Testicular Disorders

Question 1

What age group is typically affected by a testicular seminoma?

Answer 1

Those aged 30-50

Question 2

What age group is typically affected by a testicular teratoma?

Answer 2

Those aged 20-30

Question 3

Which type of testicular tumour may occur before puberty?

Answer 3

Teratoma

Question 4

What are the main risk factors for the development of testicular cancer?

Answer 4

Undescended testes, infertility, family history, mumps orchitis

Question 5

What genetic syndrome comes with an increased risk of developing testicular cancer?

Answer 5

Klinefelter’s syndrome

Question 6

90% of testicular tumours are what histological type?

Answer 6

Germ cell tumours

Question 7

Which type of testicular tumour has a solid, homogenous, pale macroscopic appearance?

Answer 7

Seminoma

Question 8

What type of testicular tumour has a variable macroscopic appearance including solid areas, cysts, haemorrhage and necrosis?

Answer 8

Teratoma

Question 9

Testicular cancers spread via the lymphatics to which lymph nodes?

Answer 9

Para-aortic nodes

Question 10

Testicular cancers spread haematogenously to where?

Answer 10

Liver and lungs

Question 11

If an older male was to present with a primary testicular tumour, what type of cancer would this be most likely to be?

Answer 11

Lymphoma

Question 12

What is the most common primary cancer to metastasise to the testicle?

Answer 12

Prostate

Question 13

How do testicular tumours tend to present?

Answer 13

Painless testicular swelling or lump

Question 14

What is the first line investigation for a suspected testicular cancer?

Answer 14

Ultrasound

Question 15

What tumour marker is produced by trophoblastic elements and is elevated in both seminomas and teratomas of the testicle?

Answer 15

Beta hCG

Question 16

What tumour marker is produced by yolk sac elements and is elevated in teratomas of the testicle?

Answer 16

AFP

Question 17

What is the initial treatment for all testicular cancers?

Answer 17

Inguinal orchidectomy

Question 18

Which type of testicular tumour is incredibly radiosensitive?

Answer 18

Seminomas

Question 19

What adjuvant therapy is given in addition to surgery in those with testicular seminomas?

Answer 19

Radiotherapy +/- chemotherapy

Question 20

When is adjuvant therapy required in addition to surgery for testicular teratomas? What is this therapy?

Answer 20

If stage II or higher, chemotherapy is given

Question 21

Which testicular swellings will transilluminate?

Answer 21

Hydroceles and spermatoceles

Question 22

If you cannot feel above a scrotal mass, what is the mass most likely to be?

Answer 22

Inguino-scrotal hernia

Question 23

In which decade is the peak incidence of testicular torsion?

Answer 23

2nd decade of life

Question 24

How does testicular torsion typically present?

Answer 24

Acute unilateral testicular pain +/- nausea/vomiting

Question 25

Where else may pain be felt by someone with testicular torsion, other than the testicle itself?

Answer 25

Abdomen

Question 26

Absence of the cremasteric reflex on examination of a testicle is suggestive of what diagnosis?

Answer 26

Testicular torsion

Question 27

What investigation can be used to demonstrate testicular torsion, but is usually not performed at the expense of surgical exploration?

Answer 27

Doppler ultrasound

Question 28

The management for testicular torsion is urgent surgery. What surgical procedures are patients consented for?

Answer 28

Bilateral ochidopexy and possible orchidectomy

Question 29

The outcome is best if testicular torsion is surgically fixed within what timeframe?

Answer 29

< 6 hours

Question 30

Torsion of the appendage testis (hydatid of Morgagni) is typically seen in individuals of what age?

Answer 30

7 - 12

Question 31

How may torsion of the appendage testis (hydatid of Morgagni) be differentiated clinically from testicular torsion?

Answer 31

Less pain, present cremasteric reflex, possible blue dot sign

Question 32

How is torsion of the appendage testis (hydatid of Morgagni) managed?

Answer 32

It will resolve spontaneously

Question 33

Where does an epididymal cyst lie in relation to the testis?

Answer 33

Above and behind

Question 34

When should an epididymal cyst be removed?

Answer 34

Only if symptomatic

Question 35

The presence of milky fluid in the testis suggests the development of what?

Answer 35

Spermatocele

Question 36

What is the most likely cause of epididymo-orchitis in those aged < 35? How should this be treated?

Answer 36

Chlamydia infection (+/- gonorrhoea) - treat with PO doxycycline and IM ceftriaxone

Question 37

What is the most likely cause of epididymo-orchitis in those aged > 35? How should this be treated?

Answer 37

E. coli infection - treat with PO ofloxacin/ciprofloxacin

Question 38

Along with testicular pain, what are some other symptoms that may be present in epididymo-orchitis?

Answer 38

Frequency and dysuria

Question 39

What imaging investigation can be used to identify epididymo-orchitis? What will it show?

Answer 39

Doppler US - will show increased blood flow

Question 40

What additional investigation should be performed in those aged < 35 with epididymo-orchitis?

Answer 40

First pass urine sample PCR for chlamydia

Question 41

How long should antibiotics be given for for epididymo-orchitis?

Answer 41

2-4 weeks

Question 42

What is a varicocele?

Answer 42

A dilation of veins of the pampiniform plexus

Question 43

95% of varicoceles occur on which side?

Answer 43

Left

Question 44

A ‘bag of worms’ appearance of the testis is suggestive of what diagnosis?

Answer 44

Varicocele

Question 45

When do varicoceles require treatment?

Answer 45

Only when they are symptomatic

Question 46

Having an undescended testis comes with a 40x increased risk of developing testicular cancer. This risk may be reduced if orchidopexy is performed before what age?

Answer 46

10 years