FN: Lumps in the groin and scrotum

Question 1

Differential

Answer 1

Cant get above: 
Seperate cystic
Seperate solid
testicular cystic
Testicular solid

Question 2

Cant get above

Answer 2

Inguinal hernia

Question 3

Seperate cystic

Answer 3

Epididymal cysts

Question 4

Seperate solid

Answer 4

Varicolcoela, sperm granuloma,, epididymitis

Question 5

testicular cystic

Answer 5

Hydrocoele

Question 6

Testicular solid

Answer 6

tumour, orchitis, haematocele

Question 7

Epididymal cyst

Answer 7

• develop in adulthood
• Contain clear or milky (spermatocele) fluid
• Lie above and behind testis
• Remove if symptomatic

Question 8

Varicocele

Answer 8

• Dilated veins of pampiniform plexus

Question 9

Varicocele presentation

Answer 9

• feel like bag f worms in the scrotum
• may be visinle dilated veins
• reduced size on lying down
• pt. may c/o dull ache
• may - oligospermia (reduced fertility)

Question 10

Varicocele pathology

Answer 10

primary: left side commoner: drain into left renal vein
Secondary: left renal tumour has tracked down renal vein - testicular vein obstruction

Question 11

Varicocele Mx

Answer 11

Conservative: scrotal support
Surgical: clipping the testicular vein (open or laP)

Question 12

Sperm granuloma

Answer 12

Painful lump of extravasated sperm after vasectomy

Question 13

Hydrocele

Answer 13

Collection of serous fluid w/i tunica vaginalis

Question 14

Hydrocele primary

Answer 14

Association with patent processus vaginalis

Commoner, large, tense, younger men

Question 15

Hydrocele secondary

Answer 15

Tumour, trauma, infection

Smaller, less tense

Question 16

Hydrocele investigation

Answer 16

US testicle to exclude tumour

Question 17

Hydrocele Mx

Answer 17

May resolve spontaneously
Surgery:
Aspiration

Question 18

Surgery Lords repair

Answer 18

Plication of the sac

Question 19

Surgery jaboulays repair

Answer 19

Eversion of the sac

Question 20

Aspiration

Answer 20

Usually recur so not 1st line

Send fluid for cytology and MC+S

Question 21

Haematocele

Answer 21

Blood in the tunica vaginalis
Hx of trauma
May need drainage or excisions

Question 22

Epididymo-Orchitis aetiology

Answer 22

STI: chlamdia, gonorrhoea
Ascending UTI: e.coli
Mumps

Question 23

Epididymo-Orchitis features

Answer 23

Sudden onset tender swelling

Sweats, fever

Question 24

Epididymo-Orchitis examination

Answer 24

Tender, red, warm, swollen testis and epididymis - elevating testicle may relieve pain

Secondary hydrocele
Urethral discharge

Question 25

Epididymo-Orchitis Investigation

Answer 25

Blood: FBC, CRP
Urine : dip, MC+S (fist catch may be test)
Urethral swab and STI screen
US: may be needed to exclude abcess

Question 26

Epididymo-Orchitis complications

Answer 26

May - infertility

Question 27

Epididymo-Orchitis Management

Answer 27

bed rest
Analgesia
Scrotal supportabx: doxycycline or cipro
Drain abcess if present