evaluating testicular pain - yale school of medicine：评价耶鲁大学医学院的睾丸疼痛

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1、EvaluatingTesticularPainKavehMansuripurAmbulatoryMedicineClerkship4/9/09LearningObjectivesBytheendofthesession,beableto:ListthedifferentialdxfortesticularpainLabelordrawtherelevantanatomyDescribethephysicalexaminationappropriateforapatientwithtesticularpainSelectappropria

2、tetestingforpatientswithtesticularpainincontextofspecificsxsandsignsSelectthemostappropriatetreatmentforpatientswithspecificcausesoftesticularpainAnatomyCase1:PatientT.R.WhatistheDifferentialDiagnosis?HPI:21yomanpresentswith3hoursofintense,constanttesticularpainBeganseve

3、ralhoursaftercollegetrackmeetAssociatednauseaandvomitingPMH:NoneMeds:Glucosamine,condroitin,creatinesupplementsAlls:PCNFH:Non-contributorySH:Sexuallyactive,multiplepartnersDifferentialDiagnosisTesticularTorsionAppendicealTorsionEpididymitisTraumaInguinalHerniaHenoch-Schon

4、leinPurpuraMumpsFournier’sGangreneReferredPainCase1:PatientT.R.Exam:Case1:PatientT.R.WhatistheNextStep?Exam:RighttesticlehigherthanleftLongaxisorientedhorizontallySignificantswellingNocremastericreflexoneithersideNoreliefofpainonelevationCase1:PatientT.R.NextStepIfDiagn

5、osisCertain(Torsion):TotheOR.OutcomesdirectlyrelatedtolengthoftimefromonsetIrreversibleischemiaatmeanof12hoursIfDiagnosisLessObviousDopplerUltrasoundTest82%sensitive,99%specificfortorsion(lossofflow)Case1:PatientT.R.Operation:testiculardetorsionandfixationUnilateralorbila

6、teral?Why?Case1:PatientT.R.OperationtesticulardetorsionandfixationUnilateralorbilateral?Why?ANSWER:Bilateral--Torsionassociatedwithabsence/insufficeincyofgubernaculum.Oftenbilateral.Whatifsurgerynotanoption?Case1:PatientT.R.Non-operative:Manualdetorsion2/3ofcasesaretorsed

7、medially,1/3laterallySuccessmarkedbydecreasedpain,returntonormalposition.Ifunsuccessful,applyice(successfulinanimalmodels)TesticularTorsion40%over21Associatedwithphysicalactivity/sleepExamAbsentcremastericDopplerSurgicalEmergencyCase2:PatientF.J.HPI:11yearoldboypresentswi

8、th3daysofincreasingscrotalpainLocalizestendernesstoanteriorsuperiorpoleofrighttesticledDx?Case2: