ClinMed Flashcards
are testicular self exams recommended?
no
what are the CDC recommendations re: the HPV vaccine for males
males through 21 years
males 22-26 yo is individual basis
what is the recommendation for HPV vaccine for men with HIV or other immunocompromised condition?
through 26 years, 3 doses
same for men who have sex with men
what positions should the patient be in for hernia examination
standing then supine
what position should the patient be in for inguinal lymphatics
standing
cremasteric reflex evaluates what nerve
genitofemoral nerve (L1-L2)
normal cremasteric reflex will be
elevation of scrotum and testes
what position should the patient be in for rectum and prostrate exams?
left lateral decubitus or upright forward flexion
are screening DREs recommended?
nope
what are two congenital penile abnormalities?
hypospadias
cryptorchidism
risk of cryptorchidism puts the patient at increased risk for what two conditions?
testicular cancer
infertility
when is surgical intervention recommended for cryptorchidism?
as soon as possible after 6 months and definitely before 2 years old
what is hypospadias?
when is surgery recommended?
abnormal placement of the urethra.
surgery before 18 months
the most common cause of painless scrotal swelling
hydrocele
what will occur on PEx in a patient with hydrocele?
transillumination
where is the fluid in a hydrocele?
within the parietal and visceral layers of the tunica vaginalis
which type of hydrocele is more common in pediatrics?
communication (patent processus vaginalis)
bag of worms refers to
variocele
what is a variocele?
abnormal dilation of the veins of the pampiniform plexus
the most common cause of primary infertility in men
varicocele
what should always be on your differential for someone presenting with testicular pain?
testicular torsion
what side is the most common side for varicocele?
left side
a painless, cystic mass in the head of the epididymus that’s separate from the testicle and may contain sperm is often
spermatocele
most sensitive PEx finding for testicular torsion
absent cremasteric reflex
how quickly does detorsion of testicular torsion need to occur
6-8 hours
most common age group for testicular torsion?
10-20
clinical manifestation for testicular torsion
abrupt onset of scrotal, inguinal, lower abdominal pain and N/V often after trauma or workout
what is the best initial test for diagnosis of testicular torsion?
doppler US
what is the treatment for testicular torsion?
bilateral orchiopexy
pain that improves with scrotal elevation, think
epididymitis
milking urethra is often seen in what STI
chlamydia
if a patient has non-specific urethritis, what STI is assumed?
chlamydia
what are the two options for testing for GC and chlamydia
urethra swab procedure and urine
a single, painless chancre or papule is associated with what STI?
syphilis
secondary syphilis sxs include
skin (rash), mucous membranes, and lymph node involvement
tertiary syphillis sxs include
gummas, cardiac, ophthalamologic and auditory
what has a classic presentation of multiple, shallow, tender erythematous ulcers that may be vesicular? +/- dysuria
HSV
bubo formation (enlarged lymph nodes) is associated with what?
chancroid
lymphogranuloma venereum is different from other infections caused by c trachomatis because it affects?
lymphatic, not mucosal, tissue
what is characterized by a small papule that quickly ulcerates to beefy-red? is it painless ?
granuloma inguinale, painless
CDC recommendation for HIV screening
all adults and adolescents from 13–64 should be tested at least once
orchitis is caused by
mumps
who typically gets orchitis?
children > adults
two most common SIS of orchitis
parotid tenderness and facial edema
how long after onset parotitis does orchitis usually develop?
7-10 days
develops in 25-40%
tx for orchitis?
symptomatic, scrotal elevation, cool compresses, analgesics
what type of HIV prevention should be considered for high risk populations
PrEP
4 risk factors for prostate cancer
age
ethnicity (AA)
high fat diet
family hx
where does prostate cancer tend to metastasize?
bones
sxs: neuro (spinal cord compression) and back pain or pathological fractures
DRE detection rate for prostate cx
1.5-7%
is serum PSA diagnostic of cancer
nope
what else can cause an increase in serum PSA besides cx?
inflammation or BPH
when is transrectal US used in the world of prostate cancer
for staging and guidance for bx (NOT screening)
what is the recommendation from USPSTF for PSA-based screening?
Recommends against routine PSA-based screening for prostate cancer for average risk regardless of age (Grade D)
what is the bottom line for screening with PSA?
discuss pt re: risks and benefits
age 50 for average risk
age 40-45 for high risk
10+ year life expectancy
your pt decides to be screened for prostate cx. he has a normal DRE and a PSA <1 ng/mL. when should you repeat the screening?
repeat 2-4 yrs
your pt decides to be screened for prostate cx. he has a normal DRE and a PSA 1-3 ng/mL. when should you repeat the screening?
1-2 years
when should you consider bx or close follow up (6 mon) or additional biomarkers after PS cx screening
PSA > 3 or abnl DRE
on TRUS, PS cancer will have what type of appearance?
hypoechoic appearance
how many cores are taken in bx for PS cancer?
8-12
describe the roles of MRI, CT and bone scan in diagnosis of ps cx?
MRI: limited role (can detect lymphadenopathy)
CT: no role in initial staging, but can identify mets
bone scan: detects bone mets
when should you consider a bone scan during the dx portion of ps cx?
consider if PSA >20, high grade histology, bone pain
what is the staging system for prostate cx?
gleason system
what is the tx for localized prostate cx and less than 10 yr life expectancy
active surveillance
what is the mainstay tx for advanced and metastatic ps cx?
androgen deprivation therapy (LHRH or anti-androgens)
via surgical (bilateral orchiectomy) or medical castration
what does prostate cancer that becomes refractory to hormone therapy indicate?
poor prognosis
3 risk factors for penile cancer
lack of neonatal circumcision
HPV 16 & 18 infection
tobacco use
MC histology of penile cancer
squamous
MC solid tumor in men age 15-34 is
testicular cancer
MC histology of testicular cancer
germ cell tumors
cryptorchidism is a risk factor in what type of cancer? which side is MC
testicular
right side
a firm, painless unilateral mass in testis, think
testicular cancer
dx of testicular cancer is made with what 2 modalities
scrotal US!
confirmed by bx w inguinal orchiectomy (don’t do FNA, worry about seeding)
what tumor markers are used for testicular cancer?
hCG, AFP, LDH
staging for testicular cancer?
TNMS
s for serum tumor markers
official dx of androgen deficiency includes low serum testosterone and how many symptoms?
3
what do you need to check prior to starting testosterone therapy?
CBC and PSA
testosterone can worsen what two other comorbid disorders?
OSA, CHF
men with ED have a greater risk for what?
cardiovascular events
mainstay tx for ED
PDE-5 inhibitor
CI for PDE-5 inhibitors
nitrates, severe CV disease
transition vs peripheral zone.
where does BPH occur most often?
transition zone
prostate cx in peripheral zone
symptoms of bph fall into what two main categories
obstructive or irritative
what two tests should you order when you are working up BPH?
UA and PSA
two pharm bph tx
- 5 alpha reductase inhibitors
2. selective alpha-1 blockers
AUA scoring
1-7: mild
8-19: moderate
20-35: severe
you are evaluating back pain in a patient. what dx should be on your differential?
acute prostatitis
MC organism in prostatitis
e.coli
which two organisms are MC in sexually active young men?
n. gonorrhea and c. trachomatis
exquisitely tender, normal or hot, boggy prostatitis
acute prostatitis
first line tx acute prostatitis? how long?
FQs or TMP/SMZ for 4-6 weeks
