Fertility

Question 1

Testicular cancer: clinical features

Answer 1

painless lump
hydrocele
gynaecomastia

Question 2

Testicular cancer: risk factors

Answer 2

mumps orchitis
klinefleter’s
cryptorchidism - no testes

Question 3

testicular cancer: seminoma

Answer 3

40 yo
increased HCG
AFP normal
lactate dehydrogenase increase
sheet-like lobular pattern
substantial fibrous component

Question 4

testicular cancer: non-seminomatous

Answer 4

20-30 yo 
teratoma
yolk sac tumour
choriocarcinoma
retroperitoneal lymph node dissection
AFP increase
HCG big increase
heterogeneous texture with occasional ectopic tissue such as hair

Question 5

hydrocele: features, management

Answer 5

transilluminates
similar to inguinal hernia

ultrasound to rule out tumour
lords plication/jaboulay’s excision
transinguinal ligation of PPV in children

Question 6

testicular torsion: presentation and management

Answer 6

sudden onset pain
cremaster reflex lost
bell clapper deformity - predisposition for torsion
age 13-15 peak

needs surgical detorsion within 4-8 hours to prevent ischaemia

all scrotal swellings assumed torsion unless proven otherwise

Question 7

epididymis-orchitis: presentation

Answer 7

acute inflammation and tenderness of the epididymis
usually caused by urthral/bladder infection - chlamydia or gonorrhoea
amiodarone can cause

Question 8

requirement for IVF

Answer 8

3 years infertile
23-39 yo
one/both diagnosed with fertility problem

have to have tried for a year

3 cycles on the NHS

Question 9

medication that stimulates ovulation

Answer 9

tamoxifen
clomifene
gonadotropins
GnRH agonist
dopamine agonist