EMQs in Clinical Medicine.pdf - Peshawar Medical College

178 The abdomen and surgery
The pressure in the artery may force this plug outwards into the
haematoma to form a small cavity inside it. This gives rise to the
appearance of an expansile and pulsatile mass and is indistinguishable
on clinical examination (if history of trauma is not known).
64 Pain/lumps in the scrotum
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A 34-year-old man with a history of undescended testes presents with
weight loss and a hard painless testicular lump.
Seminoma usually presents between the age of 30 and 40 years whereas
teratoma commonly presents earlier (20–30 years). Undescended testes
are an important risk factor for testicular tumours.
A 12-year-old boy presents with severe pain in the testis associated
with vomiting after jumping on his bicycle.
There is a congenital anatomical abnormality that allows torsion of the
whole testicle. A normal testicle is fixed within the tunica vaginalis and
cannot twist. The pain of torsion is severe and often associated with
nausea and vomiting. Testicular torsion is a urological emergency and
prompt surgical intervention is indicated to ensure salvage of the
affected testis. Acute epididymo-orchitis can give a similar presentation,
but it is always best to explore surgically to rule out torsion if there is
any doubt.
It is important to remember that torsion of the testis can occur spontaneously
without any history of trauma.
A 25-year-old man presents with a testicular swelling that has
increased in size over the last couple of months. The swelling is
fluctuant and the underlying testis impalpable.
As the fluid of the hydrocele surrounds the body of the testis, the underlying
testis is impalpable. Primary hydrocele is idiopathic. Secondary
hydrocele occurs secondary to trauma, tumour and infection.
A 45-year-old man presenting with a scrotal swelling is worried that
he is growing a third testicle. On examination there is a smooth
fluctuant swelling within the scrotum. Both left and right testes are
palpable.
An epididymal cyst is separate from the testis and therefore the testis is
palpable.
A 19-year-old man complains of severe pain and swelling of sudden
onset in his right scrotum. Testis and epididymis are very tender. He
reports that he has had unprotected intercourse recently.