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Men's Benign, torsio
CM Benign scrotal dz, epididymitis, orchitis, torsion, STDs
| Question | Answer |
|---|---|
| Two fxn's of the epididymis | facilitates sperm maturation, provides immune surveillance of sperm |
| Young male STDs | Chlamydia trachomatis (50-60%), N. gonorrhea (2nd most common) |
| sx of epididymitis | Scrotal pain, urinary frequency, urgency or dysuria. Urinary retention from bladder outlet obstruction in older pts, Nausea, fever and chills, abdominal or flank pain, usually unilateral, discharge |
| Prehn sign | decreased pain with scrotal elevation or support (not reliale vs. torsion) |
| Labs for Epididymitis | come back to |
| Acute pain required immediate evaluation to rule out | torsion. If unsure, urology consult |
| Acute inflammatory reaction of the testis secondary to infection | orchitis. Most cases are in children with viral mumps. |
| Orchitis from bacterial causes | Spread from epididymitis in sexually active men or men with BPH, gradual onset of pain and edema.Unilateral testicular edema occurs in 90% of cases. |
| Bacterial causes of Orchitis | N. gonorrhoeae, C. trachomatis, gram negatives, Pseudomonas |
| Diagnosing Orchitis | labs not helpful. Epididy-orchitis: UA, and urethral cultures. Color doppler US is the imaging test of choice for the evaluation of an acute scrotum |
| Classic presentation of Torsion | extreme pain, fast onset, absent cremasteric reflex, affected testis may appear higher and larger |
| _______covers not only the testicle and the epididymis but also the spermatic cord. This creates a "bell-clapper deformity" that allows the testis to rotate freely within the tunica vaginalis | The tunica vaginalis |
| Testicular Ischemia onset with torsion | Ischemia can occur as soon as 4 hours after torsion and is almost certain after 24 hours. |
| Population with highest rate of torsioon | young males (12-18 years old). Consider in any patient aged 12-30 years |
| Evaluation of the acute scrotum if you suspect torsion | surgical exploration. Long duration and positive UA with low probability of torsion: Color Doppler US |
| Common location of torsion in boys | torsion of the appendix testes (on superior aspect of testicle) |
| Orange peel texture of scrotal skin is a _____ finding in epididymitis | late finding in addition to edematous scrotal skin |
| "Blue dot sign" is associated with | Torsion of the appendix testis; it is a blue discoloration. Scrotal edema may obscure this sign and the presence of a nodule |
| T or F: In torsion, the affected testis may appear higher | T:The spermatic cord shortens as it twists, so the testis may appear higher in the affected scrotum with an abnormal (transverse) lie. ALSO, Because of venous congestion, the affected testis also may appear larger than the unaffected testis. |
| Diagnostic Studies of acute scrotum | imaging only when low index of torsion, any patient whom you suspect torsion needs immediate surgery. |
| Scintigraphy shows | perfusion. Doppler shows flow |
| If one testicle is lost, it is recommended to have | Prophylactic orchiopexy of the contralateral testis |
| Urethritis causes | infection, typically STDs (NGU due to infections with Chlamydia and Ureaplasma urealyticum). Trauma: catheterization or foreign bodies |
| Incubation period of Nongonococcal Urethritis | 4-14 days after contact. 50% of men will be asx |
| Chlamydia Clinical Presentation | Dysuria (worse during first morning void), urethral discharge |
| NGU Sx | Itching between voiding, Orchalgia (heaviness), systemic sx are usually absent |
| The preferred test for Chlamydia | Nucleic Acid Amplification Test (NAATs: ligase chain reaction and PCR) |
| Tx of NGU | Sx spontaneously resolve over time, treating sexual contacts prevents reinfection, abx should cover both GC and NGU (controversial). Single dose therapy. |
| Abx tx of Chlamydia | Azithromycin and Doxycyclin. (Cipro is ineffective against chlamydia) |
| Gonorrhea in men | unlike women, men with urogenital infection are usually symptomatic: Purulent penile discharge, dysuria, erythematous meatus |
| Test of choice for Gonorrhea | culture. Non culture tests: UA has similar accuracy, DNA amplification test (high sens and specificity) |
| Gonorrhea: Pharyngeal Infections | After orogenital exposure, Sx: mild or absent, PE: erythematous or exudates, anterior cervical LAD. Most spontaneously resolve. TEST WITH CHOCOLATE AGAR |
| Tx of Gonorrhea | Single Dose Ceftriaxone (Rocephin) IM or Cefixime (Suprax) |
| Primary Syphilis presentation | caused by spirochete treponema pallidum. Single PAINLESS chancre (average 3 weeks post exposure) |
| The definitive method for diagnosing early syphilis | Darkfield examination and direct fluorescent antibody (DFA) on a lesion exudate or tissue. RPR and VDRL are nonspecific, then do FTA-ABS |
| Tx of Primary Syphilis | Benzathine Penicillin G IM single dose |
| Secondary syphilis clinical manifestation | Fever, LAD, Diffuse Rash: PALMAR, perineal condylomata |
| Latent Stage Syhpilis | Sx disappear, serologic positive for T. palldium |
| Tertiary Syphilis | involves organ systems, neurosyphilis and aortic valve and root are most devastating, CSF +. Rarely infectious |
| Most common ulcerative STD | Genital Herpes |
| HSV-2 Presentation | sores usually look like blisters or cold sores on penis and scrotum and area around genital area. |
| HSV-2 Labs | Culture more informative than a blood test. Need to differentiate between HSV1 and HSV2 |
| HSV 2 tx | antivirals for 7-10 days for sx |
| Patient education with HSV2 | first outbreak is the worst. Will shed virus between outbreaks, but the worst during an outbreak. |
| cause of Chancroid and presentation | Haemophilus ducreyi. painful papules, pustules, and ulcers with painful adenopathy |
| Klebsiella granulomatis causes | Granuloma inguinale. Beefy red appearance, bleed easily, NO REGIONAL LYMPHADENOPATHY |
| Donovan Bodies indicate | Granuloma Inguinale |
| Lymphomgranuloma Venereum cause | C. trachomatis; test via culture, direct immunofluoresence or nucleic acid detection |
| Firm, smooth, round papule with central umbilication, usually 3-5mm diameter, in the lower abdomen and genital region is suggestive of | Molluscum Contagiosum (a poxvirus). Self-limited without sequelae |
| Most common etiology of Epididymitis | retrograde bacteria from the vas. In prepubertal males: coliform bacteria (E.coli) predominate |
| Varicocele | abnormal dilation of the veins of the pampiniform plexus. "bag of worms". Semen analysis reveals multiple abnormalities reflecting a 'stress pattern'. Surgical intervention is not indicated |
| Clinical presentation consistent with varicocele | the presence of two to three veins with diameter larger than 3mm and retrograde flow with Valsalva's maneuver is consistent with clinical varicocele |
| Result of Varicocele | Stasis of blood in the venous system disturbs countercurrent heat exchange responsible for maintaining testicular temperature and results in testicular parenchymal damage and impaired spermatogenesis. Unilateral V's bilaterally affect spermatogenesis |
| Most common varicocele complication | hydrocele formation |
| Indications for surgical corrections of varicoceles | male-factor infertility, testicular atrophy in adolescents with ipsilateral varicocele, and intractable pain attributed to varicocele |
| Pathophysiology of epididymitis | retrograde bacterial spread from the bladder or urethra. Most common causes in young men: G &C. in older men, UTIs caused by E.coli |
| ____ can be helpful in differentiating epididymitis from scrotal torsion | scrotal ultrasound wtih Doppler flow. |
| Hydroceles are most common in which population? | pediatric age group in association with an indirect hernia. c/o heaviness in scrotum, scrotal pain and an enlarging scrotal mass. |
| Cause of hydroceles | increased secretion and/or decreased reabsorption of serous fluid by the tunica vaginalis. Infection, trauma, neoplastic dz, and lymphatic dz are causative in adults, remainder of cases idiopathic |
| Tx of symptomatic hydrocele | hydrocelectomy. |
| Name the blood supply of the testicles | the testicular artery (aorta), the vasal artery(inferior vesicle artery), and the cremasteric artery (inferior epigastric artery) |
Created by:
ltm12