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DU PA tors, orch,std
Duke PA Epididymitis, Orchitis, Torsion, STD
| Question | Answer |
|---|---|
| __ are classically described as abnormal dilation of the veins of the pampiniform plexus | Varicoceles |
| Physical examination reveals the classic bag of worms, testicular atrophy, and tender scrotal contents | Varicocele |
| Varicoceles are commonly __ sided | Left |
| A clinical syndrome the produces fever, acute scrotal pain, and swelling as a result of inflammation and infection of the epididymis | Epididymitis |
| Epididymitis is caused by __ | Retrograde bacterial spread from bladder to urethra |
| What is the most frequent cause of epididymitis in men younger than 35 | Gonococcus and chlamydia |
| What is the most frequent cause of epididymitis in men older than 35 | E. coli and other coliforms |
| How can the causative organism of epididymitis be determined | Gram stain and culture of urethral swab or midstream urine specimen |
| How can the clinician differentiate between testicular torsion and epididymitis | Scrotal ultrasound with Doppler flow |
| A serous fluid collection within the parietal and visceral layers of the tunica vaginalis of the scrotum | Hydrocele |
| Patients with __ usually come to the clinician complaining of heaviness in the scrotum, scrotal pain, and an enlarging scrotal mass | Hydrocele |
| What are the arteries supplying the testicles | Testicular artery, vasal artery, cremasteric artery |
| How are the arteries supplying the testicles transmitted to the testicles | Via the spermatic cord |
| Characteristic symptoms of __ are acute scrotal pain, swelling, and N/V | testicular torsion |
| __ occur in more advanced cases of testicular torsion, but the testis has infarcted by this point | Ecchymosis and involvement of the scrotal skin |
| An antecedent history of __ is often present with testicular torsion | Trauma or physical activity |
| What is the clinical picture of herpes genitalis | Multiple painful vesicles on erythematous base, tender/soft adenopathy often bilateral, fever |
| What is the incubation period for HSV | 2-7 days |
| How long do the primary lesions of HSV last | 7-14 days |
| What is the incubation period of syphilis | 10-90 days (mean 21 days) |
| What is the clinical picture of chancroid | Vesicle or papule to pustule to ulcer, soft, not indurated, very painful. |
| Overall, genital recurrences of HSV develop in approximately __% of patients | 60 |
| What is the most common extra salivary site of mumps in adults | Testes (testicular swelling and tenderness) |
| Symptoms of epididymitis | Scrotal pain, urinary frequency/urgency/dysuria, urinary retention, nausea, fever and chills, ab or flank pain, urethral discharge |
| Signs of epididymitis | Edematous tender epididymis, erythematous scrotum, edematous scrotum, usually unilateral (90%) |
| What is Prehn sign | Decreased pain with scrotal elevation or support (epididymitis) |
| Supportive care for epididymitis | Scrotal elevation and support, ice pack, spermatic cord block |
| Acute inflammatory reaction of the testis secondary to infection | Orchitis |
| Most cases of orchitis are associated with __ | Viral mumps |
| Clinical picture of orchitis | Enlarged/indurated/tender/erythematous/edematous scrotal skin, soft boggy prostate, parotitis, fever |
| Imaging test of choice for the evaluation of an acute scrotum | Color Doppler ultrasound |
| Supportive therapy for viral orchitis | Bed rest, scrotal support, warm or cold packs for comfort, analgesics |
| Classic presentation of testicular torsion | Sudden onset of sever pain (as if a switch had been flipped), patient appears very uncomfortable |
| Torsion is the result of trauma in <__% of cases | 10 |
| Ischemia from torsion can occur as soon as __ and is almost certain after __ | 4 hours, 24 hours |
| Salvage rate is highly dependent on speed of detorsion with a 90% salvage rate if done in <__ | 6 hours |
| Studies have shown that __% of boys with acute scrotal pain have testicular torsion | 16-42% |
| Most cases of testicular torsion occur in boys aged __ | 12-18 |
| With scrotal trauma if pain lasts more than __ after the trauma the testicle should be evaluated for possible trauma induced torsion | 1 hour |
| What are some giveaways to the presence of testicular torsion | The testis may appear higher in the affected scrotum with an abnormal transverse lie, the affected testis may also appear larger, the cremasteric reflex is absent (99% sensitive) |
| Any patient with a history and physical examination suspicious for torsion should have __ | Immediate surgery |
| In the case of testicular torsion what is recommended for the other testis | Orchiopexy to prevent likely future torsion |
| Incubation period of Nongonococcal urethritis (NGU) | 4-14 days |
| Chlamydia dysuria is worst __ | During the first morning void and with ETOH |
| The preferred test for Chlamydia, more sensitive than traditional culture methods | NAATS (ligase chain reaction and PCR) |
| Gonorrhea has an incubation period of __ | 2-6 days |
| Purulent penile discharge, dysuria, erythematous meatus | Gonorrhea |
| Test of choice for Gonorrhea | Culture |
| What is the most common ulcerative STD | Genital herpes |
| One or more painful ulcers, with painful adenopathy, with no evidence of syphilis, or herpes simplex | Chancroid |
| Beefy red appearance, bleeds easily, painless, progressive ulcerative lesions without regional lymphadenopathy | Granuloma inguinale (donovanosis) |
| Granuloma inguinale is difficult to culture, it requires the ID of __ on tissue crush prep or biopsy | Donavan bodies |
| Tender inguinal and or femoral LAD, typically unilateral, a self limited genital ulcer or papule sometimes occurs (C. trachomatis) | Lymphogranuloma Venereum |
Created by:
bwyche
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