Acute Epididymo-Orchitis

ACUTE EPIDIDYMO-ORCHITIS

Q. 1

A 27 year old man develops bilateral parotid gland swelling and orchitis, and is generally ill with fever of 102° F. Which of the following substances is most likely to be significantly elevated in the patient’s serum?

 A

Alanine aminotransferase (ALT)

 B

Amylase

 C

Aspartate aminotransferase (AST)

 D

Ceruloplasmin

Q. 1

A 27 year old man develops bilateral parotid gland swelling and orchitis, and is generally ill with fever of 102° F. Which of the following substances is most likely to be significantly elevated in the patient’s serum?

 A

Alanine aminotransferase (ALT)

 B

Amylase

 C

Aspartate aminotransferase (AST)

 D

Ceruloplasmin

Ans. B

Explanation:

The disease is mumps, caused by a paramyxovirus.
In children, mumps causes a transient inflammation of the parotid glands, and less commonly, the testes, pancreas, or central nervous system.
Mumps tends to be a more severe disease in adults than in children.
Mumps in adults involves the testes (causing orchitis) and pancreas with some frequency.
Pancreatic involvement can cause elevation of serum amylase..
ALT and AST  are markers for hepatocellular damage. Ceruloplasmin  is a copper-carrying protein that is decreased in Wilson’s disease.
 
Ref:  Ray C.G., Ryan K.J. (2010). Chapter 10. Mumps Virus, Measles, Rubella, and Other Childhood Exanthems. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.

Q. 2

A sexually active 25-year-old man develops epididymitis and orchitis. Needle biopsy demonstrates a prominent leukocytic infiltrate with numerous neutrophils. Which of the following organisms is the most likely cause of this man’s infection?

 A

Escherichia coli

 B

Mycobacterium tuberculosis

 C

Neisseria gonorrhoeae

 D

Pseudomonas sp

Q. 2

A sexually active 25-year-old man develops epididymitis and orchitis. Needle biopsy demonstrates a prominent leukocytic infiltrate with numerous neutrophils. Which of the following organisms is the most likely cause of this man’s infection?

 A

Escherichia coli

 B

Mycobacterium tuberculosis

 C

Neisseria gonorrhoeae

 D

Pseudomonas sp

Ans. C

Explanation:

Acute epididymitis and orchitis with prominent neutrophils in a sexually active male are most likely due to infection with Neisseria gonorrhoeae or Chlamydia trachomatis.
N. gonorrhoeae can produce a nonspecific pattern of acute inflammation (nonspecific epididymitis and orchitis) or can be sufficiently severe as to cause frank abscesses within the epididymis.
Escherichia coli is an important cause of nonspecific epididymitis and orchitis in children with congenital genitourinary abnormalities and in older men.
Mycobacterium tuberculosis can cause tuberculosis of the epididymis and testes, characterized by granuloma formation.
Pseudomonas sp. has been implicated as an important cause of nonspecific epididymitis and orchitis in older men.
 
Ref: Levinson W. (2012). Part IX. Brief Summaries of Medically Important Organisms. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.

Q. 3

Orchitis without epididymitis is seen in ‑

 A

Gonorrhoea

 B

Tuberculosis

 C

Syphilis

 D

Chlamydia infection

Q. 3

Orchitis without epididymitis is seen in ‑

 A

Gonorrhoea

 B

Tuberculosis

 C

Syphilis

 D

Chlamydia infection

Ans. C

Explanation:

Ans. is ‘c’ i.e., Syphilis 


Q. 4

In differential diagnosis of epididymo-orchitis & torsion it is important that –

 A

Elevation of testis in torson relieves pain

 B

Elevation of testis in epididymo orchitis relieves pain

 C

Tenderness is characteristic of torsion of testis

 D

Fever is characteristic of epididymo orchitis

Q. 4

In differential diagnosis of epididymo-orchitis & torsion it is important that –

 A

Elevation of testis in torson relieves pain

 B

Elevation of testis in epididymo orchitis relieves pain

 C

Tenderness is characteristic of torsion of testis

 D

Fever is characteristic of epididymo orchitis

Ans. B

Explanation:

Ans. ‘b’ Elevation of testis in epididymo orchitis relieves pain 


Q. 5

Which of the following causes orchitis without epididymitis:  

March 2009

 A

Syphilis

 B

TB

 C

Gonorrhoea

 D

Chlamvdia trachomatis

Q. 5

Which of the following causes orchitis without epididymitis:  

March 2009

 A

Syphilis

 B

TB

 C

Gonorrhoea

 D

Chlamvdia trachomatis

Ans. A

Explanation:

Ans. A: Syphilis

In most cases of acute orchitis, the testicle is inflamed due to the spread of a bacterial infection from the epididymis, and therefore “epididymo-orchitits” is the correct term.

Acute epididymo-orchitis is usually a primary bacterial or rarely a tuberculous infection of the epididymis that has spread to the testicle to involve both structures.

Rarely, it can start in the testicle and spread to the epididymis.

Chlamydia trachomatis is the most common cause of sexually transmitted disease causing acute epididymitis, though gonococcal is still prevalent.

TB epididymitis should be considered when the vas is thickened and there is little response to the ususal antibiotics. Acute epididymo-orchitits develops in about 18% of males suffering from mumps, usually as the parotid swelling is waning. Orchitis may be seen in syphilis and leprosy


Q. 6

A 27 year old man develops bilateral swelling of this part markedd with arrow and orchitis, and is generally ill with fever of 102° F. Which of the following substances is most likely to be significantly elevated in the patient’s serum

 A

Alanine aminotransferase (ALT)

 B

Amylase

 C

Aspartate aminotransferase (AST)

 D

Ceruloplasmin


Q. 6

A 27 year old man develops bilateral swelling of this part markedd with arrow and orchitis, and is generally ill with fever of 102° F. Which of the following substances is most likely to be significantly elevated in the patient’s serum

 A

Alanine aminotransferase (ALT)

 B

Amylase

 C

Aspartate aminotransferase (AST)

 D

Ceruloplasmin


Ans. B

Explanation:

this structure is Parotid gland

The disease is mumps, caused by a paramyxovirus.
In children, mumps causes a transient inflammation of the parotid glands, and less commonly, the testes, pancreas, or central nervous system.
Mumps tends to be a more severe disease in adults than in children.
Mumps in adults involves the testes (causing orchitis) and pancreas with some frequency.


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