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SU30.1-6 | Penis, Testis and Scrotum — Practice Quiz
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A 24-year-old uncircumcised man presents with a painful, swollen glans. The retracted foreskin is trapped behind the corona as a tight, oedematous band that he cannot reduce. What is the correct classification and immediate priority?
Correct. A retracted foreskin trapped behind the glans causing a constricting oedematous band is paraphimosis — an emergency, because the constriction impairs venous drainage and threatens the glans. Prompt manual reduction (with analgesia) is the priority.
Paraphimosis = emergency: retracted foreskin traps behind glans, constricts it → reduce promptly. Phimosis = non-retractile foreskin (not an emergency).
This is paraphimosis (foreskin trapped behind the corona, constricting the glans) — an emergency. The priority is prompt reduction to restore venous drainage. Phimosis is the opposite (non-retractile foreskin) and is not an emergency.
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A 68-year-old uncircumcised man with poor genital hygiene presents with an ulcerating, fungating lesion on the glans penis. Biopsy is most likely to show which histology, and which factor is protective against this cancer?
Correct. Carcinoma of the penis is a squamous cell carcinoma associated with retained smegma, poor hygiene, phimosis and HPV. Circumcision — particularly in infancy — is protective.
Ca penis = SCC (smegma, poor hygiene, phimosis, HPV). Circumcision, especially in infancy, is protective.
Penile cancer is squamous cell carcinoma, linked to smegma/poor hygiene, phimosis and HPV. Circumcision (especially neonatal) is protective. Smegma and phimosis are risk factors, not protective.
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A healthy 12-month-old boy has a non-palpable right testis; the left is normally descended in the scrotum. The parents ask about timing and reasons for surgery. What is the most appropriate advice regarding orchidopexy?
Correct. Orchidopexy is performed early (around 6–18 months) to optimise fertility and to place the testis where it can be examined. The increased risk of malignancy associated with an undescended testis persists despite orchidopexy — hence the importance of self-examination.
Undescended testis: orchidopexy at 6–18 months. Malignancy risk persists despite surgery — counsel on self-examination.
Orchidopexy is done in infancy (≈6–18 months). It improves fertility prospects and allows examination, but it does NOT abolish the elevated malignancy risk, which persists — so the testis must be brought down and monitored, not left or removed routinely.
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A 16-year-old boy presents with sudden, severe pain and swelling of the right testis for 4 hours. The testis is high-riding and tender, the cremasteric reflex is absent, and elevation of the testis does not relieve the pain. What is the most important diagnosis to exclude and the correct action?
Correct. Sudden severe testicular pain with a high-riding, tender testis and an absent cremasteric reflex is testicular torsion until proven otherwise — a surgical emergency. Exploration must occur urgently (ideally within 6 hours) to save the testis; imaging must not delay surgery.
Testicular torsion = surgical emergency. Absent cremasteric reflex, high-riding testis, <6 h window. Explore immediately — never delay for imaging.
This is testicular torsion — sudden pain, high-riding tender testis, absent cremasteric reflex, no relief on elevation. It is a surgical emergency: explore immediately (window ~6 hours). Do not delay for antibiotics or imaging.
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A 30-year-old man has a 3-day history of gradually worsening scrotal pain, fever and dysuria. The affected hemiscrotum is swollen and tender, and lifting the testis eases the pain (positive Prehn sign). The cremasteric reflex is present. What is the most likely diagnosis?
Correct. Gradual-onset pain with fever, dysuria, relief on elevation (positive Prehn sign) and a preserved cremasteric reflex points to epididymo-orchitis, typically from ascending infection (STI organisms in young men, coliforms in older men). Torsion must always be excluded first when in doubt.
Epididymo-orchitis: gradual onset, fever/dysuria, Prehn relief, cremasteric reflex present. Always exclude torsion first if uncertain.
The gradual onset, fever/dysuria, relief on elevation (Prehn) and preserved cremasteric reflex indicate epididymo-orchitis. Torsion is sudden, has an absent cremasteric reflex and no relief on elevation — and must always be excluded in doubt.
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A 22-year-old man being investigated for subfertility is found to have a soft, non-tender scrotal swelling on the LEFT that feels like a 'bag of worms' and becomes less prominent when he lies down. What is the diagnosis?
Correct. A 'bag of worms' swelling that decompresses on lying down, typically left-sided and associated with subfertility, is a varicocele (dilated pampiniform plexus). The left side predominates because of the right-angle drainage of the left testicular vein into the renal vein.
Varicocele: 'bag of worms', usually left-sided, decompresses on lying down, linked to subfertility.
A 'bag of worms' that reduces on lying flat, usually left-sided and linked to subfertility, is a varicocele. A hydrocele transilluminates and surrounds the testis; it does not feel like a bag of worms.
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A 50-year-old man has a painless, smooth scrotal swelling that you cannot get above, surrounds the testis, and brightly transilluminates with a torch. What is the most likely diagnosis?
Correct. A painless swelling that surrounds the testis and transilluminates brightly is a hydrocele (fluid in the tunica vaginalis). A solid testicular tumour does NOT transilluminate; an inguinoscrotal hernia is one you cannot 'get above'.
Hydrocele: painless, surrounds testis, transilluminates. Solid tumour does NOT transilluminate — exclude underlying tumour in secondary hydrocele.
A transilluminant swelling enveloping the testis is a hydrocele. A testicular tumour is solid and does not transilluminate. Always examine the testis itself — a secondary hydrocele can hide an underlying tumour.
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A 27-year-old man has a painless, firm, craggy intratesticular lump confirmed as a solid mass on ultrasound. Which statement about management and tumour markers is correct?
Correct. A solid intratesticular mass is treated by radical INGUINAL orchidectomy — never a trans-scrotal approach or biopsy (which risks scrotal/lymphatic seeding). AFP is NOT raised in pure seminoma; beta-hCG and LDH may be elevated, and AFP rises in non-seminomatous germ-cell tumours.
Testicular tumour: radical INGUINAL orchidectomy (never trans-scrotal). Markers: AFP NOT in pure seminoma; beta-hCG/LDH variable; AFP raised in NSGCT.
Testicular tumours are removed by radical INGUINAL orchidectomy — never trans-scrotal biopsy/approach (seeding risk). AFP is NOT raised in PURE seminoma; AFP marks non-seminomatous GCT, while beta-hCG and LDH can be raised in either.
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