questions 2

Epididymitis

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Topic updated on 03/28/17 8:26pm

Snapshot
  • epididymitisA 28-year-old male presents with pain and tenderness of his right testicle. These symptoms started gradually over the last day. On physical exam, his pain is lessened with elevation of the effected testicle. An ultrasound of his testicle is given.
Introduction
  • An infection of the epididymis 
  • Pathogen varies by patient age
    • < 35 years old
      • N. gonorrhoeae, C. trachomatis
    • > 35 years old
      • E. coli, P. aeruginosa
  • Also associated with
    • systemic MTB
      • caseating granulomas seen histologically
    • AIDS
      • results in CVM, Toxoplasma, Salmonella infections
  • Must be distinguished from testicular torsion
    •  
Presentation
  • Symptoms
    • unilateral pain in scrotum
      • may radiate to flank
  • Physical exam
    • scrotal swelling, tenderness, and erythema
    • testicle is not elevated in the scrotum
      • seen in testicular torsion
    • Prehn's sign
      • decrease in pain with scrotal elevation
      • negative in testicular torsion
Treatment
  • Medical
    • ciprofloxacin or levofloxacin
      • if greater than 35 years old
      • can use if <14, cause is enteric, and if no other effective alternative (i.e. trimethoprim-sulfamethoxazole or cephalexin)
    • doxycycline + ceftriaxone 
      • empiric treatment for N. gonorrheae and C. trachomatis
      • if between 14 to 35 years old


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Qbank (2 Questions)

TAG
(M2.RL.61) A 31-year-old man with no significant past medical history presents to his primary care provider complaining of right scrotal pain. He states that the pain began 2 days ago and has gradually worsened. He denies burning on urination. On further questioning, he reports two new sexual partners in the past 6 months. Vital signs T 99.8 F, HR 75 bpm, BP 125/80 mmHg, RR 12 rpm. Exam demonstrates a swollen right scrotum that is painful to the touch. Doppler ultrasonography of his right testicle is shown in Figure A. Urinalysis is positive for white blood cells. Of the following choices, which is the next best step? Topic Review Topic
FIGURES: A          

1. Ceftriaxone and doxycycline
2. Levofloxacin
3. Supportive care and MMR vaccine
4. Referral to urologist
5. CT abdomen and pelvis

PREFERRED RESPONSE ▶
TAG
(M2.RL.82) A 68-year-old male presents with pain and tenderness of his right testicle. These symptoms started gradually over the last day. Vital signs are as follows: T 99.8 F, HR 75, BP 125/80 mmHg, RR 12. On physical exam, he has severe pain when the testicle is palpated which is lessened with elevation of the involved testicle. Doppler ultrasound shows normal blood flow in both testes. Which of the following organisms is the most likely pathogen in this patient's condition? Topic Review Topic

1. N. gonorrhoeae
2. C. trachomatis
3. E. coli
4. S. aureus
5. S. epidermidis

PREFERRED RESPONSE ▶


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