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Phase 3a > GP - Men > Flashcards

GP - Men Flashcards

1
Q

Who is benign prostatic hyperplasia more common in?

A

Black > White > Asian

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2
Q

What are the clinical features of BPH?

A
  • Voiding (obstructive) = weak flow/straining/hesitancy/terminal dribbling/incomplete emptying
  • Storage (irritative) = urgency/frequency/urgency incontinence/nocturia
  • Post-micturition dribbling
  • Complications (UTI/retention/obstructive uropathy)
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3
Q

What are the investigations for BPH?

A
  • Dipstick urine
  • U&Es
  • PSA
  • Urinary frequency-volume chart (min. 3 days)
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4
Q

What scoring system is used for prostatism?

A

International prostate symptom score (IPSS) = tool for classifying the severity of LUTS and assessing their impact on QoL

0-7 = mildly symptomatic
8-19 = moderately symptomatic
20-35 = severely symptomatic

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5
Q

What is the management for BPH?

A
  • Moderate to severe = alpha-1 antagonists e.g. tamsulosin/alfuzosin
  • 5 alpha-reductase inhibitors e.g. finasteride (sx may not improve for 6 months)
  • Combination therapy of above
  • Storage/voiding sx and alpha blocker not helping = antimuscarinic e.g. tolterodine/darifenacin
  • Surgery = transurethral resection of prostate (TURP - a.k.a transurethral prostatectomy)
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6
Q

What is the most common cause of acute bacterial prostatitis and what are the risk factors?

A
  • Gram-negative bacteria e.g. E. Coli
  • Recent UTI
  • Urogenital instrumentation
  • Intermittent bladder catheterisation
  • Recent prostate biopsy
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7
Q

What are the clinical features of acute bacterial prostatitis?

A
  • Referred pain to perineum/penis/rectum/back
  • Obstructive voiding symptoms
  • Fever/rigors
  • DRE = tender/boggy prostate gland
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8
Q

What is the management for acute bacterial prostatitis?

A

14 day course of quinolone e.g. ciprofloxacin

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9
Q

What are the risk factors for prostate cancer?

A
  • Increasing age
  • Obesity
  • Afro-Caribbean ethnicity
  • Fhx
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10
Q

What is the most common type of prostate cancer?

A

95% = adenocarcinoma

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11
Q

What are the clinical features of prostate cancer?

A
  • Asx
  • Bladder outlet obstruction = hesitancy/urinary retention
  • Haematuria/haematospermia
  • Back/perineal/testicular pain
  • Metastasis = bone pain
  • DRE = asymmetrical/hard/nodular enlargement with loss of median sulcus
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12
Q

What are the investigations for prostate cancer?

A
  • Prostate specific antigen (PSA) testing
  • Multiparametric MRI
  • Transrectal ultrasound-guided (TRUS) biopsy
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13
Q

What is the grading system for prostate cancer?

A
  • Gleason grading system
  • 2 = best prognosis
  • 10 = worst prognosis
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14
Q

When may PSA levels be raised?

A
  • BPH
  • Prostatitis/UTI
  • Ejaculation
  • Vigorous exercise
  • Urinary retention
  • Instrumentation of urinary tract
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15
Q

What si the management for prostate cancer?

A

Localised:
- Monitoring
- Surgery = radical prostatectomy
- Radiotherapy

Localised advanced:
- Hormonal therapy
- Surgery = radical prostatectomy
- Radiotherapy

Metastatic:
- Hormonal therapy = synthetic GnRH agonists e.g. Goserelin
- Hormonal therapy = non-steroidal anti-androgen e.g. bicalutamide
- Hormonal therapy = steroidal anti-androgen e.g. cyproterone acetate
- Hormonal therapy = androgen synthesis inhibitor e.g. abiraterone
- Surgery = bilateral orchidectomy
- Chemotherapy

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16
Q

What is the management for UTIs in men?

A

Abx = nitrofurantoin or trimethoprim for 7 days

17
Q

What can cause impotence?

A
  • Thiazide diuretics
  • Excess prolactin (prolactinoma)
  • Finasteride (5 alpha-reductase inhibitor)
  • Lambert Eaton syndrome
  • Degenerative cervical myelopathy
  • Leriche syndrome
18
Q

What are risk factors for impotence?

A
  • Increasing age
  • CVD
  • Obesity
  • Diabetes
  • Dyslipidaemia
  • Metabolic syndrome
  • HTN
  • Smoking
  • Alcohol use
  • Drugs = SSRIs/beta blockers
19
Q

What is the management for impotence?

A
  • PDE-5 inhibitors e.g. sildenafil (Viagra)
  • Vacuum erection devices (for those who can’t/won’t take PDE-5 inhibitor)
20
Q

What are the types of testicular cancer?

A

Germ cell tumours (95%):
- Seminomas
- Non-seminomas = embryonal/yolk sac/teratoma/choriocarcinoma

Non-germ cell tumours:
- Leydig cell tumours
- Sarcomas

21
Q

What is the peak incidence for testicular cancer?

A

20-30
- Teratomas = 25
- Seminomas = 35

22
Q

What are the risk factors for testicular cancer?

A
  • Infertility
  • Cryptorchidism
  • Fhx
  • Klinefelter’s syndrome
  • Mumps orchitis
23
Q

What are the clinical features of testicular cancer?

A
  • Painless lump
  • Pain
  • Hydrocele
  • Gynaecomastia (increased oestrogen:androgen ratio)
24
Q

What are the investigations for testicular cancer?

A
  • USS (first line)
  • Elevated hCG = seminomas
  • Elevated AFP and/or beta-hCG = non-seminomas
  • Elevated LDH = germ cell tumours
25
Q

What is the management for testicular cancer?

A
  • Orchidectomy
  • Chemotherapy and radiotherapy
26
Q

What are the clinical features of epididymal cysts and what is the investigation?

A
  • Scrotal swelling
  • Separate from body of testicle
  • Found posterior to testicle
  • USS
27
Q

What conditions are associated with epididymal cysts?

A
  • PKD
  • CF
  • Von Hippel-Lindau syndrome
28
Q

What is a hydrocele and what are the types?

A

Accumulation of fluid within tunica vaginalis

  • Communicating = patency of processus vaginalis which allows peritoneal fluid to drain down into the scrotum
  • Non-communicating = excessive fluid production within tunica vaginalis
29
Q

What are the clinical features of hydroceles and what are the investigations?

A
  • Soft, non-tender swelling of hemi-scrotum
  • Usually anterior to and below testicle
  • Swelling confined to scrotum - can ‘get above’ mass on examination
  • Transilluminates with pen torch
  • USS
30
Q

What is the management for hydroceles?

A
  • May resolve spontaneously by age 1-2 years
  • Conservative approach
31
Q

What is a varicocele?

A

Abnormal enlargement of testicular veins

32
Q

What are the clinical features of varicoceles and what is the investigation?

A
  • More common on left side
  • Feel like ‘bag of worms’
  • Subfertility
  • USS with Doppler studies
33
Q

What is the management for varicoceles?

A
  • Conservative
  • Surgery (if pain)

Phase 3a (21 decks)

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