Questions and Answers
Which age group is most commonly affected by epididymitis and orchitis?
What is the primary pathogen responsible for epididymitis in men aged 14-35 years?
Which of the following conditions is primarily characterized by unilateral scrotal pain and swelling?
Which of the following is a risk factor for epididymitis in men of all ages?
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What is the most common infectious cause of epididymitis in boys younger than 14 years?
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Which non-infectious factor may lead to epididymitis?
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What is the most common cause of viral orchitis?
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In older men, what condition is often associated with epididymitis?
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At what age range is torsion of the appendix testis most common?
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What indicates a negative response in cremasteric reflex testing?
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What does the presence of a 'blue dot' on the scrotal wall suggest?
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In which condition is Prehn's sign likely to be positive?
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What is the expected recovery time for mumps-associated orchitis without complications?
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What is indicated by a markedly decreased Doppler wave pulsation in a testicle?
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Why is a urology referral necessary for prepubescent boys with epididymitis?
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What should be assessed in men older than 50 years presenting with urogenital symptoms?
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What is the most common cause of epididymitis in men aged younger than 14 years or older than 35 years?
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Which physical finding is typical for epididymitis?
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In men who engage in insertive anal intercourse, which bacteria are commonly implicated in causing epididymitis?
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What factors are considered risk factors for epididymitis in all men?
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What is the most common cause of viral orchitis?
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Which condition is characterized by abrupt onset of unilateral scrotal pain and swelling?
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In older men, which surgical history might increase the risk of developing epididymitis?
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What abrupt clinical symptom is typically associated with viral orchitis?
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Which statement about the cremasteric reflex is accurate?
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What does a significant increase in Doppler wave pulsation suggest in a scrotal ultrasound?
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When is urology referral particularly necessary in young boys with a certain condition?
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What does a positive Prehn's sign indicate?
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After what duration is follow-up recommended for patients with a suspected testicular condition?
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What is a typical clinical indicator for torsion of the appendix testis?
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What is most indicative of testicular torsion based on ultrasound findings?
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Which symptom is most likely to worsen over time in cases of viral orchitis?
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Study Notes
Age Factors and Pathogens
- Men aged 14 to 35 years are most affected by epididymitis and orchitis.
- Common pathogens in this age group include Chlamydia trachomatis and Neisseria gonorrhoeae.
Physical Findings
- Typical findings include swollen, tender epididymis or testis in normal anatomical position with intact ipsilateral cremasteric reflex.
Prevalence and Causes
- Epididymitis is more common than orchitis.
- The primary cause of intrascrotal inflammation is epididymitis.
- Infections causing epididymitis in the 14-35 age group are predominantly from Neisseria gonorrhoeae and Chlamydia trachomatis.
- For those younger than 14 or older than 35, common urinary tract pathogens like Escherichia coli are typically responsible.
Risk Factors
-
Risk factors for all men include:
- Sexual activity
- Strenuous physical activity
- Bicycle or motorcycle riding
- Prolonged sitting (e.g., during travel or sedentary jobs)
- In men over 35 and prepubertal boys, risk factors include:
- Recent urinary tract surgery or instrumentation
- Anatomic abnormalities (e.g., prostatic obstruction in older men, posterior urethral valves, meatal stenosis in boys)
Viral Infections and Orchitis
- Mumps is the most common cause of viral orchitis, which presents with abrupt unilateral scrotal pain and swelling.
- Orchitis associated with mumps generally appears 4 to 7 days after parotitis.
Torsion and Diagnosis
- Torsion of the appendix testis typically occurs in boys aged 7 to 14 years, rarely after age 20.
- Tenderness in the spermatic cord suggests epididymitis.
- A “blue dot” sign presents as bluish discoloration on the scrotal wall, indicative of infarction and necrosis.
Reflexes and Signs
- Cremasteric reflex is elicited by stroking the skin of the upper medial thigh, resulting in ipsilateral testis elevation in normal conditions.
- The cremasteric reflex is present in epididymitis and orchitis but absent in testicular torsion.
- Prehn's sign indicates relief of pain with elevation of the testis, typically seen in epididymitis.
Ultrasound Findings
- A normal testicle showing decreased Doppler wave pulsation suggests torsion.
- An enlarged, thickened epididymis with increased Doppler wave pulsation indicates epididymitis.
Treatment and Follow-up
- Antibacterial medications are unnecessary for viral orchitis; most cases resolve spontaneously within 3 to 10 days.
- Recommended follow-up is 3 to 7 days post-evaluation to check clinical improvement and for testicular mass presence.
- Pain management typically improves within 1 to 3 days, but full resolution of induration may take 2 to 4 weeks.
Additional Recommendations
- Prepubescent boys with epididymitis require a urology referral due to a high incidence of urogenital abnormalities.
- Men over 50 should be evaluated for urethral obstruction due to prostatic enlargement.
Age Factors and Pathogens
- Men aged 14 to 35 years are most affected by epididymitis and orchitis.
- Common pathogens in this age group include Chlamydia trachomatis and Neisseria gonorrhoeae.
Physical Findings
- Typical findings include swollen, tender epididymis or testis in normal anatomical position with intact ipsilateral cremasteric reflex.
Prevalence and Causes
- Epididymitis is more common than orchitis.
- The primary cause of intrascrotal inflammation is epididymitis.
- Infections causing epididymitis in the 14-35 age group are predominantly from Neisseria gonorrhoeae and Chlamydia trachomatis.
- For those younger than 14 or older than 35, common urinary tract pathogens like Escherichia coli are typically responsible.
Risk Factors
-
Risk factors for all men include:
- Sexual activity
- Strenuous physical activity
- Bicycle or motorcycle riding
- Prolonged sitting (e.g., during travel or sedentary jobs)
- In men over 35 and prepubertal boys, risk factors include:
- Recent urinary tract surgery or instrumentation
- Anatomic abnormalities (e.g., prostatic obstruction in older men, posterior urethral valves, meatal stenosis in boys)
Viral Infections and Orchitis
- Mumps is the most common cause of viral orchitis, which presents with abrupt unilateral scrotal pain and swelling.
- Orchitis associated with mumps generally appears 4 to 7 days after parotitis.
Torsion and Diagnosis
- Torsion of the appendix testis typically occurs in boys aged 7 to 14 years, rarely after age 20.
- Tenderness in the spermatic cord suggests epididymitis.
- A “blue dot” sign presents as bluish discoloration on the scrotal wall, indicative of infarction and necrosis.
Reflexes and Signs
- Cremasteric reflex is elicited by stroking the skin of the upper medial thigh, resulting in ipsilateral testis elevation in normal conditions.
- The cremasteric reflex is present in epididymitis and orchitis but absent in testicular torsion.
- Prehn's sign indicates relief of pain with elevation of the testis, typically seen in epididymitis.
Ultrasound Findings
- A normal testicle showing decreased Doppler wave pulsation suggests torsion.
- An enlarged, thickened epididymis with increased Doppler wave pulsation indicates epididymitis.
Treatment and Follow-up
- Antibacterial medications are unnecessary for viral orchitis; most cases resolve spontaneously within 3 to 10 days.
- Recommended follow-up is 3 to 7 days post-evaluation to check clinical improvement and for testicular mass presence.
- Pain management typically improves within 1 to 3 days, but full resolution of induration may take 2 to 4 weeks.
Additional Recommendations
- Prepubescent boys with epididymitis require a urology referral due to a high incidence of urogenital abnormalities.
- Men over 50 should be evaluated for urethral obstruction due to prostatic enlargement.
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Description
This quiz covers key aspects of epididymitis and orchitis, focusing on age factors, common pathogens, and physical findings. It highlights the prevalence and causes of these conditions, particularly in the male population aged 14 to 35 years. Test your understanding of risk factors and typical infections associated with these diseases.
