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Section 10: Renal and Genitourinary Disorders > Chapter 93: Male Genital Problems > Flashcards

Chapter 93: Male Genital Problems Flashcards

1
Q

Five genitourinary emergencies

A
  • Testicular torsion
  • Fournier’s gangrene
  • Paraphimosis
  • Priapism
  • GU trauma
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2
Q

This is part of the penis that surrounds the urethra

A

Corpus spongiosum

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3
Q

This is part of the penis that forms the shaft and a major erectile bodies

A

Corpus cavernosa

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4
Q

Provide blood supply to penis

A

Internal pudendal artery

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5
Q

The deep membranous layer (Scarpa’s fascia) of the abdominal wall extends into the perineum, where it is referred to as ____

A

The deep membranous layer (Scarpa’s fascia) of the abdominal wall extends into the perineum, where it is referred to as Colles’ fascia, and forms part of the scrotal wall

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6
Q

Beneath the skin of scrotum are the smooth muscle and elastic tissue layers of Dartos’ fascia which is similar to?

A

Beneath the skin are the smooth muscle and elastic tissue layers of Dartos’ fascia, similar to the superficial fatty layer (Camper’s fascia) of the abdominal wall

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7
Q

Each testis is encased in a thick fibrous tunica albuginea except ____

A

Each testis is encased in a thick fibrous tunica albuginea except posterolaterally, where it is in tight apposition with the epididymis

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8
Q

True or False
The enveloping tunica vaginalis covers the anterior and lateral aspects of the testes and attaches to the posterior scrotal wall. Superiorly, the testes are suspended from the spermatic cord; inferiorly, the testis is anchored to the scrotum by the scrotal ligament (gubernaculum)

A

True
The enveloping tunica vaginalis covers the anterior and lateral aspects of the testes and attaches to the posterior scrotal wall. Superiorly, the testes are suspended from the spermatic cord; inferiorly, the testis is anchored to the scrotum by the scrotal ligament (gubernaculum)

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9
Q

True or False

The prostate originates from the urogenital sinus at approximately the fifth month of embryonic life

A

False

The prostate originates from the urogenital sinus at approximately the third month of embryonic life

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10
Q

Ultrasound findings of scrotal edema

A
  • Easily compressible thickened scrotal wall
  • Increased peritesticular blood floow
  • Reactive hydrocele
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11
Q

Major risk factor for Fournier’s gangrene

A

Diabetes and alcohol abuse

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12
Q

Most important predictors of death in Fournier’s gangrene?

A

Age over 60 and complications during treatment

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13
Q

The scrotal ultrasound of patient showed scrotal wall thickening, and “dirty shadowing,” suggesting air in the tissue. What is your diagnosis?

A

Fournier’s gangrene

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14
Q

Inflammation of the glans and the foreskin that primarily caused by inadequate hygiene or external irritation

A

Balanoposthitis

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15
Q

True or False

Balanoposthitis can be the sole presenting sign of diabetes

A

True

Balanoposthitis can be the sole presenting sign of diabetes

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16
Q

Anaerobic medication for balanoposthitis

A
  • Oral clindamycin, 300 milligrams three times per day for 7 days
  • Metronidazole, 500 milligrams two times per day for 7 days
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17
Q

Inability to retract the foreskin proximally and posterior to the glans penis

A

Phimosis

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18
Q

Curative for phimosis

A

Circumcision

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19
Q

Non surgical approach for phimosis

A

Topical steroid treatment (such as betamethasone, 0.05% to 0.10% twice daily) applied from the tip of the foreskin to the glandis corona for 1 to 2 months

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20
Q

A true urologic emergency, is the inability to reduce the proximal edematous foreskin distally over the glans penis into its natural position

A

Paraphimosis

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21
Q

Reduction method in paraphimosis

A

Tightly wrapping the glans with a 2-inch elastic bandage for 5 minutes will reduce edema

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22
Q

The most common cause of fracture of the penis?

A

Sexual intercourse

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23
Q

True or False

Surgery with fracture of the penis within 8 hours is recommended to minimize dysfunction

A

True

Surgery with fracture of the penis within 8 hours is recommended to minimize dysfunction

24
Q

Fibrotic disorder of the tunica albuginea

A

Peyronie’s disease

25
Q

True or False

Adult with priapism is related to hematologic disorder and in children are pharmacologic related

A

False

Adult priapism are pharmacologic related and children in hematologic disorder

26
Q

Classification of priapism

A
  • Ischemic priapism (veno-occlusive, low- flow)

- Nonischemic priapism (arterial, high-flow)

27
Q

A recurrent subset of ischemic priapism

A

Stuttering priapism

28
Q

How to differentiate nonischemic from ischemic priapism

A

Blood gas analysis of the first corporal aspirate

29
Q

True or False
Ischemic (low-flow) priapism is more common, is usually quite painful, and is characterized by the aspiration of dark acidic intracavernosal blood from the corpus cavernosum

A 
True
Ischemic (low-flow) priapism is more common, is usually quite painful, and is characterized by the aspiration of dark acidic intracavernosal blood from the corpus cavernosum
30
Q

Primary treatment methods for persistent priapism

A
  • Corporal aspiration
  • Irrigation
  • α-adrenergic agonist (i.e., phen- ylephrine) injection
31
Q

May yield detumescence when narcotic medication fails to resolve priapism

A

Ketamine, 0.5 milligram/kg per dose for up to four doses

32
Q

True or False
Testicular torsion presents in a bimodal age distribution, with extravaginal torsion occurring in the perinatal period and intravaginal torsion peaking during puberty

A

True
Testicular torsion presents in a bimodal age distribution, with extravaginal torsion occurring in the perinatal period and intravaginal torsion peaking during puberty

33
Q

What symptoms other than lower abdominal quadrant pain and scrotal pain makes the diagnosis of testicular torsion more likely?

A

Vomiting

34
Q

Examination of testicular torsion

A

When examined early, the involved testis is firm, tender, and often higher than the contralateral testis and frequently with a transverse lie

35
Q

True or False

The most sensitive finding in excluding testicular torsion is the unilateral presence of the cremasteric reflex

A

True

The most sensitive finding in excluding testicular torsion is the unilateral presence of the cremasteric reflex

36
Q

Sign that relief of pain with elevation of the affected testicle

A

Prehn’s sign which is positive for epididymitis

37
Q

How the detorsion done?

A

Detorsion initially should be done in a medial to lateral motion

38
Q

True or False
If one were to stand at the patient’s feet, the patient’s right testis would be rotated in a counterclockwise fashion and the patient’s left testis in a clockwise fashion

A

True
If one were to stand at the patient’s feet, the patient’s right testis would be rotated in a counterclockwise fashion and the patient’s left testis in a clockwise fashion

39
Q

Initial detorsion is how many degrees?

A

The initial attempt should include one and one-half rotations (540 degrees)

40
Q

What are the four testicular appendages?

A
  • Appendix testis
  • Appendix epididymis
  • Paradidymis (organ of Giraldes)
  • Vas aberrans
41
Q

Symptoms of testicular and appendages torsion are the same except?

A

in appendages torsion do not have systemic symptoms like nausea and vomiting

42
Q

Pathognomonic for torsion of the appendix testis

A

Blue spot may be observed through the scrotal skin—the “blue dot sign.”

43
Q

Management of appendages torsion?

A

Analgesics, bed rest, supportive underwear, and reassurance, with the expected symptom resolution within 3 to 5 days

44
Q

Most common cause of epididymitis?

A

Infection, sexually active men should be treated with Gonorrhea and Chlamydia

45
Q

In older men the causative agent of epididymitis is?

A

E. coli and Klebsielka

46
Q

In elder men the causative agent of epididymitis is?

A

If with epididymitis and UTI consider BPH

47
Q

Although the 2015 Centers for Disease Control and Prevention recommendations direct the coverage of sexually transmit- ted infections based on an age cut-point of ____

A

Although the 2015 Centers for Disease Control and Prevention recommendations direct the coverage of sexually transmit- ted infections based on an age cut-point of 35 years

48
Q

Treatment for acute epididymis most likely caused by sexually transmitted chlamydia or gonorrhea

A
  • Ceftriaxone 250 milligrams IM single dose, plus doxycycline 100 milligrams PO twice a day for 10 d
49
Q

Treatment for acute epididymitis most likely caused by enteric organisms

A
  • Levofloxacin 500 milligrams PO every day for 10 d

- Ofloxacin 300 milligrams PO twice a day for 10 d

50
Q

This is associated with systemic infection such as mumps or other viral illneses

A

Orchitis

51
Q

True or False
Mumps orchitis presents with unilateral involvement in 70% of cases, followed by contralateral involvement in 1 to 9 days

A

True
Mumps orchitis presents with unilateral involvement in 70% of cases, followed by contralateral involvement in 1 to 9 days

52
Q

True or False

Viral orchitis is almost always associated with epididymitis

A

False

Bacterial orchitis is almost always associated with epididymitis

53
Q

Hallmark of testicular carcinoma

A

The hallmark of testicular carcinoma is an asymptomatic testicular mass with firmness or induration

54
Q

Most common etiologic cause of acute prostatitis

A

E. coli

55
Q

Initial treatment for acute prostatitis

A

Ciprofloxacin, 500 milligrams orally twice daily for 14 days

56
Q

Multidrug resistant management for acute prostatitis

A

Fosfomycin 3 grams daily for 7 days followed by 3 grams every 48 hours for 6 weeks

Section 10: Renal and Genitourinary Disorders (8 decks)

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