Physician Assistant Genitourinary and Renal System Disorders 4

Question 1

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?

Accepted Answer

Immediate surgical exploration

Answer

Clinical testicular torsion requires immediate surgical detorsion and orchiopexy, ideally within 6 hours.

Question 2

A 25-year-old sexually active man has gradual scrotal pain relieved by testicular elevation. What is the most likely diagnosis?

Accepted Answer

Epididymitis

Answer

Pain relief with elevation (positive Prehn sign) and gradual onset suggest epididymitis.

Question 3

What is the recommended empiric treatment for epididymitis in a 24-year-old man most likely due to an STI?

Accepted Answer

Ceftriaxone plus doxycycline

Answer

CDC recommends ceftriaxone 500 mg IM plus doxycycline for epididymitis likely caused by gonorrhea or chlamydia.

Question 4

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?

Accepted Answer

Left gonadal vein drains into the left renal vein at a right angle

Answer

The left gonadal vein enters the left renal vein at a right angle, increasing venous pressure and varicocele formation.

Question 5

A new isolated right-sided varicocele that does not decompress when supine should prompt evaluation for what?

Accepted Answer

Retroperitoneal mass or IVC obstruction

Answer

A right-sided or non-decompressing varicocele may indicate IVC compression from a mass such as renal cell carcinoma.

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