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Year 4 Repro and paeds > Acute Scrotum > Flashcards

Acute Scrotum Flashcards

1
Q

testicular torsion

A

testis twists on its spermatic cord

compromise blood flow

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2
Q

testicular appendages

A

remnants of mullerian duct or wolffian duct
infarction of these structures
no risk to testis

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3
Q

testicular torsion age group

A

neonatal or peri-pubertal

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4
Q

appendage torsion age group

A

childhood and pre-adolescence

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5
Q

is intravaginal or extravaginal torsion more common?

A

intravaginal

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6
Q

intravaginal testicular torsion

A

bell clapper deformity

high narrow attachment of tunica vaginalis to spermatic cord

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7
Q

normal attachment of tunica vaginalis

A

covers anterior 70% of surface of testis only

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8
Q

result of bell clapper deformity

A

testis able to swing more freely and prone to twisting

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9
Q

torsion - medial to lateral or lateral to medial?

A

lateral to medial

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10
Q

extravaginal torsion - age

A

rare, confined to neonates

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11
Q

extravaginal torsion

A

poor attachment of tunica vaginalis to dartos muscle

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12
Q

extravaginal torsion leads to what?

A

loss of affected testis

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13
Q

intravaginal torsion presentation

A

sudden onset unilateral testicular/iliac fossa pain
nausea and vomiting
testicular enlargement
redness of overlying skin

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14
Q

presentation extravaginal testicular torsion

A

routine baby check

scrotum abnormal appearance or palpation

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15
Q

presentation testicular appendage torsion

A

insidious onset
unilateral pain and systemic upset
testicular swelling and redness of skin

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16
Q

diagnosis - intravaginal torsion

A

redness - ipsilateral hemiscrotum
skin thick and oedematous
testis lies higher and horizontal position
testis and epididymis large and tender

17
Q

diagnosis - extravaginal torsion

A

oedematous and fixed scrotal skin overlying scrotal mass - close to delivery
marble lie testis, absent testis - early in pregnancy

18
Q

diagnosis - testicular appendage torsion

A 
erythema hemiscrotum 
reactive hydrocoele
blue dot sign
pinpoint tenderness 
normal testis lie and scrotal position
19
Q

blue dot/blue pea sign

A

testicular appendage torsion

20
Q

investigations

A

doppler USS

21
Q

how long can testis survive ischaemia?

A

4-6 hours

22
Q

immediate intravaginal torsion management

A

immediate scrotal exploration

testis delivered through scrotal incision

23
Q

how is testis detorted - intravaginal

A

clockwise rotation

24
Q

what is done if the testis pinks up - intravaginal

A

orchidopex performed to fix testis in place and prevent re-torsion

25
Q

what is done if testis remains discoloured - intravaginal

A

wrapped in warm swabs and left for 10 mins

still blue - orchidectomy?

26
Q

what is done to contralateral testis - intravaginal?

A

prophylactically fixed at same time due to high incidence of bilateral abnormal investing tunica vaginalis

27
Q

extravaginal management

A

testis left to atrophy or surgically removed after exploration
contralateral orchidopexy

28
Q

managing testicular appendage torsion

A

analgesia and reassurance
unsure - surgical exploration
torted appendage removed

29
Q

torsion complications

A

atrophy

retorsion rare

30
Q

3 other causes of acute scrotum

A

idiopathic scrotal oedema
epididymo-orchitis
HSP

31
Q

idiopathic scrotal oedema

A

erythema and oedema of inguino-scrotal, penile and perineal regions

32
Q

idiopathic scrotal oedema presentation

A

painless
generalised discomfort
redness crosses midline

33
Q

epididymo-orchitis - who is it rare in?

A

pre-pubertal boys

34
Q

epididymo-orchitis presentation

A

erythema
swollen hemiscrotum
tenderness postero-lateral
urinary symptoms

35
Q

epididymo-orchitis - what needs to be taken?

A

sexual history

36
Q

epididymo-orchitis investigation

A

renal tract imaging
ultrasonography
urine sample culture

37
Q

what is orchitis seen with?

A

mumps

38
Q

HSP can present along with

A

purpura
joint swelling
abdo pain
haematuria

Year 4 Repro and paeds (14 decks)

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