SCROTAL ABNORMALITIES

Question 1

True or False
The mobility of the testicle, cremasteric muscle and the tough capsule of the testis are responsible for the infrequent rate of injury to the testis

Answer 1

True

Question 2

What usually occurs secondary to a direct blow to the testis impinging against the pubic symphisis?

Answer 2

Blunt testicular injury

Sac fills with blood and appears as a large blue tender scrotal mass

Question 3

What imaging would help delineate the extent of testicular involvement and evaluate for testicular rupture in scrotal trauma?

Answer 3

Scrotal and testicular ultrasound

Question 4

True or False

Blunt and penetrating testicular injuries require MEDEVAC to urology

Answer 4

True

Question 5

Can lacerations or avulsions just involving the skin can be closed primarily by the independent provider?

Answer 5

Yes

Question 6

What is know as necrotizing fasciitis (polymicrobial infection) of the subcutaneous tissues of the perineum often involving the scrotum?

Answer 6

Fournier’s Gangrene

Question 7

What typically begins as a benign infection or simple abscess that quickly leads to a widespread necrosis of otherwise previously healthy tissue?

Answer 7

Fournier’s Gangrene

Question 8

There needs to be a high suspicion for what when patients present with scrotal, rectal, or genitalia pain out of proportion to their physical exam findings?

Answer 8

Fournier’s Gangrene

Question 9

These are all signs and symptoms of what?

1. tense edema of scrotum and other involved skin
2. blisters/bullae
3. crepitus
4. fever
5. pain (out of proportion to physical exam)
6. tachycardia
7. hypotention

Answer 9

Fournier’s Gangrene

Question 10

A CT scan or MRI may show what in a patient with Fournier’s Gangrene?

Answer 10

Air along the fascial planes or deep tissue involvement

Question 11

The treatment for Fournier’s Gangrene involves aggressive surgical exploration and debridement, as well as what antibiotics?

Answer 11

Ertapenem (Ivansz) 1g IV q 24hrs

Question 12

Is Fournier’s Gangrene a MEDEVAC?

Answer 12

OH YEAH

Question 13

A tense hydrocele or firm spermatocele must be differentiated from what?

Answer 13

tumor

Question 14

What is known as the dilation of the pampiniform plexus of spermatic veins and is generally left sided?

Answer 14

Varicocele

Question 15

What usually appears as an aymptomatic mass separate from the testis, mild pain, feels like a “bag or worms” especially in the upright position, and the size is increased by valsalva?

Answer 15

Varicocele

Question 16

Right-sided varicocele should raise suspicion of what?

Answer 16

Inferior vena cava and intraabdominal pathology

Question 17

Sudden left-sided varicocele should raise suspicion of what?

Answer 17

Left renal vein obstruction or renal tumor

Question 18

What is a collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord?

Answer 18

Hydrocele

Question 19

What is a gradually enlarging painless cystic mass that transilluminates?

Answer 19

Hydrocele

Question 20

What is a painless, fluid filled cyst at the head of the epididymis that may contain nonviable sperm?

Answer 20

Spermatocele

1. Palpated as distinct from the testis
2. typically transilluminates as cystic in nature

Question 21

What is the diagnostic imaging of choice for scrotal and testicular abnormalities?

Answer 21

Ultrasound

Question 22

True or False

Patient with newly diagnosed testicular enlargement or mass lesions should be urgently referred to an Oncologist

Answer 22

False

Referred to urologist