumor

Answer 36

choriocaricinoma

Question 37

Non-germ cell tumors types

Answer 37

Non-germ cell tumors (Leydig cell tumors and Sertoli cell tumors)

Question 38

most common malignancies that metastasize to the testicle (extragonadal tumors).

Answer 38

Lymphoma, leukemia, and melanoma