Testis & Scrotum Flashcards
List etiologies of hydrocele
- Inc formation of fluid, 2ry
- Dec abs of fluid, 1ry
- Interference w/ lymphatic drainage
- Patent processus vaginalis (congenital)
How to diff clinically bet congenital & infantile hydrocele
Con shows diurnal change in size while infantile doesn’t as it has no connection w/ peritoneum
List comp of hydrocele
- Hernia of sac through dartos muscle
- Hematocele
- Infection, rupture, calcification
- If bilateral testicular atrophy
Mention a test for encysted hydrocele of cord
Mobility restricted on downward traction of testis (traction test)
Acute hydrocele in young man is suspicious for….
Testicular tumor
Mention MC causes of 2ry hydrocele
Acute or chronic epididymo-orchitis
Torsion, testicular tumors
Mention the main complaint for acute epididymo-orchitis
Acute painful scrotal swelling relieved by elevating scrotum
Describe local exam of varicocelr w/ mentioning how to diff 1ry from 2ry
Inspection: left hangs lower, skin shows dilated veins
Palpation:
1. Fullness at scrotal neck
2. Assciated w/ lax small 2ry hydrocele: pinching test
3. Bag of worms gives thrill on cough & relieved by lying down only in 1RY NOT 2RY
4. Examine for testicualr atrophy
List complication of varicocele
- Subfertility: asthenospermia
- Thrombosis
- 2ry hydrocele
- Testicular atrophy
- Neurosis
List inv for varicocele
- Duplex scan shows reversed blood flow DIAGNOSTIC
- Semen analysis medicolegal, OAT $
- Scrotal, transrectal US
- Abdominal US to exclude 2ry causes (RCC)
Why is varcocele more common on left?
- Left adrenal secretes adrenaline near mouth of testicular v
- It enters perpendicular to renal v
- Longer than rt
- Crossed by rt CIA & pelvic colon
- Nut-cracker effect bet aorta & SMA
- Left renal a arches over vein
- Valves on left are usually malformed
Describe etiology of 2ry varicocele
MC: RCC
Retroperitoneal fibrosis/tumor
Post-nephrectomy
MC arterial C of impotence is….
Atherosclerosis
Mention side effect & CIs for PDE5I
Headache, dyspepsia, blue vision
CI: nitrate therapy, severe uncontrolled hypotension, severe cardiac malfunction
Define:
1. Spermatocele
2. Simple cyst of epididymis
How to differentiate clinically
- Retention cyst of vasa-efferentia
- Cyst of vestigial structure “hydatid of morgagni”, degeneration of epididymis
Epididymal cyst are almost always separate from testis proper while spermatocele is not
Mention cause of acute & chronic hematocele
Describe ttt of each
Acute: trauma, postoperative, aspiration of hydrocele, acute funiculo-epididymi-orchitis, torsion. Evacuation of the blood & excision of tunica vaginalis (if torn repain)
Chronic: neglected acute, malignant neoplasm, blood disease (repeated hge).
Early: dissection & excision of tunica, late: orchiectomy to exclude malignancy
The nerve controlling external urethral sphincter is….
Pudendal
List CI of recieving renal transplant
- Active infection
- Recent malignant disease
- Active GN
- Pre-sensitization to donor HLA
Time for acute rejection is….., ttt is…..
Within 3 months
Steroid pulses, ATG, OKT3
What is triple immunosuppressive therapy for renal transplantation
CSS, mycophenolate mofetil, cyclosporine
MC cause of unilateral chronic retention is….while that of bilateral is…..
Stones
BPH
MC tumors in humans are….., in younger patients they are…..while in adulthood they turn…..
Naevi
Junctional, intradermal
Mention naevi that are most likely to turn malignant
- Giant hairy naevi (carry high possibility of malignant transformation)
- Junctional naevi
- Chronic irritation (shaving)
- Incomplete excsion
Indications for ttt of benign melanoma & its ttt
- For cosmetic reasons, subjected to repeated trauma, suspected to return malignant
- Giant hairy naevi; compound naevus covering larger area of skin
TTT: medical (quinolones), laser (Q-switched), surgical excision
Mention signs of malignant transformation in naevi
Asymmetrical, irregular border, hard, dark, chct (itching, tingling, bleeding ulcer), diameter >6mm w/satellite nodules, spontaneous ulceration & bleeding, enlargement of the lesion, inflammation w/out trauma, LN swelling in drainage area.
Mention predisposing factors of malignant melanoma
- Prolonged exposure to sunlight (UV rays)
- Inc incidence in albinism, retinitis pigmentosa, rare in negros more c in fair skinned
- On top of benign lesions (if exposed to chronic irritation)
MC malignant melanoma & its prognosis
Superficial spreading
Best (radial growth)
Nodular melanoma pattern of growth is……
Vertical growth w/out radial growth phase
MC site of acral lentigious m is…., prognosis is…..
Sole, palm, under nails
Poor (radial then vertical)
Worst type of MM is……, diagnosed by…..
Amelanotic melanoma
Dopa reaction test & biopsy
Compare clinically bet lentigo maligna & superficial spreading
LM: younger age, MC trunk in males, leg & back in females
SS: old ages females, more c on face in sun exposed areas
Describe blood spread of MM
MC to lung, high affinity to liver
Mentiom INV for MM
Diagnosis: excisional biopsy, safety margin 3mm, should include whole skin & SC tissue forcstaging, paraffin better than frozen
Staging isotope scintigraphy for sentinel LN
Preop: routine inv
In Clark’s classification, levels…..are those of radial growth, levels…..are those of vertical growth
I & II
III, IV, V
Mention how safety margin is calculated for MM
1 cm if thickness <1mm
2 cm if thickness 1-4mm
3 cm if thickness >4mm
List PDFs for non-melanotic skin malignancies
- Premalignant lesions
- UV exposure
- Radiation: IC
- Marjolin ulcer: chronic irritation, ulcer, old burn scar & sinus
- Prolonged exposure to carcinogenic agents
- Exposure to viral carcinogens, HPV
List PDFs of premalignant skin lesions
- Xeroderma pigmentosa (AR)
- Keratoacanthoma (vs BCC)
- Actinic keratosis (MC)
- Bowen’s disease
- Leukoplakia
MC malignant skin lesion is….., its site is…, edge is…., LN are…..
BCC
Face above line joining angle of mouth to tragus of ear
Rolled in & beaded
No enlarged unless SCC or infection
Mention inv for BCC & SCC
Excisional biopsy for both
B—X-ray
S—sentinel LN & CT
BCC is removed w/safety margin…..
0.5 cm
List indications for surgery in BCC
- Small lesions
- Infiltrating bone & cartilage
- Radioresistant
- Recurrence after radiation
Mention I & CI of radiation in BCC
I, debilitated patient, unfit for surgery
CI:
1. Infiltrated bone/cartilage, irradiation necrosis
2. Near the eye: avoid irradiation cataract
3. Recurrence after irradiation: avoid superselection
CI for radiation in SCC
Marjolin’s ulcer
Mention complications of BCC& SCC
- Infiltrating the surrounding
- 2ry infection
- Hge from erosion of big vessels
S—distant mets & cachexia
B—epitheliomatous transformation (baso-squamous carcinoma)
Mention MC type of BCC
Nodulo-ulcerative type
Mention causes of macroglossia
Congenital: cavernous hemagiomas, AV fistula, lymphangiomas, NF
Acquired: cretinism, acromegaly, amyloidosis
Mention pathological variations of tongue cancer
SCC (MC), verrucous carcinoma, BCC (adenocarcinoma), posterior is less differentiated
Mention causes of pain in tongue
In tongue early: infection, late: lingual n affection
Ear: referred by auriculotemporal n
On swallowing: if post 1/3 of tongue
List comp of malignant ulcer of tongue
- Inhalation pneumonia, asphyxia
- Infection, 2ry hge: lingual or ICA
- Cachexia
Mention inv for malignant tongue ulcerj
- Excisional biopsy w/ 1cm safety margin (best inv)
- FNAC
- CT neck & mandible
Mention indications of surgery & radiation in tongue cancer
S:1. Small growths, incomplete resection, regression or recurrence
2. Cancer on top of precancerous lesions
3. Close to mandible
R: T1&2
Mention ind for palliative ttt in tongue cancer
Unresectable tumor, fixed LNs, distant mets
Describe ttt of post 1/3 cancer of tongue
Total glossectomy, needs median mandibulectomy + irradiation
Mention 3 indications for COMMANDO
Sarcomatous & carcinomatous epulis & tongue cancer close to mandible
What is epulis & how is it generally treated?
Generic name applied to tumor of gingiva or alveolar mucosa
Curettage & electrosurgery & cryosuregry
Mention CP, radiology & ttt of OS of jaw
Jaw pain & swelling, paresthesia for mandibular lesions, & loosening of teeth
Sunburst appearance
Radical resection with up to 3cm free margin + preoperative & postop chemo
MC epulis is….
Fibrous
Describe ttt for the following types of epulis:
1. Fibrous
2. Granulomatous
3. Myeloid
- Teeth extract + excsion w/ wide base of peiosteum
- Excision & removal of tooth + biopsy
- Wide excision w/ safety margin
