Clinical relevance

Question 1

Hydrocele

Answer 1

Painless swelling caused by an accumulation of peritoneal fluid between the layers of the tunica vaginalis (parietal and visceral) and testes
Transillumination can be observed when light is shone through a hydrocoele. (light can be seen from other side)

Question 2

Varicocele

Answer 2

Abnormal dilation of the pampniform venous plexus.
More common on left scrotum as left testicular vein drains into the left renal vein before the IVC

Question 3

Epididymo-orchitis. What is the usual cause in younger people and older people?

Answer 3

Painful inflammation of the epididymis and testis. (in younger people often caused by STIs) (in older people it is often caused by urinary tract infection)

Question 4

Testicular torsion

Answer 4

Extremely painful twisting of testes on spermatic cord → can lead to ischemia of testis and is a surgical emergency
If left untreated, it can lead to necrosis and loss of the affected testis.

Question 5

Testicular cancer

Answer 5

Usually seen as a lump on testes.
If a testicular cancer metastasizes, it will likely follow the lymphatic drainage which follows the testicular arteries back to the lymph nodes around the aorta. Thus, testicular cancer metastases first to the para-aortic or retroperitoneal lymph nodes.

Question 6

Cryptorchidism

Answer 6

Undescended testis
During fetal development, the testes descend through the inguinal canal to reach the scrotum before birth. If this fails to occur, the infant is born with one or both testes absent from the scrotum and the affected testis will be stuck somewhere along the path of descent.
As spermatogenesis is optimal just below core body temperature, the testes will only function optimally in the scrotum.
There is also an increased risk of testicular cancer if the undescended testis is left inside the abdomen.

Question 7

Vasectomy

Answer 7

Male sterilisation
Scrotum is incised and the vasa deferentia are separated and ligated/clamped. Thus preventing the passage of sperm from the testes

Question 8

Erectile dysfunction

Answer 8

Inability to achieve or maintain an erection during sexual activity.
Erection relies on intact nerve pathways and reflexes, controlled blood flow in and out of the corpora cavernosa and psychological arousal. Thus, a problem with any of these factors lead to erectile dysfunction.
(viagra increases blood flow to the corpora of the penis)

Question 9

Abdominal aortic aneurysm

Answer 9

Bulging of a blood vessel caused by a weak point in the blood vessel wall.
Risk factors: smoking, alcohol, hypertension, atherosclerosis (narrowing of arteries).
Diagnosed if the diameter of the aorta is wider than 3cm.
If the AAA ruptures, significant intra-abdominal bleeding rapidly occurs, and mortality is high.
(Surgery or stents can be used to treat it)

Question 10

Renal cancer

Answer 10

There are 3 types
Renal cell carcinomas- originate from the lining of the nephron
Transitional cell carcinomas- arise from the epithelial lining inside the kidney
Wilms’ tumours originate from renal stem cells.
Symptoms include: pain in the flank, a palpable mass in the abdomen, and haematuria (blood in urine)
Before a renal cancer invades organs and structures, it has to grow large enough to penetrate the layers of fat and the renal capsule first.

Question 11

Urinary tract infection

Answer 11

Almost always caused by bacteria (e.coli) entering the urinary bladder via the urethra.
More common in females as female urethra is shorter
Cystitis- infection of the urinary bladder symptoms- burning pain on passing urine and the sensation of having to pass urine more frequently
If infection spreads proximally to kidney it is termed pyelonephritis. This would require intravenous antibiotics. Symptoms: fever, flank pain, nausea and vomiting in addition to cystitis symptoms.

Question 12

Kidney (uteric) stones

Answer 12

Kidney stones often made from calcium oxalate can form in kidneys and pass into the ureter.
Risk factors include: high urine calcium levels, dehydration, obesity and certain medications.
Smaller stones can pass out the urethra without problem but larger stones can obstruct the ureter.
Presentation: excruciating, pulsatile pain felt from loin to groin (as pain fibres innervating the ureters originate from T12-L2, so pain is felt in the T12-L2 dermatomes.
If flow of urine in the kidney is obstructed, the kidneys will fill with urine leading to hydronephrosis (kidney fills with urine and swells). This can injure the kidney and cause infection

Question 13

Phaeochromocytoma

Answer 13

Rare hormone producing tumour of the adrenal medulla
Secretion of excess adrenaline can cause symptoms and signs of hyperactivity of the sympathetic nervous system leading to hypertension, tachycardia and excessive sweating.

Question 14

Pelvic floor weakness

Answer 14

The pelvic floor supports the pelvic organs but they can be stretched, damaged, or weakened by childbirth, ageing, straining or obesity.
This can lead to incontinence of urine or faeces
It can lead to pelvic organ prolapse where the uterus prolapses into the vagina or rectum prolapses into the anus because they are no longer supported.

Question 15

Episiotomy

Answer 15

During childbirth, the perineal body may be damaged due to stretching or tearing of perineal tissue.
This can lead to incontinence or pelvic floor weakness which can result in pelvic organ prolapse.
During labour, an incision- episiotomy can be made just lateral to the perineal body so as to avoid injury to the perineal body or an uncontrolled tear through the anal sphincter.

Question 16

Benign prostatic hyperplasia and prostatic malignancy

Answer 16

The prostate gland completely encircles the urethra
With progressing age, benign enlargement of the prostate is common and is called benign prostatic hyperplasia/benign prostatic enlargement
This can lead to compression of the urethra and results in the inability to pass any urine → leading to urinary retention (requiring catheterisation to drain the urine)
To do a prostate examination– push the finger into the rectum via the anus and flex it anteriorly to palpate the prostate immediately anterior to the anal canal and rectum (a hard, craggy prostate is concerning for malignancy)

Question 17

Ectopic pregnancy

Answer 17

Occurs when the blastocyst implants outside the uterus.
(uterine tube is most common place for this to occur)–> fertilisation usually occurs in the uterine tubes and the zygote is swept doe the uterine tubes to the uterus by ciliated cells
BUT if the zygote does not reach the uterus, it may implant in the wall of the uterine tube which is not able to stretch to accommodate the growing embryo and so may rupture, causing significant pain and internal bleeding, which may be life threatening. (surgery is required to remove the pregnancy from the uterine tube)

Question 18

Endometriosis

Answer 18

A condition where endometrial tissue lining the inside of the uterus is found outside the uterus. (usually affecting the ovaries, uterine tubes, uterine ligaments and rectouterine pouch)
Although the cause is not fully understood, it can lead to chronic pelvic pain, cyclical pain in relation to menstruation and pain during intercourse.

Question 19

Gynaecological cancers

Answer 19

Cancer can affect any part of the female reproductive system (ovaries, uterus, cervix, vagina, vulva)
Symptoms can include pelvic pain, abnormal vaginal discharge or bleeding, urinary disturbance, can also result in fatigue and weight loss.

Question 20

Haemorrhoids

Answer 20

The wall of the anal canal are lined with an abundance of veins called ‘cushions’ which aid faecal continence. These cushions are known as haemorrhoids → they can become excessively swollen and inflamed, depending on whether they form above (painless) or below the pectinate line (painful).
They are normal and present in healthy individuals
If they are pathological, they often bleed when passing stool
Increased intra-abdominal pressure, e.g. in excessive straining, constipation, pregnancy, can increase pressure in the pelvic veins, leading to haemorrhoids becoming swollen and problematic.