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Urology > Testis & Scrotum > Flashcards

Testis & Scrotum Flashcards

1
Q

List etiologies of hydrocele

A
  1. Inc formation of fluid, 2ry
  2. Dec abs of fluid, 1ry
  3. Interference w/ lymphatic drainage
  4. Patent processus vaginalis (congenital)
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2
Q

How to diff clinically bet congenital & infantile hydrocele

A

Con shows diurnal change in size while infantile doesn’t as it has no connection w/ peritoneum

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3
Q

List comp of hydrocele

A
  1. Hernia of sac through dartos muscle
  2. Hematocele
  3. Infection, rupture, calcification
  4. If bilateral testicular atrophy
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4
Q

Mention a test for encysted hydrocele of cord

A

Mobility restricted on downward traction of testis (traction test)

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5
Q

Acute hydrocele in young man is suspicious for….

A

Testicular tumor

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6
Q

Mention MC causes of 2ry hydrocele

A

Acute or chronic epididymo-orchitis
Torsion, testicular tumors

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7
Q

Mention the main complaint for acute epididymo-orchitis

A

Acute painful scrotal swelling relieved by elevating scrotum

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8
Q

Describe local exam of varicocelr w/ mentioning how to diff 1ry from 2ry

A

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

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9
Q

List complication of varicocele

A
  1. Subfertility: asthenospermia
  2. Thrombosis
  3. 2ry hydrocele
  4. Testicular atrophy
  5. Neurosis
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10
Q

List inv for varicocele

A
  1. Duplex scan shows reversed blood flow DIAGNOSTIC
  2. Semen analysis medicolegal, OAT $
  3. Scrotal, transrectal US
  4. Abdominal US to exclude 2ry causes (RCC)
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11
Q

Why is varcocele more common on left?

A
  1. Left adrenal secretes adrenaline near mouth of testicular v
  2. It enters perpendicular to renal v
  3. Longer than rt
  4. Crossed by rt CIA & pelvic colon
  5. Nut-cracker effect bet aorta & SMA
  6. Left renal a arches over vein
  7. Valves on left are usually malformed
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12
Q

Describe etiology of 2ry varicocele

A

MC: RCC
Retroperitoneal fibrosis/tumor
Post-nephrectomy

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13
Q

MC arterial C of impotence is….

A

Atherosclerosis

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14
Q

Mention side effect & CIs for PDE5I

A

Headache, dyspepsia, blue vision
CI: nitrate therapy, severe uncontrolled hypotension, severe cardiac malfunction

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15
Q

Define:
1. Spermatocele
2. Simple cyst of epididymis
How to differentiate clinically

A
  1. Retention cyst of vasa-efferentia
  2. Cyst of vestigial structure “hydatid of morgagni”, degeneration of epididymis
    Epididymal cyst are almost always separate from testis proper while spermatocele is not
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16
Q

Mention cause of acute & chronic hematocele
Describe ttt of each

A

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

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17
Q

The nerve controlling external urethral sphincter is….

A

Pudendal

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18
Q

List CI of recieving renal transplant

A
  1. Active infection
  2. Recent malignant disease
  3. Active GN
  4. Pre-sensitization to donor HLA
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19
Q

Time for acute rejection is….., ttt is…..

A

Within 3 months
Steroid pulses, ATG, OKT3

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20
Q

What is triple immunosuppressive therapy for renal transplantation

A

CSS, mycophenolate mofetil, cyclosporine

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21
Q

MC cause of unilateral chronic retention is….while that of bilateral is…..

A

Stones
BPH

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22
Q

MC tumors in humans are….., in younger patients they are…..while in adulthood they turn…..

A

Naevi
Junctional, intradermal

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23
Q

Mention naevi that are most likely to turn malignant

A
  1. Giant hairy naevi (carry high possibility of malignant transformation)
  2. Junctional naevi
  3. Chronic irritation (shaving)
  4. Incomplete excsion
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24
Q

Indications for ttt of benign melanoma & its ttt

A
  1. For cosmetic reasons, subjected to repeated trauma, suspected to return malignant
  2. Giant hairy naevi; compound naevus covering larger area of skin
    TTT: medical (quinolones), laser (Q-switched), surgical excision
25
Q

Mention signs of malignant transformation in naevi

A

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.

26
Q

Mention predisposing factors of malignant melanoma

A
  1. Prolonged exposure to sunlight (UV rays)
  2. Inc incidence in albinism, retinitis pigmentosa, rare in negros more c in fair skinned
  3. On top of benign lesions (if exposed to chronic irritation)
27
Q

MC malignant melanoma & its prognosis

A

Superficial spreading
Best (radial growth)

28
Q

Nodular melanoma pattern of growth is……

A

Vertical growth w/out radial growth phase

29
Q

MC site of acral lentigious m is…., prognosis is…..

A

Sole, palm, under nails
Poor (radial then vertical)

30
Q

Worst type of MM is……, diagnosed by…..

A

Amelanotic melanoma
Dopa reaction test & biopsy

31
Q

Compare clinically bet lentigo maligna & superficial spreading

A

LM: younger age, MC trunk in males, leg & back in females
SS: old ages females, more c on face in sun exposed areas

32
Q

Describe blood spread of MM

A

MC to lung, high affinity to liver

33
Q

Mentiom INV for MM

A

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

34
Q

In Clark’s classification, levels…..are those of radial growth, levels…..are those of vertical growth

A

I & II
III, IV, V

35
Q

Mention how safety margin is calculated for MM

A

1 cm if thickness <1mm
2 cm if thickness 1-4mm
3 cm if thickness >4mm

36
Q

List PDFs for non-melanotic skin malignancies

A
  1. Premalignant lesions
  2. UV exposure
  3. Radiation: IC
  4. Marjolin ulcer: chronic irritation, ulcer, old burn scar & sinus
  5. Prolonged exposure to carcinogenic agents
  6. Exposure to viral carcinogens, HPV
37
Q

List PDFs of premalignant skin lesions

A
  1. Xeroderma pigmentosa (AR)
  2. Keratoacanthoma (vs BCC)
  3. Actinic keratosis (MC)
  4. Bowen’s disease
  5. Leukoplakia
38
Q

MC malignant skin lesion is….., its site is…, edge is…., LN are…..

A

BCC
Face above line joining angle of mouth to tragus of ear
Rolled in & beaded
No enlarged unless SCC or infection

39
Q

Mention inv for BCC & SCC

A

Excisional biopsy for both
B—X-ray
S—sentinel LN & CT

40
Q

BCC is removed w/safety margin…..

A

0.5 cm

41
Q

List indications for surgery in BCC

A
  1. Small lesions
  2. Infiltrating bone & cartilage
  3. Radioresistant
  4. Recurrence after radiation
42
Q

Mention I & CI of radiation in BCC

A

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

43
Q

CI for radiation in SCC

A

Marjolin’s ulcer

44
Q

Mention complications of BCC& SCC

A
  1. Infiltrating the surrounding
  2. 2ry infection
  3. Hge from erosion of big vessels
    S—distant mets & cachexia
    B—epitheliomatous transformation (baso-squamous carcinoma)
45
Q

Mention MC type of BCC

A

Nodulo-ulcerative type

46
Q

Mention causes of macroglossia

A

Congenital: cavernous hemagiomas, AV fistula, lymphangiomas, NF
Acquired: cretinism, acromegaly, amyloidosis

47
Q

Mention pathological variations of tongue cancer

A

SCC (MC), verrucous carcinoma, BCC (adenocarcinoma), posterior is less differentiated

48
Q

Mention causes of pain in tongue

A

In tongue early: infection, late: lingual n affection
Ear: referred by auriculotemporal n
On swallowing: if post 1/3 of tongue

49
Q

List comp of malignant ulcer of tongue

A
  1. Inhalation pneumonia, asphyxia
  2. Infection, 2ry hge: lingual or ICA
  3. Cachexia
50
Q

Mention inv for malignant tongue ulcerj

A
  1. Excisional biopsy w/ 1cm safety margin (best inv)
  2. FNAC
  3. CT neck & mandible
51
Q

Mention indications of surgery & radiation in tongue cancer

A

S:1. Small growths, incomplete resection, regression or recurrence
2. Cancer on top of precancerous lesions
3. Close to mandible
R: T1&2

52
Q

Mention ind for palliative ttt in tongue cancer

A

Unresectable tumor, fixed LNs, distant mets

53
Q

Describe ttt of post 1/3 cancer of tongue

A

Total glossectomy, needs median mandibulectomy + irradiation

54
Q

Mention 3 indications for COMMANDO

A

Sarcomatous & carcinomatous epulis & tongue cancer close to mandible

55
Q

What is epulis & how is it generally treated?

A

Generic name applied to tumor of gingiva or alveolar mucosa
Curettage & electrosurgery & cryosuregry

56
Q

Mention CP, radiology & ttt of OS of jaw

A

Jaw pain & swelling, paresthesia for mandibular lesions, & loosening of teeth
Sunburst appearance
Radical resection with up to 3cm free margin + preoperative & postop chemo

57
Q

MC epulis is….

A

Fibrous

58
Q

Describe ttt for the following types of epulis:
1. Fibrous
2. Granulomatous
3. Myeloid

A
  1. Teeth extract + excsion w/ wide base of peiosteum
  2. Excision & removal of tooth + biopsy
  3. Wide excision w/ safety margin

Urology (6 decks)

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