Surgery Part 2 (156-201) Flashcards
Lateral deviation of head because of hypertrophy of unilateral SCM
Torticollis
Torticollis can be caused by congenital, neoplasms, infection, trauma, disease, of drug tox… but it’s especially caused by…
D2 blockers esp phenothiazines
Tx for torticollis
Muscle relaxants and/or surgical repair
Midline congenital cyst that EVELVATES on swallowing
thyroglossal duct cyst
Lateral congenital cysts that don’t present until adulthood when they get inflammed. Don’t elevate on swallowing
Branchial cleft cyst
Aspirate of cyst contains cholesterol crystals
Branchial cleft cyst
Neck mass that is caused by occluded lymphatics, usually present in the first 2 years of life. Lateral OR midline. Transluscent, benign mass painless and soft.
Cystic hygroma
What diseases are cystic hygromas associated with?
Fetal hydrops, Turner’s syndrom or Noonan’s syndrome
Lateral or midline solid mass composed of overgrowth of epithelium. No elevation with swallowing
Dermoid cyst
Palpable mass at the bifurcation of the common carotid artery originating from neural crest cells. Located in teh carotid body within the carotid sheath.
Tumor causes bradycardia, dizziness. Can move horizontally but not vertically
Paraganglioma (carotid body tumor)
Unilateral cervical lymphadenitis is usually bc what etiololgy?
Bacterial, usually Staph aureus
Scrofula is caused by what etiology?
Tuberculosis
Enlargement of the thyroid gland, usually secondary to decreased iodine intake or inflammation.
Goiter
What is the differential for RUQ abdominal pain? (7)
- Biliary colic
- Cholecystitis
- Choledocholithiasis
- Pneumonia
- Fitz-Hugh-Curtis syndrome
- Cholangitis
- Hepatitis
Constant RUQ to epigastric pain. Ultrasound shows no gallbladder wall thickening or pericholecystic fluid
Biliary colic
fever RUQ pain, inspiratory arrest upon deep palpation of RUQ
Labs: moderate to severe leukocytosis, increased LFTs and increased bilirubing
Cholecystitis
What does the ultrasound of a pt with cholecystitis show?
gallstones (maybe), pericholecystic fluid, thickened gall bladder wall.
RUQ pain worse with fatty meals, jaundice. Ultrasound shows CBD dilation.
Labs: increased LFTs and bilirubin
Choledocolithiasis
pleuritic chest pain and fever. CXR shows infiltrate, and labs show leukocytosis
pneumonia
Syndrome of perihepatitis caused by ascending chlamydia or N. gonorrhea salpingitis
Fitz-Hugh Curtis syndrome
What does a pt’s gallbladder and biliary tree look like in pt with fitz hugh curtis syndrome?
Normal gallbladder and biliary tree
Pt shows Charcot’s triad and later develops into Raynold’s pentad… What are the sx and dx?
Charcot’s triad: fever, jaundice and RUQ pain
Reynold’s pentad: hypotension and mental status change
Dx: cholangitis
What are the labs for cholangitis? WBC? blood culture? LFTs? Bilirubin?
leukocytosis
culture shows enteric organisms
increased LFTs
increased bilirubin
What does the US for cholangitis look like?
biliary duct dilation from obstructing gallstones
How to dx cholangitis?
ERCP of percutaneous transhepatic cholangiography
RUQ pain, fever, jaundice, elevated LFTs bilirubin and leukocytosis. Whats the top 2 DDX? what’s next step to find out what pt has?
Cholangitis and Hepatitis
Do hepatitis virus serology
What is McBurney’s point
1/3 the distance from the ASIS to the umbilicus, if tender indicates appendicitis
Why must rectal exam be done on pt with suspected appendicitis?
r/o retroperitoneal appendicitis
What finding is seen on plain film or CT abd for appendicitis?
fecalith
What organism can mimic appendicitis? What would you do to differentiate it?
Yersenia enterocolitis
Do fecal culture
crampy lower abd pain, vaginal bleeding, adnexal mass, menstrual irregularity.
Labs show anemia and increased HCG.
Cudocentesis shows blood
ectopic pregnancy
Lower abd pai, purulent vaginal discharge, cervical motion tenderness, adnexal mass.
Wet mount shoes WBCs, culture could show Gonorrhea or chlamidya. What’s the two ddx?
Salpingitis or Tubo-ovarian abcess
What is the 1-10-100 rule?
In Meckel’s diverticulum, there 1-2% prevalence, 1-10cm in length. 50-100cm proximal to the ileocecal valve.
What is the rule of 2s?
In Meckel's diverticulum, 2% of population 2% are symptomatic usually before age of 2 Remnants are usually 2 inches found 2 ft from ileocecal valve 2x as common in males
How does Meckel’s diverticulum present?
GI bleed, SBO and Meckel’s diverticulitis (like appy)
Female Acute onset sharp unilateral lower abd/pelvic pain. Pain related to position, nausea, fever present, tender adnexal mass.
Ovarian torsion
If intermittent, could be incomplete torsion
MC in infants 5-10 months. Infant crying and pulling legs up to abdomen. Stool looks dark and red (name?) and dx?
Currant jelly stool
Intussusception
How do you diagnose intusussception?
barium or contrast enema has diagnostic coiled spring appearance.
Why does intussception become more likely after adenovirus infection?
Adenovirus makes peyer’s patches thick, making an anchor of tissue which stays put while the rest of bowel telescopes.
What is the Ddx for LUQ pain?
Peptic ulcer
MI
Splenic rupture
Epigastric pain relieved by food or antacits
peptic ulcer
Sudden upper abdominal pain with shoulder pain and GI bleed
perforated ulcer
CP, SOB, diaphoriesis, nausea. Labs show elevated trops
MI
What is Kher’s sign
LUQ pain and referred left shoulder pain
Tachycardia, broken ribs, hx of trauma, hypotension Kher’s sign +.
Labs leukocytosis
Splenic rupture
What is the xray finding for splenic rupture?
medially displaced gastric bubble
How to dx splenic rupture?
CT scan
LLQ pain DDX?
Diverticulitis Sigmoid volvulus Pyelonephritis Ovarian torsion Ectopic pregnancy Salpingitis
LLQ pain, mass, fever and urinary urgency. Labs show leukocytosis. CT/US show thickened bowel wall
Diverticulitis
If you are concerned about diverticular abscecess, what should you NOT do
use contrast enema
Elderly chronically constipated patient, abdominal pain, distension and obstipation
Sigmoid volvulus
What is the classic Xray and contrast enema finding for sigmoid volvulus?
xray - inverted U
contrast enema bird’s beak
High fever, rigors, CVA tenderness
Pyelonephritis
severe epigstric pain radiating to the back, N/V, signs of hypovolemis bc of third spacing. Decreased bowel sounds.
Pancreatitis
What is Gray Turner’s sign?
Sign of pancreatitis - ecchymotic appearing skin findings on flank
What’s cullen’s sign?
Ecchymotic area periumbilically
What is the classic xray finding for pancreatitis?
Sentinel loop –> dilated small bowel or transverse colon adjacent to the pancreas
What findings might a CT scan show in pancreatitis?
phlegmon, pseudocyst, necrosis, abscess
If pancreatitis does not improve, what kind of sequele finding should you look for?
Pancreatitc pseudocyst bc it might cause fever or shock in infected or hemorrhagic causes.
Back or abd pain and shock, compression on duodenum or ureters can cause obstructive symptoms. palpable pusatile mass
AAA
Position dependant mildine abdominal pain, worse after eating, dysphagia, hoarse voice
GERD
How do you diagnose GERD?
barium swallow, manometric or pH testing esophagoscopy
What is the general management for all abdominal surgical problems?
NPO, NG tube, IV fluids, and cardiac monitoring
IV antibiotics as needed.
What condition do most (80%) of pts with reflux also have?
Hiatal hernia
What are the 4 types of hiatal hernias?
Type 1 - sliding (most common) - movement of the GE junction and stomach into the mediastinum
Type 2 - herniation of the stomach fundus through the diaphragm parallel to esophagus
Type 3 - Herniation of the stomach fundus AND the GE junction above the diaphragm
Type 4 Herniation of the abdominal organs
What is the treatment for a type II hiatal hernia?Why?
Surgery because increased risk of strangulation
What is the most common motility disorder?
Achalasia
What happens in achalasia?
loss of esophageal motility and failure of Lower esophageal sphincter to relax.
What are 2 causes of achalasia?
ganglionic degneration or Chagas disease
If pt has achalasia, what type of dysphagia do they have?
Dysphagia to both solids and liquids
Why does achalasia increase the risk of esophageal cancer?
Stasis promotes development of Barrett esophagus
What would barium swallow and manometry in achalasia pt show?
barium swallow - dilation of proximal esophagus
Manometry - increased LES pressure and failure of relaxation
What is the treatment of achalasia
1st line?
alternatives?
Endoscopic dilation of LES with balloon cures 80%
Alternative is myotomy with a modified fundoplication
Surgical tx or Botox of LES could also be considered.
What kind of diverticula are proximal?
Zenker’s diverticula
What is the treatment of Zenker’s diverticula?
Myotomy of cricopharyngeus muscle and removal of diverticulum
Where are zenker’s diverticula usually located?
between the thyropharyngeal and cricopharyngeus muscle fibers
What is the most common esophageal cancer?
Squamous cell cancer
When does squamous cell esophageal cancer most commonly present?
Men in 6th decade of life.
What are some risk factors for squamous cell esophageal cancer development?
Alcohol
Tobacco
What kind of cancer is MC seen in pts with reflux which has progressed into Barrett’s esophagus (10% of pts)?
Adenocarcinoma
What are some signs/sx for esophageal cancer development?
DYSPHAGIA, wt loss, hoarseness, tE fistula, recurrent aspiration
What would barium study demonstrate in esophageal cancer?
Apple-core lesion
How do you confirm diagnosis of esophageal cancer?
endoscopy, biopsy and CT abdomen and chest (performed to figure out extent of spread)
Tx of esophageal ca?
esophagectomy with gastric pull up, poor prognosis unless resected prior to spread)
What are the most common benign gastric tumors?
leiomyoma and polyps
After what age and gender do people start to get stomach ca?Blood group?
Men >50 yrs, linked to blood group A
What are some risk factors to gastric tumors?
Nitrosamines Excess salt intake Low fiber diet H. pylori infection Achorydia chronic gastritis
What kind of cancer is stomach cancer usually? Location
Adenocarcinoma in the antrum, rarely fundus
What other cancer is associated with an H.pylori infection?
Lymphoma
What is the name of infiltrating diffuse adenocarcinoma that is the most deadliest gastric cancer?
Linitis Plastica
What is Virchow’s node?
large, rock hard supraclvicular notde
What is a krukenberg tumor?
Mucinous RED SIGNET CELLS
Where does this ca start and metastasize to?
Starts in Gi tract, ends up in ovaries
What is sister mary joseph’’s sign?
metastasis to the umbilicus so feel hard nodule there
What is Blumer’s shelf?
Palpable nodule superiorly on a rectal exam caused by matastasis of GI cancer
What is the treatment for metastatic GI cancers?
mostly palliative care, combo/chemo therapy when tolerated.
What is the diagnostic physical exam landmarks/finding you need to detmerine if a hernia is a direct inguinal hernia?
Hasselbach’s triable (inferior epigastric artery, rectus shath, and inguinal ligament
What is the most common inguinal hernia?
indirect type (2/3rds)
Where do indirect inguinal hernias pass?
lateral to inferior epigastric artery into spermatic cord, covered by cremasteric muscle
What is a hernia that protrudes below the inguinal ligament?
femoral hernia
Concurrent direct and indirect hernia
Combined (pantaloon hernia)
Part of hernia sac wall is formed by visceral organ
Sliding hernia
Part of bowel is trapped in the hernia sac
Richter hernia
Meckel’s diverticulum contained insider hernia
Littre hernia
Able to replace herniated tissue to its usual anatomic location
Reducible
Hernia that’s not reducible
Incarcerated hernia
Incarcerated hernia with vascular compromis
Strangulates hernia
Herniation through surgical inscision, commonly secondary to wound infection
Incisional
What gender are femoral hernias most common in?
women
What complication do visceral hernias have?
intestinal obstruction
What is the most common benign tumor of the liver?
hemangioma
What increases the risk of hepatic adenomas?
OCPs
If an adenoma ruptures, whats the danger?
Severe intraperitoneal bleed
What is the most common primary hepatic malignant tumor?
Hepatocellular carcinoma
What’s a hepatoma?
Another name for malignant hepatocellular carcinoma
Why is hepatocellular carcinoma most common in coutheast asia and sub saharan africa?
Bc vertical transmission of Hepatits A
What other co-morbid diseases is hepatocellular ca associated with?
cirrhosis, HBV, HCV, alcoholism, hemochromatosis, Wilson’s disease
What marker would be very high in hepatocellular ca?
Very high alpha feto protein (AFP)
If chemo is decided upon in pt with hepatocellular ca, what drug is used?
Sorafenib
What toxic exposures are hemangioscarcomas associated with?
polyvinyl chloride
thorostrat
Arsenic
What is the demographic of the patient who gets gallstones
female, forty, fertile and fat
In patients younger than 20 yrs with gallstones, what should they also undergo work up for?
congenital spherocytosis or hemoglobinopathy
What is a gallbladder with calcified gallbladder walls?
porcelain gallbladder
What are 2 risk factors in developing gallbladder ca?
Native American descent and porcelain gallbladder. These pts should undergo cholecystectomy.
Why does biliary colic occur?
transient gallstone impaction in cystic or CBD (though most gallstones stay asymptomatic)
Pt has sharp colicky pain worse with eating, especially fats
Pt has biliary colic
How do you diagnose biliary colic?
ultrasound
What if pt has biliary colic without stones? How to diagnose?
HIDA scan - less than 20% ejection fraction suggests acalculous cholecystitis
Why does cholecystitis occur?
Secondary to infection of obstructed gallbladder
What organisms are likely to cause cholecystitis
EEK! bugs - e.coli, enterobacter, enterococcus, klebsiella spp
If pt has emphysematous cholecystitis, what do you expect the WBC count to be?
> 20,000
How do you treat cholecystitis?
NPO, IV hydration and antibiotics to cover gram negatives
What should be used as pain control for cholecystitis?
Demerol because morphine causes spasm of sphincter of oddi
Why does choledocholithiasis occur?
Gall stone stuck in common bile duct
What is the first line diagnosis for choledocholithiasis
Ultrasound, CBD >9 mm dm
What is the normal diameter of the CBD?
3-4mm - it increases by 1mm per 10 years over the age of 50
Passage of the stone into CBD can cause what complication?
pancreatitis if the ampulla of vater is obstructed.
Pt comes in with charcot’s triad progressing to Reynold’s pentad, what should be done?
Charcots = jaundice, RUQ pain, jaundice, fever
Reynold’s altered mental status and hypotension
LIFE THREATENING EMERGENCY - ascending cholangitis
Tx: NPO, IV hydration, antibiotics to cover gram negative rods and anaerobes
ERCP/PTC to decompress biliary tree
What organism is associated with gall bladder cancer?
Clonorchis sienensis (liver fluke) infestation
What is Klatskin’s tumor?
When the tumor forms at the confluence of the hepatic ducts forming in the common duct
What is courvoisier’s law?
Gallbladder enlargens when CBD is obstructed by pancreatic cancer, but not when CBD is obstructed by a stone.
What is the treatment for gallbladder cancer?
palliative stenting of bile ducts, consider surgical resection only of palliation
What is happening in pancreatitis?
pancreatitic enzymes autodigest pancreas causing hemorrhagic fat necrosis and calcium deposition which leads to pseudocyts
Why do pancreatitis patient prefer prostration position?
The fetal position allows more room in the retroperitoneal space for the swollen pancreas
What lab is 90% sensitive for pancreatitis?
Serum amylase
When should you start a pancreatitis pt on TPN?
if they have been NPO >7-10 days
How do you determine the prognosis of pacreatitis?
Ranson’s criteria. Look up p173
What is the treatment of a pancreatic pseudocyst?
Percutaneous drainage or pracreaticogastrostomy or pancreaticojejunostomy
How can you tell if a pancreatic pseudocyst is new or old?
new - contain blood, necrotic debris, leukocytes
Old - straw colored fluid
What kind of cancer is most pancreatic ca
adenocarcinoma 90%
Which demographic is pancreatic cancer mc in?
african americans, cigarette smokes, males.
What is Trousseau’s syndrom?
classic sign of pancreatic cancer - migratory thrombophlebitis
How to dx pancreatic ca?
CT scan
What is the mc pancreatic islet cell tumor?
insulinoma (proliferation of B-cells)
What is a glucagonoma?
proliferation of alpha cell –> produces sx of hyperglycemia, exfoliative dermatitis
Somatostatinoma?
delta cell proliferation –> makes somatostatin, pts develop diabetes
Secretes vasoactive intestinal peptide, causes prolonges watery diarrhea with severe electrolyte balances
VIPoma
Clinically pt has elevated serum insulin, glucagon, and/or +gastrin secretin test. What does pt have?
Gastrinoma - Zollinger Ellison syndrome
What genetic dz is zollinger ellison associated with?
MEN 1
Where are gastrinomas often located?
in the gastrinoma triangle - confluence of the cystic and CBD superiorly, the second and third portions of the duodenum inferiorly and neck and body of the pancreas medially
What would an abdominal series show in small bowel obstruction?
“stepladder” pattern of air fluid levels – distended loops of small bowel, air fluid levels
Tx for SBO
IV fluids, NG tube decompression andfoley catheter.
What is the most likely cause of postoperative SBOs?
adhesions - 80% resolve without surgery.
What is the most common benign tumor of the small bowel?
Leiomyoma
Where are the top 2 locations of carcinoid tumors?Sx?
appendix
small bowel
Sx include cutaneous flushing, diarrhea and respiratory distress.
Where do most polyps arise?
sigmoid or rectum
What is the most malignant polyp?
villous adenoma
What is the smallest malignant potential polyp
tubular adenoma
What is the most common cc for neoplastic complaints?
rectal bleeding
If invasive adenoCA is found on colonoscopy, tx?
colectomy is not mandatory if gross and margins are clear.
What gene is FAP associated with?
APC gene - abundant polyps thought the colon and rectum beginning at puberty
Pt with poplyposis, desmoid tumors, osteomas of the mandible and skull, and sebaceous cysts
Gardener’s syndrome
Pt with polyposis with medullablastoma or glioma
Turcot’s syndrome
What is the most sensitive way to predict FAP
retinal pigment epithelium predicts FAP with 97% sensitivity
Pt with autosomal dominant dz has nonneoplastic hamartomatous polyps in the stomach, small intestine, and colon, skin, mucous membranes and HYPERPIGMENTATION of the freckles on the lips
Tx?
Peutz-jegher’s syndrome
prophylactic colectomy
Jeuvenile Polyposis syndrome syndrome - also has hamartomatous polyps Tx?
Polypectomy for pts who are symptomatic
True diverticula are..
herniations involving the full bowel wall
Where are true diverticula often found?
in cecum and ascending colon.
What are false diverticula?
only mucosal herniations through muscular wall
Where are false diverticula found?
> 90% found in sigmoid colon
What causes diverticula?
increased intraluminal pressure promoted by a low fiber diet
Is bleeding more consistent with diverticulosis or diverticulitis?
Dierticulosis
What is the most common fistula associated with diverticular dz?
colovesicula (presents with recurrent UTIs and /or pneumaturia
What must be done 4-6 weeks after resolution of symptoms of diverticulitis?
colonoscopy to exclude underlying neoplasm
Bright red blood per rectum is indicative of what?
bleeding in the distal small bowel or colon.
How to dx GI bleed?
Digital rectal exam and visualization with an anoscope/sigmoidoscope to locate site of bleed.
How to tx lower GI bleed?
IV fluids and transfusions to maintain hemodyanimic stability. Surgery is rarely required, and should only be considered if bleeding persists (resolves in 90% of cases)
What are the 3 MCC of large intestinal obstruction?
adenoCA, scarring secondary to diverticulitis, and volvulus.
What should you NEVER do with suspected obstruction?
DO NOT GIVE BARIUM ORALLY W SUSPECTED OBSTRUCTION
What is Ogilvie’s syndrome?
Pseudo - obstruction –> massive right sided colon dilatation with no evidence of obstruction
What should you treat ogilvie’s syndrome with?
Colonoscopy and rectal tube for decompression
What is the indication for Neostigmine in ogilvie’s syndrome?
For rapid bowel evacuation once a distal obstruction has been ruled out and pt has no hx of cardiac disease (why? bc neostigmine will cause bradycardia so pt needs to be monitored while it’s being administered)
Rotation of the large intestine along its mesenteric axis
Volvulus
What is the most common site of volvulus?
sigmoid and cecum in elderrly
What is classic finding on xray of a volvulus?
dilated loops of bowel with loss of haustra with a kidney bean appearance
What is the classic finding on barium enema of a volvulus?
bird’s beak or ace of spades picture with point of beak pointing to the site of bowel rotation
What is the second leading cause of cancer deaths?
colon cancer
When should CEA be obtained?
pre operative and post operative to colon ca resection
Autosomal dominant predisposition to colorectal ca with right sided predominance (70% proximal to splenic flexure)
Lynch syndrome I
All features of lynch syndrome I + extracolonic cancer esp in the endometrium, ovary, stomach and pancreas
Lynch syndrome II
What are the screening guidelines for colonoscopy?
> 50 yrs without risk factors
Yearly stool occult blood tests
flexible sigmoidoscopy every 3-5 yrs or colonoscopy every 10 years or barium enema every 5-10 yrs
What is the adjuvent tx for metastatic colon ca??
FOLFOX (p184)
why are hemorrhoids caused?
varicosity in the lower rectum or anus caused by congestion in the veins of the hemorrhoidal plexus
Which type of hemorrhoids are painful
internal hemorrhoid is generally not painful
external = pain
What is a thrombosed external hemorrhoid?
Classically painful, but a true hemorrhoid, but a subcutaeneous external hemorrhoidal veins of the anal canal. Classified by degreed p185
What is the definitive tx for hemorrhoids?
sclerotherapy, cryosurgery, rubber band ligation
What are factors that predispose to maintaining fistula patency?
Foreign body Radiation Infection Epithelialization Neoplasm Distal obstruction
Pt with severely painful bowel movement associated with bright red bleeding
Classic presentation for anal fissure, 90% located in the posterior midline
Tx for anal fissure?
stool softeners, dietary modifications, bulking agents, Botox type A or nitroglycerin ointment.
What drug is used to presensitivze tumor cells before radiation is administered to tx rectal cancer?
5- flourouracil
What are the 2 indications for bariatric surgery?
BMI >40
or BMI>35 with one or more related comorbid conditions
Pts must undergo 6 mo supervised medical weight loss program before consideration of surgery
What is Roux en Y gastric bypass associated with postop complication?
Dumping syndrome
*dumping syndrome is not an issue with vertical sleeve gastrectomy
What kind of deficiencies might a pt with gastric bypass have?
Hyperparathyroid bc hypocalcemia
Iron
B12
Zinc
Cyclical or noncyclical breast pain not because of breast lumps
mastalgia
Tx for mastalgia?
Danzol
Thoracoepigastric vein phlebitis where there is skin retraction along the vein course
Mondor’s disease
What kind of states is gynecomastia seen in?
hyperestrogen –> anything that inhibits liver breakdown of estrogen
What are the risk factors of breast cancer?
Woman
age
young first menarche 50
FHx (BRCA 1 or 2)
Not by: increased caffine, sexual orientation, fibroadenoma
Where does breast cancer most commonly occur?
Upper outer quadrant.
MC breast issue in teens and young women (20’s) — histo shows myxoid stroma with curvilinear, slit ducts. Tx?
none required- fibroadenoma. will resorb within a few weeks. Re-eval in 1 month.
Look at breast mass work up algorithm
p. 191
MC breast tumor in 35-50 yrs, arise in terminal ductal lobar unit. Multiple bilateral small umpts tender during menstrual cycle
Fibrocystic disease
Pt with serous, bloody nipple discharge
Intraductal papilloma (solitary papillomas dont increase cancer risk, but multiple do)
Pt with irregularly shaped ductal calcifications on mammography. Dx? Tx?
ductal CA in situ Tx: excision of mass, ensure clean margins on excision add, post op radiation to reduce rate of recurrance
Therapy with what SERM reduced the incidence of recurrence of invasive of DCIS by half
Tamoxifen therapy for 5 years.
Histo shows mucinoius cells with saw tooth and cloverleaf configurations dx?
Lobular cardinoma in situ –> not precancerous but IS a marker for future IDC risk in both breasts.
WHAT IS THE MOST IMPORTANT PROGNOSIS FACTOR OF IDC?
tumor size
Pt with dermatitis and macular rash over the nipple/areola. Dx?
Paget’s breast disease - underlying ductal ca is almost always present
What issue in young women interferes with a mammography’s sensitivity and specificity?
Dense breast tissue
Pt iwth absent cremestaric reflex on affected side, acute onset testicular pain, edema and vomiting. Dx? Tx?
Testicular torsion, do dopplar ultrasound to assess artery flow
Tx: Emergent surgical decompression with excision of testicle if it infarcts
unilateral testicular pain, dysuria. pccasional urethral discharge, fever, leukocytosis in severe cases , painful and swollen epididimys
Epididymitis
What do labs show for epididymitis?
UA?
Urine Cx?
Swab?
UA - negative or pyuria
get culture
Swab for gonorrhoeae and chalmydia
What is the blue dot sign?
uhmm..
