scrotal pain swelling and masses Flashcards
what is concerning for scrotum cancer?
non painful mass that does not transluminate
masses that arise from w/in the testes are usually malignant T/F?
true
if you are unsure if an image is solid what imaging is preferred?
ultrasound
what are some causes of hydrocele?
patent processus vaginalus
epididymitis
trauma/testicular torsion
testicular cancer
what is assoicated w/ hydrocele?
testicular tumors
patient presents w/ heaviness in testicles that transilluminates?
hyrdrocele
what is the treatment for hydrocele?
watchful waiting w/ regular follow ups, surgery
DO NOT ASPIRATE
patient presents w/ mass <2cm that’s distinct from the testical and located on the top. DX trx
epididymal cyst
benign: watchful waiting
patient presents w/ >2 cm lesion that arises from head of epididymis, non tender. DX TRX
maybe us US
spermatocele
watchful waiting, painful then surgery
pt. presents / hx of infertility. Complaining of dull ache. Sx worse w/ activity and a bag of worms that increases w/ valsalva. DX TX
varicocele
watchful waiting, scrotal support, activity mod. NSAIDS prn
if infertility and/or pain: surgery (ligartion of the gonadal vein
what varicocele requires further evaluation w/ CT and abdominal exam?
unilateral R side pain
lesion remains dilated w/ supination
occur abruptly or enlarge rapidly
what is the causeof indirect hernia?
patent process vaginalis
what is the cuase of a direct hernia?
weakness of the posterial waal of inguinal canal (acquired)
what is the treatment for hernia?
refer to general surgery for repair
what should you do if you are unsure if a mass is comig from w/in the testicle or not?
scrotal US and urologic consultation
what is necessary for diagnosis of testicular cacner?
orchiectomy
what is an important risk factor for testicular cancer?
cryptorchidism (r-side)
what is used for staging of testicular cacner?
CT/PET
labs for teticular cancer?
inc HCG inc alpha fetoprotein inc. lactate dehydrogenase CBC for anemia LFT (liver)
what is the MC secondary testicular tumor metastases?
lymphoma
what does the USPSTF recommend for testicular self exam?
grade D (don’t)
who is testicualr torsion MC in?
neonates and post pubertal boys
what is predisposes someone to testicular torsion?
bell clapper deformity
what is the most sensitive finding for torsion?
absent cremasteric reflex
what is a negative prehn sign?
elevation of scrotum fails to relive pain: testicular torsion
what is the test of choice for testicular torsion?
color doppler, but lack of U/S should not delay surgery
what are signs of manual detorsion success?
relief of pain
lower testicle
no longer transverse, more longitudinal
blood flow on doppler U/S
what is the MC cause of scrotal pain in adults?
epididymitis and epidiymo-orchitis
what are the two types of epidiymitis and epdydmo-orchitis?
sexually transmitted (Gonorrhea, chlamydia)
nonsexually transmitted
what are sexually transmitted epidydimites associated w/?
urethritis in men <40
what are non sexually transmitted epididymitis associated w/?
old men w/ UTIs and prostatitis
what is the treatment for sexually transmitted epididymitis?
ceftriaxone and doxycycline (+sexual partner)
bed rest, scrotal elevation
what is the treatment for non-sexually transmitted epididymitis?
ciprofloxacin or levofloxacin
bed rest, scrotal elevation
scrotal skin reveals a blue dot?
torsion of appendix testis
causes of referred pain?
stones, UTI, pyelonephritis, low back pain, AAA, post surgical (herniorrhaphy)
fever and partotitis preceding orchitis?
mumps
nec fasc of perinemu and scrotal skin in diabetics?
fournier’s gangrene; urgent surgery
