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45 Cards in this Set
- Front
- Back
a male aged 30 years old, presents with aslight enlargement in his left scrotum
Namefour possible differential diagnoses. |
Hydrocele Haematocele Varicocele Testicularcancer |
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Define Hydrocele |
Accumulation of serous fluid in a body sac |
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Define Haematocele |
Accumulation of bloodin the tunica vaginalis |
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Define Varicocele |
A mass of Varicose veins in the spermaticcord |
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Define Testicular cancer |
A cancer that develops in the testicles,Not all lumps on the testicles are tumours and not all tumours are malignant |
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Describe the structure of the scrotum
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* Pouch or sac
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a male aged 30 years old, presents with aslight enlargement in his left scrotum From his history, it is determined theswelling is also accompanied with a dragging sensation,some degree ofdiscomfort and a dull ache in the abdomen and groin. What is the most likediagnosis? |
Testicular cancer
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Describethe structure of the testis. |
§ Tunica vaginalis – fromvaginal process out pouching of the peritoneal cavity – Superficial parietal layer – Cavity – serous fluid – Visceral layer (sinus epididymus) § Tunica albuginea – fibrouscapsule of testis § Septum divides testis into250-300 lobules § Each lobule contains 3-4seminiferous tubules § Seminiferous tubules → tubulusrectus → Rete testis in Mediastinum testis (a region of dense connective tissuein the posterior part of the testis) → efferent ductules |
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What are the clinical manifestations oftesticular cancer |
· Enlargementof the testicle · Some degreeof discomfort · Dull achein abdomen or groin area · Draggingsensation or heaviness in scrotum · Frank painin later stages with enlargement and haemorrhage of testicle |
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a male aged 30 years old, presents with aslight enlargement in his left scrotum Ultrasound and blood tests are performed.Theblood test indicates high levels of ά-fetoprotein.What is the most likediagnosis? |
Testicular cancer
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What are the three tumour markers used |
ά-fetoprotein (AFP) HCG Lactic acid dehydrogenase (LDH) |
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What are the two main classifications oftesticular cancer |
- Germinal(germ) cell tumours – derived from germ cells- Nongerminalcell tumours – stromal tumours derived from leydig or sertoli cells
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What are the two groups of germ cell tumors |
- Seminomas
- Nonseminomas |
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Describe seminomas |
- From seminiferousepithelium - Most commontype of testicular cancer - 40% ofall germ cell tumours |
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What are the 3 types of non-seminomas |
- embryonalcarcinoma, - teratoma - choriocarcinoma |
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Describe the radiographicappearance of Testicular cancer
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Uniform, wellcircumscribed, hypoechoic mass without calcification or cysts
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a male aged 30 years old, presents with aslight enlargement in his left scrotum On examination the testis feels smooth but with a lump,however there is also a swelling just superior to the testis that feels like a“bag of worms”. What is the diagnosis |
Varicocele
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Describethe structure of the spermatic cord and its contents. |
– External spermatic fascia, Cremasteric fascia (cremaster muscle),Internal spermatic fascia – Testicular artery, Pampiniform plexus (testicular vein) – Nerves, Lymphatics – Ductus deferens |
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a male aged 30 years old, presents with aslight enlargement in his left scrotum His history indicates an earlier episode ofepididymitis, but no history of recent scrotal trauma or abdominal surgery. Onexamination the enlargement can be transilluminated. This can also develop as a congenital condition What is the diagnosis |
Hydrocele
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Describethe neural control of miturition |
Ø As urine accumulates stretch receptors inthe bladder wall are activated. Ø Stretch receptors send nerve impulses tothe sacral region of the spinal cord Ø This results in a nerve reflex whichinhibits the detrusor muscle, keeps the internal urinary sphincter closed andcauses contraction of the external sphincter. Ø When about 200 mLs of urine has accumulatedimpulses are transmitted to the brain creating the urge to urinate. Ø If it is convenient to urinate an ‘on/off’switch in the brain called the micturition centre is activated Ø This centre sends impulses to contract thedetrusor muscle, open the internal sphincter and relax the external sphincter. Ø Urine flows. Ø If it is not convenient to urinate the urgesettles temporarily Ø After another 200 to 300 mL has collectedimpulses are transmitted to the brain again creating the urge to urinate. |
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Describethe structure of the prostate gland (accessory sexual gland) |
Prostate – Single doughnut shaped gland about the size of achestnut – Numerous glands embedded in smooth muscle andconnective tissue – Ducts open into prostatic urethra – Fibrous capsule – Base – against bladder neck – Apex – against urogenital diaphragm |
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A male aged 65, presents with urinarysymptoms of hesitancy, frequency, a small weak stream and straining to initiateurination. To confirm suspicions about the cause ofhis urinary symptoms a digital rectal exam (DRE) is performed. An enlargedprostate with a smooth rubbery feel is detected. What condition of the prostate is mostlikely to be causing his urinary symptoms? |
Benignprostatic hyperplasia (BPH)
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Define prostatic hyperplasia |
Hyperplasia of the para urethral prostategland, commonly seen in med over the age of 50, causing variable degrees ofbladder outlet obstruction |
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Describe the structure of the urinary bladder |
• Hollow distensible muscular organ • Located in the pelvic cavity • Four surfaces and four angles • Shape: empty = collapsed (pyramid) slightly full = spherical distended = pear shaped • Surfaces – Superior surface – 2 x inferolateral surfaces – Posterior surface (base) • Angles – Apex – 2 x posterolateral angles – neck • Structures – Apex = urachus – Posterolateral = ureters – Neck = urethra
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Describe the internal features of the urinary bladder |
• MUCOSA – Transitional epithelia – Lamina propria – Rugae = folds of mucosa permitting expansion • MUSCULARIS – Smooth muscle = detrusor – 3 layer – Circular fibres form the internal urethral sphincter • ADVENTITIA – Superior surface = serosa (peritoneum) |
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Describe bladdercompensation due to urethral obstruction
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· Bladderhypertrophies → ↑ sensitive to bladder filling → with continuation → furtherhypertrophy of bladder muscle → thickening of bladder wall. → ↑ force needed to expel urine → musclefatigue → stagnation of urine →. ↑frequency of voiding → develop diverticula → stasis → secondary infection →hypertrophy of trigone. → ↑ backpressure on ureters → hydroureters → hydronephrosis. |
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a middle aged male, presents with acute onset of urinary frequency, urgency and dysuria. On further questioning he reveals, among other things, he is also experiencing muscle and joint pain. What is a possible diagnosis? |
ACUTE BACTERIAL PROSTATITIS |
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Describe acute bacterial Prostatitis |
an inflammatory disorder of the prostate gland caused by pathogens (80% e.coli) |
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what are the general clinical manifestations of acute bacterial prostatitis |
Urethral discharge, fever, chills, malaise |
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What are the 4 parts of the male urethra |
Urethra Membranous urethra spongy urethra |
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describe the male urethra
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– Terminal part of the reproductive system |
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describe Prostatic urethra |
2-3 cm long through prostat |
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describe Membranous urethra |
-1-2 cm long |
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describe spongy urethra |
- 15 cm long -Through corpus spongiosum from the bulb of the penis to the glans -External urethral orifice |
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what findings may be expected on a digital rectal examination for acute bacterial prostatitis |
Prostate swollen, tender, warm and soft areas, pus discharge
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what is the most likely causitive agent for acute bacterial prostatitis |
E.coli (80%) |
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what is the recommended treatment for acute bacterial prostatitis |
Bed rest, antipyretics, and analgesics |
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what is the complication that is most important to avoid for a patient with acute bacterial prostatitis |
Prostate abscesses - usually small → may rupture in several directions. Subsequent fibrosis may follow with urethral obstruction. |
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A male aged in his late sixties, presents with mild constant back pain, described as “aching”, mild but not unmanageable nocturia with some hesitancy. He has noticed occasionally what appears to be blood in his urine, though he has discounted this as the result of something he has eaten. A digital rectal examination (DRE) is performed. The prostate is found to be nodular and fixed. What do you suspect this man to have? |
carcinoma of the prostate
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what are the clinical manifestations of carcinoma of the prostate |
- majority of cases are asymptomatic - incidentally discovered on rectal examination |
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when examining the patient what are the clinical indications of carcinoma of the prostate |
prostate is nodular and fixed bone metastises (if present) characterized by lower back pain pathological #'s can occur weight loss |
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Describe the structure of this accessory sex gland |
Single doughnut shaped gland about the size of a chestnutNumerous glands embedded in smooth muscle and connective tissueDucts open into prostatic urethraFibrous capsule |
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Describe the pathology of prostate carcinoma |
• Usually glandular; |
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describe the radiographic appearance on excretory urography of prostate carcinoma |
Elevates and impresses the floor of the contrast-filled bladder Impression usually more irregular c.f. BPHBladder neck obstruction, infiltration of the trigone or invasive obstruction of the ureters above the bladder may produce obstruction of the proximal urinary tract |
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describe the spread of prostate carcinoma |
• Direct throughout prostate and surrounding tissue |