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Clinical Med II > Exam 3 - Men's Health > Flashcards

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
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2
Q

What are the four zones of the prostate?

A
  • Transitional
  • Central
  • Peripheral
  • Fibromusclar
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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)
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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

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5
Q

What is the 1st line treatment for BPH?

A

Alpha-1-adrenergic antagonists/Alpha blockers (Tamsulosin, doxazosin, terazosin)

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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
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7
Q

How is prostatitis diagnosed?

A
  • DRE reveals tender and edematous prostate

- Urine grain stain/culture

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8
Q

How can you differentiate prostatitis from UTI?

A

Prostate exam will reveal a tender and edematous prostate in prostatitis

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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
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10
Q

What is the gold standard for diagnosing Chronic bacterial prostatitis?

A

Prostatic fluid analysis

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11
Q

What is the treatment for chronic bacterial prostatitis?

A
  • Fluoroquinolone for 6 weeks

- Bactrim is alternate

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12
Q

What is the first line treatment for chronic bacterial prostatitis?

A

Fluoroquinolone x 6 weeks

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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

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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

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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
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16
Q

How is Chronic prostatitis/Chronic pelvic pain syndrome diagnosed?

A

Diagnosis of exclusion

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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
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18
Q

What is the most common diagnosed cancer in men in the 60-79 age group?

A

Prostate cancer

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19
Q

Who should you target prostate cancer screening at?

A
  • African American males

- Family hx of prostate cancer

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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

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21
Q

How will the prostate appear in prostate cancer?

A

Nodular and asymmetric

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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

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23
Q

How is prostate cancer staged?

A

Tumor Node Metastases system

Gleason score

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24
Q

What are treatment options for prostate cancer?

A
  • Observation
  • Radical prostatectomy
  • Radiation therapy
  • Androgen deprivation therapy
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25
Q

After a patient has been treated for prostate cancer, how should follow-up look?

A
  • 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
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26
Q

What is the treatment for ED?

A
  • Address underlying cause
  • PDE-5 Inhibitors (1st line)
  • Vaccum erection device
  • Penile self injectables
  • Intraurethral suppository (MUSE)
  • Penile prosthesis/surgery
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27
Q

What is the 1st line treatment for ED?

A

PDE-5 Inhibitors (sildenafil, vardenafil, tadalafil, avanafil)

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28
Q

What is the 2nd line treatment for ED?

A
  • Vaccum erection device
  • Penile self injectables
  • Intraurethral suppository (MUSE)
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29
Q

What is the 3rd line treatment for ED?

A
  • Penile prosthesis/surgery
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30
Q

In what population is urethritis most common?

A

Young sexually active males

31
Q

What are clinical features associated with urethritis?

A
  • May be asymptomatic
  • Dysuria and urethral discharge
  • Inflamed meatus
32
Q

How is urethritis diagnosed?

A
  • Mucopurulent/purulent discharge
  • Gram stain of urethral secretions
  • First-void urine for NAAT
33
Q

What will gram stain show in gonococcal urethritis?

A

Polymorphonuclear cells and gram-negative diplococci

34
Q

What is the treatment for gonococcal urethritis?

What is the treatment for non-gonococcal urethritis?

A

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
Q

In young males, what is epididymitis associated with?

What about in older men?

A

Young males: Associated with STDs (chlamydia and gonorrhea)

Older men: Typically urinary pathogens

36
Q

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)
A

Epididymitis

37
Q

Is a positive Prehn’s sign associated with epididymitis or testicular torsion?

A

Epididymitis

38
Q

What is the treatment for epididymitis if patient hx is suspicious for Chlamydia or N. gonorrhea?

What about if enteric organism is suspected?

A

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
Q

What are general characteristics associated with epididymoorchitis?

A
  • Involvement of the testicle by retrograde infection

- Mumps

40
Q

What are clinical features associated with epididymoorchitis?

A
  • Acute, ipsilateral testicular swelling and tenderness
  • Fever
  • +/- urinary symptoms
41
Q

What is the treatment for epididymoorchitis if mumps is suspected?

What about if bacterial infection suspected?

A

Mumps:
Supportive care

Bacterial:
Similar to epididymitis

42
Q

Is Varicocele typically on the left, right, or both?

A

Typically on the left due to longer spermatic vein, but can occur bilaterally

43
Q

What should you be suspicious for in right-sided only varicocele?

A

Pelvic/abdominal malignancy

44
Q

What are clinical features associated with varicocele?

A
  • “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
Q

How is Varicocele diagnosed?

A

Physical exam
- If no decompression in recumbent position, CT scan for outlet obstruction

Doppler scrotal ultrasound

46
Q

What is the treatment of varicocele?

A
  • Ligation of spermatic vein if symptomatic, infertility concerns, or testicular atrophy
  • Supportive care if mild symptoms and no reproductive concern
47
Q

In what age groups is testicular torsion more common?

A

Neonates and post-pubertal boys

48
Q

What are clinical features of testicular torsion?

A
  • Acute onset of scrotal pain, unilateral with hemi scrotal swelling
  • Pain on palpation, without relief with elevation
  • Bell-Clapper deformity
  • Absent cremasteric reflex
49
Q

How is testicular torsion diagnosed?

A

Scrotal ultrasound shows limited or loss of flow to spermatic cord and testis

50
Q

What is the treatment for testicular torsion?

A
  • Manual detorsion

- Urological emergency requiring surgical detorsion and orchiopexy (even if manually de-torsed)

51
Q

In what age range is testicular cancer most common?

A

15-35 years old

52
Q

What are risk factors for testicular cancer?

A
  • Personal hx of testicular cancer
  • Cryptorchidism
  • Klinefelter Syndrome
  • Family history
53
Q

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
A

Testicular cancer

54
Q

How is testicular cancer diagnosed?

A
  • Scrotal ultrasound
  • CT abdomen/pelvis
  • Tumor Markers: Beta-HCG, LDH, AFP
55
Q

What is the treatment for testicular cancer?

A
  • Radical inguinal orchiectomy
  • Radiation and chemotherapy with medical oncologist based on tumor staging
  • Offer sperm banking prior to treatment
56
Q

In testicular cancer, which tumors are radiosensitive and which are radioresistant?

A

Radiosensitive - Seminatous tumors

Radioresistant - Nonseminatous

57
Q

How does the surveillance of testicular cancer look?

A
  • 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
Q

A hernia which protrudes through Hesselbach’s triangle is direct or indirect?

59
Q

A hernia which develops at internal inguinal ring and can travel through inguinal canal into the scrotum is direct or indirect?

60
Q

Which hernia occurs at the medial aspect of the femoral canal?

A

Femoral hernia

61
Q

What is the most common type of hernia?

A

Indirect inguinal hernia (most common on right)

62
Q

Which hernia is due to weakness in the floor of the inguinal canal?

A

Direct inguinal hernia

63
Q

Which hernia is least common, more common in women, and more likely to become incarcerated/strangulated?

A

Femoral hernia

64
Q

What are clinical features of inguinal hernia?

A
  • Heaviness/discomfort with straining
  • Painless bulge
  • N/V, abdomen distention and pain, redness, fever if incarcerated/strangulated
65
Q

What can strangulated hernias cause?

A

Bowel obstruction, peritonitis, and toxic appearance

66
Q

What is the treatment for inguinal hernias?

A
  • Definitive treatment is surgical
  • If reducible, elective surgery is viable
  • Watchful waiting only if inguinal hernia with minimal to no symptoms
67
Q

What is the second most common urological malignancy?

A

Bladder cancer

68
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma

69
Q

What are clinical features of bladder cancer?

A
  • 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
Q

What is the gold standard for diagnosis of bladder cancer?

A

Cystourethroscopy

71
Q

What is the treatment for bladder cancer?

A
  • 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
Q

What are treatments for urinary urgency incontinence?

A
  • Antimuscarinic (tolterodine, fesoterodine, oxybutynin)

- Alpha blockers if BPH present

73
Q

What are treatments for stress incontinence?

A
  • Condom catheters, penile clamp

- Surgical options

74
Q

What are the treatments for overflow incontinence?

A

Alpha blockers

Clinical Med II (17 decks)

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