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Clin Med 3 > Testicular torsion, Prostate, and Scrotal Infections - Exam 2 > Flashcards

Testicular torsion, Prostate, and Scrotal Infections - Exam 2 Flashcards

1
Q

testicular torsion is a urologic ___

A

emergency!!!

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2
Q

testicular torsion is most common in?

A

neonates and post-pubertal boys (babies can be born with this)

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3
Q

what is testicular torsion d/t?

A

” Inadequate fixation of the lower pole of the testes to the tunica vaginalis

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4
Q

if one teste is torsed, can the other one have damage?

A

yes!!!

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5
Q

what may testicular torsion result in?

A

infertility

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6
Q

important finding for testicular torsion that you won’t see in any other testicular problems?

A

NEGATIVE CREMASTERIC REFLEX

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7
Q

what gives you dx for testicular torsion?

A

sudden onset testicular pain in PE

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8
Q

what confirm dx for testicular torsion? what does it measure?

A

US w/Doppler flow

-measures arterial flow into the testes and there won’t be any flow with testicular torsion

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9
Q

tx for testicular torsion?

A

manual detorsion
-most rotate medially, so detours it laterally (if doesn’t work turn the other way)

detorsion surgery w/gubernacular fixation
-look at both testes

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10
Q

what is the function of the seminal vesicle?

A

Responsible for a significant amount of fluid that become semen

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11
Q

epididymis connects testes to what? stores what?

A

connects testes to vas deferens

stores sperm for 2-3 months while they mature

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12
Q

testes produce?

A

sperm and androgens

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13
Q

what is the Denonvillier’s fascia?

A

structure b/w the prostate and the rectum

-barrier that prevents prostate cancer from spreading

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14
Q

what does prostate secrete?

A

fluid that nourishes and protects sperm

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15
Q

what zone of the prostate is felt on exam and has the highest occurrence of cancer?

A

peripheral zone

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16
Q

most common pathogen for acute bacterial prostatitis?

A

E. coli and pseudomonas

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17
Q

most likely route of infection for acute bacterial prostatitis?

A

ascent up the urethra

-reflex of infected urine into prostatic ducts

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18
Q

acute bacterial prostatitis risk factors?

A
  • Urogenital tract infections
  • Prostate bx (If just had bx done then usually give abx to prevent acute bacterial prostatitis)
  • Instrumentation
  • Structural abnormalities
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19
Q

acute bacterial prostatitis s/sx’s?

A

Fever -> THIS PATIENT LOOKS ILL!!!

Irritative voiding symptoms - dysuria

Perineal, suprapubic, and back pain

May have obstructive sx - urinary retention

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20
Q

acute bacterial prostatitis physical exam?

A
  • pt looks ill
  • generalized pelvic tenderness
  • DRE -> BE GENTLE!!!

Prostate is tender, edematous, warm

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21
Q

acute bacterial prostatitis lab findings?

A

Leukocytosis with left shift

UA will show pyuria, bacteriuria and hematuria

UC will grow offending bacteria

Elevated inflammatory markers (CRP, ESR)

Elevated PSA (prostate specific antigen)

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22
Q

is imaging necessary for initial dx of acute bacterial prostatitis? when do you do imaging for it?

A

NO!!!

Do imaging if no improvement in 48hrs

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23
Q

if pt with acute bacterial prostatitis sx’s don’t improve in 48hrs, what do you do and what should you start thinking?

A

Do imaging (CT, MRI) and start thinking it may be a prostate abscess

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24
Q

indications for admission of acute bacterial prostatitis?

A
  • Signs of sepsis
  • Can’t tolerate oral abx
  • Multiple comorbidities
  • Or even a pt that won’t follow the treatment plan
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25
acute bacterial prostatitis tx? these meds achieve what?
Empiric abx until cx -Cipro, Levo, Bactrim, Gentamycin (4-6 wks of tx) ALL OF THESE ACHIEVE HIGH LEVELS IN PROSTATE TISSUE
26
what is chronic bacterial prostatitis?
Chronic or recurrent urogenital symptoms with evidence of bacterial infection of the prostate (get bacterial prostatitis over and over)
27
what may chronic bacterial prostatitis be due to?
inadequate or too short treatment
28
when does chronic bacterial prostatitis develop?
after an acute infection
29
most common pathogen for chronic bacterial prostatitis?
E. coli
30
chronic bacterial prostatitis s/sx's?
Can be subtle Irritative voiding sx's that won't go away (frequency, dysuria, urgency) Low grade fever Can be asymptomatic
31
chronic bacterial prostatitis physical exam?
often unremarkable prostate is usually not tender (as it is in acute)
32
UA for chronic bacterial prostatitis is usually?
normal
33
what does a urologist do for chronic bacterial prostatitis? what will you see?
expresses prostate secretions see: - increased leukocytes - increased bacteria
34
chronic bacterial prostatitis tx?
Bactrim, quinolone, cephalexin (6-12 weeks of treatment)
35
what is most common of the prostatitis syndromes?
inflammatory prostatitis
36
s/sx's of inflammatory prostatitis?
- ***subtle sx's - Pain in the perineum, lower abd, testicles, penis - Voiding difficulties - Blood in sperm - Identical to chronic bacteria prostatitis - Erectile dysfunction - Ejaculatory pain - ***Depression
37
inflammatory prostatitis is what type of dx?
dx of exclusion
38
labs for inflammatory prostatitis?
UA normal UC no growth Prostate secretions show increase in WBC, and increase in macrophages Prostate bx you see inflammatory tissue
39
treatment for inflammatory prostatitis?
Alpha blockers, antibiotics, 5-alpha-reductase inhibitors are most efficacious - Tamsulosin 0.4mg PO QD - Cipro 500mg PO BID
40
what med for tx of inflammatory prostatitis is for older men?
Dutasteride
41
2 categories of epididymitis?
sexually transmitted and non-sexually transmitted
42
sexually transmitted epididymitis (common in who, associated with? pathogens?)
common in men < 35 y/o associated with urethritis pathogens: gonorrhea and chlamydia
43
non-sexually transmitted epididymitis (common in who, associated with? pathogens?)
most common in older men associated with UTI and prostatitis pathogens: e. coli
44
route of infection for epididymitis?
Urethra to ejaculatory duct down the vas deferens to epididymis
45
epididymitis s/sx's
- Unilateral - Acute onset of scrotal pain - Fever - Scrotal swelling - Radiation pain to flank - Urethral discharge - Dysuria - ***Cremasteric reflex unaltered
46
what is unaltered in epididymitis?
Cremasteric reflex is unaltered -> check it to r/o testicular torsion
47
epididymitis labs?
UA, UC, urine for GC/Chlamydia
48
imaging for epididymitis?
Scrotal U/S - want to make sure it's not orchitis or testicular torsion
49
epididymitis tx?
- Bed rest - Scrotal elevation - Ice Gonorrhea and chlamydial cause: -treat with doxy and azithro or ceftriaxone Non-sexually transmitted cause: -treat with Levo
50
what is orchitis?
Acute inflammatory reaction of the testes due to infection ***Most cases associated with mumps
51
orchitis associated with what?
MUMPS!!! -> M/C cause
52
older men with bacterial infection and orchitis due to?
BPH
53
what can orchitis mimic?
testicular torsion, but cremasteric reflex is still present in orchitis
54
signs/sx's of orchitis?
fever, malaise, myalgia, swollen red testicle PAROTITIS (D/T MUMPS)
55
labs needed for orchitis?
NONE - Hx and PE are sufficient
56
imaging for orchitis?
scrotal US
57
treatment for orchitis?
SUPPORTIVE!!! - scrotal elevation - NSAIDs - Ice
58
urethritis is a common manifestation of what in men?
sexually transmitted infections
59
urethritis classified as?
gonococcal or non-gonococcal (if non then it's chlamydia)
60
urethritis s/sx's?
- dysuria - pruritus and burning at the urethral meatus - ***DISCHARGE (purulent and green/brown = gonococcal and watery = chlamydia) - ***ANXIETY!!!
61
labs for urethritis?
UA and first catch urine w/out cleansing
62
gram stain of chalmydia and gonorrhea for urethritis?
chlamydia -> PMN gonorrhea -> intracellular gram-negative diplococci
63
urethritis tx?
When cx is not available, sexually active men should be treated for both (Cx not available for 24hrs) Treatment for NGU (targets Chalmydia) -Azithromycin or Doxycycline Preferred treatment for Gonorrhea: -Ceftriaxone (Rocephen) IM AND 1 gram Azithromycin PO Trichomonas suspicion treatment: single dose Metronidazole
64
urethritis tx if chlamydia?
azithro or doxy
65
urethritis tx if gonorrhea?
ceftriaxone
66
partners of pt with urethritis need to be treated when and with what?
Partners w/in last 60 days need to be treated with doxy and azithromycin
67
is a genital swab needed for urethritis? what if female?
NO!!! if a female tho, then need swab of cervix for discharge

Clin Med 3 (21 decks)

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