Acute Scrotum

Question 1

testicular torsion

Answer 1

testis twists on its spermatic cord

compromise blood flow

Question 2

testicular appendages

Answer 2

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

Question 3

testicular torsion age group

Answer 3

neonatal or peri-pubertal

Question 4

appendage torsion age group

Answer 4

childhood and pre-adolescence

Question 5

is intravaginal or extravaginal torsion more common?

Answer 5

intravaginal

Question 6

intravaginal testicular torsion

Answer 6

bell clapper deformity

high narrow attachment of tunica vaginalis to spermatic cord

Question 7

normal attachment of tunica vaginalis

Answer 7

covers anterior 70% of surface of testis only

Question 8

result of bell clapper deformity

Answer 8

testis able to swing more freely and prone to twisting

Question 9

torsion - medial to lateral or lateral to medial?

Answer 9

lateral to medial

Question 10

extravaginal torsion - age

Answer 10

rare, confined to neonates

Question 11

extravaginal torsion

Answer 11

poor attachment of tunica vaginalis to dartos muscle

Question 12

extravaginal torsion leads to what?

Answer 12

loss of affected testis

Question 13

intravaginal torsion presentation

Answer 13

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

Question 14

presentation extravaginal testicular torsion

Answer 14

routine baby check

scrotum abnormal appearance or palpation

Question 15

presentation testicular appendage torsion

Answer 15

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

Question 16

diagnosis - intravaginal torsion

Answer 16

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

Question 17

diagnosis - extravaginal torsion

Answer 17

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

Question 18

diagnosis - testicular appendage torsion

Answer 18

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

Question 19

blue dot/blue pea sign

Answer 19

testicular appendage torsion

Question 20

investigations

Answer 20

doppler USS

Question 21

how long can testis survive ischaemia?

Answer 21

4-6 hours

Question 22

immediate intravaginal torsion management

Answer 22

immediate scrotal exploration

testis delivered through scrotal incision

Question 23

how is testis detorted - intravaginal

Answer 23

clockwise rotation

Question 24

what is done if the testis pinks up - intravaginal

Answer 24

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

Question 25

what is done if testis remains discoloured - intravaginal

Answer 25

wrapped in warm swabs and left for 10 mins | still blue - orchidectomy?

Question 26

what is done to contralateral testis - intravaginal?

Answer 26

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

Question 27

extravaginal management

Answer 27

testis left to atrophy or surgically removed after exploration contralateral orchidopexy

Question 28

managing testicular appendage torsion

Answer 28

analgesia and reassurance unsure - surgical exploration torted appendage removed

Question 29

torsion complications

Answer 29

atrophy | retorsion rare

Question 30

3 other causes of acute scrotum

Answer 30

idiopathic scrotal oedema epididymo-orchitis HSP

Question 31

idiopathic scrotal oedema

Answer 31

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

Question 32

idiopathic scrotal oedema presentation

Answer 32

painless generalised discomfort redness crosses midline

Question 33

epididymo-orchitis - who is it rare in?

Answer 33

pre-pubertal boys

Question 34

epididymo-orchitis presentation

Answer 34

erythema swollen hemiscrotum tenderness postero-lateral urinary symptoms

Question 35

epididymo-orchitis - what needs to be taken?

Answer 35

sexual history

Question 36

epididymo-orchitis investigation

Answer 36

renal tract imaging ultrasonography urine sample culture

Question 37

what is orchitis seen with?

Answer 37

mumps

Question 38

HSP can present along with

Answer 38

purpura joint swelling abdo pain haematuria