2
NURS I6531 IFinal IExam IStudy IGuide
1.) Hydrocele (member did not use template, no review questions received-this is all I got)
I I I I I I I I I I I I I I
Definition: I Ian Iaccumulation Iof Ifluid Iwithin Ithe Itunica Ivaginalis Isurrounding Ithe Itesticle; Iit Imay Ialso
Iresult Ifrom Ia Ipatent Iprocessus Ivaginalis Iat Ibirth Iand Isometimes Icloses Ispontaneously Iwithin Ithe Ifirst I1
Ito I2 Iyears Iof Ilife. IHydroceles Iare Ithe Imost Icommon Icause Iof Ipainless Iscrotal Iswelling.; Iin Iadults Ithey Iare
Ioften Ithe Iresult Iof Itrauma, Ia Ihernia, Itesticular Itumor, Ior Itorsion Ior Ia Icomplication Iof Iepididymitis. I
Presenting ISymptoms: IUsually Ipainless Iand Imay Ibe Ipresent Ifor Ilong Iperiods, Ipartially Iresolve, Iand Irecur
Ibefore Ithe Ipatient Iseeks Imedical Iattention. IGradual Ienlargement Iof Ithe Iscrotum Ioccurs Iwith Imarked
Iedema, Iwhich Imay Ibe Iuncomfortable Ibecause Iof Ithe Iadded Iweight. IA Ihydrocele Imay Ioccur Isecondary Ito
Ia Itumor Iwhen Iexcess Iserous Ifluid Iaccumulates Iin Ithe Iscrotal Isac. IIt Iwill Itransluminate Ibut Imay Imake
Itesticular Ipalpation Idifficult.
Leik IReview:
Hydrocele Imore Icommon Iin Iinfants. ISerous Ifluid Icollects Iinside Ithe Itunica Ivaginalis. IDuring Iscrotal Iexam,
Ihydroceles Iare Ilocated Isuperiorly Iand Ianterior Ito Ithe Itestes IMost Ihydroceles Iare Iasymptomatic. I Will
Iglow Iwith Itransillumination. IIf Inew-onset Ihydrocele Iin Ian Iadult Ior Ienlarging Ihydrocele, Iorder Iscrotal
Iultrasound Iand Irefer Ito Iurologist.
Differential IDiagnoses: IEpididymitis, ITesticular Itorsion, Iepididymal Icyst Review
Iquestions:
1. I IA Ipatient Iwho Ihas Ihad Ia Iswollen, Inontender Iscrotum Ifor Ione Iweek Iis Ifound Ito Ihave Ia Imass Iwithin Ithe
Itunica Ivaginalis Ithat Itransilluminates Ireadily. IThe Ifamily Inurse Ipractitioner Isuspects: a.) Ia Ihydrocele.
b.) Ia Ivaricocele.
c.) Ian Iindirect Iinguinal Ihernia.
d.) Icarcinoma Iof Ithe Itestis.
2.) Chronic Kidney failure: (member did not use template, no review questions received-this is all
I I I I I I I I I I I I I I
I got) I
I I
Definition: I IThe Iabsence Iof Ikidney Ifunction. IKidney Ifailure Iis Ialso Iknown Ias IEnd IStage IKidney IDisease. IIt
Iis Icharacterized Iby Ianuria Iand Ithe Ineed Ifor Irenal Ireplacement Itherapy Ior Ikidney Itransplant. IThe Ikidneys
Iand Iurinary Itract Isystem Ino Ilonger Ifilter Iblood, Icreate Ifiltrate. IOr Iexcrete Iurine Iin Iamounts Isufficient Ito
Iclear Iwaste Iand Ibalance Ifluid Iintake Iwith Ioutput. IKey Ihighlights: IProteinuria Ior Ihematuria, Iand I/or Ia
Ireduction Iin Ithe Iglomerular Ifiltration Irate, Ifor Imore Ithan I3 Imonths Iduration. IThe Imost Icommon Icauses
Iare Idiabetes Imellitus Iand Ihypertension. IMost Ipeople Iare Iasymptomatic Iand Ithe Idiagnosis Iis Idetermined
Ionly Iby Ilaboratory Istudies. I
Differential Idiagnosis: Iobstructive Iuropathy, Inephrotic Isyndrome, Iglomerulonephritis
3.) Acute tubular necrosis (member did not use template, no review questions received-this is all I
I I I I I I I I I I I I I I I
got)
I
P a g e 1 | 101
,2
Definition: I I Ireversible Ior Iirreversible Itype Iof Irenal Ifailure Icaused Iby Iischemic Ior Itoxic Iinjury Ito Irenal
Itubular Iepithelial Icells. IThe Iinjury Iresults Iin Icell Ideath Ior Idetachment Ifrom Ithe Ibasement Imembrane
Icausing Itubular Idysfunction.
A Ihistory Iof Ihypotension, Ifluid Idepletion, Ior Iexposure Ito Inephrotic Iagents Iis Iusually Ipresent. IIn Iotherwise
Ihealthy Iindividuals, Iwhen Ithe Iunderlying Iinsult Iis Icorrected, Ithe Ipatient Ifrequently Ihas Ia Igood Ioutcome
Iwith Icomplete Irenal Irecovery. IThere Iis Ino Ispecific Itherapy Ifor Iacute Itubular Inecrosis Iapart Ifrom
Isupportive Icare. I
Differential Idiagnosis I-Prerenal Iazotemia, Iintrinsic Irenal Iazotemia
Treatment IOptions: I IThere Iis Ino Ispecific Itreatment Iapart Ifrom Isupportive Icare Iin Imaintaining Ivolume
Istatus Iand Icontrolling Ielectrolyte Iand Iacid-base Iabnormalities. INephrotoxins Ishould Ibe Iceased Ior Iif Ithis
Iis Inot Ipossible, Idose Ishould Ibe Idecreased.
Review I questions:
A Iclient Ihad Iexcessive Iblood Iloss Iand Iprolonged Ihypotension Iduring Isurgery. IHis Ipostoperative Iurine
Ioutput Iis Isharply Idecreased, Iand Ihis Iblood Iurea Initrogen I(BUN) Iis Ielevated. IThe Imost Ilikely Icause Ifor Ithe
Ichange Iis Iacute:
A) IPrerenal Iinflammation
Bladder Ioutlet Iobstruction
C) ITubular Inecrosis
D) IIntrarenal Inephrotoxicity
Which Iof Ithe Ifollowing Iis Ia Isign Ior Isymptom Iof Iacute Itubular Inecrosis I(acute Ikidney Iinjury)?
answer-Thirst Iand Iincreased Irapid Ipulse symptoms Iof IATN Ican Ivary Idepending Ion Iseverity. Iand
Ione Imay Ihave- Iproblems Iwaking Iup, Ifeeling
Idrowsy Ieven Iduring Iday Itime I, Ifeeling Ilethargic Ior Iphysically Idrained, Ibeing Iexcessively Ithirsty Ior
Iexperiencing Idehydration, Iurinating Ivery Ilittle Ior Ieven Inot Iat Iall, Iretaining Ifluid Ior Iexperiencing Iswelling
Iin Ibody, Ihaving Iepisodes Iof Iconfusion Iand Iexperiencing Inausea Iand Ivomit
4. Indirect inguinal hernia
I I I I
Definition: IIndirect Iinguinal Ihernia I– IIndirect Iinguinal Ihernia Iis Icaused I Iby Ia Ibirth Idefect Iin Ithe Iabdominal
Iwall Ithat Iis Ipresent Iat Ibirth. IA Iscrotal-inguinal Ihernia Iresults Iwhen Ia Isegment Iof Ithe Ibowel Islips Ithrough
Ithe Iinternal Iinguinal Iring, Iwhere Iit Imay Iremain Iin Ithe Iinguinal Icanal Ior Ipass Iinto Ithe Iscrotal Isac. IAn
Iinguinal Ihernia Imay Ioccur Ias Ia Iresult Iof Ia Idefect Iin Ithe Ianterior Iabdominal Iwall Ior Ibecause Iof Ia Ipatent
Iprocess Ivaginalis. IInguinal Ihernias Ipredominantly Iaffect Imen I(9:1) Iand Ihave Ithe Ihighest Iincidence Iin
Imen Iaged I40 Ito I59. IA Ihernia Imay Imove Ifreely Ibetween Ithe Iabdomen Iand Ithe Iscrotum Ior Ican Ibe
Ispontaneously Ireduced Iby Idigital Imanipulation. IWhen Ia Ihernia Ibecomes Istrangulated Ior Iis Iunreducible,
Ithis Icompromises Ithe Iblood Isupply Iand Irequires Iemergent Isurgical Ireduction. IStrangulation Ishould Ibe
Isuspected Iwhen Ia Itender Imass Iis Ipalpated Iin Ithe Iscrotum Iin Iaddition Ito Iredness, Inausea, Iand Ivomiting
Presenting ISymptoms: IScrotal Iswelling, Imild Ito Imoderate Ipain Ion Istraining, Iscrotal Iheaviness, Iand Ithe
Ipossible Ipresence Iof Ia Ibulge Iare Icommon Icomplaints. IIncreased Iedema Iafter Istanding Iin Ian Ierect
Iposition Ibut Idecreases Iwhen Ithe Ipatient Iis Irecumbent. I
3 IDifferential IDiagnoses: Iundescended Itestis, Ilymphadenopathy, Ifemoral Ihernia
Pattern IRecognition: IEnlarged Ihemiscrotum Ior Ia Ibulge Iin Ithe Igroin Iarea Ithat Imay Ispontaneously Ireduce
P a g e 2 | 101
,2
Iwhen Ithe Ipatient Iis Isupine Ior Iwith Imanual Ireduction. IThe Iprovider Iwill Inot Ibe Iable Ito Imove Ithe Ifingers
Iabove Ithe Imass, Iwhich Ishould Ibe Isoft Iand Imushy Ibut Ipainless Iunless Iit Iis Iincarcerated Iand Iischemic.
IScrotal Ihernias Ido Inot Itransilluminate. IAuscultation Iof Ibowel Isounds Iover Ithe Imass Iis Isignificant Ifor Ithe
Idiagnosis Iof Ibowel Iin Ithe Iscrotal Isac.
Treatment Ioptions: IIf Ithe Iherniated Ibowel Iis Ireducible, Isurgical Ireferral Ifor Ipossible Ifuture Irepair Iis
Iindicated. IDifficulty Iin Ireducing Ia Ihernia Iis Icause Ifor Iurgent Isurgical Iintervention. IHowever, Ipain Imay
Iindicate Iincarceration Iof Ithe Ibowel Ior Icomplete Iinability Ito Ireduce Ithe Ihernia, Iwhich Iis Icause Ifor
Iimmediate Iemergency Idepartment Ireferral Iand Isurgical Iexploration. I Review Iquestions:
1. I IMr. IS. Icomes Ito Iyou Iwith Iscrotal Ipain. I IThe Iexaminations Iof Ihis Iscrotum, Ipenis, Iand Irectum Iare Inormal.
IWhich Iof Ithe Ifollowing Iconditions Ioutside Iof Ithe Iscrotum Imay Ipresent Ias Iscrotal Ipain?
A. IInguinal Iherniation Iand Iperitonitis I**
B. IRenal Icolic Iand Icardiac Iischemia
C. IPancreatitis Iand ICrohn I’ Is Idisease
D. IPolyarteritis Inodosa Iand Iulcerative Icolitis
Rationale: I IConditions Ioutside Iof Ithe Iscrotum Ithat Imay Ipresent Iwith Iscrotal Ipain Iare Iabdominal Iaortic
Ianeurysm, Iinguinal Iherniation, Ipancreatitis, Irenal Icolic, Iperitonitis, Iintraperitoneal Ihemorrhage, Iand
Ipolyarteritis Inodosa. IKeep Iin Imind Ithat Iany Iclient Iwith Iscrotal Ipain Ishould Ibe Iconsidered Ito Ihave
Itesticular Itorsion Iuntil Iproved Iotherwise, Iespecially Iin Ithe Iage Igroups Iof Ithe Ineonate Iand Iadolescents.
2. I IThe Imost Icommon Itype Iof Ihernia Iis Ia(n):
A. Iindirect Iinguinal Ihernia. I I**
B. Idirect Iinguinal Ihernia.
C. Ifemoral Ihernia.
D. Iumbilical Ihernia.
Rationale: I IAn Iindirect Iinguinal Ihernia Iis Ithe Imost Icommon Itype Iof Ihernia Iaffecting Iall Iages Iand Iboth
Igenders Iand Iaccounts Ifor I50% Iof Ihernias Itreated. IThe Ipoint Iof Iorigin Iis Iabove Ithe Iinguinal Iligament Iand
Ioften Itravels Iinto Ithe Iscrotum. IA Idirect Iinguinal Ihernia Iis Iless Icommon I(accounts Ifor Iabout I25% Iof
Ihernias Iseen) Iand Iusually Ioccurs Iin Imen Iolder Ithan Iage I40. I IThe Ipoint Iof Iorigin Iis Iabove Ithe Iinguinal
Iligament Iand Irarely Itravels Iinto Ithe Iscrotum. IThe Ifemoral Ihernia Iis Ithe Ileast Icommon I(about I10% Iof
Ihernias Iseen) Iand Ioccurs Imore Ioften Iin Iwomen Ithan Iin Imen. IThe Ipoint Iof Iorigin Iis Ibelow Ithe Iinguinal
Iligament Iand Inever Itravels Iinto Ithe Iscrotum Iin Imen. IAn Iumbilical Ihernia Ioccurs Imore Ifrequently Iin
Iinfants Iand Iis Ia Iprotrusion Iof Ipart Iof Ithe Iintestine Iat Ithe Iumbilicus.
3. I IMax, Iage I70, Iis Iobese. IHe Iis Icomplaining Iof Ia Ibulge Iin Ihis Igroin Ithat Ihas Ibeen Ithere Ifor Imonths. I IHe
Istates Ithat Iit Iis Inot Ipainful, Ibut Iit Iis Iannoying. I IYou Inote Ithat Ithe Iorigin Iof Iswelling Iis Iabove Ithe Iinguinal
Iligament Idirectly Ibehind Iand Ithrough Ithe Iexternal Iring. IYou Idiagnose Ithis Ias Ia(n): A. Iindirect Iinguinal
Ihernia.
B. Idirect Iinguinal Ihernia. I I**
C. Ifemoral Ihernia.
D. Istrangulated Ihernia.
Rationale: I IA Idirect Iinguinal Ihernia Iusually Ioccurs Iin Imiddle-aged Ito Iolder Imen Iand Iis Ithe Iresult Iof Ian
Iacquired Iweakness Icaused Iby Iheavy Ilifting, Iobesity, Ior Ichronic Iobstructive Ipulmonary Idisease I(COPD).
P a g e 3 | 101
, 2
IThe Iorigin Iof Iswelling Iis Iabove Ithe Iinguinal Iligament Idirectly Ibehind Iand Ithrough Ithe Iexternal Iring. IAn
Iindirect Iinguinal Ihernia Iis Icongenital Ior Iacquired Iand Iis Imore Icommon Iin Iinfants Iyounger Ithan I1 Iyear Iof
Iage Iand Iin Imen Iages I16 I– I25. IThe Iorigin Iof Iswelling Iis Iabove Ithe Iinguinal Iligament. IThe Ihernia Isac Ienters
Ithe Icanal Iat Ithe Iinternal Iring Iand Iexits Iat Ithe Iexternal Iring. IA Ifemoral Ihernia, Iwhich Ioccurs Imore
Ifrequently Iin Iwomen, Iis Iacquired Iand Iresults Ifrom Ian Iincrease Iin Iabdominal Ipressure, Ias Iwell Ias Imuscle
Iweakness. IThe Iorigin Iof Iswelling Iis Ibelow Ithe Iinguinal Iligament. IBecause IMax Iis Inot Ihaving Iany Ipain Iand
Ithe Icondition Ihas Ibeen Ithis Iway Ifor Imonths, Iyou Iknow Ithat Ithe Ihernia Iis Inot Istrangulated. IA
Istrangulated Ihernia, Iwhich Irequires Iimmediate Ireferral Ito Ia Isurgeon, Iresults Iin Ino Iblood Isupply Ito Ithe
Iaffected Ibowel Iand Icauses Inausea, Ivomiting, Iand Itenderness.
5. Orchitis
I I
Definition: IOrchitis Iis Ia Isystemic, Iblood-borne Iinfection Ithat Iresults Iin Ian Iacute Iinflammation Iof Ione Ior
Iboth Itesticles. IIt Imay Icoexist Iwith Iinfections Iof Ithe Iprostate Iand Iepididymis; Icauses I– Iviral Iinfection I(ex.
IMumps), IC. Itrachomatis Iand IN. Igonorrhoeae Iin Iadolescents, IE. Icoli I– Imen, Icomplication Iof Isyphilis,
Imycobacterial, Ifungal; Ihydrocele Iand Iscrotal Iwall Ithickening Imay Ibe Iseen Ias Ia Icomplication Iof Imumps
Presenting ISymptoms: IGradual Ionset Iof Iacute Ior Imoderate Ipain, Itesticular Iswelling, Iand Ifever
3 IDifferential IDiagnoses: Iepididymitis, Itesticular Itumor, Ihernia, Itesticular Itorsion
Pattern IRecognition: ITesticular Iedema Imay Ibe Iso Ipronounced Ithat Iit Iis Idifficult Ito Idistinguish Ithe Itestes
Ifrom Ithe Iepididymis. IPalpation Imay Ireveal Iswollen, Ivery Itense Itestes Ithat Iare Ipainful, Iand Ithe Ipatient
Imay Ibe Ifebrile. IInflammation Iof Ithe Itestis Iusually Iinvolves Isystemic Iviral Iinfections I(commonly Imumps)
Iand Iincludes Iunilateral Ior Ibilateral Ierythema, Iedema, Iand Iscrotal Itenderness, Iwhich Ioccurs I4 Ito I7 Idays
Iafter Iinitial Ifever. I
Treatment Ioptions: IAnti-infective Itherapy Iis Irecommended, Iwith Iguidance Iby Ilocal Isensitivity Ireports.
IThe Ifollowing Iantibiotic Iregimens Iare Ieffective Iagainst Ithe Imost Icommon Icauses Iof Iepididymitis:
Isingledose Iceftriaxone Igiven Iintramuscularly I(IM), I250 Ito I500 mg, Iand Idoxycycline, I100 mg Itwice Idaily
Ifor I10
Idays Ifor Imen Iyounger Ithan I35 Iyears; Iin Imen Iolder Ithan I35 Iyears, Ilevofloxacin I(given Iintravenously I[IV] Ior
Iorally I[PO]), I500 Ito I750 mg/day, Ior Iciprofloxacin, I500 mg I(IV Ior IPO), Ifor I10 Ito I14 Idays. IAntipyretics
Ishould Ibe Iused Ito Ireduce Idiscomfort Iand Ifever, Iand Ian Ianti-inflammatory Iagent Ishould Ibe Iprescribed. I
IAn Iantiemetic Ican Ialso Ibe Iprescribed Ifor Inausea Iand Ivomiting. IBed Irest Iand Iscrotal Ielevation Iare Ialso
Irecommended Ifor Iepididymitis. I IHot Ior Icold Icompresses Imay Ibe Ihelpful Ifor Iorchitis.
Review Iquestions:
A I35 Iyear Iold Isexually Iactive Iman Ipresents Iwith Ia I1 Iweek Ihistory Iof Ifever Iand Ipain Iover Ithe Ileft Iscrotum.
IIt Iis Iaccompanied Iby Ifrequency Iand Idysuria. IThe Iscrotum Iis Iedematous Iand Itender Ito Itouch. IHe Idenies
Iflank Ipain, Inausea, Iand Ivomiting. IHe Ireports Ithat Ieh Ipain Iis Ilessend Iwhen Ihe Iuses Iscrotal-support Ibriefs.
IThe Iurinalysis Ishows I2 I+ Iblood Iand Ia Ilarge Inumber Iof Ileukocytes. IWhat Iis Ithe Imost Ilikely Idiagnosis?
A. I IAcute Iurinary Itract Iinfection
B. I IAcute Ipyelonephritis
C. I IAcute Iorthitis
D. I IAcute Iepididymitis I I**
P a g e 4 | 101
NURS I6531 IFinal IExam IStudy IGuide
1.) Hydrocele (member did not use template, no review questions received-this is all I got)
I I I I I I I I I I I I I I
Definition: I Ian Iaccumulation Iof Ifluid Iwithin Ithe Itunica Ivaginalis Isurrounding Ithe Itesticle; Iit Imay Ialso
Iresult Ifrom Ia Ipatent Iprocessus Ivaginalis Iat Ibirth Iand Isometimes Icloses Ispontaneously Iwithin Ithe Ifirst I1
Ito I2 Iyears Iof Ilife. IHydroceles Iare Ithe Imost Icommon Icause Iof Ipainless Iscrotal Iswelling.; Iin Iadults Ithey Iare
Ioften Ithe Iresult Iof Itrauma, Ia Ihernia, Itesticular Itumor, Ior Itorsion Ior Ia Icomplication Iof Iepididymitis. I
Presenting ISymptoms: IUsually Ipainless Iand Imay Ibe Ipresent Ifor Ilong Iperiods, Ipartially Iresolve, Iand Irecur
Ibefore Ithe Ipatient Iseeks Imedical Iattention. IGradual Ienlargement Iof Ithe Iscrotum Ioccurs Iwith Imarked
Iedema, Iwhich Imay Ibe Iuncomfortable Ibecause Iof Ithe Iadded Iweight. IA Ihydrocele Imay Ioccur Isecondary Ito
Ia Itumor Iwhen Iexcess Iserous Ifluid Iaccumulates Iin Ithe Iscrotal Isac. IIt Iwill Itransluminate Ibut Imay Imake
Itesticular Ipalpation Idifficult.
Leik IReview:
Hydrocele Imore Icommon Iin Iinfants. ISerous Ifluid Icollects Iinside Ithe Itunica Ivaginalis. IDuring Iscrotal Iexam,
Ihydroceles Iare Ilocated Isuperiorly Iand Ianterior Ito Ithe Itestes IMost Ihydroceles Iare Iasymptomatic. I Will
Iglow Iwith Itransillumination. IIf Inew-onset Ihydrocele Iin Ian Iadult Ior Ienlarging Ihydrocele, Iorder Iscrotal
Iultrasound Iand Irefer Ito Iurologist.
Differential IDiagnoses: IEpididymitis, ITesticular Itorsion, Iepididymal Icyst Review
Iquestions:
1. I IA Ipatient Iwho Ihas Ihad Ia Iswollen, Inontender Iscrotum Ifor Ione Iweek Iis Ifound Ito Ihave Ia Imass Iwithin Ithe
Itunica Ivaginalis Ithat Itransilluminates Ireadily. IThe Ifamily Inurse Ipractitioner Isuspects: a.) Ia Ihydrocele.
b.) Ia Ivaricocele.
c.) Ian Iindirect Iinguinal Ihernia.
d.) Icarcinoma Iof Ithe Itestis.
2.) Chronic Kidney failure: (member did not use template, no review questions received-this is all
I I I I I I I I I I I I I I
I got) I
I I
Definition: I IThe Iabsence Iof Ikidney Ifunction. IKidney Ifailure Iis Ialso Iknown Ias IEnd IStage IKidney IDisease. IIt
Iis Icharacterized Iby Ianuria Iand Ithe Ineed Ifor Irenal Ireplacement Itherapy Ior Ikidney Itransplant. IThe Ikidneys
Iand Iurinary Itract Isystem Ino Ilonger Ifilter Iblood, Icreate Ifiltrate. IOr Iexcrete Iurine Iin Iamounts Isufficient Ito
Iclear Iwaste Iand Ibalance Ifluid Iintake Iwith Ioutput. IKey Ihighlights: IProteinuria Ior Ihematuria, Iand I/or Ia
Ireduction Iin Ithe Iglomerular Ifiltration Irate, Ifor Imore Ithan I3 Imonths Iduration. IThe Imost Icommon Icauses
Iare Idiabetes Imellitus Iand Ihypertension. IMost Ipeople Iare Iasymptomatic Iand Ithe Idiagnosis Iis Idetermined
Ionly Iby Ilaboratory Istudies. I
Differential Idiagnosis: Iobstructive Iuropathy, Inephrotic Isyndrome, Iglomerulonephritis
3.) Acute tubular necrosis (member did not use template, no review questions received-this is all I
I I I I I I I I I I I I I I I
got)
I
P a g e 1 | 101
,2
Definition: I I Ireversible Ior Iirreversible Itype Iof Irenal Ifailure Icaused Iby Iischemic Ior Itoxic Iinjury Ito Irenal
Itubular Iepithelial Icells. IThe Iinjury Iresults Iin Icell Ideath Ior Idetachment Ifrom Ithe Ibasement Imembrane
Icausing Itubular Idysfunction.
A Ihistory Iof Ihypotension, Ifluid Idepletion, Ior Iexposure Ito Inephrotic Iagents Iis Iusually Ipresent. IIn Iotherwise
Ihealthy Iindividuals, Iwhen Ithe Iunderlying Iinsult Iis Icorrected, Ithe Ipatient Ifrequently Ihas Ia Igood Ioutcome
Iwith Icomplete Irenal Irecovery. IThere Iis Ino Ispecific Itherapy Ifor Iacute Itubular Inecrosis Iapart Ifrom
Isupportive Icare. I
Differential Idiagnosis I-Prerenal Iazotemia, Iintrinsic Irenal Iazotemia
Treatment IOptions: I IThere Iis Ino Ispecific Itreatment Iapart Ifrom Isupportive Icare Iin Imaintaining Ivolume
Istatus Iand Icontrolling Ielectrolyte Iand Iacid-base Iabnormalities. INephrotoxins Ishould Ibe Iceased Ior Iif Ithis
Iis Inot Ipossible, Idose Ishould Ibe Idecreased.
Review I questions:
A Iclient Ihad Iexcessive Iblood Iloss Iand Iprolonged Ihypotension Iduring Isurgery. IHis Ipostoperative Iurine
Ioutput Iis Isharply Idecreased, Iand Ihis Iblood Iurea Initrogen I(BUN) Iis Ielevated. IThe Imost Ilikely Icause Ifor Ithe
Ichange Iis Iacute:
A) IPrerenal Iinflammation
Bladder Ioutlet Iobstruction
C) ITubular Inecrosis
D) IIntrarenal Inephrotoxicity
Which Iof Ithe Ifollowing Iis Ia Isign Ior Isymptom Iof Iacute Itubular Inecrosis I(acute Ikidney Iinjury)?
answer-Thirst Iand Iincreased Irapid Ipulse symptoms Iof IATN Ican Ivary Idepending Ion Iseverity. Iand
Ione Imay Ihave- Iproblems Iwaking Iup, Ifeeling
Idrowsy Ieven Iduring Iday Itime I, Ifeeling Ilethargic Ior Iphysically Idrained, Ibeing Iexcessively Ithirsty Ior
Iexperiencing Idehydration, Iurinating Ivery Ilittle Ior Ieven Inot Iat Iall, Iretaining Ifluid Ior Iexperiencing Iswelling
Iin Ibody, Ihaving Iepisodes Iof Iconfusion Iand Iexperiencing Inausea Iand Ivomit
4. Indirect inguinal hernia
I I I I
Definition: IIndirect Iinguinal Ihernia I– IIndirect Iinguinal Ihernia Iis Icaused I Iby Ia Ibirth Idefect Iin Ithe Iabdominal
Iwall Ithat Iis Ipresent Iat Ibirth. IA Iscrotal-inguinal Ihernia Iresults Iwhen Ia Isegment Iof Ithe Ibowel Islips Ithrough
Ithe Iinternal Iinguinal Iring, Iwhere Iit Imay Iremain Iin Ithe Iinguinal Icanal Ior Ipass Iinto Ithe Iscrotal Isac. IAn
Iinguinal Ihernia Imay Ioccur Ias Ia Iresult Iof Ia Idefect Iin Ithe Ianterior Iabdominal Iwall Ior Ibecause Iof Ia Ipatent
Iprocess Ivaginalis. IInguinal Ihernias Ipredominantly Iaffect Imen I(9:1) Iand Ihave Ithe Ihighest Iincidence Iin
Imen Iaged I40 Ito I59. IA Ihernia Imay Imove Ifreely Ibetween Ithe Iabdomen Iand Ithe Iscrotum Ior Ican Ibe
Ispontaneously Ireduced Iby Idigital Imanipulation. IWhen Ia Ihernia Ibecomes Istrangulated Ior Iis Iunreducible,
Ithis Icompromises Ithe Iblood Isupply Iand Irequires Iemergent Isurgical Ireduction. IStrangulation Ishould Ibe
Isuspected Iwhen Ia Itender Imass Iis Ipalpated Iin Ithe Iscrotum Iin Iaddition Ito Iredness, Inausea, Iand Ivomiting
Presenting ISymptoms: IScrotal Iswelling, Imild Ito Imoderate Ipain Ion Istraining, Iscrotal Iheaviness, Iand Ithe
Ipossible Ipresence Iof Ia Ibulge Iare Icommon Icomplaints. IIncreased Iedema Iafter Istanding Iin Ian Ierect
Iposition Ibut Idecreases Iwhen Ithe Ipatient Iis Irecumbent. I
3 IDifferential IDiagnoses: Iundescended Itestis, Ilymphadenopathy, Ifemoral Ihernia
Pattern IRecognition: IEnlarged Ihemiscrotum Ior Ia Ibulge Iin Ithe Igroin Iarea Ithat Imay Ispontaneously Ireduce
P a g e 2 | 101
,2
Iwhen Ithe Ipatient Iis Isupine Ior Iwith Imanual Ireduction. IThe Iprovider Iwill Inot Ibe Iable Ito Imove Ithe Ifingers
Iabove Ithe Imass, Iwhich Ishould Ibe Isoft Iand Imushy Ibut Ipainless Iunless Iit Iis Iincarcerated Iand Iischemic.
IScrotal Ihernias Ido Inot Itransilluminate. IAuscultation Iof Ibowel Isounds Iover Ithe Imass Iis Isignificant Ifor Ithe
Idiagnosis Iof Ibowel Iin Ithe Iscrotal Isac.
Treatment Ioptions: IIf Ithe Iherniated Ibowel Iis Ireducible, Isurgical Ireferral Ifor Ipossible Ifuture Irepair Iis
Iindicated. IDifficulty Iin Ireducing Ia Ihernia Iis Icause Ifor Iurgent Isurgical Iintervention. IHowever, Ipain Imay
Iindicate Iincarceration Iof Ithe Ibowel Ior Icomplete Iinability Ito Ireduce Ithe Ihernia, Iwhich Iis Icause Ifor
Iimmediate Iemergency Idepartment Ireferral Iand Isurgical Iexploration. I Review Iquestions:
1. I IMr. IS. Icomes Ito Iyou Iwith Iscrotal Ipain. I IThe Iexaminations Iof Ihis Iscrotum, Ipenis, Iand Irectum Iare Inormal.
IWhich Iof Ithe Ifollowing Iconditions Ioutside Iof Ithe Iscrotum Imay Ipresent Ias Iscrotal Ipain?
A. IInguinal Iherniation Iand Iperitonitis I**
B. IRenal Icolic Iand Icardiac Iischemia
C. IPancreatitis Iand ICrohn I’ Is Idisease
D. IPolyarteritis Inodosa Iand Iulcerative Icolitis
Rationale: I IConditions Ioutside Iof Ithe Iscrotum Ithat Imay Ipresent Iwith Iscrotal Ipain Iare Iabdominal Iaortic
Ianeurysm, Iinguinal Iherniation, Ipancreatitis, Irenal Icolic, Iperitonitis, Iintraperitoneal Ihemorrhage, Iand
Ipolyarteritis Inodosa. IKeep Iin Imind Ithat Iany Iclient Iwith Iscrotal Ipain Ishould Ibe Iconsidered Ito Ihave
Itesticular Itorsion Iuntil Iproved Iotherwise, Iespecially Iin Ithe Iage Igroups Iof Ithe Ineonate Iand Iadolescents.
2. I IThe Imost Icommon Itype Iof Ihernia Iis Ia(n):
A. Iindirect Iinguinal Ihernia. I I**
B. Idirect Iinguinal Ihernia.
C. Ifemoral Ihernia.
D. Iumbilical Ihernia.
Rationale: I IAn Iindirect Iinguinal Ihernia Iis Ithe Imost Icommon Itype Iof Ihernia Iaffecting Iall Iages Iand Iboth
Igenders Iand Iaccounts Ifor I50% Iof Ihernias Itreated. IThe Ipoint Iof Iorigin Iis Iabove Ithe Iinguinal Iligament Iand
Ioften Itravels Iinto Ithe Iscrotum. IA Idirect Iinguinal Ihernia Iis Iless Icommon I(accounts Ifor Iabout I25% Iof
Ihernias Iseen) Iand Iusually Ioccurs Iin Imen Iolder Ithan Iage I40. I IThe Ipoint Iof Iorigin Iis Iabove Ithe Iinguinal
Iligament Iand Irarely Itravels Iinto Ithe Iscrotum. IThe Ifemoral Ihernia Iis Ithe Ileast Icommon I(about I10% Iof
Ihernias Iseen) Iand Ioccurs Imore Ioften Iin Iwomen Ithan Iin Imen. IThe Ipoint Iof Iorigin Iis Ibelow Ithe Iinguinal
Iligament Iand Inever Itravels Iinto Ithe Iscrotum Iin Imen. IAn Iumbilical Ihernia Ioccurs Imore Ifrequently Iin
Iinfants Iand Iis Ia Iprotrusion Iof Ipart Iof Ithe Iintestine Iat Ithe Iumbilicus.
3. I IMax, Iage I70, Iis Iobese. IHe Iis Icomplaining Iof Ia Ibulge Iin Ihis Igroin Ithat Ihas Ibeen Ithere Ifor Imonths. I IHe
Istates Ithat Iit Iis Inot Ipainful, Ibut Iit Iis Iannoying. I IYou Inote Ithat Ithe Iorigin Iof Iswelling Iis Iabove Ithe Iinguinal
Iligament Idirectly Ibehind Iand Ithrough Ithe Iexternal Iring. IYou Idiagnose Ithis Ias Ia(n): A. Iindirect Iinguinal
Ihernia.
B. Idirect Iinguinal Ihernia. I I**
C. Ifemoral Ihernia.
D. Istrangulated Ihernia.
Rationale: I IA Idirect Iinguinal Ihernia Iusually Ioccurs Iin Imiddle-aged Ito Iolder Imen Iand Iis Ithe Iresult Iof Ian
Iacquired Iweakness Icaused Iby Iheavy Ilifting, Iobesity, Ior Ichronic Iobstructive Ipulmonary Idisease I(COPD).
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IThe Iorigin Iof Iswelling Iis Iabove Ithe Iinguinal Iligament Idirectly Ibehind Iand Ithrough Ithe Iexternal Iring. IAn
Iindirect Iinguinal Ihernia Iis Icongenital Ior Iacquired Iand Iis Imore Icommon Iin Iinfants Iyounger Ithan I1 Iyear Iof
Iage Iand Iin Imen Iages I16 I– I25. IThe Iorigin Iof Iswelling Iis Iabove Ithe Iinguinal Iligament. IThe Ihernia Isac Ienters
Ithe Icanal Iat Ithe Iinternal Iring Iand Iexits Iat Ithe Iexternal Iring. IA Ifemoral Ihernia, Iwhich Ioccurs Imore
Ifrequently Iin Iwomen, Iis Iacquired Iand Iresults Ifrom Ian Iincrease Iin Iabdominal Ipressure, Ias Iwell Ias Imuscle
Iweakness. IThe Iorigin Iof Iswelling Iis Ibelow Ithe Iinguinal Iligament. IBecause IMax Iis Inot Ihaving Iany Ipain Iand
Ithe Icondition Ihas Ibeen Ithis Iway Ifor Imonths, Iyou Iknow Ithat Ithe Ihernia Iis Inot Istrangulated. IA
Istrangulated Ihernia, Iwhich Irequires Iimmediate Ireferral Ito Ia Isurgeon, Iresults Iin Ino Iblood Isupply Ito Ithe
Iaffected Ibowel Iand Icauses Inausea, Ivomiting, Iand Itenderness.
5. Orchitis
I I
Definition: IOrchitis Iis Ia Isystemic, Iblood-borne Iinfection Ithat Iresults Iin Ian Iacute Iinflammation Iof Ione Ior
Iboth Itesticles. IIt Imay Icoexist Iwith Iinfections Iof Ithe Iprostate Iand Iepididymis; Icauses I– Iviral Iinfection I(ex.
IMumps), IC. Itrachomatis Iand IN. Igonorrhoeae Iin Iadolescents, IE. Icoli I– Imen, Icomplication Iof Isyphilis,
Imycobacterial, Ifungal; Ihydrocele Iand Iscrotal Iwall Ithickening Imay Ibe Iseen Ias Ia Icomplication Iof Imumps
Presenting ISymptoms: IGradual Ionset Iof Iacute Ior Imoderate Ipain, Itesticular Iswelling, Iand Ifever
3 IDifferential IDiagnoses: Iepididymitis, Itesticular Itumor, Ihernia, Itesticular Itorsion
Pattern IRecognition: ITesticular Iedema Imay Ibe Iso Ipronounced Ithat Iit Iis Idifficult Ito Idistinguish Ithe Itestes
Ifrom Ithe Iepididymis. IPalpation Imay Ireveal Iswollen, Ivery Itense Itestes Ithat Iare Ipainful, Iand Ithe Ipatient
Imay Ibe Ifebrile. IInflammation Iof Ithe Itestis Iusually Iinvolves Isystemic Iviral Iinfections I(commonly Imumps)
Iand Iincludes Iunilateral Ior Ibilateral Ierythema, Iedema, Iand Iscrotal Itenderness, Iwhich Ioccurs I4 Ito I7 Idays
Iafter Iinitial Ifever. I
Treatment Ioptions: IAnti-infective Itherapy Iis Irecommended, Iwith Iguidance Iby Ilocal Isensitivity Ireports.
IThe Ifollowing Iantibiotic Iregimens Iare Ieffective Iagainst Ithe Imost Icommon Icauses Iof Iepididymitis:
Isingledose Iceftriaxone Igiven Iintramuscularly I(IM), I250 Ito I500 mg, Iand Idoxycycline, I100 mg Itwice Idaily
Ifor I10
Idays Ifor Imen Iyounger Ithan I35 Iyears; Iin Imen Iolder Ithan I35 Iyears, Ilevofloxacin I(given Iintravenously I[IV] Ior
Iorally I[PO]), I500 Ito I750 mg/day, Ior Iciprofloxacin, I500 mg I(IV Ior IPO), Ifor I10 Ito I14 Idays. IAntipyretics
Ishould Ibe Iused Ito Ireduce Idiscomfort Iand Ifever, Iand Ian Ianti-inflammatory Iagent Ishould Ibe Iprescribed. I
IAn Iantiemetic Ican Ialso Ibe Iprescribed Ifor Inausea Iand Ivomiting. IBed Irest Iand Iscrotal Ielevation Iare Ialso
Irecommended Ifor Iepididymitis. I IHot Ior Icold Icompresses Imay Ibe Ihelpful Ifor Iorchitis.
Review Iquestions:
A I35 Iyear Iold Isexually Iactive Iman Ipresents Iwith Ia I1 Iweek Ihistory Iof Ifever Iand Ipain Iover Ithe Ileft Iscrotum.
IIt Iis Iaccompanied Iby Ifrequency Iand Idysuria. IThe Iscrotum Iis Iedematous Iand Itender Ito Itouch. IHe Idenies
Iflank Ipain, Inausea, Iand Ivomiting. IHe Ireports Ithat Ieh Ipain Iis Ilessend Iwhen Ihe Iuses Iscrotal-support Ibriefs.
IThe Iurinalysis Ishows I2 I+ Iblood Iand Ia Ilarge Inumber Iof Ileukocytes. IWhat Iis Ithe Imost Ilikely Idiagnosis?
A. I IAcute Iurinary Itract Iinfection
B. I IAcute Ipyelonephritis
C. I IAcute Iorthitis
D. I IAcute Iepididymitis I I**
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