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73 Cards in this Set

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  • Back

Scrotal Transillumination

Scrotal lesions that transilluminate include hydrocele, spermatocele, and varicocele

Hydrocele, observed via scrotal transillumination

Testicular torsion

Acute, unilateral scrotal pain usually occurring in adolescents due to sudden twisting of spermatic cord producing testicular ischemia.

Involved testicle is tender, edematous and indurated

Elevation of testicle does not relieve pain.

Reduced blood flow via doppler US; requires immediate surgery.

US: Testicular torsion with reduced blood flow to left testicle. Will become ischemic if not fixed in <6 hrs

Differential diagnosis: acute epididymitis, renal stone, incarcerated hernia

Deformity which predisposes males for testicular torsion

Bell clapper deformity: tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate

Testicular mass/nodule

Non-tender, solid testicular mass; assumed to be cancer until proven otherwise.

Testicular cancer is the most common solid cancer in men 15-35 yrs of age


Dilatation of pampiniform plexus of spermatic veins causes scrotal enlargement that feels like "bag of worms"

Disappears when lying down (recumbence)

On exam: cannot find sup. margin of lesion

Usu. asymptomatic; more common on left side

Can cause infertility; may signal renal cell carcinoma if cancer invades L renal vein, impedes L testicular venous drainage


Tortuous veins visible on examination

On palpation, feels like "bag of worms"

May be assoc. w/ renal cell carcinoma. Can cause infertility.

Common (15-20% in post-pub. males)

"Nutcracker" syndrome: L renal vein compression by sup. mes. artery/aorta-->varicocele/hematuria

Genital wart

Reflects HPV infection (STD)

HPV infection is also a risk factor for penile carcinoma

Genital warts on upper shaft of penis

Herpes simplex lesion

Usu. occurs as multiple painful vesicles

Due to HSV-2 infxn (most commonly)

Primary infxn: ~6 days post-exposure

-Very painful; assoc. w/ dysuria, fever, inguinal adenopathy, headache, occ. viral meningitis

Recurrent dz: milder symptoms, occ. lesions

Asymp. pt's may shed virus, transmit dz w/ sexual contact (70% attack rate in sero(-) people)

HSV-2 lesions

Painful vesicles on head and shaft of penis


Inability to replace retracted foreskin

Usu. very painful, unless there is severe neuropathy

Considered a medical emergency: increasing penile edema-->penile ischemia/necrosis


Risk in uncircumsized men

Considered a risk factor for penile cancer

Considered a medical emergency

Penile cancer

Squamous cell carcinoma (most)

Begins as painless papule that progresses

HPV DNA in 30-50% of lesions

Penile cancer on head

Usu. squamous cell carcinoma

Progresses from painless papule

Assoc. w/ HPV in 30-50% of cases


Inability to retract foreskin

Strong risk factor for squamous cell carcinoma of the penis

May use topical steroid cream


Strong risk factor for squamous cell carcinoma of penis

Treat with circumcision

Syphilitic chancre

Painless lesion occurring ~21 days after exposure

Reflects site of spirochete entry (Treponema pallidum)

Solitary papule-->ulceration (indurated, w/out exudate)

Heals in 4-8 weeks w/out treatment

Syphilitic chancre (primary syphilis)

Painless, indurated ulcer without exudate

Occurs ~21 days post-exposure

Heals in 4-8 weeks w/out treatment


Fluid-filled sac (often painless) surrounding a testicle, causing scrotal swelling

Common in newborns; usu. disappears w/out intervention in 1st yr of life (comm v. non-comm)

May form in reaction to infection or injury

Will cause scrotal transillumination


Abnormal sac which develops in epididymis

Usu. filled with clear/milky fluid

Usu. asymptomatic unless it becomes large enough to cause discomfort


Can be observed via transillumination or ultrasound

Typically asymptomatic

May require surgical removal if it becomes large enough to cause discomfort

Testicular cancer

Seminoma is most common malignant testicular tumor--usu. seen in men in their 20s-30s

Typically painless on presentation

Will not transilluminate (solid mass)

Easily curable if detected early

May present w/ mets (10%): supraclavicular lymph nodes, pulmonary symptoms, back/bone pain


Most common malignant testicular cancer; usually seen in men in their 20s and 30s

Direct inguinal hernia

Usu. due to weakness in abdominal wall mms.

Hernia proceeds directly through abd. wall; does not traverse inguinal canal

Hernia sac will touch side of examining finger in inguinal canal

Rare in children

Direct and indirect inguinal hernia routes

Indirect inguinal hernia

Goes down inguinal canal, "indirectly" into scrotal sac

Hernia sac will touch tip of finger in examination of inguinal canal

Most common type of hernia in newborns/babies

Femoral hernia

More common in women

Occurs through femoral canal, inferior to inguinal ligament (differentiates it from inguinal hernia)

Femoral hernia

More common in women

Through femoral canal

Inferior to inguinal ligament

Palpable kidneys: differential diagnoses

1. Adult Polycystic Kidney Disease (APDK)

2. Renal cell carcinoma (also assoc. w/ varicocele)

3. Angiomyolipoma (tubular sclerosis)

4. Xanthogranulomatous pyelonephritis (rare)

Renal cell carcinoma

Associated w/ varicocele in males

Will present with palpable kidney

Adult polycystic kidney disease

30s-40s: Will present w/ palpable kidney, flank pain, hematuria, renal stones

Autosomal dominant: PKD1 (more severe), PKD2

75% hypertensive

Cysts in multiple viscera (30%-liver)

5-10%: intracranial aneurysm (subarachnoid)

50% have renal failure by age 60

Angiomyolipoma (tubular sclerosis)

Benign tumor

Mixed tissue findings on CT

Benign prostatic hypertrophy (BPH)

Common in older men

Presents w/: frequent urination, weak stream, incomplete bladder emptying, nocturia, intermittency, hesitancy

Exacerbated by anticholinergics (benadryl, cogentin, etc.)--distended bladder, anuria

Digital Rectal Exam: diffusely enlarged gland, rubbery consistency, non-tender

Benign Prostatic Hypertrophy (BPH)

Adenocarcinoma of the prostate

Common in older men

Generally asymptomatic

May present w/ mets (e.g. back pain--spine mets)

May coexist w/ benign prostatic hypertrophy

DRE: hard nodule

Prostate adenocarcinoma

Acute prostatitis

Usu. presents as acute illness in young/middle-aged men

Symptoms: fever, malaise, dysuria, pelvic/penile pain, obstructive complaints

This is a medical emergency; give antibiotics

DRE: tender, edematous gland

Costo-vertebral angle tenderness

Swelling of renal capsule; elicited by percussion w/ medial aspect of fist

Due to pyelonephritis (most common), or hydronephrosis


Usu. due to migrating UTI (cystitis), but can also arise from bacteria in bloodstream

Presents w/ palpable kidney, radiating flank pain, fever, chills, and dysuria

Can lead to sepsis, kidney failure, death

Treat w/ antibiotics


Striated nephrogram/CT imaging


Typically due to obstruction in ureter

May be due to congenital structural abnormalities (such as posterior urethral valves in males), injury, infection, or radiation exposure

If left untreated, can lead to ESRD

Increased incidence of UTIs may be only symptom of dysfunction early on

Bilateral hydronephrosis

Abdominal palpation findings

1. Distended bladder (urethral strictures or BPH+anticholinergic medications)--intern's tumor

2. Splenomegaly (spleen will move with respiration; L kidney is retroperitoneal, will not move w/ resp.)


On palpation, will move with respiration

Skin findings

1. Impetigo (Staph aureus or Strep pyogenes; risk of post-strep glomerulonephritis)

2. Henoch-Schonlein purpura (IgA vasculitis; risk of glomerulonephritis)

3. Uremic frost

Syphilis Stages

Primary: painless, indurated chancre representing spirochete entry site (~21 days incubation)

Secondary: skin manifestations 2-10 weeks after chancre; often palms/soles; may show constitutional findings

Tertiary: neurologic, cardiovascular


Skin infxn caused by Staph aureus or Strep pyogenes (GAS)

Flaccid vesicles and bullae-->rupture = honey-colored crusts

Commonly seen in low-SES school children in warm climates

If GAS-->risk for post-strep glomerulonephritis


Henoch-Schonlein purpura (HSP)

IgA vasculitis

Usu. in kids

Assoc. rash, glomerulonephritis, risk for GI bleed (20-30%)

Skin finding is palpable purpura

Henoch-Schonlein Purpura

IgA vasculitis

Rash, acute glomerulonephritis, risk for GI bleed

Palpable purpura--not specific to HSP; look for RBC casts in urine

Uremic Frost

Relatively uncommon; only occurs w/ serum BUN >200 mg/dl

Crystallized urea from swet

Indicates severe renal failure

Uremic frost (crystallized urea)

BUN >200 mg/dl

Severe renal failure

Urine sediment types

1. Oxalate crystals

2. Struvite crystals (aka: triple phosphate)

3. White cell casts (aka: coarse granular cast)

4. Uric acid crystals

5. Red cell casts

Oxalate crystals

"Rhomboid crystals"

Ethylene glycol (EG) ingestion

Ethylene glycol-->oxalate w/ EtOH-dehydrogenase catalyzing step 1 of 2-step rxn

EG metabolites-->renal failure, acidosis

Treat w/ fomepizole+dialysis (old tx was EtOH)

Methanol also-->increased AGAP acidosis/retinal injury (but no oxaluria)

Oxalate crystals

Ethylene glycol (anti-freeze) ingestion

Acidosis + renal failure

Tx: fomepizole+dialysis

Struvite lithiasis (aka: triple phosphate)

Composed of Mg, ammonium, and phosphate

Occurs w/ upper UTI with urease-producing organism (PROTEUS)+alkaline urine

Shaped like "coffin lids"

Grows rapidly, forming branching structure ("staghorn" calculus) w/in renal pelvis & collecting system

X-ray: dense calcific lesion

Struvite crystals

Struvite lithiasis

Proteus most common organism involved

Urease-producing organism

Staghorn calculus

Often associated with struvite lithiasis

Proteus infection in upper UT

Uric acid crystals in urine

Usu. seen in acidic urine of patients w/ hyperuricemia, uric acid renal stones, and/or gout

Uric acid crystals

Seen in acidic urine

Hyperuricemia, uric acid renal stones, &/or gout

White cell cast (coarse granular cast)

Assoc. w/ inflammation in kidney tubules

Usu. acute pyelonephritis

White cell casts (coarse granular casts)

Assoc. w/ inflammation of kidney tubules, acute pyelonephritis

Red cell cast

Specific for acute glomerulonephritis

Red cell cast

Assoc. w/ acute glomerulonephritis (not 100% sensitive)

Malignant hypertension

Nephrosclerosis due to vascular damage, fibrin and platelet deposits-->inadequate blood perfusion (DON'T GIVE DIURETICS--already intravascular volume depletion)

Ischemia-->activation of renin-aldosterone system-->angiotensin II-->renal vasoconstriction, further elevation of blood pressure

Onion-skin glomerular lesions on kidney biopsy; visual impairment/papilledema

Onion-skin lesion

Typical finding in disorders which cause thrombotic microangiopathy

Malignant hypertension, scleroderma renal crisis, eclampsia, etc.

Arterioles would show damage w/ necrosis

Lindsay's nails ("half-and-half" nails)

Assoc. w/ renal failure

Metab. acidosis + hyperkalemia

Hyperkalemia-->peaked T waves, QRS complex widening-->sine wave pattern-->death

Address w/ IV calcium, lower serum [K] w/ insulin/glucose, albuterol, dialysis

Lindsay's nails

Associated w/ hyperkalemia, renal failure

Xanthogranulomatous pyelonephritis

Due to recurrent UTIs

Associated w/ palpable renal mass

Xanthogranulomatous Pyelonephritis

Will present w/ palpable kidney

Due to recurrent UTIs

Tumor Lysis Syndrome

Risk usu. following chemo for some aggressive cancers (~58%)

Lysis-->spillage of intracell'r contents (K, P, uric acid)-->acute tubular necrosis + hyperkalemia

Acute tubular necrosis: urine shows "muddy brown casts"

After 2-3 days: Intravasc. volume overload, high AGAP metab. acidosis, uremia