Scrotal mass

Question 1

An acutely tender, swollen scrotum is X until proven otherwise

Answer 1

Testicular torsion

Question 2

Symptoms of UTI

Answer 2

Suprapubic pain
Dysuria
Polyuria
Urgency
Offensive smelling urine

Question 3

Symptoms of STI

Answer 3

Suprapubic pain
Offensive discharge
Purulent urethral discharge

Question 4

A crucial question for testicular cancer?

Answer 4

Does the testis feel heavy?

Question 5

Things to check for in testicular examination

Answer 5

Is the mass tender
Is the lump hard or soft
Can you get above the swelling? 
Does it transluminate 
Can you palpate the testis, epididymis and spermatic cord?

Question 6

Can’t get above the scrotal swelling =>

Answer 6

Inguinoscrotal hernia

Question 7

Most important questions to differentiate a testicular swelling

Answer 7

Is it separate from the testis
Does it transilluminate
Is it tender

Question 8

Where would you refer a potential testicular tumour?

Answer 8

Urology

Question 9

Which nodes do the testis drain to?

Answer 9

Paraarotic

Show as a mass in centre of abdomen

Question 10

First line investigation of testicular tumour

Answer 10

Ultrasound scan of the testes

Question 11

Which tumour markers would you test for in potential testicular cancer?

Answer 11

aFP => teratoma
bHCG => seminoma
Take them before and after treatment to monitor repsonse

Question 12

Treatment of testicular cancer

Answer 12

Sperm storage
Orchidectomy
Histology
Radiotherapy

Question 13

Management of epididymal cyst

Answer 13

Can be conservative

Can drain it

Question 14

Bag of worms presentation

Answer 14

Varicocele

Question 15

Can you get above a varicocele?

Answer 15

YES

Question 16

Which plexus causes the tortuous veins of a varicocele?

Answer 16

The pampiniform plexus

Question 17

Which scrotal swelling may change in size over the course of the day/strenuous exercise?

Answer 17

Varicocele

Question 18

Management of varicocele

Answer 18

Scrotal support
Embolisation
Surgical ligation
Sclerotherapy

Question 19

A hydrocele is…

Answer 19

Transilluminable
Undescernible from the testis
Fluctuant (fluid filled)
A collection of fluid within the tunica vaginalis

Question 20

Management of hydrocele

Answer 20

Reassure
Drain
If secondary (e.g after infection or trauma), need to treat the underlying condition

Question 21

Symptoms of epididymo orchitis

Answer 21

Febrile
Sexually active
Painful micturition
Prehn’s positive!

Question 22

Ix of epididymo-orchitis

Answer 22

Urine dip
GUM (urethral swab)
If systemically unwell, blood cultures
Consider HIV test

Question 23

Does orchidoplexy reduce cancer risk?

Answer 23

No, but it does mean they are easier to now detect than if they were in the abdomen!

Question 24

Which testicular tumour is most likely in 20-30yo

Answer 24

Teratoma

Question 25

What might the SUDDEN appearance of varicocele suggest?

Answer 25

Renal carcinoma, can invade and interrupt drainage, leading to sudden varicocele

Question 26

Most likely causes of epididymis-orchiditis in <35yo

Answer 26

STI e.g. chlamydia and gonorrhoeae

Question 27

Most likely cause of epididymis-orchiditis in 35yo

Answer 27

E.coli

Question 28

What should you consider with testicular and jaw swelling?

Answer 28

Mumps

Question 29

What is idiopathic scrotal oedema?

Answer 29

Often seem in 6-7yo boys
They really aren’t bothered by it and it just happens
Resolves in 48-72hr