Male Problems

Question 1

cause of penile fracture?

Answer 1

usually intercourse

Question 2

presentation of penile fracture

Answer 2

pop/crack that was heard
pain
discolouration
swelling
urethral injury (haematuria)

Question 3

management of penile fracture

Answer 3

circumcision with degloving to expose all 3 compartments

repair

Question 4

what is testicular torsion?

Answer 4

cord rotates around arterial supply causing ischaemia and cell death

Question 5

presentation of testicular torsion

Answer 5

bell clapper deformity
extreme pain that can refer to lower abdomen
N&V

Question 6

diagnosis of testicular torsion

Answer 6

testes high in scrotum
absence of cremasteric reflex
doppler USS

Question 7

management of testicular torsion

Answer 7

prompt exploration

if necrotic remove

Question 8

what is torsion of appendage?

Answer 8

twisting of tissue above th etesticle

Question 9

presentation of torsion of appendage

Answer 9

tenderness at upper pole
blue dot sign
cremasteric reflex is present

Question 10

management of torsion of appendage

Answer 10

often resolves spontaneously

Question 11

causes of epididymitis

Answer 11

UTI
urethritis
catheterisation
instrumentation

Question 12

presentation of epididymitis

Answer 12

dysuria
pyrexia
cremasteric reflex present

Question 13

diagnosis of epididymitis

Answer 13

doppler USS
urine for culture
chlamydia PCR

Question 14

what does a doppler USS for epididymitis show?

Answer 14

swollen epididmyitis and increased blood flow

Question 15

management of epididymitis

Answer 15

analgesia
scrotal support
ofloxacin

Question 16

what is paraphimosis?

Answer 16

painful swelling of foreskin distal to phimotic ring

Question 17

cause of paraphimosis

Answer 17

often due to foreskin retraction and not replaced

Question 18

management of paraphimosis

Answer 18

iced glove, granulated sugar 1-2 hours
multiple punctures in oedematous skin
manual compression of glans with distal traction, dorsal slit

Question 19

what is priapism?

Answer 19

prolonged erection >4hours that is not associated with sexual arousal

Question 20

causes of priapism

Answer 20

injection for ED
trauma
haematological dyscrasias (sickle cell)
neurological
idiopathic

Question 21

classification of priapism

Answer 21

1. ischaemic

2. non-ischaemic

Question 22

what is ischaemic priapism?

Answer 22

compartment syndrome

corpora cavernosa are rigid and tender

Question 23

what is non-ischaemic priapism?

Answer 23

traumatic disruption to artery

Question 24

diagnosis of priapism

Answer 24

• aspiration of blood from corpus cavernosum= if dark with low and high CO2 then ischaemic
• Colour duplex USS= minimal flow in vascular and normal flow in non-ischaemic

Question 25

management of ischaemic priapism

Answer 25

aspiration +/- irrigation with saline and alpha agonist

if delay do penile prosthesis

Question 26

management of non-ischaemic priapism

Answer 26

observe as most can resolve

arterial embolisation

Question 27

what is Fournier’s gangrene?

Answer 27

necrotising fasciitis around male genitalia

Question 28

presentation of Fournier’s gangrene

Answer 28

toxicity out of proportion with exam

Question 29

diagnosis of Fournier’s gangrene

Answer 29

XR

USS

Question 30

management of Fournier’s gangrene

Answer 30

antibiotics

surgical debridement

Question 31

three examples of infective emergencies

Answer 31

1. Fournier’s gangrene
2. emphysematous pyelonephritis
3. perinephric abscess

Question 32

what is emphysematous pyelonephritis?

Answer 32

acute necrotising parenchyma and perirenal infection

Question 33

cause of emphysematous pyelonephritis

Answer 33

E. coli

Question 34

presentation of emphysematous pyelonephritis

Answer 34

fever
vomiting
flank pain

Question 35

diagnosis of emphysematous pyelonephritis

Answer 35

KUB shows gas

Question 36

management of emphysematous pyelonephritis

Answer 36

nephrectomy

Question 37

cause of perinephric abscess

Answer 37

rupture of an acute cortical abscess into perinephric space or haematogenous spread

Question 38

presentation of perinephric abscess

Answer 38

insidious onset
pyrexia
flank mass
pyuria

Question 39

diagnosis of perinephric abscess

Answer 39

high CK

CT

Question 40

management of perinephric abscess

Answer 40

antibiotics

percutaneous or surgical drainage