Testicular concerns Flashcards

1
Q

refractory scrotal pain despite adequate therapy for epididymitis should be evaluated for:

A

testicular torsion, testicular abscess or testicular infarction

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2
Q

can you tell the difference based on history or physical exam about the difference between testicular torsion, testicular abscess or testicular infarction?

A

no must get a additional imaging like a testicular U/S

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3
Q

testicular abscess

A

may not show fluctuance

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4
Q

testicular torsion is associated with

A

no cremasteric reflex but this is more common in boys <12 yrs cremasteric reflex test not reliable for ruling in or out testicular torsion in men

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5
Q

scrotal pain and swelling that is decreased with sac elevation may be

A

consistent with epididymitis but not specific to epididymitis

Needs to get U/S and urologist or radionucleotide scrotal imaging to see cause of pain to determine if he needs surgical management.

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6
Q

testicular cancer can present as

A

acute testicular pain.

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7
Q

bacterial causes of epididymitis based on age

A

<35 years see chlamydia and neisseria gonorrhea

>35 yrs see E coli and these are in men who engage in anal intercourse

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8
Q

common causes of epididymitis would be

A

chlamydia trachomatis - ok to treat with quinolones, macrolides, and doxycycline (low levels of in vivo resistance to these antibiotics)

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9
Q

when should pts start to feel better after being treated with epididymitis?

A

1-3 days and so continued pain should get further exploration of cause of pain.

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10
Q

does HIV and syphilis cause epididymitis pain?

A

no. more likely chlamydia but also consider other causes.

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11
Q

acute severe onset of pain, profound testicular swelling high riding testis bell clapper deformity

A

think testicular torsion which has pain in location of testis

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12
Q

screening test for testicular torsion?

A

U/S

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13
Q

epididymitis presentation

A

fever,

urinary frequency, urgency (acute)

induration, swelling, and exquisite tenderness of involved epididymis

pyuria and bacteruria on urinalysis

urine culture recommended

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14
Q

what do you order for someone who has epididymitis?

A

get urine culture

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15
Q

severe pain from anterior abdomen into scrotum and penis see skin edema and crepitus and blisters and bulla

A

fournier’s gangrene pain is diffuse scrotum

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16
Q

best way to evaluate for fournier’s gangrene?

A

need surgical management and evaluation CT/MRI is preferred.

17
Q

chart of acute testicular pain

A
18
Q

anatomy of testicle and testicular torsion chart

A
19
Q

what are the associated characteristics of a varicocele?

A
20
Q

varicocele pathophysiology

A
21
Q

When should we get a CT scan for varicocele?

A

CT scan is suggested, not indicated when

when there’s a right sided varicocele as they are rare and can indicate an inferior vena cava compression (with renal cell carcinoma) or obstruction (thrombus)

Sudden onset of left sided varicocele that does not diminish with lying in the recumbent position may also indicate obstruction

22
Q

a varicocele is (definition)

A

tortuous dilation of pampiniform plexus of veins surrounding the spermatic cord and testis of the scrotum.

Occur in about 20% of men usually age 15-25 yrs and are left sided but 30% are bilateral.

Left spermatic gonadal vein enters the left renal vein at a right angle. the aorta and superior mesenteric artery can compress the left renal vein and increase intravascular pressure within the left renal vein and gonadal veins and this can cause incompetence in valves retrograde blood flow and venous dilation.

23
Q

varicocele symptoms

A

asymptomatic but can have dull ache with standing, or pain is worsened with standing and relieved with sitting. See a soft mass on exam that is enlarged with standing and valsalva maneuvers but diminishes when supine.

U/S can show retrograde venous flow and dilation of pampiniform plexus.

24
Q

how to treat varicocele?

A

asymptomatic pts don’t need treatment

scrotal discomfort pts can get NSAIDS and scrotal support.

Potential complications are infertility and testicular atrophy with the increased temperature.

Don’t need annual U/S but if there’s a solid mass need to get one.

25
Q

viral orchitis without epididmyitis is

A

MUMPS rubella andparvo

see scrotal swelling, pain and tenderness with erythema but seen in kids and adults - have more of a cross over between epididmymo orchitis

26
Q

sharp left testicular pain that worsens when he takes a step down with left foot. Left testicle is more swollen nad has severe tenderness with palpation in the posterior aspect. NO inguinal hernias and no urethral discharge

A

Epididymitis - presents with acute onset testicular pain, fever, and possible urinary symptoms and exquisite pain with palpation

Urinalysis can be normal without urinary symptoms.

Diagnosis is clinically made but doppler u/s of testes is done in equivocal cases to document increased flow to affected epididymis.

Tx is outpatient with testicular elevation, NSAIDs and antibiotics with close follow up.

27
Q

first line therapy for symptomatic left sided varicocele that is not associated with testicular atrophy or infertility is:

A

analgesic agents and scrotal support

varicoceles are leading cause of infertility; 40% of men who are infertile have varicocels

dilation of pampiniform plexus of spermatic veins and cause symtpoms from dull to aching scrotal fullness

see left sided bag of worms soft scrotal mass.

the bag of worms improves with lying down and worsens with standing.

28
Q

right sided varicoceles should merit a

A

deeper examination - get a CT abd/pel

uncommon and may be a sign of a significant abnormality - inferior vena cava obstruction due to tumor or thrombosis because right gonadal vein empties directly into the inferior vena cava

29
Q

when do you get surgery for treatment of varicocoele?

A

when there’s presence of testicular atrophy or infertility

ligation or embolizaiton of gonadal vein prevents retrograde flow of blood into the pampiniform in the scrotum.