Epididymo-Orchitis, Flashcards
The epididymis is located on the testicles and functions to store sperm until they are mature enough to fertilise an egg. Epididymitis and orchitis is inflammation of the epididymis and orchi (testicle). What is the incidence of Epididymo-orchitis?
1 - 2 cases per 100,000
2 - 20 cases per 100,000
3 - 200 cases per 100,000
4 - 2000 cases per 100,000
3 - 200 cases per 100,000
What age does the incidence of Epididymo-orchitis peak in?
1 - 5-10 years old
2 - 10-20 years old
3 - 20-30 years old
4 - 30-40 years old
3 - 20-30 years old
Epididymitis is the most common cause of scrotal pain in adults.
Which of the following is NOT a risk factor for developing epididymo-orchitis?
1 - congenital abnormality reproductive tract
2 - age 20-29 years old
3 - increased sexual activity
4 - multiple sexual partners
5 - protection during sex
6 - anal sex
5 - protection during sex
In adult men, sex with a full bladder can cause reflux of infected urine from the prostatic urethra to the epididymis via the ejaculatory ducts and vas deferens
In children which of the following could lead to Epididymo-orchitis?
1 - bladder outlet obstruction or a urethral stricture.
2 - ectopic ureter
3 - posterior urethral valves
4 - vesicoureteral reflux
5 - all of the above
5 - all of the above
What is the most common cause of Epididymo-orchitis in men aged <35 years old?
1 - UTI
2 - STI
3 - Constipation
4 - fissure from GIT
2 - STI
STI is the most common cause of Epididymo-orchitis in men aged <35 years old. Which 2 of the following organisms are most common?
1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae
3 - Escherichia coli
4 - Pseudomonas spp
1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae
What is the most common cause of Epididymo-orchitis in men aged >35 years old and children?
1 - UTI
2 - STI
3 - Constipation
4 - fissure from GIT
1 - UTI
UTI is the most common cause of Epididymo-orchitis in men aged <35 years old and children. Which 2 of the following organisms are most common?
1 - Chlamydia trachomatis
2 - Neisseria gonorrhoeae
3 - Escherichia coli
4 - Pseudomonas spp
3 - Escherichia coli
4 - Pseudomonas spp
In addition to UTI and STI, all of the following can cause Epididymo-orchitis, EXCEPT which one?
1 - inguinal hernia
2 - trauma
3 - mumps virus
4 - medication (amiodarone)
5 - autoimmune disease
1 - inguinal hernia
Is testicular torsion or Epididymo-orchitis more common in pre-pubertal men?
- testicular torsion
Do the symptoms of epididymo-orchitis typically present in an acute or insidious manner?
- acute onset
Typically over a number of days
Which of the following is NOT a typical sign of Epididymo-orchitis?
1 - bilateral scrotal pain
2 - groin pain
3 - swelling of the groin and scrotum
4 - sudden onset of symptoms
1 - bilateral scrotal pain
Typically unilateral, but in 5-10% of adults it can be bilateral
Which 2 of the following could help identify that Epididymo-orchitis is caused by an STI?
1 - urethritis
2 - urethral discharge
3 - blood in urine
4 - anal fissure
1 - urethritis
2 - urethral discharge
Which of the following could help identify that Epididymo-orchitis is caused by a UTI?
1 - polyuria
2 - dysuria
3 - urine urgency
4 - urinary retention
5 - abdominal pain
6 - dark, cloudy and smelly urine
7 - all of the above
7 - all of the above
In a patient with suspected Epididymo-orchitis, we need to examine the scrotum while the patient is standing and lying down. All of the following may be observed EXCEPT which one?
1 - enlarged, erythematous scrotum
2 - tender to palpation on the affected side of the testis, epididymis or cord
3 - oedematous scrotum
4 - urethral discharge
5 - appendicitis
6 - secondary hydrocele, and pyrexia
7 - thickened and hard vas deferens
5 - appendicitis
May present with similar symptoms, but Epididymo-orchitis does not cause this
A Prehn sign is when the patient feels relief of pain upon elevation of the scrotum. If there is relief of pain upon elevation of the scrotum, will this be more likely to be Epididymo-orchitis or testicular torsion?
Epididymo-orchitis
Does NOT rule out testicular torsion, if you suspect testicular torsion, then surgery needs to be performed asap
All of the following would be performed if Epididymo-orchitis is suspected, EXCEPT which one?
1 - STI test
2 - ultrasound scan
3 - mid-stream urine analysis
4 - pelvic CT scan
4 - pelvic CT scan
All of the following are likely differentials for Epididymo-orchitis, but which is the LEAST likely?
1 - testicular tumour
2 - testicular torsion
3 - hydrocele
4 - trauma
1 - testicular tumour
Possible, but would more likely cause a painless lump
The cause of Epididymo-orchitis needs to be treated on an individualised basis. If an STI is suspected, which of the following should be used?
1 - BASHH recommendations for antibiotic treatment
2 - local guidelines for antibiotics
3 - wait and see approach
4 - admit to hospital
1 - BASHH recommendations for antibiotic treatment
BASHH guidelines:
- ceftriaxone 500mg IM
- doxycycline 100mg oral BD 10-14 days
CONTACT TRACING IS IMPORTANT AS WELL
If the organism causing Epididymo-orchitis is unknown and patient presents acutely, which of the following would be most appropriate?
1 - 10 days of oral levofloxacin
2 - Referral for ultrasound scan (2 week wait)
3 - Single IM ceftriaxone and 10-14 days of doxycycline
4 - Single dose doxycycline and 10-14 days of ceftriaxone
5 - Urgent referral to urology for surgical intervention
3 - Single IM ceftriaxone and 10-14 days of doxycycline
The cause of Epididymo-orchitis needs to be treated on an individualised basis. If a UTI is suspected, which of the following should be used?
1 - BASHH recommendations for antibiotic treatment
2 - local guidelines for antibiotics
3 - wait and see approach
4 - admit to hospital
2 - local guidelines for antibiotics
Typically oral quinolone for 2 weeks (e.g. ofloxacin)
Following treatment for Epididymo-orchitis, either due to a UTI or STI, how lomg should patients seek medical advice if there is no improvement?
1 - 24h
2 - 3 days
3 - 5 days
4 - 7 days
2 - 3 days
In Epididymo-orchitis, how long can the swelling in the testicles and groin take to return to normal?
1 - 12 weeks
2 - 6 weeks
3 - 2 weeks
4 - 24h
2 - 6 weeks
Can be quicker though
Which of the following is NOT a complication of Epididymo-orchitis?
1 - reactive hydrocele.
2 - testicular tumour
3 - infertility or sub-fertility
4 - abscess formation and infarction of the testicle
5 - testicular atrophy
2 - testicular tumour
