Exam 3 - Men's Health Flashcards
1
Q
What symptoms are associated with BPH?
A
- Irritative (frequency, urgency)
- Obstructive (hesitancy, weak stream, dribbling)
- 3 months of bothersome urinary symptoms
2
Q
What are the four zones of the prostate?
A
- Transitional
- Central
- Peripheral
- Fibromusclar
3
Q
What is the treatment for BPH?
A
- Behavior modification
- Alpha-1-adrenergic antagonists/Alpha blockers (1st line)
- 5-alpha reductase inhibitors (Finasteride, dutasteride)
4
Q
What is the MOA and SE of - 5-alpha reductase inhibitors (Finasteride, dutasteride)?
A
MOA: decreases prostate size via antiandrogen effects
SE: decreased libido, sexual dysfunction
5
Q
What is the 1st line treatment for BPH?
A
Alpha-1-adrenergic antagonists/Alpha blockers (Tamsulosin, doxazosin, terazosin)
6
Q
What are some symptoms associated with acute bacterial prostatitis?
A
- Acute onset of urinary frequency, urgency, and dysuria
- Obstructive voiding symptoms (hesitancy, weak stream)
- Perineal/pelvic pain
- Fever, chills, myalgia, malaise
7
Q
How is prostatitis diagnosed?
A
- DRE reveals tender and edematous prostate
- Urine grain stain/culture
8
Q
How can you differentiate prostatitis from UTI?
A
Prostate exam will reveal a tender and edematous prostate in prostatitis
9
Q
What is the treatment for acute bacterial prostatitis?
A
- If toxic, admit and start IV antibiotics
- Treat OP if stable and reliable
- Fluoroquinolone or Bactrim for 6 weeks
- Repeat urine culture after 7 days of antibiotic therapy
10
Q
What is the gold standard for diagnosing Chronic bacterial prostatitis?
A
Prostatic fluid analysis
11
Q
What is the treatment for chronic bacterial prostatitis?
A
- Fluoroquinolone for 6 weeks
- Bactrim is alternate
12
Q
What is the first line treatment for chronic bacterial prostatitis?
A
Fluoroquinolone x 6 weeks
13
Q
What is chronic pelvic pain for at least three of the preceding six months in the absence of other identifiable causes?
A
Chronic prostatitis/Chronic pelvic pain syndrome
14
Q
In Chronic prostatitis/Chronic pelvic pain syndrome, what will be found on rectal exam?
A
Prostate will be non-tender or mildly tender
15
Q
What are clinical features of Chronic prostatitis/Chronic pelvic pain syndrome?
A
- Pain (perineum, lower abdomen, testicles, penis, and with ejaculation)
- Voiding difficulty
- Blood in semen
- Relapsing-remitting pattern over many months
16
Q
How is Chronic prostatitis/Chronic pelvic pain syndrome diagnosed?
A
Diagnosis of exclusion
17
Q
What is the treatment for Chronic prostatitis/Chronic pelvic pain syndrome?
A
- No uniform treatment
- Alpha blockers, abx, 5-alpha-reductase inhibitors are most effective
- Psychological support
- Urology referral
18
Q
What is the most common diagnosed cancer in men in the 60-79 age group?
A
Prostate cancer
19
Q
Who should you target prostate cancer screening at?
A
- African American males
- Family hx of prostate cancer
20
Q
What are some clinical features of prostate cancer?
What is rarely present in prostate cancer?
A
- Urinary frequency, urgency, nocturia, and hesitancy are common but often due to concomitant BPH
- Bone pain, fatigue, weight loss (advanced)
Rarely presents with hematuria or hematospermia
21
Q
How will the prostate appear in prostate cancer?
A
Nodular and asymmetric
22
Q
How is prostate cancer diagnosed?
A
Abnormal prostate exam/abnormal PSA will lead to an ultrasound guided prostate biopsy
Gold standard is the biopsy
23
Q
How is prostate cancer staged?
A
Tumor Node Metastases system
Gleason score
24
Q
What are treatment options for prostate cancer?
A
- Observation
- Radical prostatectomy
- Radiation therapy
- Androgen deprivation therapy
25
After a patient has been treated for prostate cancer, how should follow-up look?
- Total PSA every 6-12 months x 5 years and then annually
- If PSA rises, refer
- Serum PSA every 3-6 months in recurrence and/or metastatic work-up
26
What is the treatment for ED?
- Address underlying cause
- PDE-5 Inhibitors (1st line)
- Vaccum erection device
- Penile self injectables
- Intraurethral suppository (MUSE)
- Penile prosthesis/surgery
27
What is the 1st line treatment for ED?
PDE-5 Inhibitors (sildenafil, vardenafil, tadalafil, avanafil)
28
What is the 2nd line treatment for ED?
- Vaccum erection device
- Penile self injectables
- Intraurethral suppository (MUSE)
29
What is the 3rd line treatment for ED?
- Penile prosthesis/surgery
30
In what population is urethritis most common?
Young sexually active males
31
What are clinical features associated with urethritis?
- May be asymptomatic
- Dysuria and urethral discharge
- Inflamed meatus
32
How is urethritis diagnosed?
- Mucopurulent/purulent discharge
- Gram stain of urethral secretions
- First-void urine for NAAT
33
What will gram stain show in gonococcal urethritis?
Polymorphonuclear cells and gram-negative diplococci
34
What is the treatment for gonococcal urethritis?
What is the treatment for non-gonococcal urethritis?
Gonococcal:
- Ceftriaxone 250 mg IM + Azithromycin 1000 mg x 1 dose
- Gentamycin 240 mg IM + Azithromycin 2 grams x 1 dose (PCN allergy)
Non-gonococcal:
- Azithromycin 1 gram orally OR Doxycycline 100mg PO BID x 7 days
35
In young males, what is epididymitis associated with?
What about in older men?
Young males: Associated with STDs (chlamydia and gonorrhea)
Older men: Typically urinary pathogens
36
The following presentation is associated with what condition?
- Acute and unilateral, dull to severe scrotal pain radiating to ipsilateral flank
- Hemi-scrotal swelling and tenderness which may progress to erythematous fluctuant mass
- Fever, chills
- Prehn's sign (elevation of scrotum provides relief)
Epididymitis
37
Is a positive Prehn's sign associated with epididymitis or testicular torsion?
Epididymitis
38
What is the treatment for epididymitis if patient hx is suspicious for Chlamydia or N. gonorrhea?
What about if enteric organism is suspected?
STD:
Ceftriaxone 250 mg IM x 1 and Doxycycline 100 mg BID x 10 days
Enteric:
Levofloxacin500 mg QD x 10 days OR Ofloxacin 300 mg
BID x 10 days
***Advise adjunct use of NSAIDs for pain relief
39
What are general characteristics associated with epididymoorchitis?
- Involvement of the testicle by retrograde infection
| - Mumps
40
What are clinical features associated with epididymoorchitis?
- Acute, ipsilateral testicular swelling and tenderness
- Fever
- +/- urinary symptoms
41
What is the treatment for epididymoorchitis if mumps is suspected?
What about if bacterial infection suspected?
Mumps:
Supportive care
Bacterial:
Similar to epididymitis
42
Is Varicocele typically on the left, right, or both?
Typically on the left due to longer spermatic vein, but can occur bilaterally
43
What should you be suspicious for in right-sided only varicocele?
Pelvic/abdominal malignancy
44
What are clinical features associated with varicocele?
- "Bag of worms" (venous varicosity)
- Increases in size with valsalva and decreases in size when supine or if scrotum is elevated
- Dull, achy testicular pain relieved with support or supine
45
How is Varicocele diagnosed?
Physical exam
- If no decompression in recumbent position, CT scan for outlet obstruction
Doppler scrotal ultrasound
46
What is the treatment of varicocele?
- Ligation of spermatic vein if symptomatic, infertility concerns, or testicular atrophy
- Supportive care if mild symptoms and no reproductive concern
47
In what age groups is testicular torsion more common?
Neonates and post-pubertal boys
48
What are clinical features of testicular torsion?
- Acute onset of scrotal pain, unilateral with hemi scrotal swelling
- Pain on palpation, without relief with elevation
- Bell-Clapper deformity
- Absent cremasteric reflex
49
How is testicular torsion diagnosed?
Scrotal ultrasound shows limited or loss of flow to spermatic cord and testis
50
What is the treatment for testicular torsion?
- Manual detorsion
| - Urological emergency requiring surgical detorsion and orchiopexy (even if manually de-torsed)
51
In what age range is testicular cancer most common?
15-35 years old
52
What are risk factors for testicular cancer?
- Personal hx of testicular cancer
- Cryptorchidism
- Klinefelter Syndrome
- Family history
53
The following presentation is associated with what condition?
- Painless, solid testicular swelling or nodule
- Dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum
- Inguinal lymphadenopathy or para-aortic lymphadenopathy
- +/- abdominal pain with pulmonary symptoms or neuro deficits
Testicular cancer
54
How is testicular cancer diagnosed?
- Scrotal ultrasound
- CT abdomen/pelvis
- Tumor Markers: Beta-HCG, LDH, AFP
55
What is the treatment for testicular cancer?
- Radical inguinal orchiectomy
- Radiation and chemotherapy with medical oncologist based on tumor staging
- Offer sperm banking prior to treatment
56
In testicular cancer, which tumors are radiosensitive and which are radioresistant?
Radiosensitive - Seminatous tumors
Radioresistant - Nonseminatous
57
How does the surveillance of testicular cancer look?
- Office visits every 3 months x 2 years, then every 6 months yearly after 5 year mark
- CXR, Tumor markers and CT abdomen/pelvis
- Genital exam at every visit
58
A hernia which protrudes through Hesselbach's triangle is direct or indirect?
Direct
59
A hernia which develops at internal inguinal ring and can travel through inguinal canal into the scrotum is direct or indirect?
Indirect
60
Which hernia occurs at the medial aspect of the femoral canal?
Femoral hernia
61
What is the most common type of hernia?
Indirect inguinal hernia (most common on right)
62
Which hernia is due to weakness in the floor of the inguinal canal?
Direct inguinal hernia
63
Which hernia is least common, more common in women, and more likely to become incarcerated/strangulated?
Femoral hernia
64
What are clinical features of inguinal hernia?
- Heaviness/discomfort with straining
- Painless bulge
- N/V, abdomen distention and pain, redness, fever if incarcerated/strangulated
65
What can strangulated hernias cause?
Bowel obstruction, peritonitis, and toxic appearance
66
What is the treatment for inguinal hernias?
- Definitive treatment is surgical
- If reducible, elective surgery is viable
- Watchful waiting only if inguinal hernia with minimal to no symptoms
67
What is the second most common urological malignancy?
Bladder cancer
68
What is the most common type of bladder cancer?
Transitional cell carcinoma
69
What are clinical features of bladder cancer?
- Painless gross hematuria is mot common presenting symptom
- Obstructive or irritative urinary symptoms
- Hepatomegaly, supraclavicular lymphadenopathy, or periumbilical nodes in metastatic disease
- Pain consistent with the areas of invasion or metatasis
70
What is the gold standard for diagnosis of bladder cancer?
Cystourethroscopy
71
What is the treatment for bladder cancer?
- Transurethral resection of bladder tumor
- High grade tumors will require intra-vesical chemo
- Muscle invasive tumors will require systemic chemo prior to radial cystectomy
72
What are treatments for urinary urgency incontinence?
- Antimuscarinic (tolterodine, fesoterodine, oxybutynin)
| - Alpha blockers if BPH present
73
What are treatments for stress incontinence?
- Condom catheters, penile clamp
| - Surgical options
74
What are the treatments for overflow incontinence?
Alpha blockers
