Master the board step 3

Surgery
Testicular Torsion
Testicular torsion classically presents as severe, sudden-onset testicular pain
without fever or pyuria. The testis is swollen, exquisitely tender, “high riding,”
and with a “horizontal lie.”
Basic Science Correlate
The sensory and motor components of the cremasteric reflex are at L1/L2.
Their absence is suggestive of testicular torsion.
Diagnose with ultrasound, but do not wait for results to do surgery. Treat
with immediate surgical intervention with bilateral orchiopexy.
Acute Epididymitis
The patient presents with acute scrotal pain (sometimes referred to the abdomen),
fever, and urinary symptoms.
To diagnose, get a urinalysis and urine cultures and obtain a culture of discharge
if present.
Treatment is as follows:
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Males < 35: Treat for gonorrhea/chlamydia with ceftriaxone and doxycycline.
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Older males: Treat as a urinary tract infection (E. coli) with levofloxacin.
Basic Science Correlate
Serotypes D–K of Chlamydia trachomatis (obligate intracellular) are
responsible for urethritis and other STD-related sequelae.
A 72-year-old man is being observed; he has a ureteral stone that is expected to
pass spontaneously. He develops chills, a temperature of 102.9°F, flank pain, and
elevated creatinine. Which of the following is the next step in management?
a. Prescribe oral antibiotics
b. Prescribe loop diuretics
c. Perform lithotripsy
d. Place Foley catheter
e. Place percutaneous stent
Answer: E. Place a percutaneous stent to relieve the obstruction.
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