Scrotal swelling/pain

Question 1

5 layers of the scrotum

Answer 1

skin
dartis muscle
3 fascial layers
tunica vaginalis
tunica albuginea

Question 2

4 contents of the spermatic cord

Answer 2

vas deferens
tesitcular artery
nerves
vein

Question 3

Important questions in Hx (4)

Answer 3

SOCRATES
trauma
fever/dysuria
previous episodes of pain>intermittent torsion

Question 4

Hydrocele definition and subtypes (3)

Answer 4

fluid within tunica vaginalis

Primary-due to patent processus vaginalis. usually resolves w/i 1 yr so don’t Rx pt. if <12mo

Secondary-due to tumour, trauma or infection

Question 5

Features of hydroceles (2)

Answer 5

not felt separately (DDx from epididymal cysts)

trans-illuminates (DDx from tumour)

Question 6

Rx for hydroceles (3)

Answer 6

if not bothering pt. then wait;may resolve spontaneously

aspiration-risk of recurrence

surgery-tighten tunica vaginalis

Question 7

Definition, features, Rx of haematocele (3)

Answer 7

blood in tunica vaginalis

usually follows trauma

may need drainage/excision

Question 8

Features of epididymal cysts (6)

Answer 8

most common testicular swelling
separate from testes;usually above and behind
transilluminates
smooth
contain clear/milky spermatocele fluid
develop in adulthood

Question 9

Conditions assoc. w. epididymal cysts

Answer 9

CF
PCKD
vHL syndrome

Question 10

Rx of epididymal cysts

Answer 10

remove only if symptomatic

Question 11

Features and Ex of inguinoscrotal hernias (4)

Answer 11

cannot get above it
direct or indirect
attempt to reduce standing and supine
check cough impulse

Question 12

Varicocele definition and features (6)

Answer 12

dilated veins in pampiniform plexus
feel like bag of worms
get larger when standing
may have dull ache
left side more commonly affected (80%)
unresolved left-sided varicocele can be due to RCC compressing left renal vein

Question 13

complications of varicoceles (2)

Answer 13

testicular atrophy

subfertility

Question 14

Rx of varicoceles (2)

Answer 14

reassure if not problematic

otherwise repair via surgery/embolisation

Question 15

Prehn’s test?

Answer 15

pain relieved by lifting testes in epididymitis

Question 16

Causes of epididymo-orchitis (6)

Answer 16

young people: chlamydia then gonorrhoea
older: e. coli, klebsiella, pseudomonas, proteus
TB
mumps
amiodarone-ceases after stopping drug
post-cytoscopy

Question 17

Presentation of epididymo-orchitis (5)

Answer 17

sudden onset of redness, swelling and warmth
Hx of exposure to infection
dysuria
fever/sweats
cremasteric reflex present (not in torsion)

Question 18

Ix for epididymo-orchitis (2)

Answer 18

urine leucocytes

STI screen

Question 19

Rx of epididymo-orchitis

Answer 19

if<35: doxycycline , IM ceftriaxone if gonorrhoea suspected
if>35: ciprofloxacin

give Abx for 2-4wks

Question 20

complications of epididymo-orchitis

Answer 20

subfertility

Question 21

Vasculitic causes of testicular pain/swelling (3)

Answer 21

HSP
Kawasaki
Buerger’s

Question 22

Ix for cryptorchidism

Answer 22

MRI to check position

Question 23

Mx of cryptorchidism (2)

Answer 23

by 1yr 2/3 spontaneously descend

otherwise do orchidopexy before 2yrs to prevent subfertility (similar procedure for torsion)

Question 24

complications of cryptorchidism

Answer 24

increased risk of testicular ca.

Question 25

RFs for torsion (2)

Answer 25

clapper bell deformity

cryptorchidism