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PANCE 2.0 > Genitourinary #6 > Flashcards

Genitourinary #6 Flashcards

1
Q

MC type of penile cancer

A

Squamous cell carcinoma

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2
Q

Penile cancer is commonly associated with what risk factors? SHHL

A

Smoking
HIV
HPV 6, 16, and 18
Lack of circumcision

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3
Q

What is Bowen’s Disease and how is it related to penile cancer?

A

Leukoplakia on the shaft of penis or scrotum
Associated with HPV 16
Minority progresses to SCC

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4
Q

Diagnostics for penile cancer

A

Biopsy

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5
Q

Symptoms of penile cancer

A

-Mass, palpable lesion, or ulcer on penis
-Rare to bleed or rash

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6
Q

If the penile cancer is early, limited excision is recommended. However, if late, what is the treatment?

A

Penile amputation with therapeutic lymph node dissection

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7
Q

What is the MCC of erectile dysfunction?

A

Vascular (atherosclerosis, diabetes)

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8
Q

What are some medications that can cause erectile dysfunction?

A

BB
Thiazide diuretics
Spironolactone
CCB
SSRI
TCAs

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9
Q

If the ED is abrupt onset in nature, what is the likely culprit?

A

Psychological cause rather than systemic

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10
Q

What is the first-line therapy for ED?

A

Phosphodiesterase-5-inhibitors (Sildenafil, Tadalfil, and Vardenafil)

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11
Q

MOA of PD-5 inhibitors

A

-Potentiates nitric oxide mediated penile smooth muscle relaxation, leading to ability to generate and maintain erection

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12
Q

Adverse effects of PD5 inhibitors

A

-Headaches
-Flushing
-Hearing loss
-Visual disturbances

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13
Q

When should PD5 inhibitors NOT be used?

A

In conjunction with nitrates or if the patient has cardiovascular disease (may cause severe hypotension)

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14
Q

Second line therapy for ED

A

-Intracavernosal injection therapy (prostaglandin E1 Alprostadil)

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15
Q

Last line therapy for ED

A

-Penile prosthesis or corrective penile revascularization

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16
Q

What is hypospadias?

A

Congenital anomaly of the male urethra that results in abnormal VENTRAL placement of the urethral opening

-Penile curvature present as well most times

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17
Q

What is the pathophysiology of hypospadias?

A

Failure or urogenital folds to fuse during development

18
Q

Symptoms of hypospadias

A

-Recurrent UTIs
-ED
-Deflection of urinary stream

19
Q

What is the management for a patient with hypospadias?

A

Patients should NOT be circumcised because the foreskin can be used to repair the defect

Elective surgical correction: Performed in healthy, full-term infants ages 6 months - 1 year

20
Q

On the other hand, what is epispadias?

A

Abnormal DORSAL placement of the urethral opening

21
Q

Epispadias is often associated with what?

A

Bladder exstrophy (protrusion of the bladder wall through a defect in the abdominal wall)

22
Q

What is the pathophysiology of epispadias

A

Failure of midline penile fusion

23
Q

Treatment for epispadias?

A

Surgical correction

24
Q

What is enuresis?

A

Episodes of urinary incontinence in children 5 years of age or older, while sleeping

25
Q

What is the difference between primary and secondary enuresis?

A

Primary: absence of any period of nighttime dryness (MC type)

Secondary: enuresis after a period of dryness of at least 6 months. Due to stressful event (divorce, birth, etc.)

26
Q

First-line therapy for enuresis?

A

behavioral therapy (washable products, motivational therapy, education)

Bladder training: regular voiding, schedule, waking child to urinate, avoid caffeine and high sugar drinks, fluid restriction

27
Q

What is the most effective LONG TERM therapy for enuresis?

A

Enuresis alarm. Used if children fail to respond to behavioral therapy.

28
Q

What are two medications that can be used in the treatment for enuresis?

A

Desmopressin (DDAVP): synthetic antidiuretic hormone (ADH). Reduces urination

Imipramine: TCA, stimulates ADH secretion

29
Q

What is priapism?

A

Prolonged, painful erections without sexual stimulation

30
Q

MC type of priapism

A

Ischemic (low flow): decreased venous outflow. Painful and rigid erection. May lead to compartment syndrome.

31
Q

However, the other type of priapism is

A

Nonischemic (high flow): increased arterial outflow. Due to fistula and commonly related to penile or perineal trauma. Less painful and not super rigid penis.

32
Q

Etiologies of priapism

A

MC is idiopathic
Others include: sickle cell disease, drugs (cocaine, marijauna, alcohol). Trauma. Trazodone, PD5 inhibitors, Alpha blockers. Head trauma. Subarachnoid hemorrhage.

33
Q

What diagnostic can be done if the erection lasts longer than 4 hours?

A

Cavernosal blood gas (low flow shows hypoglycemia, hypoxemia, and hypercarbia)

34
Q

First-line medication for priapism

A

Phenylephrine (intracavernosal injection). Causes contraction of cavernous smooth muscle which increases venous outflow.

35
Q

Other treatments for priapism

A

-Needle aspiration (can be used with phenylephrine)
-Ice packs
-Terbutaline (if < 4 hours)
-Shunt surgery saved for refractory cases

36
Q

However, if the priapism is HIGH FLOW, what is the treatment?

A

Observation for most cases (most resolve on their own)

37
Q

MC etiology of urethral injuries

A

Blunt trauma: straddle-type falls
-Other causes: physical or sexual assault

38
Q

Symptoms of a urethral injury

A

-Gross hematuria
-Dysuria
-Urinary retention
-Lower abdominal pain

39
Q

What is seen on physical exam of a patient with a urethral injury?

A

-Blood at urethral meatus
-Swelling or ecchymosis of the scrotum
-High-riding prostate

40
Q

What is the diagnostic test of choice for a urethral injury?

A

Retrograde urethrogram (done prior to catheterization)

41
Q

What’s the hallmark triad of symptoms for a urethral injury?

A

-Blood at urethral meatus
-Inability to void
-Distended bladder

42
Q

Treatment for urethral injury

A

-Nonoperative: catheter placement and monitoring
-Operative: temporary suprapubic catheter placement prior to repair

PANCE 2.0 (62 decks)

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