Exam #2 Flashcards
Testicular torsion can manifest as an absence or weakness of the ________ __________
Scrotal ligament
Prostate cancer is most commonly found in the __________ ____________ of the prostate
Peripheral zone
Tx of balanitis/posthitis
Lotrimin
+/- topical steroid
DM control
Hygiene
Tx for phimosis
Child: give topical steroid after 4 y/o
Circumcision for refractory
Adults: Nystatin +/- topical steroid
Most common etiology of urethritis
STI
Chlamydial most common
Also gonococcal
Tx for urethritis
Ceftriaxone/Cipro + Azithro/Doxy
Risk factors for erectile dysfunction
DM, HTN, CAD, HLD, smoking, surgery
Penile condylomas
Warts; HPV related; check the anus as well
Causes of primary hypogonadism
Testicular failure
Mumps orchitis
Causes of secondary hypogonadism
Age-related (ADAM)
Chronic opiates
What diagnostic study is appropriate if testosterone levels are found to be < 100 ng/dL?
DEXA Scan
What testosterone level is defined as hypogonadism?
150-200 ng/dL
Risks associated with exogenous testosterone treatment
Infertility
Prostate CA
CV Events
Follow up/monitoring after starting a patient on exogenous testosterone
PSA; H and H; testosterone; urinary ROS; DRE
3, 6, 12 mo after initiating tx, then annually thereafter
Tx for cryptorchidism
Hormonal manipulation (GnRH injections)
The testis are actually absent in ____% of cryptorchidism cases
20%
Risk factors for cryptorchidism
Twins, low birth weight, preterm delivery, fam hx, prune belly syndrome
Complications of cryptorchidism
CA risk (even in contralateral)
Decreased fertility
Torsion risk is 10x higher
Negative cremaster sign, negative Prehn’s sign
Testicular torsion
Positive Prehn’s sign
Epididymitis
Most common etiologies of epididymitis
< 35 y/o = chlamydia, gonorrhea
> 35 y/o = E. coli
Most common etiology of orchitis
Viral mumps in children
_________ __________ (stratified epithelium) comprises 30% of the prostate
Glandular tissue
70% of prostate adenocarcinomas arise from the _________ ________
Peripheral zone
Tx for BPH
Non-selective alpha blockers (-zosin)
Selective alpha blockers (-dosin, -losin)
5-alpha reductase inhibitors (-steride)
Antimuscarinics (oxybutynin)
Risk factors for BPH
UTI Prostatitis Neurologic disease (CVA/TIA, Parkinson's MS) Dietary indiscretion (caffeine, alcohol) DM OSA (snoring) Advanced cancer of the prostate (rare)
Enzyme that liquefies ejaculate
Allows sperm to swim freely
PSA (prostate specific antigen)
Etiologies of UTI
E. coli (80%)
Staph, Klebsiella, Proteus
Etiologies of pyelonephritis
E. coli
Proteus, pseudomonas, klebsiella
Treatment of pyelonephritis
IV ABX, good hydration, blood glucose monitoring
90% of kidney stones < _______ will pass spontaneously
4 mm
Instructions for use of diaphragm for sexual intercourse
Must be used with spermicide
Should be left in place for at least 6 hours after intercourse
Instructions for use of cervical cap
Must be used with spermicide
Should be left in place for 6-8 hours after intercourse
Can be left in place up to 48 hours
Three actions of estrogen/progestin contraceptives
- Suppression of ovulation
- Thinning of the endometrium
- Thickening of cervical mucus
Risks associated with estrogen/progestin contraceptives
MI Ischemic stroke HTN Venous thromboembolism (increased with obesity, 40+) Hepatic adenoma
Contraindications to estrogen/progestin contraceptives
Smoker over age 35 Uncontrolled HTN Hx of stroke or ischemic heart dz Hx of VTE Inherited thrombophilia SLE Migraine with aura Breast CA Cirrhosis Liver tumor
Side effects of estrogen/progestin contraceptives
Breakthrough bleeding (most common) Amenorrhea Bloating Nausea Breast tenderness Weight gain HA
Mode of Action for Progestin Only Contraceptives
Thickens cervical mucus
Thinning of endometrium
Variable suppression of ovulation
Contraindications for progestin only contraceptives
Breast CA
Undiagnosed abnormal uterine bleeding
Active liver dz
Side effects for progestin only contraceptives
Irregular bleeding
Amenorrhea
Sx of bacterial vaginosis
Asymptomatic
Watery, white/grey discharge
No pruritus, urinary sx, or pain
Foul “fishy” odor, esp. after menses or sex
Treatment for BV
Metronidazole Metrogel Clindamycin Clindesse Tinidazole
Sx of trichomonas vaginalis
Asymptomatic Copious yellow/grey/green frothy discharge Possibly mixed with blood Malodorous Vulvar pruritus and dysuria
Signs on exam of trichomonas vaginalis
Vulvar/vaginal erythema and inflammation
pH > 4.5
Strawberry cervix
Wet prep with high WBCs and motile trichomonas (flagella)
Tx of Trichmonas vaginalis
Metronidazole
Tinidazole
CDC recommend repeat testing with NAAT 2 wk-3 mo
CDC recommendations for GC/Chlamydia Testing
Routine annual screening of all females sexually active < 25 y/o
Routine screening of all pregnant women in 1st trimester
Routine annual screening of all sexually active women > 25 y/o with risk factors
Tx of gonorrhea
Ceftriaxone plus Azithromycin/Doxycycline
Sx of vulvovaginal candidiasis
Vulvovaginal pruritus
Vulvovaginal burning
Thick white odorless “cottage cheese” discharge
_________ __________ most common disorder seen with pregnancy loss
Uterine septum
DDx of an enlarged uterus
Pregnancy Uterine adenomyosis Leiomyoma uteri Hematometra (cervical stenosis/vaginal septum) Malignancy
Presence of endometrial glands and stroma in the myometrium
Benign Adenomyosis
Benign tumors of smooth muscle origin (arise in myometrium). Most common solid pelvic tumor in women
Leiomyomata Uteri
Most frequent indication for benign hysterectomy
Leiomyomata Uteri
Overgrowth of proliferative endometrium resulting rom protracted E stimulation in the absence of P
Endometrial hyperplasia
Unopposed E
Endometrial hyperplasia
Classically associated with inability to smell
Kallmann Syndrome
GnRH deficiency: will present as primary amenorrhea
Medications that can cause secondary amenorrhea
Hormonal contraceptives
Progestin IUD
Metoclopramide (Reglan): causes hyperprolactinemia
Antipsychotic drugs (Thorazine, Haldol, Risperdal): causes hyperprolactinemia
Irregular bleeding, especially between menses
Metorrhagia
Excessive and irregular uterine bleeding
Menometorrhagia
Cycle length less than 24 days
Polymenorrhea
Simple epithelial-lined cyst or fibroid adjacent to the ovary, usually within the broad ligament
Paraovarian cyst or fibroid
Types of Ovarian Cancers
Epithelial tumors (90%) - serous adenocarcinoma most frequent subtype
Stromal tumors
Germinal tumors
Risk factors for ovarian cancers
Age, genetics (BRCA 1/2, Lynch 2 syndrome), early menarche, late menopause, nulliparity, infertility, endometriosis, PCOS, smoking, obesity
Protective factors for ovarian cancers
Oral contraceptive use Multiparity Breastfeeding Tubal ligation Salpingo-oophorectomy Hysterectomy
