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