Surgery

Question 1

Dukes classification of colorectal tumours

A-D

Answer 1

Dukes classification

Dukes A: Tumour confined to the mucosa
Dukes B: Tumour invading bowel wall
Dukes C: Lymph node metastases
Dukes D: Distant metastases

Question 2

Single or multiple cysts
May contain clear or opalescent fluid (spermatoceles)
Usually occur over 40 years of age
Painless
Lie above and behind testis
It is usually possible to “get above the lump” on examination

Answer 2

Epidiymal cysts

Question 3

Often history of dysuria and urethral discharge
Swelling may be tender and eased by elevating testis
Most cases due to Chlamydia
Infections with other gram negative organisms may be associated with underlying structural abnormality

Answer 3

Acute epididymo-orchitis

Question 4

Often discrete testicular nodule (may have associated hydrocele)
Symptoms of metastatic disease may be present
USS scrotum and serum AFP and β HCG required

Answer 4

Testicular tumours

Question 5

If inguinoscrotal swelling; cannot “get above it” on examination
Cough impulse may be present
May be reducible

Answer 5

Inguinal hernia

Question 6

Severe, sudden onset testicular pain
Risk factors include abnormal testicular lie
Typically affects adolescents and young males
On examination testis is tender and pain not eased by elevation
Urgent surgery is indicated, the contra lateral testis should also be fixed

Answer 6

Testicular torsion

Question 7

Non painful, soft fluctuant swelling
Often possible to “get above it” on examination
Usually contain clear fluid
Will often transilluminate
May be presenting feature of testicular cancer in young men

Answer 7

Hydrocele

Question 8

Varicosities of the pampiniform plexus
Typically occur on left (because testicular vein drains into renal vein)
May be presenting feature of renal cell carcinoma
Affected testis may be smaller and bilateral ones may affect fertility

Answer 8

Varicocoele