2025 – PAGE 74 – ADOLESCENT MEDICINE

OVERWEIGHT VERSUS OBESE

A BMI that falls in the 85–95% range for sex and age is considered overweight. If the BMI is >95%, the patient is considered obese.

PEARL: Do not use the absolute number of 25 (referring to BMI) as your cutoff for categorizing a patient as overweight. Rather, use the percentage for sex and age to guide you.

SCROTAL MASS

TESTICULAR CANCER

Testicular cancer results in a painless scrotal mass. When doing the cancer workup, get HCG and AFP levels. If either is high, get a scrotal ultrasound and a CT of the chest/abdomen/pelvis for staging. A biopsy should not be performed due to the risk of tumor seeding. Treatment will include at least an orchiectomy.

PEARL: Assume that any PAINLESS scrotal mass is CANCER until you can prove otherwise (by physical exam findings, symptoms, testing).

HYDROCELE

Hydroceles are painless, change shape with position and Valsalva, are superior and anterior to the testes, and transilluminate. They usually resolve by one year old. (If not, consider surgical intervention.)

SPERMATOCELE

Spermatoceles are painless, superior and posterior (basically on top of the epididymis), do not change with position, are nodular, and also transilluminate. They contain sperm. No treatment is needed.

VARICOCELE

Varicoceles are generally painless. A varicocele is a dilatation of the pampiniform Venous plexus.

MNEMONIC: “Bag ov Vorms” on the LE1^<T SIDE.” Described often as feeling like a bag of worms and is usually on the left side (the F in the mnemonic is made with a V).

INGUINAL HERNIA

Inguinal hernias are often PAINFUL. The scrotal mass changes with position and has no transillumination.

TESTICULAR AND PENILE ISSUES

TESTICULAR PAIN

Use ultrasound with Doppler as your preferred initial study.