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#passmed 2022 > Scrotal Lumps > Flashcards

Scrotal Lumps Flashcards

1
Q

What is a scrotal lump?

A

Abn mass / swelling in sctrotum

Originates from testicular / extra-testicular sources

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2
Q

What is a testicular lump until proven otherwise?

A

Cancer

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3
Q

What is an acute tender enlargement of testis until proven otherwise?

A

Torsion

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4
Q

What questions should you answer when examining a scrotal lump? (3 things)

A
  1. Can you get above it?
  2. Is it separate from testis?
  3. Cystic or solid
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5
Q

Can diagnosis of a scrotal lump be made from examination alone?

A

Yes

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6
Q

If you CANNOT get above a scrotal lump what are the differentials? (2 things)

A
  1. Inguinoscrotal hernia

2. Hydrocele (extending proximally)

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7
Q

If a scrotal lump is SEPARATE from testis + CYSTIC what are the differentials?

A

Epididymal cyst

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8
Q

If a scrotal lump is SEPARATE from testis + SOLID what are the differentials? (2 things)

A
  1. Epididymitis

2. Varicocele

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9
Q

If a scrotal lump is TESTICULAR + CYSTIC what are the differentials?

A

Hydrocele

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10
Q

If a scrotal lump is TESTICULAR + SOLID what are the differentials? (4 things)

A
  1. Tumour
  2. Haematocele
  3. Granuloma
  4. Orchitis

Do US

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11
Q

What are the 6 S’s when inspecting a scrotal lump?

A
  1. Site
  2. Size
  3. Shape
  4. Symmetry
  5. Skin changes
  6. Scars
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12
Q

What are the extra-testicular differentials for a scrotal lump? (4 things)

A
  1. Hydrocele
  2. Varicocele
  3. Epididymal cyst (spermatocele)
  4. Epididymitis
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13
Q

What are the testicular differentials for a scrotal lump? (2 things)

A
  1. Testicular tumour

2. Testicular torsion

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14
Q

What is a Hydrocele?

A

Fluid in tunica vaginalis (serosa covering of testeis)

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15
Q

What are the features of the scrotal lump in Hydrocele? (3 things)

A
  1. CANNOT get above it
  2. Testicular (not separate)
  3. Cystic
  4. Transilluminates (lets light through)
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16
Q

What is a PRIMARY hydrocele caused by?

A

Congenital = patent processus vaginalis

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17
Q

What is the treatment of a PRIMARY hydrocele?

A

Nothing, it resolves within 1st year of life

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18
Q

What is a SECONDARY hydrocele caused by? (3 things)

A
  1. Trauma
  2. Tumour
  3. Infection
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19
Q

What should you do if sus SECONDARY hydrocele?

A

Urgent US

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20
Q

Are hydroceles painful?

A

No

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21
Q

What are the management options of hydroceles? (2 things)

A
  1. Aspiration

2. Surgery

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22
Q

What is the surgical management of hydroceles? (2 things)

A
  1. Folding of tunica vaginalis (Lord’s repair)

2. Inverting sac (Jaboulay’s repair)

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23
Q

What is a Varicocele?

A

Dilated veins of pampiniform plexus

24
Q

What are the features of the scrotal lump in Varicocele? (3 things)

A
  1. Separate from testes
  2. Solid
  3. Feels like bag of worms
25
Q

Which side are varicoceles most commonly found on?

A

Left (90%)

26
Q

What can a varicocele cause? (2 things)

A
  1. Infertility

2. Testicular atrophy

27
Q

What is the management of a varicocele? (2 things)

A
  1. Embolisation (by interventional radiologist)

2. Ligation of spermatic veins

28
Q

What are the symptoms of a varicocele?

A

Dull ache

29
Q

What is a Epididymal cyst (spermatocele)?

A

Benign fluid filled sac arising from epididymis

smooth fluctual node) (often multiple

30
Q

What are the features of the scrotal lump in an Epididymal cyst? (3 things)

A
  1. Separate (above) testes
  2. Cystic
  3. Transilluminates
31
Q

What are the symptoms of an epididymal cyst?

A

Asymptomatic

32
Q

What is the treatment for an epididymal cyst?

A

Doesn’t need treatment

33
Q

Why should you avoid doing surgery on an epididymal cyst?

A

Surgery can lead to infertility

34
Q

What is Epididymitis?

A

Inflamm of epididymis

35
Q

What are the features of the scrotal lump in an Epididymitis? (3 things)

A
  1. Separate from testes

2. Solid

36
Q

What is the most common cause of scrotal pain in adults?

A

Epididymitis

37
Q

What is the pain in Epididymitis?

A

Unilateral + acute

38
Q

What are the assoc symptoms of Epididymitis? (3 things)

A
  1. Swelling
  2. Eryhematous overlying skin
  3. Fever
39
Q

What are the findings on examination of Epididymitis?

A
  1. Tender epididymis

2. Prehn’s sign (pain relieved @ testes elevation)

40
Q

What is the management of Epididymitis?

A
  1. Oral abx

2. Analgesia

41
Q

What is a testicular tumour?

A

Painless lump arising from testes

42
Q

What are the findings on examination of Testicular tumours?

A
  1. Firm irreg mass

2. DOES NOT transilluminate (bc solid)

43
Q

What should you do if you sus Testicular tumour? (2 things)

A
  1. Urgent US for diagnosis

2. Tumour markers

44
Q

What is the use of tumour markers in Testicular tumours? (3 things)

A
  1. Aids diagnosis
  2. Staging
  3. Monitors treatment
45
Q

What are the tumour markers for Testicular tumour? (2 things)

A
  1. alpha-FP

2. Beta-hCG

46
Q

What are the signs of Testicular tumours? (4 things)

A
  1. Painless testis lump
  2. Secondary hydrocele
  3. Dyspnoea (lung mets)
  4. Abd mass (enlarged nodes)
47
Q

What are the risk factors for Testicular tumours? (3 things)

A
  1. Undescended testis
  2. Infant hernia
  3. Infertility
48
Q

What does a Stage 1 Testicular tumour indicate?

A

No metastasis evidece

49
Q

What does a Stage 2 Testicular tumour indicate?

A

Infradiaphragmatic node involvement

50
Q

What does a Stage 3 Testicular tumour indicate?

A

Supradiaphragmatic node involvement

51
Q

What does a Stage 4 Testicular tumour indicate?

A

Lung involvement (haematogenous spread)

52
Q

What is the management of Testicular tumours?

A

Radical orchidectomy (removing testicle)

53
Q

What is Testicular torsion?

A

Twisting of testes on spermatic cord –> ischaemia

54
Q

What are the clinical features of Testicular torsion? (4 things)

A
  1. Sudden onset severe unilat scrotal pain
  2. Nausea + vom
  3. Tender + raised + swollen testes
  4. Loss of cremasteric reflex (inner thigh stroke pulls up testes)
55
Q

Why is Testicular torsion a surgical emergency?

A

To prevent permanent testicular damage

#passmed 2022 (27 decks)

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