4.4 Flashcards
most common metastases of colon cancer
liver
most common metastases of rectal cancer
lungs
ACS recommendations for colorectal cancer screening
colonoscopy at 45 for average risk
For IBD - 8 years after diagnosis
teens for genetic stuff
most common malignancy of the urinary system
bladder cancer
most common type of bladder cancer
urothelial (transitional cell) carcinoma
common metastases for bladder cancer
lymph nodes
lungs
liver
bone
2 types of lesions that can cause bladder cancer
flat lesions
papillary lesions
gold standard of diagnosis for bladder cancer
cystoscopy with biopsy
most common type of colorectal cancer
adenocarcinoma arising from adenomatous polyp
what ethnic group has the highest rates of CRC
African Americans
genetic mutation of the APC gene
familial adenomatous polyposis
What hereditary syndrome increases risk of CRC and endometrial cancer
Lynch syndrome (hereditary nonpolyposis colorectal cancer)
hereditary syndrome that increases risk of CRC and is associated with hamartomatous polyps and mucocuteanous hyperpigmentation
Peutz-Jehgers syndrome
most common clinical manifestations of CRC on the right
chronic occult bleeding (iron deficiency anemia + positive Guaiac)
diarrhea
most common clinical manifestations of CRC on the left
bowel obstruction
changes in stool diameter
change in bowel habits
most common cancer in men after skin cancer
prostate cancer
most common type of prostate cancer
adenocarcinoma
risk factors for prostate CA
increasing age (> 40) – strongest risk factor
genetics
Black race
Western diet
Fhx
Clinical manifestations of prostate CA
most are asymptomatic
urethral obstruction –> urinary frequency, urgency, retention, decreased stream, hematuria
back or bone pain (associated with METS)
DRE for prostate CA
hard, indurated, nodular, enlarged asymmetrical prostate
what general value of PSA indicates greater probability of prostate CA
> 4 ng/mL
most accurate test for prostate CA
transrectal US-guided needle biopsy
when is a bone scan indicated to rule out METS in prostate CA
if PSA > 10 ng/dL
what determines the aggressiveness or malignant potential of prostate CA – higher grade suggests more benefit from surgical removal
Gleason grading system – higher grade suggests more benefit from surgical removal
herniation of the rectum
rectocele
common cause of rectocele
damage to levator ani muscle
in what zones does prostate hyperplasia occur in BPH
periurethral or transitional zones
hyperplasia is part of the normal aging process and is hormonally dependent on
DHT
irritative (storage) symptoms of BPH
urinary frequency
urgency
nocturia
incontinence
obstructive symptoms of BPH
hesitancy, weak, slow, splitting or intermittent stream force
incomplete emptying
terminal dribbling
straining to void
BPH findings on DRE
uniformly (symmetrically) enlarged, smooth, form, contender, rubbery prostate
from what type of cells do carcinoid tumors arise
enterochromaffin cells
carcinoid syndrome
diarrhea
flushing
tachycardia
bronchoconstriction
where do most carcinoid tumors occur
GI tract
prostate gland inflammation secondary to an ascending infection
prostatitis
most common cause of prostatitis > 35 years
E. coli
Proteus
most common cause of prostatitis < 35 years
chlamydia and gonorrhea
most common cause of prostatitis in children
mumps (viral)
Clinical manifestations in prostatitis
irritative voiding symptoms
obstructive symptoms
clinical manifestations in ACUTE prostatitis
spiking fever
chills
perineal pain
clinical manifestations in CHRONIC prostatitis
recurrent UTIs or intermittent dysfunction
fever not common
PE for ACUTE prostatitis
boggy and exquisitely tender
PE for CHRONIC prostatitis
boddy and nontender
urinalysis and urine culture in acute prostatitis
pyuria and bacteriuria
often negative in chronic
what should you avoid in acute prostatitis
prostatic massage
- you can do this in chronic bc usually negative for bacteria
Why should you avoid prostatic massage in prostatitis
could cause bacteremia
how should you treat refractory chronic prostatitis
transurethral resection of the prostate
From what vein do internal hemorrhoids originate from
superior hemorrhoid vein
where are internal hemorrhoids located in terms of the dentate line
proximal to the dentate line (above the dentate line)
clinical manifestations of internal hemorrhoids
intermittent rectal bleeding
PAINLESS
most common renal cell carcinoma
clear cell
risk factors for renal cell carcinoma
smoking
HTN
obesity
men
dialysis
classic triad of renal cell carcinoma
hematuria
flank or abdominal pain
palpable abdominal or flank mass
other common finding in renal cell carcinoma
left-sided varicocele
METS for renal cell carcinoma
cannon ball metastases to the lungs
initial test for diagnosis of renal cell carcinoma
CT scan
epididymal cyst that contains sperm
spermatocele
when is an epididymal cyst considered a spermatocele
if > 2 cm
are spermatoceles painful
no
does spermatocele transilluminate
yes
treatment for spermatocele
none
most common cause of painless scrotal swelling
hydrocele
two different type of hydrocele
communicating versus noncommunicating
is hydrocele painful
no
does hydrocele transilluminate
yes
initial test of choice for spermatocele and hydrocele
testicular US
management of hydrocele
no management; watchful waiting
cystic testicular mass of varicose veins
varicocele
what is the most common surgically correctable cause of male fertility
varicocele
on what side are most varicoceles
on the left
what does varicocele feel like
bag of worms
when does dilation worsen with varicocele
when patient is upright or with valsalva
initial test of choice for varicocele
testicular US
will varicocele transilluminate
no
right sided varicocele may be due to
retroperitoneal or abdominal malignancy
left sided varicocele may be due to
renal cell carcinoma
most common cause of erectile dysfunction
vascular (DM, atherosclerosis)
abrupt onset in erectile dysfunction indicates
psychological cause
gradual onset in erectile dysfunction indicates
systemic cause
first line therapy for erectile dysfunction
PDE5 inhibitors
spermatic cord twists and cuts off testicular blood supply
testicular torsion
what age groups are at the highest risk for testicular torsion
adolescents (10-20 years), neonates
pathophysiology of testicular torsion
insufficient fixation of the testes to the tunica vaginalis
name of the deformity in testicular torsion
bell-clapper deformity
clinical manifestations of testicular torsion
abrupt onset of moderate to severe scrotal, inguinal, or lower abdominal pain
when should you def suspect torsion
if nausea or vomiting are present
what will you see on PE for testicular torsion
swollen, tender, retracted (high-riding) testicule
prehn sign for testicular torsion
NEGATIVE –> holding it up doesn’t help
cremesteric reflex for testicular torsion
NEGATIVE
definitive diagnosis for testicular torsion
emergency surgical exploration
most commonly used imaging modality for testicular torsion
testicular US
management of testicular torsion
surgical exploration with urgent detorsion and orchiopexy (fixation of the testes)
within how many hours should testicular torsion be treated
Within 6 hours
most common solid tumor in young men
testicular cancer
average range of men with testicular cancer
15-35 (average = 32)
what is one of the most curable cancers
testicular cancer
most significant risk factor for testicular cancer
cryptorchidism
most common type of tumor in testicular cancer
germinal cell tumor
REMEMBER TO WRITE YOUR OWN LI ON TESTICULAR CANCER AND COME BACK TO THIS
:)
most common type of penile cancer
squamous cell carcinoma
what is penile cancer commonly associated with
HPV 16, 18, smoking, lack of circumcision, HIV
disease with leukoplakia on the shaft and penis or scrotum and some progress to squamous cell carcinoma of the penis
Bowen’s disease
most common cause of epididymitis in males 14-35
chlamydia trachomatis (mc) and neisseria gonorrhoeae
most common cause of epididymitis in males > 35
e coli
clinical manifestations of epididymitis
gradual onset (over a few hours to days) of localized testicular pain and swelling
prehn sign in epididymitis
POSITIVE –> lifting it up relieves pain
cremasteric reflex in epididymitis
POSITIVE (elevation of the testicule after stroking the inner thigh)
most common cause of orchitis
viral – mumps
keep in mind that epididymitis is usually bacterial while this is viral
what is spared in orchitis
the epididymis
management of orchitis
symptomatic – bc this is a viral illness
type of inguinal hernia with bowel protrusion at the internal inguinal ring
indirect inguinal hernia
origin of the sac in indirect hernia
lateral to the inferior epigastric artery
most common type of hernia in both sexes, young children, and young adults
indirect inguinal hernia
pathophysiology of indirect hernia
due to a persistent patent processus vaginalis
clinical manifestations of incarcerated indirect hernia
painful, enlargement of an irreducible hernia
same for direct
clinical manifestations of strangulated indirect hernia
ischemic incarcerated hernias with systemic toxicity
may refrain from defecation due to increased pain
same for direct
origin of the sac in direct inguinal hernia
medial to the inferior epigastric artery within Hesselbach’s triangle
Hesselbach’s triangle
RIP
Rectus abdominis muscle
Inferior epigastric artery
Poupart ligament (inguinal ligament)
pathophysiology of direct inguinal hernia
result of weakness in the floor of the inguinal canal
urge incontinence is due to
detrusor muscle overactivity
urge incontinence is also called
overactive bladder
overflow urinary incontinence is caused by
bladder detrusor muscle underactivity or bladder outlet obstruction (BPH for example)
what type of incontinence would people with BPH likely experience
overflow incontinence
do people with overflow incontinence get an “urge” before they urinate
no– they just do it
diagnosis of overflow incontinence
post void residual > 200 mL
stress incontinence is due to
increased abdominal pressure
what type of incontinence do I have ):
stress incontinence
what is hydronephrosis
urinary tract obstruction –> dilation of the collecting system in one or both kidneys
enlargement of glandular breast tissue and adipose tissue in males due to increased effective estrogen or decreased androgens
gynecomastia
first line med for gynecomastia if med is indicated
tamoxifen
prolonged painful erection without sexual stimulation
priapism
decreased VENOUS outflow
ischemic priapism
increased ARTERIAL flow
nonischemic priapism
most common type of priapism
ischemic
nonischemic priapism is primarily associated with
trauma
is ischemic priapism painful
YES
is nonischemic priapism painful
NO
most common testicular cancer in young boys 10 or younger
yolk sac nonseminomas germinal cell
which testicular cancer type has the worst prognosis
choriocarcinoma nonseminomas germinal cell
nonseminomas germinal cell tumors are associated with
increased serum alpha fetoprotein and beta-hCG and resistance to radiation
the 4 S’s of seminomas
Simple - lacks tumor maker alpha-fetoprotein
Sensitive - sensitive to radiation
Slower growing
Stepwise spread
Most common non-germinal cell tumors for testicular cancer
leydig cell tumors
Sertoli cell tumors
both may be benign and both may secrete hormones
