Tiêu đề UROLOGY ✅

Examiner No giliran pelajar Batch Final diagnosis Problem list Takde Takde Batch 5 Testicular tumor Testicular tumor Case 19 yo Male patient Urinary sx : straining, dribbling Constipation, tenesmus Abdomen pain Firm mass in abdomen Usg abd cant see right kidney. 1. History taking Chief complaint i. Painless scrotal swelling 1. Sometime painful - dull, aching, dragging pain in scrotum HOPI ii. Sensation of heaviness iii. Back pain - due to infiltration of paraaortic node iv. Compressive symptoms - abdominal mass, urinary problem, difficulty in BO v. Constitutional symptoms - LOA, LOW, fatigue vi. Metastatic symptoms - sob, jaundice, headache, bone pain vii. Must rule out other common cause of scrotal swelling 1. Indirect hernia a. Ask for risk factor - factor causing increased intraabdominal pressure (heavy lifting, job like heavy labor, sport like tug war, underlying disease like COPD, straining when BO or PU, BPH) b. Ask for symptoms - heaviness, mass coming out when standing or doing activity, reducible or not, painful or not 2. Varicocele a. Usually associated with infertility (because sperm stored in cold temperature. In increased vascularity condition like varicocele temperature usually heightened, not conducive for sperm storing) 3. Hydrocele 4. Epididymo-orchitis a. Fever b. Urinary symptoms - FUN viii. Risk factor 1. Hx of undescended testis 2. Hx of testicular trauma 3. Family history same problems
Systemic review ix. Mets symptoms x. Compressive symptoms Past medical Past surgical xi. Orchidopexy done before Drug and allergic history xii. On chemotherapy before? Family history xiii. Hx of testicular problem xiv. Hx of malignancy Social history 2. Physical examination General examination Abdominal examination i. Cough impulse - rule out other causes Genital examination ii. Inspection: unilateral, bilateral, skin changes, prominent vein (varicocele) iii. Palpation: 1. Swelling: site, size, surface, consistency, tenderness, erythema, edge, can get above mass (if cant get above it is hernia usually bowel, try auscultate there is bowel sound), not transilluminate (hydrocele positive) 2. Palpate for testis (separable or not - inseparable, if separable not testicular origin), spermatic cord Lymph node iv. Examine inguinal lymph node (paraaortic LN) and supraclavicular LN