CC July 2016 Epididymitis

echoecho's version from 2017-03-01 06:31


Question Answer
Anatomy of epididymis?Coiled tubular structure on the posterior aspect of the testis that runs from the superior to the inferior pole
What is a common cause of scrotal pain?Inflammation of the epididymis (Epididymitis)
It is typically caused by spread of microorganism from the _____, ____ or _____ to the epididymis; less likely infection may be the result of _________ spread?1) urethra 2) prostate 3) seminal vesicles. 4) hematogenous
It usually has an ______ onset and is associated with both constitutional symptoms (fevers) and lower urinary tract symptoms (urinaryt frequency, urgency and dysuria)?Insidious
Is the involvement usually bilateral or unilateral?Unilateral
What other condition must b e differentiated from Epididymitis?Testicular torsion (presents w/ unilateral testicular pain and is a surgical emergency)
What imaging study is used to aid in dx of testicular torsion, but not Epididymitis?Ultrasound
Among sexually active men, acute epididymitis is usually caused by what 2 bacteria?1) Neisseria gonorrhea. 21) Chlamydia trachoma this
In men who are not sexually active or who are monogamous, what is the most common causative organism?Escherichia coli
Are viruses a common cause of Epididymitis in children and prepubescent adolescents?Yes
List the causes of chronic Epididymitis (present for > 6 weeks)?1) trauma 2) cancer 3) autoimmune disorders. 4) Mycobacterium tuberculosis infection
In addition to sexual activity, list other risk factors for Epididymitis?1) strenuous physical activity. 2) bicycle riding. 3) motorcycle riding. 4) sedentary job
True or false? Non-infectious types tend to be more chronic?True
What does physical exam show?Tender, swollen and infuriated epididymis with a normal cremasteric reflex
What is the Prehn's sign?Improvement of the pain of Epididymitis with elevation of the affected testicle (described in 1930s but not been validated)
What is physical findings are seen in more advanced cases?Testicular swelling and pain along with scrotal erythema
*** Epididymitis / orchitis should be suspected in patients with testicular pain and a CRP level of > ____ mg/L?24
The 2015 CDC recommends that all patients suspected of having acute Epididymitis should be evaluated for the presence of _______ with one of the 3 point-of-care tests?Inflammation
List the 3 point-of-care tests mentioned in the above question?1) gram stain, methylene blue stain or Gentian violet stain of urethral secretions demonstrating > 2 WBCs per oil immersion field. 2) positive leukocyte ester are test on first-void urine. 3) microscopic exam of urine sediment with a spun first-void urine demonstrating > 10 WBCS per high-powered field
What test is recommended in sexually active men?NAAT (nucleic acid amplification test for Neisseria gonorrhea and Chlamydia trachomatis)
What test is recommended in men in whom a coli form bacterial source is suspected?Urine culture
List the 3 treatment regimens for acute Epididymitis recommended by the CDC?1) suspected Neisseria gonorrhea or Chlamydia trachomatis infection: Ceftriaxone (Rocephin) 250 mg IM X 1 dose and Doxycycline (Vibramycin) 100 mg BID X 10 days. 2) Suspected Neisseria gonorrhea or Chlamydia trachomatis infection in men practicing insert ice anal intercourse: Ceftriaxone 250 mg IM X 1 dose and Levofloxacin (Levaquin)( 500 mg daily X 10 days OR Ofloxacin (Floxin) 300 mg BID X 10 days. 3) Suspected enteric organism infection: Levofloxacin 500 mg daily X 10 days or Ofloxacin 300 mg BID X 10 days
Men undergoing treatment for Neisseria gonorrhea or Chlamydia trachomatis should abstain from intercourse, their partners from the previous _____ days should be treated as well?60
These men should be offered what other testing?STD
*** SUMMARY = Epididymitis is typically caused by the spread of micro organisms from the _____, _____ or _____ ____ to the epididymis?1) urethra. 2) prostate. 3) seminal vesicles
*** SUMMARY = Among sexually active men, acute Epididymitis is usually caused by ______ ______ or ____ ______?1) Neisseria gonorrhoeae. 2) CHlamydia trachomatis
*** SUMMARY = testing is recommended to look for signs of ________?inflammation