Male Genital pathology 6.15

Question 1

Young male, acute onset testicular pain+++, nausea & vom, abdo pain. Testicle sitting higher in scrotum than other.

Answer 1

Testicular torsion - spermatic cord is twisted round and testicle is pulled up. Surgical emergency - ischaemia / necrosis if not.

Question 2

45 yo man, painless swelling of scrotum - transilluminates when light shone through it.
Testes not palpable on examination.

Answer 2

Hydrocoele - idiopathic / congenital = fluid between layers of tunica vaginalis (peritoneal covering of testes)

Question 3

Other causes of hydrocoele in tropical countries leading to - wheelbarrow sized scrotum

Answer 3

Filiarisis

Question 4

Man kicked in scrotum on rugby pitch - tender swollen scrotum, fluid filled but not translucent.

Answer 4

Haematocoele - blood in tunica vaginalis

Question 5

50 yo man with painless lump above and behind teste - slowly developed over few years, lump is distinct from teste on examination.

Answer 5

Epididymal cyst

Question 6

Bag of worms feel to scrotum - coughing distends veins

Answer 6

Varicocoele - can be due to kidney tumour, renal vein obstruction. Surgery reqd for pain / fertility.

Question 7

Child with mumps complaining of painful, hot swollend scrotum. OE evidence of hydrocoele.

Answer 7

Orchitis / Epididymo orchitis - infection causing inflammation of testes - treat underlying infective cause.

Question 8

Protrusion of abdominal contents through inguinal canal into scrotum - direct or indirect hernia?

Answer 8

Indirect - “in” the canal

Question 9

Testicular cancer will metastisize to which lymph nodes?

Answer 9

Paraaortic

Question 10

Penile cancer (rare SCC) will metastisize to which lymph nodes?

Answer 10

Inguinal

Question 11

This hormone is produced by seminoma and non seminomas causing gynocomastia in males

Answer 11

Beta HCG

Question 12

95% of testicular cancers are germ cell or non germ cell tumours?

Answer 12

Germ cell tumours (cells which are precursors to sperm)

Question 13

Germ cell tumours are split into roughly 2 types - what are they

Answer 13

Seminomas

Non - seminomas (5 sub types)

Question 14

Man presenting with haematuria, costovertebral pain and a mass on kidney palpation. History of wt loss, malaise & fever.

Answer 14

Renal Cell Carcinoma (RCC) - 85% of malignant renal cancers.

Question 15

Woman 55yo with painless haematuria, increasing frequency, urgency and dysuria.

Answer 15

Transitional Cell Carcinoma (TCC) = Urothelial cell ie bladder derived. Also found renal pelvis, ureter, urethra.

Question 16

Man with acute onset colicy loin pain - waves radiating from LHS to groin. Microscopic haematuria, difficulty urinating, tender over renal angle. No pelvic discharge or genital tenderness.

Answer 16

Renal colic - kidney stones

Question 17

Common obstruction sites for renal stones (3)

Answer 17

Pelvi-uteric junction - from kidney to ureter
Iliac brim - vessels crossing over pelvis
Uteric/bladder junction

Question 18

2 drugs used in medical expulsion of stones

Answer 18

beta blockers

Nifedipine