Genitourinary and Renal System Disorders Flashcards
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Read the first 7 Genitourinary and Renal System Disorders flashcards as text
A 15-year-old has sudden severe unilateral scrotal pain, a high-riding horizontal testis, and absent cremasteric reflex. What is the best next step?
Answer: Immediate surgical exploration
Clinical testicular torsion requires immediate surgical detorsion and orchiopexy, ideally within 6 hours.
A 25-year-old sexually active man has gradual scrotal pain relieved by testicular elevation. What is the most likely diagnosis?
Answer: Epididymitis
Pain relief with elevation (positive Prehn sign) and gradual onset suggest epididymitis.
What is the recommended empiric treatment for epididymitis in a 24-year-old man most likely due to an STI?
Answer: Ceftriaxone plus doxycycline
CDC recommends ceftriaxone 500 mg IM plus doxycycline for epididymitis likely caused by gonorrhea or chlamydia.
A scrotal mass feels like a 'bag of worms' that enlarges with Valsalva and is on the left side. Why is it more common on the left?
Answer: Left gonadal vein drains into the left renal vein at a right angle
The left gonadal vein enters the left renal vein at a right angle, increasing venous pressure and varicocele formation.
A new isolated right-sided varicocele that does not decompress when supine should prompt evaluation for what?
Answer: Retroperitoneal mass or IVC obstruction
A right-sided or non-decompressing varicocele may indicate IVC compression from a mass such as renal cell carcinoma.
A painless, firm testicular mass in a 28-year-old man with elevated AFP points to which tumor type?
Answer: Nonseminomatous germ cell tumor
Elevated AFP excludes pure seminoma and indicates a nonseminomatous component such as yolk sac tumor.
What is the appropriate initial approach to a suspected testicular cancer after ultrasound confirms a solid intratesticular mass?
Answer: Radical inguinal orchiectomy
Radical inguinal orchiectomy is diagnostic and therapeutic; transscrotal approaches risk altering lymphatic spread.
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