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PAEA Urology/Renal: Questions/Answers
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PAEA Urology/Renal: Questions/Answers
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PAEA Urology/Renal: Questions/Answerswhat is epididymitis Correct Ans - inflammation of the epididymis -
the back of the testis
what is the most common cause of epididymitis in men <40 Correct Ans -
STD
what is the most common cause of epididymitis in men > 40 Correct Ans -
non STD
what are the symptoms of epididymitis Correct Ans - +/- urethritis,
prostatitis, cystitis symptoms
fever
pain and swelling in scortum - if late infection it may be hard ti distinguish
from testis
+/- retractable hydrocele
+/- inguinal lymphadenopathy
+ phren sign
what is phren sign Correct Ans - relief of pain upon elevated of the
scrotum
how is epididymitis diagnosed Correct Ans - UA - pyuria, bacteriuria,
hematuria, culture
urethral swab - gonorrhea - gram neg diplococci, chlamydia - WBC without
organism
PCR for gonorrhea/chlamydia
CBC: WBC with left shift
what is the treatment for epididymitis Correct Ans - bed rest, scrotal
elevated, ice packs
NSAIDs
antibiotics - improve by about 3 days, resolution in 2-4 weeks
STD - ceftriaxone + doxy
Unlikely STD - levofloxacin 500 mg
,what is a hydrocele Correct Ans - peritoneal fluid between layers of
tunica vaginalis
what population is a hydrocele common in Correct Ans - infants -
resolves by 1 year.
what are the 2 types of hydrocele Correct Ans - communicating
non communicating
what is a communicating hydrocele Correct Ans - patent processus
vaginalis allows peritoneal fluid to flow into tunica vaginalis - fluctuates
what is a noncommunicating hydrocele Correct Ans - processus
vaginalis closed, fluid is trapped and it is not reducible
how is a hydrocele diagnosed Correct Ans - transillumination
- scrotal US to check contents
what is the treatment for hydrocele Correct Ans - supportive
treatment until about 1-2 years old.
surgery is indicated if it is not resolved by 1-2 years old, there are symptoms
or compromised skin.
what is testicular torsion Correct Ans - twisting of the spermatic cord
how does testicular torsion present in an infant Correct Ans - cord
above insertion of tunica vaginalis
how does testicular torsion present in adolescent Correct Ans - bell
clapper deformity - testicle is able to twist freely
what are the symptoms of testicular torsion Correct Ans - pain that is
worse with activity
nausea and vomiting
red, tender, swollen scrotum with a tender, swollen, elevated testis
absent cremasteric reflex, negative phren signs
exquisite pain on palpation from testis
can compromise spermatogenesis in 4-6 hours
, what is a big concern with testicular torsion Correct Ans - infertility
how is testicular torsion diagnosed Correct Ans - US of the scrotum
how is testicular torsion treated Correct Ans - Urgent urological
consult and surgery
orchipexy - detorsion within 4-6 hours
manual detorsion
- twisted clockwise/counterclockwise
- successful will demonstrate rapid return of blood.
what is a varicocele Correct Ans - dilated, engorged, tortuous veins
within the pampiniform plexus of scrotal veins
what is the most common surgically correctable cause of male infertility
Correct Ans - varicocele
what side is more common for varicocele Correct Ans - left
what are the symptoms of varicocele Correct Ans - scrotal
enlargement or heaviness
infertility as initial complaint
what is the physical exam findings for varicocele Correct Ans - dilated
veins in sac - bag of worms
increases with standing, valsalva
improved while supine
how is varicocele diagnosed Correct Ans - labs to rule out other
disorders
US confirms diagnosis
how is varicocele treated Correct Ans - asx - observe
conservative - scrotal support and NSAIDs
Surgical - occlusion (balloon) or embolization
injected ablation of vein
surgical ligation of pampiniform plexus
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