Disorders of Scrotum, Testes, Spermatic Cord

Question 1

If epididymitis occurs in men under 40, it is likely due to _______ / If epididymitis occurs in men over 40, it is likely caused by __________ and not __________

Answer 1

STI - Chlamydia or Gonorrhea / Gram negative bacteria / STI

Question 2

Medication that can cause Epididymitis?

Answer 2

Amiodarone

Question 3

Epididymitis symptom onset usually occurs after (3)

Answer 3

Physical activity or straining, trauma, sexual activity

Question 4

Symptoms of epididymitis include: / What is Prehn Sign?

Answer 4

Painful enlargement of epididymis, fever, irritative voiding / When pt is supine, if scrotum is elevated, pain decreases

Question 5

Treatment for epididymitits? / if STI related

Answer 5

Antibiotics / Treatment of partner

Question 6

What condition is often associated with mumps? / What type of this condition is rare?

Answer 6

Orchitis / Bacterial

Question 7

Onset of Orchitis / Signs and symptoms?

Answer 7

variable / Scrotal erythema, edema, swelling, fever malaise, parotid swelling

Question 8

Treatment for orchitis?

Answer 8

Pain meds, hot and cold packs, elevation

Question 9

What might you need to order in order to discern between orchitis and testicular torsion?

Answer 9

Doppler US

Question 10

Collection of fluid between the 2 layers of the tunica vaginalis is called?

Answer 10

Hydrocele

Question 11

What is the key way of diagnosing a hydrocele?

Answer 11

Transillumination

Question 12

What often accompanies a hydrocele

Answer 12

Testicular tumor

Question 13

Should you refer for a hydrocele?

Answer 13

yes! Don’t assume it is benign

Question 14

Hydrocele onset is gradual or abrupt? / patients are in pain or asymtomatic?

Answer 14

Gradual / Asymptomatic

Question 15

Benign condition described as a “bag of worms”

Answer 15

Varicocele

Question 16

When might a varicocele need to be treated? / how would it be treated?

Answer 16

Infertility / surgically

Question 17

What color is the fluid of a spermatocele? / Where is it located?

Answer 17

Milky-colored (d/t sperm) / behind the testes

Question 18

Is a spermatocele painful or painless? / What test can you do to assess for a spermatocele?

Answer 18

Painless / Transillumination

Question 19

Usual treatment for a spermatocele? / Chronic symptomatic spermatoceles?

Answer 19

None, it’s benign / Aspiration or surgical excision

Question 20

Which type of hernia goes into the scrotum (direct/indirect)? / Which type happens to men much more often than women?

Answer 20

Indirect / Direct

Question 21

In a Direct Inguinal Hernia, bowel herniates through:

Answer 21

The Hasselbach triangle

Question 22

Which hernia is more medial? / Which type of hernia do you feel on the PAD of your finger? / which on the TIP of your finger?

Answer 22

Direct hernia is more medial / Direct / Indirect

Question 23

What might a hernia lead to / treatment for all hernias?

Answer 23

Strangulation of bowel / Surgical fixation

Question 24

In females, an indirect hernia passes through the canal with the __________

Answer 24

Round ligament

Question 25

Testicular Torsion is an emergent situation that occurs most frequently to:

Answer 25

Pre-pubertal males or males 10-20 years

Question 26

Etiology of testicular torsion?

Answer 26

Spermatic cord is twisted and blood supply is cut off

Question 27

50% of testicular torsion cases occur during _______?

Answer 27

Sleep

Question 28

In testicular torsion, the injured testis will appear higher/lower than the other? / What test is key to diagnosing testicular torsion?

Answer 28

Higher / Cremastaric reflex is ABSENT on effected side

Question 29

Key difference in patients with epididymitis vs testicular torsion?

Answer 29

Patients with epididymitis can void; those with testicular torsion cannot

Question 30

Important radiologic test for testicular torsion?

Answer 30

Doppler/Duplex US

Question 31

Testicular torsion prognosis is best if the patient has had symptoms for less than ________

Answer 31

6 hours

Question 32

What is the appendix of the testis? / present in what % of boys?

Answer 32

Vestigal remnant of embryologic duct near the head of the epididymis / 50%

Question 33

Demographic that most often experiences torsion of the appendices of the testis?

Answer 33

young boys

Question 34

Onset of Torsion of the Appendices of the Testis? / What test is often performed?

Answer 34

Abrupt / Blue Dot Sign

Question 35

What is the Blue Dot Sign?

Answer 35

A small, palpable “blue dot” is observed on the superior pole of the testis/epididymis; appears when overlying skin is pulled taught

Question 36

How is torsion of the appendices of the testes treated? / how is that different than testicular torsion? / what might you need to order to discern the two conditions?

Answer 36

Pain management / non-emergent / doppler US

Question 37

What is retrograde ejaculation? / 2 of the most common symptoms of retrograde ejaculation?

Answer 37

Some semem enters the bladder upon ejaculation / men notice cloudy urine after sex & low sperm volume

Question 38

What are 3 potential causes of retrograde ejaculation?

Answer 38

Diabetes, medications, surgery (i.e. prostatectomy)

Question 39

What type of medication often causes retrograde ejaculation?

Answer 39

Alpha Blockers

Question 40

Medications you can use to try and treat retrograde ejaculation?

Answer 40

Pseudoephedrine or imipramine

Question 41

How can fertility issues be dealt with in men with retrograde ejaculation?

Answer 41

You can draw it from the bladder and inseminate the partner with it.