Renal 2- Defranco- Scrotum

Front 1

What organism is most likely causing epididimys?

Back 1

N. gonorrhea or C. trachomatis

Front 2

If he were 13 or 50, what other organisms would you suspect with epididemys? UTI?

Back 2

Typical urinary tract pathogens – E. Coli. Less commonly Proteus, Klebsiella, Pseudomonas
Also, can be purely inflammatory – due to systemic infection with Mycoplasma or viruses

Front 3

Tx for gonorrhea, chlamydia?

Back 3

Rocephin (ceftriaxon) 250mg x 1 IM and doxycycline 100mg PO BID for 10 days. Azithromycin 1g PO x 1 may be substituted in patients in whom compliance will be an issue

Front 4

If untreated, what complications may arise? What are the recommendations for treatment of epididymitis due to coliform bacteria? What other studies can you order to rule out a more complicated diagnosis?

Back 4

Orchitis; sepsis; testicular abscess; infertility;
Oral fluoroquinolone x 10 days
Testicular ultrasound – look for hypoechoic areas (abscess)

Front 5

Untreated young patients with epididymes, untreated result what later in life?

Back 5

infertility

Front 6

13 year old boy presents with sudden onset of pain in right testicle.

Back 6

testicular torsion until proven otherwise

Front 7

Ischemia of the testis results and can be irreversible after

Back 7

~6hours;

Front 8

Diagnostic for testicular torsion:

Back 8

Doppler ultrasonography with color flow analysis only if readily available or diagnosis is uncertain. Radionuclide imaging also used, but not as readily available

Front 9

32 year old male presents to your office with a non-tender mass in his left testicle.
DD?

Back 9

Varicocele
Hydrocele
Hematocele

Front 10

Varicocele

Back 10

– discomfort in affected testicle, most commonly left; “bag of worms” on exam. Treated surgically; can cause oligospermia

Front 11

– discomfort in affected testicle, most commonly left; “bag of worms” on exam. Treated surgically; can cause oligospermia

Back 11

Varicocele

Front 12

unilateral swelling; transillumates; common in newborns

Back 12

Hydrocele

Front 13

Hydrocele

Back 13

unilateral swelling; transillumates; common in newborns

Front 14

Hematocele

Back 14

unilateral tender non-transilluminating mass, usually presents after trauma

Front 15

unilateral tender non-transilluminating mass, usually presents after trauma

Back 15

Hematocele

Front 16

Transillumination of both testicles
can results in::

Back 16

Solid masses don’t transilluminate – malignancy, hematocele
Hydroceles, which can be quite large, transilluminate well

Front 17

Doppler ultrasonography
Normal parenchyma

Back 17

– torsion, epididymitis

Front 18

Doppler ultrasonography
Heterogeneous parenchyma

Back 18

malignancy

Front 19

Doppler ultrasonography
Increased blood flow

Back 19

epididymitis/orchitis; malignancy

Front 20

Doppler ultrasonography
Decreased blood flow

Back 20

testicular torsion

Front 21

Doppler ultrasonography
Varicocele

Back 21

“bag of worms” seen on color flow

Front 22

TX testicular cancer

Back 22

Urologic referral for biopsy and orchiectomy (removal of testicle)
Serum HCG and AFP (human chorionic gonadotropin and alpha fetoprotein) – for staging, these hormones are produced by the tumor
CT scan of abd/pelvis for staging
Orchiectomy in stage I disease is 70% curative; chemo used for relapses or residual disease; Poor risk disease has 50-60% cure rate with 3-drug chemotherapy

Front 23

What are common benign masses in the scrotum and how would they present?

Back 23

Varicocele – discomfort in affected testicle, most commonly left; “bag of worms” on exam. Treated surgically; can cause oligospermia
Hydrocele – unilateral swelling; transillumates; common in newborns
Hematocele – unilateral tender non-transilluminating mass, usually presents after trauma

Front 24

macrolide include

Back 24

erythromycin, clarithromycin and
azithroymcin.

Front 25

9-14yo male, MC mass in scrotum

Back 25

testicular cancer

Front 26

Treatment acute prostatitis
and duration

Back 26

o generic doxycycline 100 mg twice daily or trimethoprim-sulfamethoxazole DS 1 tablet twice daily is cheapest empirical therapy

3-4 weeks

Front 27

TX for pt acute bacterial prostatitis who do not require hospitalization

Back 27

o oral fluoroquinolone with anti-Pseudomonas activity (ciprofloxacin or levofloxacin) is reasonable first choice
o trimethoprim-sulfamethoxazole is an alternative
o if gonorrhea suspected - use ceftriaxone instead of fluoroquinolone

Front 28

Tx for gonorrhea

Back 28

use ceftriaxone instead of fluoroquinolone

Front 29

Treatment epididymitis
acute epididymitis

Back 29

• if acute epididymitis likely caused by enteric organism or if negative gonococcal tests(2)
o levofloxacin 500 mg orally once daily for 10 days
o ofloxacin 300 mg orally twice daily for 10 days

Front 30

TX for epididymitis

Back 30

ceftriaxone 250 mg intramuscularly once + doxycycline 100 mg orally twice daily for 10 days