Benign And Malignant Testicular Disease

Front 1

How do you tell if a mass is cystic in the testes or not?

Back 1

Transillumination

Front 2

What's the most common cancer in men under 35?

Back 2

Testicular cancer

Front 3

What races most commonly get testicular cancer?

Back 3

Caucasian > Asians > African americans

Front 4

What are risk factors for testicular cancer/

Back 4

Race
Age
Previous testis cancer
Cryptorchidism (SUPER HIGH RISK!!!)
Male infertility

Front 5

What are the signs and symptoms of testicular cancer?

Back 5

Mass/swelling
Pain

Trauma

Front 6

What's the best diagnostic tool for testicular cancer?

Back 6

PE

Scortal US

Front 7

What are serum markers for testicular cancer?

Back 7

AFP
Beta-HCG

Front 8

If there's a solid mass in the testes, what is it until proved otherwise?

Back 8

Germ cell malignancy

Front 9

What's the management of a testicular mass?

Back 9

Surgical exploration.

Front 10

What's the management of a testicular neoplasm?

Back 10

Radical Orchiectomy: you take the testes along with the entire spermatocord out up to the internal ring (lymphatic reasons)

Front 11

What imaging studies should you order up in a man with testicular cancer? Why?

Back 11

CT scan
CXR
Tumor marks (pre, post-op)

Look for mets.

Front 12

What is the HCG in a:
Choriocarcionma?
Embryonal?
Seminoma?

Back 12

Choriocarcionoma: SUPER HIGH! (thousands.)
Embryonal: rather high

Seminoma: only ocasionally elevated

Front 13

What kinds of testicular tumors show an elevated AFP?

Back 13

Yolk sac
Pure embryonal
Teratocarcinoma

Front 14

What kind of tumor never shows an elevated AFP?

Back 14

Pure seminomas

Front 15

What's the staging of germ cell neoplamss?

Back 15

A: confined to testis
B: nodal involvmeent in retroperitoneum
C: nodal spread beyond the retroperitoneum
D: other solid organs.

Front 16

What's the spread of a choriocarcinoma?

Back 16

Hematogenously

Can easily met to other organs: lungs. Commonly mets to lungs.

Front 17

What's the therapy for a seminoma in stage A or B1?

Back 17

radical orchiectomy
External radiation.
Watchful waiting (lots of CT scans)

Easily curable.

Front 18

What's the treatment for a stage B2 or C seminoma?

Back 18

Radical orchiectomy
Chemo

85% survival

Front 19

What's the therapy for a non-seminoma germ cell tumor?

Back 19

Stage A:
Radical orchiectomy or
Chemo or
Close observation or
Retroperitoneal lymph node dissection

Front 20

What's the therapy for a NSGCT B2 tumor?

Back 20

Chemo

Front 21

What's the therapy for a stage B3, C, or D NSGCT?

Back 21

Radical orchietomy
Chemotherapy

Front 22

What's the most common age for testicular torsion?

Back 22

12-18

Front 23

What's the disease process of testicular torsion?

Back 23

Twisting of the spermatic cod causes testicular ischemia

Front 24

How long does it take for ischemic damage to happen to a testicle?

Back 24

6 hours.

Front 25

What's the presentation of testicular torsion?

Back 25

Acute pain in absence of trauma (I was sound asleep and was awakened by my ballz hurting)

Nausea vomiting

Low-grade fever

Front 26

What is the presentation of a testicle that is under torsion?

Back 26

Anterior epididymis
Testicle is horizontal instead of verticle
High in the scrotum
TENDER TO PALPATION!!

Front 27

What's on the differential diagnosis for acute scrotal pain?

Back 27

Epididymitits
Testicular tumor
Orchitis
Torsion of appendix testis
Traumatic rupture of testis

Front 28

What are some good diagnostic tests for testicular torsion?

Back 28

Doppler ultrasound: see where the blood flow is going! (if at all)

Front 29

What's the treatment for a testicular torsion?

Back 29

Surgery!

If dead, take it out
If viable, suture it to the scrotal wall (as well as the other)

Front 30

What's the effect of not taking out a dead testicle?

Back 30

Negative anti-fertility effects on the other testicle
Necrosis and all of the associated complications

Front 31

What is pathomnemonic for a a toresed epididimyal appendix?

Back 31

Blue dot sign

Front 32

What is the normal location for epididymitis/orchitis?

Back 32

Retrograde infection up the vas deferens

Front 33

What kind of infection causes epididymitis/orchitis?

Back 33

TB
VIral

Front 34

What's the most common cause of epididymitis/orchitis?

Back 34

Sexual activity (far and away the most common)
Congenital anomalies
Bladder outlet obstruction
Neurogenic bladder dysfunction

Front 35

What's the presentation of someone with epididymitis/orchitis?

Back 35

Scrotal pain, swelling
Voiding symptoms
Fever
Hydrocele
Epididymal pain instead of testicular

Front 36

What found upon urinalysis in epididymitis/orchitis?

Back 36

Pyuria
Bactiruria

Front 37

What kind of bacteria cause epididymitis/orchitis in:
Peds?
Young adults?
Older adults?

Back 37

Peds and older adults: gram negative enterics (E. coli)

Young adults: chlamydia, gonorrhea

Front 38

What's the treatment for epididymitis/orchitis?

Back 38

Gm- enterics: SMX: TMP, quinolones

STDs: tetracyclines, ceftriaxone, quinolones

Front 39

What are the benign masses of the scrotum?

Back 39

Hydrocele
Spermatocele
Varicocele
Hematocele

Front 40

What underlies a hydrocele?

Back 40

Imbalance between production and absorption

Front 41

What's the difference between the location of a hydrocele and spermatocele?

Back 41

Hydrocele: anterior
Spermatocele: posterior

Front 42

What is the cause of a varicocele?

Back 42

Abnormally dilated internal spermaticvein

Front 43

Where are varicoceles found most of the time? Why?

Back 43

Left side.

Due to the spermatic vein going into the vasculature at a right angle

Front 44

If someone has an isolated R side varicocele, what should you do?

Back 44

IMAGE THE ABDOMEN!

-Tumors

Front 45

What's the history of symptoms from a varicocele?

Back 45

Dull pain as the day continues

Front 46

What's the therapy for a varicocele?

Back 46

Ligate the veins.

Front 47

What's the cause of a spermatocele?

Back 47

Rupture of epididymal ducts

Asymptomatic