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Clin Med III > testicular torsion and GU infections > Flashcards

testicular torsion and GU infections Flashcards

1
Q

testicular torsion

A
  • urologic emergency
  • more common in neonates and postpubertal boys
  • irreversible damage after 12 hours, may result in infertility of both testes
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2
Q

causes of testicular torsion

A
  • can occur spontaneously or after inciting damage
  • inadequate fixation of lower testes to tunica vaginalis
  • bell clapper deformity- testes lay horizontally
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3
Q

clinical manifestations of testicular torsion

A
  • mod- severe testicular pain
  • swelling
  • no cremasteric reflex
  • n/v
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4
Q

diagnosis of testicular torsion

A
  • H&P

- US with doppler flow- no arterial flow

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5
Q

management of testicular torsion

A
  • manual detorsion- usu not successful

- detorsion surgery with gubernacular fixation to both sides

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6
Q

acute bacterial prostatitis

A
  • make up very small % of prostatitis
  • usu young an middle aged men
  • route of infection- ascend up urethra
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7
Q

what are the most common pathogens in acute bacterial prostatitis

A
  • e coli

- pseudomonas

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8
Q

risk factors for acute bacterial prostatitis

A
  • urogenital tract infections
  • prostate biopsy
  • instrumentation
  • structural abnormalities
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9
Q

clinical presentation of acute bacterial prostatitis

A
  • pt will look very ill
  • fever
  • dysuria
  • perineal, suprapubic and back pain
  • may have obstructive sx
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10
Q

PE for acute bacterial prostatitis

A
  • generalized pelvic tenderness
  • DRE -> exquisite pain
  • prostate is tender, edematous, warm
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11
Q

lab findings for acute bacterial prostatitis

A
  • leukocytosis with L shift
  • UA- pyuria, bacteriuria, hematuria
  • UC
  • elevated inflammatory markers
  • elevated PSA
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12
Q

imaging for acute bacterial prostatitis

A
  • usually none

- CT or MRI if no improvement in 48 hours- think prostatic abscess

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13
Q

indications for admission in acute bacterial prostatitis

A
  • signs of sepsis
  • cant tolerate PO abx
  • multiple comorbodities
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14
Q

treatment for acute bacterial prostatitis

A
  • empiric abx until culture results
  • cipro, levo
  • bactrim
  • gentamycin
  • abx X 4-6 weeks
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15
Q

chronic bacterial prostatitis

A
  • chronic or recurrent urogenital sx with evidence of infection of prostate
  • inadequate or too short tx for acute
  • common in young and middle aged men
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16
Q

risk factors for chronic bacterial prostatitis

A
  • acute episodes of bacterial prostatitis
  • prostate stones
  • same RF as acute
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17
Q

clinical presentation of chronic bacterial prostatitis

A
  • can be very subtle
  • irritative voiding sx that dont go away
  • low grade fever
  • dull pelvic or perineal pain
  • testicular pain
  • some asymptomatic
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18
Q

PE for chronic bacterial prostatitis

A
  • often unremarkable
  • prostate may feel boggy, normal or firm
  • usu prostate is non-tender
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19
Q

lab findings for chronic bacterial prostatitis

A
  • UA normal
  • expressed prostate secretions tested by urology
  • increased leukocytes and bacteria
  • culture grows offending agent
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20
Q

imaging for chronic bacterial prostatitis

A
  • usu not necessary

- may see prostate calculi on plain film

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21
Q

treatment of chronic bacterial prostatitis

A
  • bactrim- assoc with best cure rate
  • quinolones of cephalexin as alternative due to resistance
  • tx for 6-12 weeks
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22
Q

inflammatory prostatitis

A
  • most common of prostatitis
  • unknown cause
  • most common in young and middle aged men
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23
Q

clinical presentation of inflammatory prostatitis

A
  • subtle sx
  • pain in perineum, lower abd, testicles, penis
  • voiding sx
  • blood in semen
  • ED, ejaculatory pain
  • depression
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24
Q

labs for inflammatory prostatitis

A
  • UA and UC normal
  • expressed prostate secretions- done by urology
  • prostate biopsy
  • dx of exclusion
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25
treatment for inflammatory prostatitis
- alpha blockers - abx - 5 alpha reductase inhibitors - usu tamsulosin + cipro X 6 weeks - dutasteride used in older men
26
epididymitis categories
- sexually vs non-sexually transmitted
27
sexually transmitted epididymitis
- most common in men < 35 | - assoc with urethritis, gonorrhea, chlamydia
28
non-sexually transmitted epididymitis
- most common in older men | - assoc with UTI, prostatitis, e coli
29
what is the most common cause of acute onset scrotal pain in adults
- epididymitis
30
clinical presentation of epididymitis
- unilateral pain - fever - scrotal swelling - pain radiates to flank - urethral d/c - dysuria - normal cremasteric reflex
31
labs/imaging for epididymitis
- UA, UC - urine for GC/ chlamydia - scrotal US
32
treatment for epididymitis
- bed rest - scrotal elevation - ice - if non-sexual- levoflox - if GC/chlamydia- doxy, ceftriaxone, azithromycin
33
orchitis
- acute inflammatory reaction of testes d/t infection - usu assoc with mumps - 70% of time unilateral - assoc with parotitis which presents 4-7 days prior
34
clinical presentation of orchitis
- fever - malaise - myalgias - swollen red testicle - rarely bilat
35
diagnosis of orchitis
- usually clinical | - may get scrotal US
36
treatment for orchitis
- supportive- mainly viral cause - scrotal elevation - NSAIDs - ice
37
urethritis
- inflammation of urethra - common manifestation of STI in men - usu young sexually active men - classified as gonococcal or non-gonococcal - common coinfection with chlamydia
38
pathogens that cause urethritis
- n gonorrhea - c trachomatis - m genitalium - trichomonas vaginalis - treponema pallidum
39
clinical manifestations of urethritis
- dysuria - pruritis and burning at urethral meatus - discharge- if purulent likely gonorrhea, if watery likely chlamydia - may be asymptomatic
40
PE for urethritis
- anxious - inguinal LAD - meatus may be red and tender - prurulent brown/ greenish penile d/c - white watery d/c
41
labs for urethritis
- UA - first catch urine without cleansing - pos for leukocytes - > 10 WBCs - can do genital swabs
42
treatment for urethritis
- usu treat sexually active men for gonorrhea and chlamydia - chlamydia- azithromycin - gonorrhea- ceftiraxone IM - treat partners within last 60 days
43
cystitis
- infection of bladder - lower UTI infection - colonization of vaginal introitus or urethral meatus - usu GN bacteria
44
common pathogens that cause cystitis
- e coli* - enterobacteriaecea - klebsiella pneumonia - proteus
45
what bacteria can you assume are contaminants when testing for cystitis
- lactobacilli - group B strep - enterococci - coag neg staph
46
clinical manifestations of cystitis
- dysuria, frequency, urgency - suprapubic pain - hematuria - older women sx more subtle- falls, confusion, change in functional status
47
diagnosis of cystitis
- H&P - UA - +/- HCG - urinalysis- look for leukocyte esterase and nitrites - test for gonorrhea and chlamydia in men
48
management of cystitis
- macrobid - bactrim - cefpodoxime (vantin) - cipro - symptomatic tx with pyridium
49
risk factors for cystitis in women
- intercourse - hx of UTI - spermicide coated condoms - diaphragms - urinary tract abnormalities
50
risk factors for cystitis in men
- anal intercourse | - uncircumcised
51
pyelonephritis
- infection of kidney - upper UTI, complicated - less common than acute cystitis - involves kidney parenchyma and renal pelvis
52
causes of pyelonephritis
- e coli* - klebsiella pneumonia - proteus - pseudomonas if due to health care instrumentation
53
how does pyelonephritis occur
- ascend to kidneys via ureters | - seeding from bacteremia
54
clinical manifestations of pyelonephritis
- dysuria, frequency, urgency - suprapubic pain - hematuria - fever, chills - flank pain, CVA tenderness - n/v - more systemic sx than cystitis
55
diagnosis of pyelonephritis
- H&P - UA, UC - CBC- elevated with L shift - blood cultures and lactate - imaging not usu necessary but may use if suspicious of stone or unsure of dx
56
indications for hospitalization in pyelonephritis
- sepsis - persistent fever - pain control - unable to maintain PO intake - urinary tract obstruction - pt adherence
57
inpatient management of pyelonephritis
- ceftriaxone - zosyn - cipro, levo - vanco for MRSA - imipenem- saved for critically ill pts
58
outpatient management of pyelonephritis
- cipro, levo | - ceftriaxone IV loading dose then PO bactrim, augmentin, or vantin
59
symptomatic treatment of pyelonephritis
- pyridium - motrin, APAP - anti-emetics - IVF
60
UTI and pregnancy
- considered complicated - commonly asymptomatic - incidence same as nonpregnant females but more likely to be recurrent - usu early in pregnancy
61
risk factors for UTI in pregnancy
- hx of prior UTI - preexisting DM - increased parity - lower SES
62
diagnosis of UTI in pregnancy
- requires 2 positive UC
63
treatment for UTI in prengnacy
- macrobid - augmentin - cefpodoxime - fosfomycin - quinolones NOT recommended
64
follow up for UTI in pregnancy
- 30% fail to clear asymptomatic bacteriruria after short course tx - f/u culture recommended - repeat cultures monthly until end of pregnancy
65
pyelonephritis and pregnancy
- considered complicated - usu d/t anatomic changes during pregnancy and immunosuppression - most in 2nd and 3rd trimester
66
risks of pyelonephritis in pregnancy
- obstetric complications - septic shock - anemia - bacteremia
67
clinical manifestations of pyelonephritis in pregnancy
- flank pain - n/v - fever - CVA tenderness - with or without typical sx
68
diagnosis of pyelonephritis in pregnancy
- H&P - UA, UC - +/- blood cultures and lactate - renal US considered
69
management of pyelonephritis in pregnancy
- based on site of care and potential complications - tx with beta lactams, penicillins, cephalosporins - quinolones NOT recommended
70
asymptomatic bacteriuria
- isolation of bacteria without si/sx - increased prevalence with age - most common in pregnant women
71
diagnosis of asymptomatic bacteriuria
- in women need 2 consecutive clean catch voided urine samples - in men nee one single clean catch voided urine sample
72
treatment for asymptomatic bacteriuria
- appropriate to treat and screen in pregnant women and pts undergoing procedures - renal transplant - use of abx same as cystitis - older pts often colonized- do not treat

Clin Med III (26 decks)

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