RENAL 138 Testicular Lumps

Question 1

What is epididymitis?

Answer 1

Inflammation of the epididymis

Question 2

What is orchitis?

Answer 2

Inflammation of the testes

Question 3

What would you suspect was the cause of epididymo-orchitis in a patient less than 35 years old?

Answer 3

STD

Question 4

What would you suspect was the cause of epididymo-orchitis in a patient greater than 35 years old?

Answer 4

Urine infection pathogens

Question 5

What are the clinical features of epididymo-orchitis?

Answer 5

Tender, swollen, dysuria, sweating, fever, possible discharge

Question 6

Why is testicular torsion a medical emergency?

Answer 6

As it can cut off blood supply to the testes which can cause irreversible damage

Question 7

Describe testicular torsion

Answer 7

Twisting of the spermatic cord with strangulation of the blood supply

Question 8

How would a patient with testicular torsion present?

Answer 8

Acute onset of pain in one testes, may have associated nausea and vomiting, inflammation, testis may look high and transverse

Question 9

What is a varicocoele due to?

Answer 9

Dilated veins of the pampiniform plexus - incompetent venous valves

Question 10

Define a hydrocoele

Answer 10

A fluid collection within the parietal and visceral layers of the tunica vaginalis

Question 11

What are the risk factors for testicular cancer?

Answer 11

Undescended testes, family hx, infertility, caucasian, infection

Question 12

What are some of the symptoms of a testicular cancer?

Answer 12

painless testicular lump, heaviness/dragging and any symptoms associated with metastases

Question 13

What are primary testicular cancers mainly cancers of?

Answer 13

Germ cells

Question 14

What lymph nodes do testicular cancers involve?

Answer 14

Para-aortic lymph nodes

Question 15

How do alkylating chemotherapeutic agents work?

Answer 15

Form covalent bonds between DNA bases interfering with DNA replication

Question 16

Give some examples of alkylating agents?

Answer 16

metachloratemine, cyclophosphamide, ifosfamide

Question 17

How do platinum chemotherapeutic agents work?

Answer 17

form adducts/cross-links between DNA strands = strands break

Question 18

Give some examples of platinum agents

Answer 18

cisplatin and carboplatin

Question 19

How do anthracyclines work?

Answer 19

Intercalate in the DNA moleculem blocking action of topsoimerase

Question 20

Give an example of some anthracyclines?

Answer 20

Doxoribillin, epirubillin

Question 21

How does the anti-metabolite fluorouracil work?

Answer 21

Inhibits thymidine synthesis by mimicking uracil

Question 22

How does the anti-metabolite methotrexate work?

Answer 22

inhibits a key enzyme in the metabolism of folate

Question 23

How do anti-microtubule agents work?

Answer 23

Prevent polymerisation and depolymerisation of tubulin

Question 24

What are the two groups of anti-microtubule agents?

Answer 24

taxanes and vinca alkaloids

Question 25

Name some risk factors for prostate cancer

Answer 25

Age, family hx, caucasian, BRCA2 gene mutations and lynch syndrome

Question 26

What are some of the symptoms of prostate cancer?

Answer 26

Obstructive voiding: dribbling, difficulty getting going, poor stream; haemospermia, bone pain and anaemia

Question 27

Why is PSA not an accurate and specific test for prostate cancer?

Answer 27

It can easily be raised e.g. in UTI and is hormone dependant

Question 28

When would PSA be relevant to initiate a urology referral?

Answer 28

with an abnormal DRE

Question 29

How would you treat localised prostate cancer

Answer 29

radial prostatectomy/ radiotherapy +/- hormonal ablative therapy

Question 30

How would you treat metastatic prostate cancer?

Answer 30

Palliatively depending on the hormonal dependance:

Castration, anti-androgens, LNRH analogues and any bone metastases with bisphosphonates (reduce pain not treat)

Question 31

How do bisphosphonates work?

Answer 31

By inhibiting osteoclast formation, migration and subsequent osteolytic activity