Test your knowledge on...
Some of the clinical statements below are true, and some are not. Can you distinguish the facts from the fibs on acute onset scrotal pain, lactose intolerance and high-grade PIN. If you’d like to do another quiz, try your hand at The PE Clinical Knowledge Contest on page 27. You could win.
1. In acute onset scrotal pain
True / False
a) Testicular torsion is the most common cause in adults.
b) Testicular torsion is the most common cause in children.
c) Prehn’s sign — pain relieved by lifting scrotum — is generally reliable in distinguishing torsion from epididymitis.
d) Cremasteric reflex — side of scrotum contracts when ipsilateral inner thigh is stroked — is generally reliable in distinguishing torsion from epididymitis.
e) Doppler ultrasound can almost always definitively distinguish the two conditions.
f) Testicular torsion occurs more frequently in winter.
g) If treatment of torsion is delayed more than 12 hours, most affected testicles are lost.
h) Most cases of torsion occur during teenage years.
i) Most cases of epididymitis are caused by Neisseria gonorrheae.
j) Fluouroquinolones are not recommended in epididymitis because of N. gonorrheae resistance.
2. In lactose intolerance
True / False
a) Humans are unusual among mammals in that so many adult humans can tolerate lactose.
b) The condition may also be referred to as hyperlactasia.
c) Drinking lactose-free milk can distinguish lactose intolerance from milk allergy.
d) The hydrogen breath test can generally identify lactose-intolerant patients in a few minutes.
e) Infants can’t perform the breath test and generally require endoscopic intestinal biopsy.
f) Enzymatic lactase supplements are ideally taken before ingesting lactose, but not on an empty stomach.
g) Globally, lactose intolerance becomes more frequent as one travels north.
3. In high-grade prostatic intraepithelial neoplasia (PIN)
True / False
a) The chance of finding prostate cancer on a biopsy of a man with previous history of high-grade PIN diagnosis has historically been about 30%.
b) PIN is most commonly diagnosed by fine needle aspiration.
c) MRI is another common tool.
d) There is such a thing as low-grade PIN, but it’s not mentioned in pathology reports.
e) Low-grade PIN is not a risk factor for prostate cancer.
f) A combination of vitamin E, selenium, and soy has been shown to prevent progression from PIN to cancer.
1. In acute onset scrotal pain: a) False, epididymitis is a more frequent cause; b) True; c) False, test is nonspecific; d) True; e) True; f) True, due to rapid scrotal contraction on exposure to Cold; g) True; h) True, about 65%; i) False, N. gonorrheae is the second most common pathogen, Chlamydia trachomatis causes about two-thirds of cases; j) True.
2. In lactose intolerance: a) True; b) False, it’s hypolactasia; c) True; d) False, it takes 2-3 hours; e) False, they require stool acidity test; f) True; g) False, it becomes more frequent as one travels south.
3. In high-grade prostatic intraepithelial neoplasia (PIN): a) True; b) False, by biopsy and microscopic examination; c) False; d) True; e) True; f) False, it’s been tested and had no effect.
We'll send you $100 if we print your diagnostic challenge. Send case description (app. 450 words) with final diagnosis and outcome to: parkex@parkpub.com.
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