testes

Question 1

What is an acute, tender enlargement of the tests until proven otherwise?

Answer 1

Testicular torsion

Question 2

When examining a scrotal mass what are the three questions you must ask yourself?

Answer 2

Can you get above it?
Is it separate from the testis?
Cystic or solid?

Question 3

What will be the presentation of an epididymal cyst?

Answer 3

They will be separate from the testis and cystic

Usually develop in adulthood and lie above and behind the testis

Question 4

What is a mass you cannot get above?

Answer 4

Likely to be an inguinoscrotal hernia

Question 5

What is a mass that is separate from the testis and solid?

Answer 5

This is likely to be epididymitis or a varicocele

Question 6

What is a mass that is testicular and solid?

Answer 6

Tumour, haematocele, granuloma, orchitis

Question 7

What is a mass that is testicular and cystic?

Answer 7

Hydrocele

Question 8

What is a hydrocele?

Answer 8

This is fluid in the tunica vaginalis
Result from patent processus vaginalis
Usually resolve by themselves
Can be aspirated or operated on

Question 9

What is epidiymo orchitis? causes? treatment?

Answer 9

This is infection of the testis and epididymus
Caused by chlamydia, e coli, umps, gonorrhoea, TB
It presents with sudden onset tender swelling, dysuria, sweas/fever
Take first catch urine samples and look for urethrl discharge
Do STI screen
Treat with doxycycline and if gonorrhoea suspected then add ceftriaxone IM stat

Question 10

What are the types of testicular tumours?

Answer 10

Seminoma (55%)
Non-seminomatous germ cell tumour (33%)
Mixed germ cell tumours
Lymphoma

Question 11

What are the signs of testicular tumours?

Answer 11

Painless testicular lump
Haematospermia
Pain
Dyspnoea (lung mets)
Abdo mass - enlarged nodes
Effect of secreted hormones - gaenocomastia

Question 12

What are the risk factors for testicular cancer?

Answer 12

Undescended testis, infant hernia, infertility

Question 13

What is the staging of testicular cancer?

Answer 13

1 - no evidence of mets
2 - infradiaphragmatic node involvement
3 - supradiahragmatic node involvement
4 - lung involvement

Question 14

What are the tumour markers for testicular cancer?

Answer 14

There is beta human corionic gonadotrophin and alpha fetoprotein

Question 15

What tests are done for testicular cancer?

Answer 15

CXR, CT, excision biopsy, tuour markers (useful for monitoring)

Question 16

What is the treatment of testicular cancer?

Answer 16

Radical orchidectomy
Seminomas are very sensitive to radiotherapy
Non seminomas give chemo

Question 17

What are the symptoms and signs of testicular torsion?

Answer 17

Sudden onset pain in the testis with abdo pain and often vomiting
Signs:
-Inflammation of one testis, hot swollen

Question 18

What is the main differential for testicular torsion?

Answer 18

Epidiymorchitis

Question 19

What is the treatment of testicular torsion?

Answer 19

Surgical exploration to expose and untwist testis, bilateral fixation is done to prevent other happening, orchidectomy may be required