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pance/eoc > Genitourinary #2 > Flashcards

Genitourinary #2 Flashcards

1
Q

Etiologies of acute prostatitis

A
  • > 35 years: E. Coli

- < 35 years: Chlamydia and Gonorrhea

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2
Q

MCC of CHRONIC prostatitis is

A

E. Coli

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3
Q

Symptoms of prostatitis

A
  • Irritative voiding symptoms
  • Obstructive symptoms: hesitancy, incomplete emptying
  • Fever, chills, perineal pain, lower back pain
  • Recurrent UTIs, intermittent dysfunction
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4
Q

Describe the prostate in prostatitis

A
  • Boggy prostate
  • Exquisitely tender boggy (acute)
  • Nontender and boggy (chronic)
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5
Q

Diagnostics for prostatitis

A
  • UA and urine culture

- Avoid prostatic massage in acute because it may cause bacteremia

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6
Q

Treatment for prostatitis

A
  • > 35 years: Fluoroquinolones or Bactrim

- < 35 years: Ceftriaxone + Doxy or Azithromycin

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7
Q

Although the causes of epididymitis are the same as prostatitis, what are the symptoms?

A
  • Localized testicular pain and swelling
  • Gradual onset
  • Groin, flank, or abdominal pain
  • Positive Prehn Sign: relief of pain with scrotal elevation
  • Positive (normal) Cremasteric reflex: elevation of testicle after stroke inner thigh
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8
Q

What is the best initial test for epididymitis and what do you see?

A

Scrotal US: enlarged epididymis, increased testicular blood flow

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9
Q

Treatment for epididymitis

A
  • Scrotal elevation, cool compresses, NSAIDs
  • < 35 years: Ceftriaxone + Doxy or Azithromycin
  • > 35 years: Fluoroquinolones (Cipro, Oflox, Levo)
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10
Q

What are some common causes of Priapism?

A
  • Idiopathic (MC)
  • Sickle Cell Disease
  • Trazodone, Alpha Blockers, Antipsychotics
  • Cocaine, Marijuana, Alcohol
  • Trauma
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11
Q

What is a diagnostic that can be done for priapism?

A
  • Cavernosal blood gas

- Can also do doppler US

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12
Q

Management of low flow (ischemic) priapism

A
  • Phenylephrine (intracavernosal injection)
  • Needle aspiration
  • Shunt surgery if not responsive to injection or needle aspiration
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13
Q

What happens in testicular torsion?

A

Spermatic cord twists and cuts off testicular blood supply

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14
Q

Symptoms of testicular torsion

A
  • Abrupt onset of scrotal, inguinal, or lower abdominal pain
  • N/v
  • Negative Prehn
  • Negative Cremasteric
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15
Q

Diagnostics for testicular torsion

A
  • Clinical diagnosis
  • Emergency surgical exploration (definitive)
  • Testicular Doppler US
  • Radionuclide scan (most sensitive but never used)
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16
Q

Management of testicular torsion

A

-Urgent detorsion and orchiopexy within 6 hours of pain onset

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17
Q

testicular cancer occurs in what age group normally

A

15-35

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18
Q

Risk Factors for Testicular Cancer

A
  • Cryptorchidism
  • Klinefelter Syndrome
  • Hypospadias
  • Caucasian
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19
Q

MC type of testicular cancer

A

Germinal cell tumors

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20
Q

Nonseminomas are associated with what characteristics?

A
  • Increased serum alpha-fetoprotein and beta-HCG

- Resistance to radiation

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21
Q

Seminomas are associated with what characteristics?

A
  • 4 S’s
  • -Simple (lacks tumor markers)
  • -Sensitive (to radiation)
  • -Slower growing
  • -Stepwise spread
22
Q

Symptoms of testicular cancer

A
  • Testicular mass MC (painless)
  • Dull pain or testicular heaviness
  • Firm, hard, fixed mass that does not transilluminate
23
Q

Initial diagnostic of choice for testicular cancer

A

Scrotal US

24
Q

What tumor markers are present in nonseminomas

A

-Increased alpha-fetoprotein and beta-HCG

25
Q

Treatment for testicular cancer

A
  • Stage 1: radical orchiectomy with retroperitoneal lymph node dissection
  • High grade seminoma: Chemo followed by orchiectomy and radiation
26
Q

A hydrocele is

A

Serous fluid collection within the layers of the tunica vaginalis of the scrotum

27
Q

Symptoms of a hydrocele

A
  • Painless scrotal swelling
  • Dull ache or heavy sensation
  • Translucency (transilluminates)
  • Swelling worse with Valsalva
28
Q

Initial test of choice for hydrocele

A

-Testicular US

29
Q

Treatment for hydrocele

A

Watchful waiting and resolves within first 12 months of life

30
Q

A spermatocele is

A

an epididymal cyst that contains sperm

31
Q

What is on physical exam of a patient with a spermatocele

A

-Round, soft mass in head of epididymis superior, posterior and separate from the testicle freely movable mass that transilluminates

32
Q

What is the MC surgically correctable cause of male infertility

A

Varicocele

33
Q

Physical exam finding of a patient with varicocele

A
  • Bag of worms feel superior to testicle

- Dilation worsens when patients upright or with Valsalva

34
Q

Initial test of choice for Varicocele

A

US

35
Q

Sudden onset of left-sided varicocele in an older man may be possibly due to

A

Renal cell carcinoma

36
Q

Right-sided varicocele may be due to

A

Retroperitoneal or abdominal malignancy

37
Q

Symptoms of a urethral stricture

A

Chronic obstructive voiding symptoms (weak urinary stream, recurrent UTIs)

38
Q

MC type of bladder cancer

A

Urothelial (Transitional cell) Carcinoma

39
Q

Risk Factors for bladder cancer

A
  • Smoking (MC)
  • Occupational exposures to dyes, leather, rubber
  • Caucasian
  • Males
  • Cyclophosphamide
  • Long term indwelling catheter use
40
Q

Symptoms of bladder cancer

A
  • Painless gross hematuria

- Dysuria, urgency, frequency

41
Q

Gold standard diagnostic for bladder cancer

A

-Cystoscopy with biopsy

42
Q

Treatment for bladder cancer

A
  • Localized: Transurethral resection of tumor (electrocautery)
  • Invasive: radical cystectomy, chemo, radiation
43
Q

If the bladder cancer is recurrent and electrocautery is unsuccessful, what vaccine should be given?

A

Intravesicular BCG

44
Q

Symptoms of BPH

A
  • Irritative symptoms: increased frequency, urgency, nocturia
  • Obstructive symptoms: hesitancy, incomplete emptying
45
Q

Diagnostics for BPH

A
  • DRE: uniformly enlarged, firm, nontender rubbery prostate
  • PSA: Normal < 4
  • UA: to look for hematuria
  • Urine cytology
46
Q

Medical treatment for BPH

A
  • Alpha blockers (Tamsulosin, Terazosin)

- 5-alpha-reductase inhibitors (Finasteride)

47
Q

Surgical management for BPH

A

-TURP: removes excess prostate tissue; may cause sexual dysfunction, urinary incontinence

48
Q

MOA for Alpha-1 blockers

A

-Smooth muscle relaxation of prostate and bladder neck, leading to decreased urethral resistance, obstruction relief, and increased urinary outflow

49
Q

Adverse effects of alpha-1 blockers

A

-Dizziness and orthostatic hypotension

50
Q

MOA of 5-alpha reductase inhibitors

A

-Androgen inhibitor: suppresses prostate growth, reduces bladder outlet obstruction (size reduction and decreases need for surgery)

pance/eoc (63 decks)

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