Another potential cause of acute testicular pain involves vestigial structures that you may remember in the deepest recesses of you medschool brain. Appendix testis Derived from the Müllerian system They are paired embryonic structures that eventually regress in males and form the Fallopian tubes, uterus, cervix and upper third of the vagina in girls. Appendix epididymis Derived [...]
It should be no surprise that acute testicular torsion is a surgical emergency. The testicle twists on the spermatic cord which leads to the following sequence: Venous compression Edema of testicle and cord Arterial occlusion Ischemic testicle The risk 1/4000 for males < age 25. There is a bimodal distribution, with rates peaking in the neonatal period and again during [...]
This is the beginning of a new series - the focus will be limited to the 50% of the population - but, in reading the theme I think you'll understand why we left the girls out. The first post will focus on how to do an effective H&P focused on acute testicular and scrotal pain. History First and foremost you'll want [...]
I was recently thinking about the number of facilities that refer patients to our ED in good ole Cincinnati, OH and I realized that the number is quite large. I also wanted to understand better their locations as it relates to transit time for patients coming to the ED. So I made a custom Google Map, which I embedded below. [...]
A school age child presents with a lesion on their cheek that has been oozing blood for the past several hours. The parents noted a small red bump several weeks prior to presentation, but he says that it just started bleeding in class. The school officials were freaked out and called an ambulance - mom and dad meet you in [...]
The case An infant presents with swelling of the ankle after being picked up from the babysitter. He has been able to pull to stand and cruise for a while now, but appears to be in pain when he attempts to bear weight after he pulls up to stand. X-Rays reveal the following. Diagnosis This is a metaphyseal corner fracture. [...]
It's no secret that youngsters like Instagram. For the unfamiliar, it is an "online mobile photo-sharing, video-sharing and social networking service that enables its users to take pictures and videos." The Division or Radiology at Cincinnati Children's Hospital Medical Center has set up an education-focused Instagram page with a plethora of great images and cases. Add it to the list [...]
Did you know that hospital waste an incredible number of IV fluid bags every year? One of the most significant occurrences of the aforementioned waste is in DKA, where frequent changes to the dextrose concentration are needed as the acidosis is corrected with an insulin infusion. Instead of changing to a new bag each time you want to alter the [...]
There are many demands in the emergency department, some of which come from patients and their families. This post in the Art of Medicine series looks at those situations in which patients/parents are requesting - nay demanding specific tests. As I noted in a previous post in this series the ED is an emotionally charged environment. Often parents are seeking an answer as [...]
Geographic tongue is a common oral finding. It is AKA benign migratory glossitis and is seen in up to 1/30 of the human population. Females have it twice as often as males. It is thought that inheritance is polygenic. There is a slightly increased risk if the patient has psoriasis. Most are asymptomatic - though it may cause mild sensitivity to spicy foods. [...]
