Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3(S) - Urology > Peno-scrotal Disease > Flashcards

Peno-scrotal Disease Flashcards

1
Q

What are some differentials for scrotal/testicular lumps?

A

Hydrocoele
Varicocele
Epididymo-orchitis
Epidymal cyst
Testicular cancer
Inguinal hernia
Testicular torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a painful scrotal/testicular lump in a young male until proven otherwise?

A

Testicular torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 3 main questions you assess on examination of a testicular lump?

A

1.Can you get above the lump? (Hernia?)
2. Does the lump transilluminate?
3. Is the lump seperate to the testes?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the go to imaging method for peon-scrotal disease?

A

Ultrasound scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most likely diagnoses for a patient that presents like this:

Can get above lump
Transilluminate so
Testes not separate
Painless
May have had recent infection

A

Hydrocoele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the pathophysiology of a Hydrocoele?

A

Fluid accumulates between the visceral and parietal layers of the tunica vaginalis (potentially didn’t close properly so some of processus vaginalis is open)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What Ix is done for a patient who you think has Hydrocoele?

A

US scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is Hydrocoele managed?

A

Only treat if bothers patient

Visceral and parietal peritoneum of tunica vaginalis enveloped on each other and sewed together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a varicocele?

A

Venous insufficiency of the pampiniform plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does varicocele typically present?

A

BAG OF WORMS

Can get above lump
Separate to the testicle
WORSE at the end of day (throbbing dull pain)
Pain worse when standing
Dragging sensation
Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why can patients with varicocele have sub/infertility?

A

Pampiniform plexus distension leads to impaired Thermoregulation of the testicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which testicle is typically affected by varicocele and why?

A

Left testicle

Left testicular vein drains into left renal vein which then has to pass anteriorly over the abdominal aorta to drain into the inferior vena cava, theres a higher pressure in the left testicular vein and more chance for valvular dysfunction to occur

Right testicular vein drains straight into the inferior vena cava

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What Ix do you do in a patient with a suspected varicocele?

A

US Scrotum
+
US left kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why would you do a left Kidney ultrasound when a patient has a suspected left sided varicocele?

What questions would you also ask?

A

Left sided renal cell carcinoma (RCC) can obstruct the left renal vein leading to increased pressure in the left testicular vein

Any:
-weight loss
-malaise
-fever
-night sweats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is varicocele managed?

A

Only treat if patient is trying for children, has testicular atrophy or pain is too much

Treat with embolistion of vessels done by interventional radiologist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is epididymo orchitis?

A

Infection of the epididymis - testis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does a patient with epididymo-orchitis typically present?

What’s it normally caused by?

A

Can get above lump
Can transilluminate is presents with associated Hydrocoele
Not seperate lump to testes
Painful
Discharge
Other LUTS

Mainly caused by STIs in young people

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the typical causative organisms of STI that cause epididymo-orchitis?

A

Neisseria gonorrhoeae
Chlamydia trachomatis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the imaging done for a suspected epidymo-orchitis?

A

US scrotum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What investigations are done when suspecting epididymo orchitis?

A

FBC
U+Es
LFTs
CRP
Urine dipstick

First void urine sample for NAAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the management of epididymo-orchitis?

A

Abx and analgesia

Empirical abx can be given before culture results back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What abx are given for enteric causes of epididymo orchitis?

A

Ofloxacin 200mg PO BD for 14days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What abx are given for STI causes of epididymo orchitis?

A

Ceftriaxone 500mg IM SINGLE DOSE
+
Doxycycline 100mg PO BD 14days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is phrens test?

A

Patient lies supine and examiner elevates the testes and sees if the patient has any pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is typically the result of phrens test in a patient with epididymo orchitis?

A

Positive (pain relieved)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Is the cremasteric reflex present in individuals withi epididymo orchitis?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the pathophysiology of testicular torsion?

A

Mobile testis rotates within the tunica vaginalis twisting the spermatic cord impairing venous drainage leading to swelling, oedema and impaired arterial supply to the testis leading to infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What deformity increases the risk of testicular torsion?

A

Bell clapper deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is. Bell clapper deformity?

A

When the testis have a horizontal lie within the tunica vaginalis due to lack of connection to tunica. Vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the risk factors for testicular torsion?

A

Young age
Family history
Previous torsion
Cryptotorchidism
Bell clapper deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a typical presentation of testicular Torsion?

A

Extreme acute unilateral scrotal pain (N+V due to pain)
Previous trauma
Young male
Swollen
Loss of cremasteric reflex
Negative phrens test
Affected teste will. Have a high lie

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the imaging techniques for suspected testicular torsion?

A

IMMEDIATE SURGICAL EXPLORATION

US Doppler of scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the management for testicular torsion?

A

Emergency surgical exploration with surgical fixation

Analgesia + antiemetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How does an Inguinal-scrotal hernia present?

A

Cant get above lump
Doesn’t transilluminate
Seperate to testis but might not be able to feel

Cough can increase size
May or may not be reducible
May or may not be painful (strangulated?)
May or not lead to bowel obstruction (obstruction)

35
Q

What imaging is done for an Inguinal-scrotal hernia (typically indirect hernia)?

A

US scrotum

36
Q

What is the management for an indirect inguino-scrotal hernia?

A

Refer to general surgery for hernia repair

37
Q

What is an epididymal cyst?

A

Soft fluid filled cyst at head of epididymis

38
Q

What is the presentation of an epdiiymal cyst?

A

Can get above lump
Transilluminate
Seperate from testes

39
Q

What imaging is done for an epidiymal cyst?

A

US scrotum

40
Q

What is the management for an epididymal cyst?

A

Only needs surgical excision if its symptomatic

41
Q

What age group are testicular tumours most common in?

A

20-40yrs

42
Q

What is the presentation for a testicular Tumor?

A

Can get above lump
Doesnt transilluminate
Not seperate from testes
Usually painless
Firm irregular mass

Weight loss?
Back pain?
SOB?

43
Q

What are the 2 broad categories of testicular tumours?

A

Germ cell tumours
Non germ cell tumours

44
Q

What are the 2 types of non germ cell tumours?

A

Sertoli cell tumours
Leydig cell tumours

45
Q

What are the 2 sub categories of germ cell tumours?

A

Seminomatous germ cell tumours

Non seminomatous germ cell tumours

46
Q

What are some examples of non seminomatous non germ cell tumours?

A

Choriocarcinoma
Teratoma
Yolk sac tumours
Embryonal carcinoma

47
Q

What has a better prognosis, germ cell tumours or non germ cell tumours and why?

A

Non germ cell tumours are typically benign

48
Q

What has a better prognosis seminomatous germ cell tumours or non seminomatous germ cell tumours and why?

A

Seminomas since they remains localised until quite late stage

49
Q

What imaging is done for testicular cancers?

A

US scrotum (initial lump exploration)

CT CAP with contrast for staging

50
Q

What are the importation investigations to be done with a testicular cancer?

A

Tumour markers

51
Q

What tumour markers are assessed for with testicular cancer?

A

AFP
bHCG
LDH.

52
Q

What does raised AFP indicate?

A

Indicates non seminomatous germ cell Tumor

NEVER RAISED IN SEMINOMAS

53
Q

What does elevated bHCG indicate?

A

Likely a non seminomatous germ cell tumour but could also be a seminoma

54
Q

Which testicular cancer is bHCG always elevated with?

A

Choriocarcinoma

55
Q

What is the importance of LDH levels?

A

Indicates tumour bulk

Can be used to measure tumour response to chemotherapy/treatment

56
Q

What are the treatments for testicular tumours?

A

Depends on the risk of the tumour

Low risk = surveillance
High risk = chemotherapy with orchidectomy

Most tumour cancers have a good prognosis even if they have metastasis

57
Q

What is normally required to diagnose testicular cancer?

A

Tumour markers + imaging

58
Q

What is phimosis?

A

Tight foreskin that is unable to be retracted

59
Q

Is phimosis physiological?

A

Yes most babies have it but it slowly goes away by 16yrs old

60
Q

What causes pathological/scarring phimosis?

A

Balanitis Xerotica Obliterans

61
Q

What is the pathological process of balanitis xerotica obliterans?

How does it cause pathological phimosis?

A

Chronic inflammation of the glans penis lead to plaques and scarring forming causing fusion of the foreskin to the glans penis making it unuretractable

62
Q

How does pathological phimosis present (caused by balanitis xerotica obliterans)?

A

Difficulty passing urine
Pain
Cracking of penis when erect

63
Q

What is the treatment for pathological phimosis/balanitis xerotica obliterans?

A

Topical steroids
Or
Circumcision under LA or GA

64
Q

What is paraphimosis?

A

The foreskin is trapped behind the corona of the glans penis

65
Q

Why is paraphimosis an emergency?

A

The tightness of the foreskin leads to impaired venous return from the glans penis, this leads to oedema and ischaemia of the glans penis

66
Q

What is the main cause of paraphimosis?

A

NEGLECT
Failure to replace the foreskin by carer after catheterisation

67
Q

What is the treatment for paraphimosis?

A

Manually compress and replace the foreskin

Do a penile block with or without a dorsal slit if unable to just manually compress

68
Q

What is Fourniers gangrene?

A

Necrotising fasciitis of the perineum, Perianal or Genital areas

69
Q

What are the risk factors for developing necrotising fasciitis?

A

Poorly controlled diabetes
Alcoholism
Obesity
Indwelling catheter

70
Q

What is the management for necrotising fasciitis?

A

URGENT ESCALATION

Debridement of necrotic tissue
Debrided tissue sent for MC+S (can then give targeted abx)
Broad spectrum abx

71
Q

Why do patients with necrotising fasciitis need urgent escalation?

A

Has a 50% mortality
Patients often present septic

72
Q

What is Peyronie’s disease?

A

Significant penile curvature due to damage to the tunica albuginea leading to fibrous plaque formation (like Dupuytrens of the hand)

73
Q

What imaging is done for Peyronie’s disease?

A

US penis to identify plaque

74
Q

What are the risk factors for developing Peyronie’s disease?

A

Old
Diabetes Mellitus
Ischaeamic heart disease
Hypertension
Certain medications like b blockers

75
Q

What is the management for Peyronie’s disease?

A

Sildenafil (to help with the erectil dysfunction)

Penis pumps

Surgical correctiooon

76
Q

What is the mechanism of action of sildenafil?

A

Phosphodiesterase-5 inhibitor

77
Q

How does sildenafil being a phosphodiesterase-5 inhibitor treat erectile dysfunction?

A

PDE-5 normally breaks down cGMP
If its inhibited it means levels of cGMP remain higher for longer allowing more nitrous oxide to dilate the smooth muscle of the blood vessels to the penis

78
Q

Why is important to assess patients with erectile dysfunction?

A

Can indicate ischaemic heart disease risk due to vascular risk factors

79
Q

What age should you assess cardiovascular risk factors in men with new onset Erectile dysfunction?

A

60yrs old

80
Q

What are some causes of erectile dysfunction?

A

Vascular
Neurological
Hormones
Antidepressants
Psychological

81
Q

What are some causes of erectile dysfunction?

A

Vascular
Neurological
Hormones
Antidepressants
Psychological

82
Q

What are some vascular issues that can cause ED?

A

Ischameic heart disease risk factors:
-alcohol
-smoking
-obesity

83
Q

What are some neurological causes of erectile dysfunction?

A

Diabetes (diabetic neuropathy)

Spinal injury

Parkinson’s

84
Q

What medication treats erectile dysfunction?

A

Sildenafil

Y3(S) - Urology (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions