Testicular OSCE Examination Quiz

See Characterising a Scrotal Lump. Option D is correct because every feature points to a benign, fluid-filled sac arising from the epididymis. The epididymis is the comma-shaped structure on the back of the testis where sperm are stored. An epididymal cyst (also called a spermatocele when it contains sperm) is a smooth, fluctuant nodule found above and separate from the testis that transilluminates, which means light from a torch passes through it because it contains clear fluid. Being able to feel a normal spermatic cord above the swelling, in other words to get above it, shows that the swelling stays within the scrotum and does not come down from the inguinal canal, which argues against an inguinal hernia. The lack of a cough impulse supports this. To work through any lump, identify what it arises from (testis, epididymis or cord) and then describe it systematically, which is where a checklist helps:

• Consistency, Attachments, Mobility, Pulsation, Fluctuation, Irreducibility, Regional lymph nodes and Edge (CAMPFIRE)
• Add tenderness, temperature and transillumination

• Epididymal cyst: A smooth, fluctuant nodule above and separate from the testis that transilluminates.
• Get above: A normal cord felt above the swelling shows it stays within the scrotum, which argues against an inguinal hernia.
• Cough impulse: Absent, which supports a swelling confined to the scrotum.