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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
Q

acute bacterial prostatitis tx? these meds achieve what?

A

Empiric abx until cx
-Cipro, Levo, Bactrim, Gentamycin (4-6 wks of tx)

ALL OF THESE ACHIEVE HIGH LEVELS IN PROSTATE TISSUE

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26
Q

what is chronic bacterial prostatitis?

A

Chronic or recurrent urogenital symptoms with evidence of bacterial infection of the prostate (get bacterial prostatitis over and over)

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27
Q

what may chronic bacterial prostatitis be due to?

A

inadequate or too short treatment

28
Q

when does chronic bacterial prostatitis develop?

A

after an acute infection

29
Q

most common pathogen for chronic bacterial prostatitis?

A

E. coli

30
Q

chronic bacterial prostatitis s/sx’s?

A

Can be subtle

Irritative voiding sx’s that won’t go away (frequency, dysuria, urgency)

Low grade fever

Can be asymptomatic

31
Q

chronic bacterial prostatitis physical exam?

A

often unremarkable

prostate is usually not tender (as it is in acute)

32
Q

UA for chronic bacterial prostatitis is usually?

A

normal

33
Q

what does a urologist do for chronic bacterial prostatitis? what will you see?

A

expresses prostate secretions

see:

  • increased leukocytes
  • increased bacteria
34
Q

chronic bacterial prostatitis tx?

A

Bactrim, quinolone, cephalexin (6-12 weeks of treatment)

35
Q

what is most common of the prostatitis syndromes?

A

inflammatory prostatitis

36
Q

s/sx’s of inflammatory prostatitis?

A
  • ***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
Q

inflammatory prostatitis is what type of dx?

A

dx of exclusion

38
Q

labs for inflammatory prostatitis?

A

UA normal
UC no growth
Prostate secretions show increase in WBC, and increase in macrophages

Prostate bx you see inflammatory tissue

39
Q

treatment for inflammatory prostatitis?

A

Alpha blockers, antibiotics, 5-alpha-reductase inhibitors are most efficacious

  • Tamsulosin 0.4mg PO QD
  • Cipro 500mg PO BID
40
Q

what med for tx of inflammatory prostatitis is for older men?

A

Dutasteride

41
Q

2 categories of epididymitis?

A

sexually transmitted and non-sexually transmitted

42
Q

sexually transmitted epididymitis (common in who, associated with? pathogens?)

A

common in men < 35 y/o

associated with urethritis

pathogens: gonorrhea and chlamydia

43
Q

non-sexually transmitted epididymitis (common in who, associated with? pathogens?)

A

most common in older men

associated with UTI and prostatitis

pathogens: e. coli

44
Q

route of infection for epididymitis?

A

Urethra to ejaculatory duct down the vas deferens to epididymis

45
Q

epididymitis s/sx’s

A
  • Unilateral
  • Acute onset of scrotal pain
  • Fever
  • Scrotal swelling
  • Radiation pain to flank
  • Urethral discharge
  • Dysuria
  • ***Cremasteric reflex unaltered
46
Q

what is unaltered in epididymitis?

A

Cremasteric reflex is unaltered -> check it to r/o testicular torsion

47
Q

epididymitis labs?

A

UA, UC, urine for GC/Chlamydia

48
Q

imaging for epididymitis?

A

Scrotal U/S - want to make sure it’s not orchitis or testicular torsion

49
Q

epididymitis tx?

A
  • Bed rest
  • Scrotal elevation
  • Ice

Gonorrhea and chlamydial cause:
-treat with doxy and azithro or ceftriaxone

Non-sexually transmitted cause:
-treat with Levo

50
Q

what is orchitis?

A

Acute inflammatory reaction of the testes due to infection

***Most cases associated with mumps

51
Q

orchitis associated with what?

A

MUMPS!!! -> M/C cause

52
Q

older men with bacterial infection and orchitis due to?

A

BPH

53
Q

what can orchitis mimic?

A

testicular torsion, but cremasteric reflex is still present in orchitis

54
Q

signs/sx’s of orchitis?

A

fever, malaise, myalgia, swollen red testicle

PAROTITIS (D/T MUMPS)

55
Q

labs needed for orchitis?

A

NONE - Hx and PE are sufficient

56
Q

imaging for orchitis?

A

scrotal US

57
Q

treatment for orchitis?

A

SUPPORTIVE!!!

  • scrotal elevation
  • NSAIDs
  • Ice
58
Q

urethritis is a common manifestation of what in men?

A

sexually transmitted infections

59
Q

urethritis classified as?

A

gonococcal or non-gonococcal (if non then it’s chlamydia)

60
Q

urethritis s/sx’s?

A
  • dysuria
  • pruritus and burning at the urethral meatus
  • ***DISCHARGE (purulent and green/brown = gonococcal and watery = chlamydia)
  • ***ANXIETY!!!
61
Q

labs for urethritis?

A

UA and first catch urine w/out cleansing

62
Q

gram stain of chalmydia and gonorrhea for urethritis?

A

chlamydia -> PMN

gonorrhea -> intracellular gram-negative diplococci

63
Q

urethritis tx?

A

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
Q

urethritis tx if chlamydia?

A

azithro or doxy

65
Q

urethritis tx if gonorrhea?

A

ceftriaxone

66
Q

partners of pt with urethritis need to be treated when and with what?

A

Partners w/in last 60 days need to be treated with doxy and azithromycin

67
Q

is a genital swab needed for urethritis? what if female?

A

NO!!!

if a female tho, then need swab of cervix for discharge

Clin Med 3 (21 decks)

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