Mehl. penile/testicular disorders nr. 2 Flashcards
M. Torsion of appendix testis - not the same as torsion of testis.!! Asked on a 2CK form.
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M. Q will tell you there’s a kid with a painful testis + the superior pole is blue + there’s an intact cremasteric reflex (“regular torsion” it’s not intact). Dx?
Torsion of appendix testis
M. “Blue dot” sign = blue superior pole of testis. Dx?
Not my opinion if you think it’s nitpicky or weird. Take it up with the NBME exam.
Torsion of appendix testis
M. Inflammation/infection of the testis. Dx?
Orchitis
M. Orchitis - what infection might cause?
Mumps is HY cause in unvaccinated / immigrants (sometimes implies unvaccinated).
M. Orchitis - bacterial cause?
If not caused by mumps virus, then the bacterial causes are same as epididymitis and prostatitis for young vs old (i.e., STIs vs E. coli, respectively).
M. Erection lasting longer than 4 hours. Dx?
Priapism
M. Priapism. Cause? 2
Can be caused by sickle cell or by PDE-5 inhibitors (i.e., tadalafil/sildenafil).
M. Priapism. Tx?
Injection of alpha-1 agonist (i.e., phenylephrine) into the erectile tissue is treatment –> decreases blood flow due to blood vessel constriction.
M. Serous fluid collection within the scrotum between the layers of the tunica vaginalis surrounding the testis. Dx?
Hydrocele
M. Hydrocele. Mechanism?
Mechanism is patent processes vaginalis.
The processus vaginalis is an embryonic outpouching of peritoneum that descends into the scrotum. It normally obliterates shortly after birth, but if it remains open, can cause hydrocele or indirect inguinal hernia.
M. Hydrocele. light testing?
Transilluminates when a light is shone to it.
M. Hydrocele. Tx?
USMLE wants no treatment before the age of 1; most spontaneously close.
M. Obscure serous fluid collection within the epididymis containing sperm. Dx?
Spermatocele
M. Spermatocele. Age?
Occurs usually in adult men (rather than neonates as with hydrocele).
M. Spermatocele. Light?
Transilluminates similar to hydrocele. But once again, it’s an older adult, not neonate
M. Hydrocele - neonates; spermatocele - adults.
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M. Dilation/congestion of pampiniform venous plexus draining the scrotum. Dx?
Varicocele
M. Varicocele. light?
Does not transilluminate (in contrast to hydro- and spermatoceles).
M. Varicocele. buzzy words?
Can be described as buzzy “bag of worms.” Sounds too easy, but an NBME Q literally uses this colloquialism.
Can also be described as a heavy, dragging scrotum lower on the left.
M. Varicocele. on what side?
Occurs almost always on the left side due to the anatomy of venous drainage of the testis.
On the left, we have left testicular vein -> left renal vein -> IVC.
On the right, we have right testicular vein -> IVC (“right to IVC”).
The left testicular vein drains at a 90-degree angle into the left renal vein, creating a proclivity for hydrostatic pressure backup ipsilaterally.
M. Varicocele. There is a 2CK NBME Q where bilateral varicocele is the answer. Highly obscure, but just be aware it’s somehow possible/exists.
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!!!! M. Varicocele.
Can occur due to left renal vein thrombosis in setting of nephrotic syndrome (loss of antithrombin III in the urine -> hypercoagulable state).
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M. Testicular cancer. Seminoma most likely in what age?
Seminoma most likely in teens and older.
M. Testicular cancer. Yolk sac tumor most likely in what age?
Yolk sac tumor most likely in school-age kids and younger.
M. Testicular cancer. buzzy?
Hard nodule on testis is buzzy, but be aware of it as DDx for non-transilluminating testicular mass that does not present as classic hard nodule.
