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What are the common causes of scrotal masses?
- Within testes, transluscent (T): hydrocoele
- Within testes, non-T: testicular ca, syphilitic
- gumma
- Separate from testes, T: epididymal cyst, spermatocoele
- Separate from testes, non-T: chronic epididymitis
Other: variecoele, undescended testes, inguinal hernia
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What is the pathophysiology underlying indirect inguinal hernia?
- Failure of obliteration of patent processus vaginalis.
- This allows bowel contents to herniate through deep inguinal ring through inguinal canal.
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Describe the pathogenesis of torsion of testes.
- Normally, the tunica vaginalis attachments prevent torsion.
- Congenital abnormality allow increased mobility of testes
- Testicular non-descent
- Absence of scrotal ligaments
- Testicular atrophy
- Pecipitating event e.g. trauma
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What are the causes of chronic and acute epididymo-orchitis?
- Acute: Chlamydia & N. gonorrhoea for <40 yo, Pseudomonas & E.coli for >40 yo.
- Chronic: TB, or progression from acute infection
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List the factors predisposing to testicular neoplasms.
- Cryptorchidism (10% of testic tumours) – the higher the testis, the greater the cancer risk.
- Genetic
- Genomic changes
- Testicular dysgenesis e.g. Klinefelter
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Compare seminomatous germ cell tumours and non-seminomatous germ cell tumours of the testes.
- Seminomatous germ cell tumours: peak 30yo, 70% are stage I, localised and better prognosis
- Non-seminomatous germ cell tumours: common in young but occur in all ages, stage II &III, haematogenous spread to lungs/liver/brain
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How are AFP, hCG and LDH related to testicular tumours?
- AFP: +ve in yolk sac tumours (non-S)
- hCG: +ve in choriocarcinomas (non-S)
- LDH: for tumour load
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