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Men Health > Dz > Flashcards

Dz Flashcards

1
Q

In which zone does BPH occur?

A

transition zone

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2
Q

In which zone does prostate cancer occur?

A

peripheral zone

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3
Q

What is the purpose of DRE?

A

to check for nodules/cancer

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4
Q

Is DRE helpful for detecting BPH?

A

NO

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5
Q

What are the type of BPH?

A

obstructive and irritative

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6
Q

What is obstructive BPH? ie?

A

mechanical obstruction
ie) Bladder outlet obstruction
dynamic component
ie) adrenergic tone - muscle tone is causing obstruction

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7
Q

What is irritative BPH?

A

detrusor muscle hypertrophy/hyperplasia

the BLADDER is irritated

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8
Q

How may a pt with BPH come in looking like?

A

swollen abdomen/bladder

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9
Q

When should peds get imaging done on their kidneys/bladders?

A

male <2yo
GU anaomolies
recurrent (3+/yr)

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10
Q

What labs should be done for BPH?

A

Serum creatinine

UA

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11
Q

Serum creatinine would be elevated or decreased in BPH? What next?

A

elevated

US

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12
Q

UA in BPH? What next?

A

hematuria
CT urogram
refer to urology

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13
Q

What imaging if considering cancer?

A

cystoscopy

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14
Q

BPH mild - tx?

A

mild: nothing

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15
Q

BPH mod- severe - tx?

A 
selective alpha 1a-receptor blocker (not lungs)
-tamsulosin (flomax)
-alfuzosin (uroxatrol)
nonselective alpha blockers (lungs)
-terazoin (hytrin) 
-doxazosin (cardura)
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16
Q

BPH w/ large prostate + hematuria?

A

5 alpha-reductase inhibitors
6mo until benefit
ADD W/ ALPHA BLOCKER

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17
Q

BPH when to refer?

A 
failed tx
cannot urinate
recurrent UTI
recurrent hematuria
renal insufficiency
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18
Q

BPH surgery gold standard?

A

Transurethral resection of the prostate (TURP)

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19
Q

What does PSA measure?

A

NOT cancer
protein that is measured in the blood –> if elevated may indicate: infxn, cancer, enlarged prostate
–further eval would be needed

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20
Q

Hypospadias?

A

failure of the urethral folds to close at the tip of the penis
benign

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21
Q

Hypospadias -refer?

A

if infant has a strong pee

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22
Q

Hypospadias - tx?

A

nothing - unless bothersome

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23
Q

Urethral stricture/meatal stenosis?

A

narrowing of the urethra

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24
Q

Complication from uncircumcised penis?

A 
phimosis
pearly penile papules
balanitis
smegma
HPV
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25
Q

Decrease urine stream, spraying/double stream, postvoiding dribbling?

A

urethral stricture/meatal steonsis

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26
Q

Phimosis?

A

chronic infxn from poor hygiene

SQUAMOUS CELL CARCINOMA UNDER FORESKIN

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27
Q

Phimosis - tx?

A

abx

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28
Q

Paraphimosis?

A

foreskin gets stuck when retracted behind the glans

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29
Q

Paraphismosis - sx/pe?

A

edema d/t venous congestion

arterial occlusion and necrosis may occur

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30
Q

Paraphismsis - tx?

A

firmly squeezing glans for 5min to decrease tissue edema
skin can be drawn forward over glans
abx

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31
Q

Curvature of the penis of the painful erection but NO pain when not erected?

A

peyronie’s dz

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32
Q

Penis is rigid but NOT painful?

A

nonischemic priaprism

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33
Q

Nonischemic priapism -tx?

A

observe/self limiting

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34
Q

What should sickle cell pts be aware of?

A

ischemic priapism

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35
Q

What is happening in ischemic priapism?

A

venous drainage circulation gets cut off –> build up of viscous and poorly oxygenated blood in copora cavernosa

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36
Q

What drug can cause ischemic priapism?

A

trazodone

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37
Q

Ischemic priapism - tx?

A

analgesia + alpha agonist
corporal aspiration
surgical shunt

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38
Q

If pt has sickle cell and ischemic priapism?

A

treat the underlying sickle cell dz - O2, hydration, transfusion

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39
Q

Where does LH and FSH come from?

A

anterior pituitary

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40
Q

LH?

A

leydig –> synthesize testosterone –> secondary characterisitcs

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41
Q

FSH?

A

sertoli cell –> spermatogensis

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42
Q

Fails at testes?

A

primary hypergonadotrophic hypogonadism

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43
Q

Primary hypergonadotrophic hypogonadism- LH and FSH?

A

HIGH

NO negative feedback because testes are broken –> continuos LH and FSH is made but NO testosterone

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44
Q

Secondary hypogonadotrophic hypogonadism?

A

fails at the gonads

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45
Q

Secondary hypogonadtrophic hypogonadism - LH and FSH?

A

low LH and FSH –> LOW testosterone

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46
Q

Secondary hypogonadtrophic hypogonadism PE-before puberty?

A

before puberty- nothing

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47
Q

Secondary hypogonadtrophic hypogonadism PE-after puberty?

A

after puberty - NO secondary characteristics (hair, narrow shoulders, gynocomastia)

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48
Q

Secondary hypogonadtrophic hypogonadism PE-later in life?

A

later in life - erectile dysfxn, poor libido, mood changes (depression), low energy

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49
Q

Normal range for testosterone?

A

300-1,000

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50
Q

What do to if lower than 300 testosterone level?

A

suspect androgen deficiency

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51
Q

What do you a LH and FSH lab test for those w/have small testes?

A

to distinguish between primary hypergonadtrophic and secondary hypogondatrophic hypogoandism

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52
Q

When do you tx for hypogonadism?

A

testosterone is <300

AND 3 sx (erectile dysfxn, poor libido, mood changes, fatigue)

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53
Q

How long do you monitor hypogonadisim tx? What else do you monitor?

A

after 3 mo + q 3 mo

consider prostate screening, hct, lipids

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54
Q

What are contraindications for testosterone replacement?

A 
incr Hct
sleep apnea
CHF, MI, unstable angina
hx of prostate cancer, breast cancer 
severe lower urinary tract sx
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55
Q

What form does testosterone replacement come in?

A 
oral
buccal
patch
gel
IM
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56
Q

What are DIs for testosterone replacement?

A

anticoag
antidiabetic
corticosteroids
ACTH

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57
Q

What are the benefits of testosterone replacement?

A

better mood –> depression
better libido –> libido
decrease erectile dysfunction –> erectile dysfunction
more muscle strength and endurance –> fatigue

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58
Q

What are the treatments for hypogonadism?

A

testosterone replacement

gonadotropins

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59
Q

Premature gonadal failure vs “andropause”?

A

premature gonadal failure: ABNORMAL decrease of testosterone in YOUNG males
andropause: NATURAL decrease of testosterone w/age

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60
Q

What are the diff types of testicular dysfxn?

A 
Klinefleter
cryptorchidism
trauma/torsion
mumps/infxn orchitis
radiation
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61
Q

What is Klinefleter?

A

XXY

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62
Q

What is cryptorchidism?

A

incomplete dropping of the testes

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63
Q

Cryptorchidism -tx?

A

correct before 2yo - surgery

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64
Q

Cryptorchidism - complication?

A

Bilateral > unilateral
increase risk for testicular neoplasm
increase risk for inguinal hernias

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65
Q

What is testicular torsion?

A

twisting of the testes

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66
Q

Testicular torsion - cx?

A

trauma
growth spurt
tumor
HX OF CRYPTOCHIDISM (complication)

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67
Q

Testicular torsion - population?

A

<25yo

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68
Q

Testicular torsion - sx/pe?

A 
"bellclapper"
testes move freely in the tunica vaginls 
ACUTE pain
swelling
asymmetric scrotum
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69
Q

What is the timeframe for testicular torsion saving?

A

sx w/ 6+hrs = risk of losing testes

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70
Q

What haps if you lose one testes?

A

other will kick into gear - not a prob

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71
Q

Testicular torsion - test?

A

cremastric reflex

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72
Q

Testicular torsion - tx?

A

surgery

manual detorsion

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73
Q

Erection?

A

parasympathetic
S2-S4
blood flow increases –> presses down on the veins –> blood accumulates –> erection

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74
Q

Ejaculation?

A

sympathetic
T10-L2
needs both pudendal nerve and skeletal muscle
1) seminal emission
2) projectile ejaculation
–needs both pudendal nerve and skeletal muscle

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75
Q

How to tx premature ejaculation?

A
  • behavioral therapy: stop stimulation just prior to climax and hold base of penis anterior to posterior to prevent emission (kind of like desensitizing)
  • SSRI: d/t increase in serotonin
  • reduce penile sensitivity: condomn, topical anesthetizing cream
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76
Q

What can cx delayed oragsm?

A

SSRI

opiates

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77
Q

What is retrograde ejaculation?

A

backflow of semen into the bladder

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78
Q

Cx of retrograde ejaculation?

A 
after TURP (d/t BPH)
alphablockers for BPH
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79
Q

Tx for retrograde ejaculation?

A

alphasympathomimetics (benadryl)

remove alphablockers

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80
Q

Erectile dsyfunction-types?

A

organic

psychogenic

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81
Q

What is organic erectile dysfunction?

A

having the desire but not able to physically get the penis erected

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82
Q

What is pychogenic erectile dysfunction?

A

not having the desire to get an erection

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83
Q

What must be ruled out before erectile dysfunction?

A

neurological disorder

  • brain lesions
  • peripheral neuropathy (diabetes)
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84
Q

Pt comes in erectile dysfunction - what is important to take note of/review?

A
  • meds: SSRI, opiates, non selective beta blockers, antishitamines, H2 blockers
  • ETOH drinker
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85
Q

If pt is taking meds for the heart and is having trouble with erections, what drug can be used? avoided?

A
  • change the beta blocker to alpha agonist

- do NOT use sildenfil in case pt needs to take nitro

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86
Q

What pts should have labs done for erectile dysfunction?

A

ONLY if they are:

  • depressed
  • fatigue
  • libido
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87
Q

Tx erectile dysfunction?

A 
lifestyle changes
adjust meds (Beta blockers, SSRI)
drugs: PDE 5Is
transurethral therapy: alprostadil
vacuum pump device
intracavernous injection 
penile implant
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88
Q

What adjustment to meds for erectile dysfunction?

A

Beta blockers –> alpha agonist

SSRI –> bupropion/wellbutrin, drug holiday, reduce SSRI

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89
Q

What drugs can be used for erectile dsyfunction?

A
  • sildenafil
  • verdenafil
  • tadalafil
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90
Q

When are the drugs for erectile dysfunction effective?

A

IF he is aroused

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91
Q

MOA of sildenafil?

A

increase cGMP levels –> vasodilation

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92
Q

Who may NOT respond to sildenafil?

A

DM

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93
Q

Sildenfil ADR?

A 
HA
flushing
GI
vision (blue)
hypotensive
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94
Q

Sildenfil DI?

A

NO nitrites
alpha blockers
CYP450

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95
Q

Which tx of erectile dysfunction does NOT need sexual arousal?

A

intracavernous injection

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96
Q

What are the types of hernias?

A 
groin --> inguinal and femoral
incisional
hiatal
ventral
umbilical
rectus diastasis
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97
Q

RF for hernias?

A 
CHRONIC COUGH/CONSTIPATION
abdominal wall injury
HX OF CRYPTORCHIDISM
older age
male
caucasian
smoker
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98
Q

Hx of cryptorchidism can cx?

A

inguinal hernias
testicular torsion
cancer
sterility

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99
Q

Population for hernias?

A

50yo

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100
Q

Hernia hx/sx?

A

dull pain when NOT moving

worse w/ moving, heavy lifting, coughing

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101
Q

Hernia PE?

A

bulge in groin but NON TENDER

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102
Q

Inguinal hernia: direct vs indirect PE?

A

direct: rounder
indirect: ‘narrow’

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103
Q

Complication of hernia?

A

if painful:

incarceration –> strangulation –> bowel obstruction

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104
Q

What is incarceration (hernia)?

A

the bowel gets stuck outside - pain

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105
Q

What is strangulation (hernia)?

A

bowel AND ischemia starts - blood flow compromised

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106
Q

What is bowel obstruction (hernia)?

A

BLOCKING of gas/stool - DIFFUSE abdomen pain

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107
Q

How to diff indirect and direct hernia?

108
Q

When to use CT for hernia?

A

COMPLICATED

109
Q

When to use MRI for hernia?

A

to check if strangulated

110
Q

How to tx hernia uncomplicated w/ little sx?

A

watchful waiting

111
Q

How to tx hernia uncomplicated w/ sx?

A

elective repair

112
Q

How to tx ACUTE incarcerated hernia w/ no sx of strangulation?

A

manual reduction - trandelenburg w/ slow pressure

113
Q

How to tx unreducible incarerated hernia +/-strangulation?

A

emergent repair

114
Q

Congenital hernia vs acquired hernia?

A

congenital: processus vaginalus did NOT oblierate and internal ring did NOT close
acquired: trauma/damage to fibromuscular tissue of abdominal wall (cyclists, straining of the abdomen that increases pressure, etc)

115
Q

What hernia is ABOVE the inguinal ligament?

A

indirect and direct inguinal hernia

116
Q

What hernia is BELOW the inguinal ligament?

A

femoral hernia

117
Q

What hernia is congenital?

A

indirect hernia

118
Q

What hernia is acquired?

A

femoral hernia

119
Q

What hernia can be both congenital and acquired?

A

direct hernia

120
Q

Which hernia can be seen in children?

A

indirect hernia

121
Q

Which hernia can be seen in adults?

A

direct hernia

femoral hernia

122
Q

Which hernia is the most common? least?

A

most: indirect
least: femoral but MORE complications

123
Q

What is hap in indirect hernia?

A

goes THROUGH the inguinal ring

LATERAL to the inferior epigastric artery

124
Q

What is hap in direct hernia?

A

goes THROUGH the Hesselbach’s triangle
LATERAL to inferior epigastric vessels
MEDIAL to rectus muscle

125
Q

What is hap in femoral hernia?

A

goes THROUGH the empty space MEDIAL to femoral canal

THROUGH the femoral ring

126
Q

What is follicular/sebaceous cyst?

A

BLOCKED sebaceous gland/hair follicle

127
Q

Is follicular/sebaceous cyst - benign/malignant?

128
Q

“small dome-shaped skin-colored ‘pearly’ papules on the CORONAL margin”?

A

pearly penile papules

129
Q

“benign dome shaped subcutaneous papules on SCROTUM”?

A

follicular/sebaceous cysts

130
Q

“black/blue/dark red dome shaped papules on scrotum”?

A

angiokeratomas of fordyce

131
Q

Which derm are reassurance and tx for cosmetics?

A

follicular/sebaceous cysts
pearly penile papules
angiokeratomas of fordyce
lichen planus unless lesions

132
Q

Pearly penile papules vs herpes/warts?

A

pearly penile papules: ON THE CORONAL

133
Q

What is psoriasis?

A

non infectious and of the GLANS

134
Q

“Well demarcated scaly erythematous plaques”?

135
Q

Psoriasis tx?

A

symptomatic: hydrocortisone
prevention: calcipoterine

136
Q

Pt comes in with dilated thin walled venules and black/blue papules on scrotum - pt most likely has…?

A

passed puberty

137
Q

“violet flat topped lesions” on…?

A

glans and shaft

138
Q

Pruitic/painful lesions on glans and shaft?

A

lichen planus

139
Q

Lichen planus tx?

A

papular lesions - topical corticosteroids

erosive lesions - intralesional steroid injection

140
Q

Pt is <5yo, uncircumcised, poor hygiene + early stages of red erosions on glans?

141
Q

Balanitis - later stages?

A

erythema
swelling
discharge
pain

142
Q

Balanitis -tx?

A

abx
antifungal
steroid

143
Q

Uncircumcised + old skin cells, oils, but NO skin irritation?

144
Q

Smegma - tx?

A

retract foreskin

145
Q

What is lichen sclorsis also called?

A

balanitis xerotica obliterans

146
Q

What are the stages of lichen sclorsis?

A

early: atophic puritic white plaques/papules
progressing: dysuria, painful erection
later: phimosis, meatal stenosis

147
Q

Tx for lichen sclorsis?

A

early: HD topical steroids
later: intralesional corticosteroids

148
Q

What are the gonadal deficiency?

A

HIV, COPD, cancer, liver/kidney dz
obesity
age
drugs

149
Q

What drugs can affect gonadal deficiency?

A 
spirnolactone
ketecoonazole 
steroids
ETOH
marijuana
opoids
pit. tumor
150
Q

What is androgen insensitivity?

A

do not have secondary characteristics

151
Q

How does an androgen insensitivity person look like?

A

genitally male (XX) but appearance is female

152
Q

What is precocious puberty?

A

puberty comes on TOO fast

<9yo

153
Q

What is delayed puberty?

A

NO secondary characteristics by 14yo

154
Q

Delayed puberty vs constitutional delay?

A

GnRH stimulation

155
Q

What is officially gynecomastia?

A

bigger than 4cm

GLANDULAR tissue NOT adipose

156
Q

What is hydrocele?

A

fluid accumlating

157
Q

Cx of hydrocele?

A

trauma

infxn

158
Q

What can hydrocele be associated with?

A

testicular:

  • neoplasm
  • torsion
159
Q

Why do a US in hydrocele?

A

distinguish between simple (watch) vs complex (refer)

160
Q

If young child has hydrocele?

A

normal d/t testes dropping

161
Q

Spermatocele/epididymal cyst?

A

PAINLESS cyst that is MOVEABLE

located AWAY from testes

162
Q

Spermatocele/epididymal cyst -tx?

163
Q

“dilation of venous plexus and internal spermatic vein” - what would you expect?

A

bag full of worms

164
Q

Which side is varoicele commonly found?

A

Left
Right –> refer
right is DIRECTLY connected to the IVC

165
Q

Tx of varicocele?

166
Q

What can cause infertility?

A

varicocele

hx of cryptochiasm

167
Q

Pt notices ONE blue dot that is hard and tender?

A

torsion of appendix testes

168
Q

What is high and low risk in HPV?

A

high: 16, 18
low: 6, 11

169
Q

How can HPV be transmitted?

A

skin to skin

sexual contact

170
Q

HPV incubation period?

171
Q

HPV sx/pe?

A

asymptomatic

genital warts: condylomata acuminata, flat genital, smooth papule

172
Q

Do you bx HPV?

A

ONLY if pt is immunosuppressed, bleeding, ulceration

173
Q

What STD has a vaccine?

174
Q

What are the vaccines available for HPV?

A

Quadrivalent and bivalent

175
Q

Age for vaccine HPV?

A

between 9-10yo; before 11yo

men who have sex w/men: cut off is 26yo

176
Q

HPV vaccine dosage?

A

1st –> 2) 2mo later –> 3) 6mo later

177
Q

First line tx for HPV? dosage?

A

podofilox 0.5% GEL NOT solution

3x/daily x 4days for 4 cycles –> no change? suspect cancer

178
Q

How does HSV1 present?

A

oral

papules –> vesicles –>pustules –> ulcers –> crust

179
Q

HSV1 on the nose?

A

be careful for ocular herpes/herpes keratits–> may cause blindness
test w/ Floursecein –> medical emergency

180
Q

HSV1 and HSV2 present?

A

F/C/HA/Fatigue/dysuria

181
Q

What can trigger HSV2?

A

sunlight
stress
burning and tingling

182
Q

HSV dx? what is no longer used?

A

viral culture - gold standard

Tzanck is no longer used

183
Q

HSV tx for fist episdoe?

A

1) acyclovir 800mg TID
2) valacyclovir 1000mg BID
3) Famciclovir 250mg TID
x7-10days

184
Q

HSV tx chronic suppressive if..?

185
Q

HSV tx chornic suppressive?

A

acyclovir TID x3-5days
valacyclovir 1gx5days
famiciclovir 1g BID x1day

186
Q

Complication for HSV2?

A

somatitis and pharyngitis

neonatal herpes

187
Q

if HSV is on the face?

A

aseptic meningitis

188
Q

What is chlamydia assocaiated with?

189
Q

RF for chlamydia?

A

15-24yo

AA

190
Q

Chlamydia sx/pe?

A 
WATERY discharge
oropharynx infxn - NO discharge
conjunctivitis
proctitis 
dysuria
191
Q

Chlamydia dx?

192
Q

When to culture for chlamydia?

A

if suspicion for child abuse

193
Q

Chlamydia tx?

A

azithromycin 1g PO x 1 dose

194
Q

IF pt is allergic to azithormycin-chlamydia?

A

doxycycline 100mg PO BID x7days

levofloxacin 500mg PO daily x 7days

195
Q

Pt education for chlamydia?

A

NO sex for 7 days after tx OR after 7days w/ abx

196
Q

Trichomoniasis pe?

A

scant grayish green penile discharge

197
Q

Trichomoniasis tx?

A

metronidazole 2g PO x 1dose

198
Q

What to advise during tx for trichomoniasis?

A

do NOT drink ETOH

199
Q

Pubic lice sx/pe?

A

pruitic reddish/bluish papules/wheals

200
Q

Pubic lice tx?

A

permethrin RINSE 1% x10min
OR
permethrin CREAM 5% for 8hrs

201
Q

Granuloma inguinale cx?

A

klebsiella

202
Q

Where is granuloma inguinale found?

203
Q

Granuloma inguinale sx/pe?

A

1) painless
2) painful - foul smelling purulent discharge
lesions WAIST down

204
Q

Granuloma inguinale dx?

A

bx–> DONOVAN BODIES

205
Q

Granuloma inguinale tx?

A

doxycylcline 100mg PO BID x3-4wks
OR
TMP-SMX DS Q12hrs x3wks
UNTIL ALL LESIONS HEAL

206
Q

Which STI have bubos?

A

lymphogranuloma venereum

Chancoid

207
Q

Lymphgogranuloma venereum cx?

A

subset CHLYMADIA

208
Q

Where is lymphogranuloma found?

209
Q

Lymphogranuloma venereum sx/pe?

A

1) painless ulcer/papule
2) painful inguinal LYMPHADENOPATHY
3) BUBOS -purple
check partners w/in 60 days

210
Q

Lymphogranuloma venereum tx?

A

doxycycline 100mg PO BID 3-4wks

tx partners like chlyamdia b/c it is subset

211
Q

What STI are txd with doxycylcine?

A

granuloma inguinale
lymphogranuloma venereum
chlyamdia if allergic to azithromycin

212
Q

Chancroid found where?

213
Q

What is important to keep in mind for chancroid?

A

CO FACTOR FOR HIV

214
Q

Chancroid sx/pe?

A

1) PAINFUL vesticulopustural lesion - red at the base and bleeds easily (friable)
2) bubos
INGUINAL CANAL

215
Q

Chancroid tx?

A 
ceftriaxone 250mg IM x1dose 
OR
azithromycin 1g PO x1dose
MUST RTC 3-7DAYS
check parter w/in 60 days
216
Q

Chlamydia associated?

217
Q

What are AA RF?

A

chlamydia
gonorrhea
syphilis

218
Q

Chlamydia vs gonorrhea sx/pe?

A

chlamydia: water discharge, NO discharge from oropharynx
gonorrhea: PURULENT discharge and in oropharynx

219
Q

What do BOTH chlamydia and gonorrhea have?

A

dysuria

conjunctivitis

220
Q

How dx chlamydia and gonorrhea?

221
Q

How to tx gonorrhea?

A

Ceftriaxone 250mg IM x1dose

AND cover for chlyamdia - azythromycin 1g PO x1dose

222
Q

What is the diff between dipstick, microscopy, and culture?

A

UA is a screening tool

microscopy can be used for dx

223
Q

When to use culture?

A

when microscopy is positive for bacteria/WBC

224
Q

When to suspect false positive for dipstick?

A

if the sticks have been exposed to air for a proglonged period of time

225
Q

Sx/PE for acute bacterial cystitis?

A

foul smelling urine

226
Q

Tx for acute bacteria cystitis?

A

bactrim or cipro (fluroquinolone) x 7days

227
Q

What sx/PE acute bacterial cystitis, acute prostitis, and chronic prostitis have in common?

A 
dysuria
hematuria
frequency
suprapubic pain
urgency
228
Q

What is the difference between acute prostitis and chronic prostitis?

A

acute: fast, FEVER, PAINFUL DRE/prostate, can lead to septic
chronic: slow, afebrile, normal DRE

229
Q

How to tell difference between acute bacterial cystitis vs prostitis?

A

prostitis has PERINEAL PAIN

230
Q

Tx of acute prostitis?

A

bactrim or cipro x 4-6wks

231
Q

Tx for chronic prostitis?

A

bactrim or cipro x 6wks-3mo

232
Q

What are younger men likely to have-acute or chronic prostits? bug?

A

acute - e.coli

233
Q

pt has scrotal pain?

A

epididmytis/orchitis

234
Q

What other PE can epididmytis/orchitis have?

A

positive phren sign

reactive hydrocele

235
Q

How to tx epididmytis/orchitis?

A

50yo

o Fluroquinolone PO x14days

236
Q

RF for syphilis?

A

AA

25-29yo

237
Q

How can syphilis be spread?

A

skin to skin

sexual

238
Q

Syphilis sx/pe?

A

ANYTIME! ANY rash!

239
Q

What are the sub types of syphilis?

A

primary and secondary syphilis
latent syphilis: early latent and late latent
tertiary syphilis

240
Q

Primary syphilis sx/pe?

A

chancre

PAINLESS w/ CLEAN bse

241
Q

Secondary syphilis sx/pe?

A

rash

warts

242
Q

When does chancre heal?

243
Q

When does secondary syphilis sx/pe occur?

244
Q

How can primary and secondary syphilis present?

A

THEY CAN OVERLAP

245
Q

How does latent syphilis present?

A

NO lesions

246
Q

When does latent syphilis occur?

A

between primary and secondary
secondary relapses
AFTER secondary stage

247
Q

What is the criteria for early latent syphilis?

A 
pos w/in 12mo
4 fold incr from previous titer test
sx w/in 12 mo
contact w/ someone who has syphilis (documented)
possible exposure w/in 12 mo
248
Q

What is late latent syphilis?

A

same sx as early but more than 1 yr

249
Q

PE for tertiary syphilis?

A

gummatous lesions - destruction of nasal bone/septum

cardiovascular syphilis - aneurysms, aortic regurgitation, CAD

250
Q

What is early neurosyphilis?

A

mo-yrs
cranial nerve dsyfxn
meningitis
altered mental status

251
Q

What is late neurosyphilis?

A

tabes dorsalis
18-25yo
poor judgement skills

252
Q

What labs should you run for syphilis? to be aware of?

A

partners should get VDRL

note: if sx are early in primary syphilis - may be false negative

253
Q

What is dx if pt has chancre?

A

darkfield microscopy + VDRL/RPR

254
Q

What is dx if pt doe snot have chancre?

A

FTA-ABS + VDRL/RPR

255
Q

How to tx primary, secondary, and early latent? F/u?

A

Benzathine penicillin G: 2.4million units IM x1dose

f/u: 6-12mo

256
Q

How to tx late latent and tertiary?

A

Benzathine penicillin G: 2.4million x3 doses (total 7.2)

f/u: 6, 12, 18, 24mo

257
Q

How to tx neurosyphilis?

A

aqueous crystalline penicillin G + admit

258
Q

Complication from tx’ing syphilis?

A

Jarisch-Herxheimer Rxn

259
Q

What is Jarisch-Herxcheimer rxn?

A

NOT an allergic rxn from the penicillin –> the bug dying int he body
usually occurs w/in 24hrs after therapy

260
Q

“pearly, skin colored, umbilicated papules”?

A

molluscum contagiosum

261
Q

Molluscum contagiosum - bug?

262
Q

How can molluscum contagiosum spread?

A

skin-skin
fomites
bathes/swimming pool

263
Q

When is molluscum contagiosum the most contagious?

A

thick white paste

264
Q

How to tx molluscum contagiosum?

A

imiquimod 5% 3x/wk for 1-3mo

265
Q

Incubation period for chlaymdia?

266
Q

Incubation period for gonorrhea?

Men Health (3 decks)

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