Special Operations Forces Medical Handbook

3-85

IV qd (or spectinomycin 2 gm IV q 12 hours) until symptoms improve, followed by Cipro 500 mg po
bid (or Levaquin 500 mg po qd) for 7 more days.
d. If neither fever nor discharge are present, empirically treat for chlamydia: doxycycline 100 mg po bid
for 7-10 days (or Floxin 400 mg po qd for 7-10 days or Levaquin 500 mg po qd for 7-10 days).

Patient Education
General: Use condoms.
Activity: Light duty until swelling has resolved.
Diet: Regular
Medications: Be alert for allergic reactions to some antibiotics. Avoid sun exposure if on doxycycline.
Prevention and Hygiene: The epididymis is susceptible to repeated inflammation, so recommend a
comfortable athletic supporter for all high-impact activities. If symptoms occur on the other side, be suspicious
that the first episode was torsion.

Follow-up Actions
Return evaluation: Follow up in 1 month for reevaluation of the scrotum. Refer patients with progression of
symptoms for exploration and possible orchiectomy if significant abscesses are found.
Evacuation/Consultation Criteria: Evacuation is not usually necessary. If there is a persistent mass in the
scrotum, refer patient for ultrasound. Consult urologist as needed.

Symptom: Memory Loss

LCDR Christopher Jankosky, MC, USN

Introduction: Memory dysfunction is the most common cognitive problem brought to the clinician and is
common in deployed active duty forces. 34% of Persian Gulf veterans indicated in a survey that they had
symptoms of memory problems. Determining the etiology of the symptoms and whether they represent a
life threatening condition can be difcult. Memory loss may occur in isolation, or may be associated with
difculties in attention, concentration, naming, or language. Sorting out these symptoms is very complex.
Head injury is the most common cause of amnesia.

Subjective: Symptoms
Vary widely, including headache, neck pain, weakness, fatigue, delusions, hallucinations, changes in sleep
pattern, and physical/emotional stresses.
Focused History: What is your name? (rare for a patient to forget his own name, and if this occurs it is
unlikely to represent an organic etiology) Have you had this problem before? Have you had any physical or
psychological illnesses in the past? (can suggest diagnosis, or related illnesses; also tests memory) Have
you had any recent head injuries, infections, fevers, medication change, alcohol use, or toxic exposure? (can
explain etiology of symptoms)

Objective: Signs
Using Basic Tools: Perform vital signs assessment, HEENT exam, and a complete neurological exam,
including a Mini-Mental State Examination (MMSE) (see Appendix). Assess memory function in detail. May
have obvious head injury, odor of alcohol, fever. Difculty with immediate recall is generally seen in patients
with confusion or delirium. Test this aspect of memory with the simple test of digit span. A normal individual
should have a digit span of ve or more. Slowly recite to the patient a string of 5 digits, and then immediately
ask them to repeat them to you. Document the longest string that he can correctly repeat. Additional tests
can include counting backwards from 20, or reciting months in reverse order. Normal patients should be able
to perform these tests correctly. A patient with amnesia may have difculty with the learning ability function of
memory. Ask the patient to retain 3 unrelated words for 5-10 minutes, during which you perform other testing.
Although an anxious patient may need prompting to recall one of the three words, most patients should be