GU 2 - Male Conditions Flashcards
MC benign enlargement/tumor of prostate
BPH
BPH requires what two things for PE?
- DRE
2. PSA w/o prostate massaging before testing
Must also perform a _____ to r/o prostatitis in BPH
C&S
____ Drug class (ex. ____) to relax smooth muscle of bladder and prostate but DOES NOT reduce the size of the prostate in BPH
Alpha blockers drug class ex. is Tamsulosin
____ Drug class (ex. ____) to block conversion of testosterone to DHT to reduce the size of the prostate in BPH
5-alpha reductase inhibitors
ex. is finasteride
OTC dietary supplement for BPH that is sometimes used with variable efficacy
saw plametto
is chronic or acute prostatitis more common?
chronic
prostatitis organisms > 35 y/o
E.coli, Kleb, Proteus, other GNR
prostatitis organisms < 35 y/o
gonorrhea and chlamydia
none organism cause of prostatitis
reflux of infected urine back into urethra and into ascending parts usually secondary to cath usage
acute or chronic prostatitis is ASx?
chronic
DRE of prostatitis
acute: boggy, tender prostate
chronic: enlarged, nontender
ABX duration of prostatitis
28 - 30 days
MC prostate cancer type
adenocarcinoma
urinary retention, back pain, hematuria, bone pain in a male
prostate cancer
Most prostate cancer is ___ in the beginning. (clinical manifestations)
ASx
Once the Sx appear for prostate cancer, you start to see _____ sx and it’s quite common for the cancer to have ____.
Bone pain sx
common for the cancer to have spread/metastasized to lymph nodes/bones (spine/pelvis)
DRE shows hard, nodular, asymmetrical, irregular prostate
prostate cancer
PSA does not = ____
prostate cancer
best diagnostic study for prostate cancer
transrectal U/S with a biopsy if indicated in different areas of prostate
prostate cancer is a ______ type of cancer
slow metastasizing cancer
Patient is > 65 and has prostate cancer. What’s the best way to manage?
Watchful waiting
heavy scrotum, herniation into scrotum, filariasis
hydrocele
Hydroceles are usually ____
congenital
Collection of fluid in serous scrotal space between the layers of tunica vaginalis
hydrocele
communicating hydrocele
fluid from peritoneum enters the hydrocele and flows back and forth freely
non-communicating hydrocele
herniation of thickened cord above testicle on affected side (no free fluid movement)
Hydrocele’s do or do not transilluminate?
DO transilluminate
tropical infection with filariasis
can cause a hydrocele
transillumination, bag of worms, varicosities
varicocele
Varicose veins that drain into internal spermatic veins
varicocele
Bag of worms posterior and superior to testes
varicocele
round soft painless mass above and behind testicle
spermatocele
spermatocele
Epidydimal cysts containing sperm (scrotal mass)
1) Painless, cystic testicular mass on PE
Round, soft mass at epidydimal head, superior and posterior, separate from testicle
spermatocele
positive Phern’s sign, Cremasteric reflex
epididymitis
STI form of epididymitis
due to gonorrhea or chlamydia
NON STI forms of epididymitis
E.coli, Pseudomonas, Kleb
lifting testicle decreases pain
this PE test is also + in what condition?
Phern’s sign
epididymitis
brushing thigh and scrotum lifts
this PE test is also + in what condition?
Cremasteric reflex
epdidymitis
MUMPS, monocytes, MONO test
orchitis
Inflammation of testicle commonly from systemic infections like MUMPS
orchitis
Bell-Clapper defect, Loss of cremasteric reflex & phren’s sign
testicular torsion
Teenage males following scrotal trauma or physical activity
Can just wake up with it in the AM
testicular torsion
Testicular U/S with doppler with no arterial flow
testicular torsion
Rapidly spreading necrotizing infection of scrotum
Fournier’s gangrene
RF for Fournier’s gangrene (4)
DB
obesity
Pelvic trauma
immunocompromised
20-35 y/o, AFP, beta HCG tumor markers, CT of head/chest/abdomen/pelvis, painless/firm/hard/fixed scrotal mass
testicular cancer
Testicular cancer is common in _____ y/o males
Common in 20 - 35 y/o males
Testicular cancer RF are ____ & ______
cryptoorchidism
kleinfelter’s
MC testicular cancer type
germ cell tumors
Two main types of testicular cancer
germ cell and non-germ cell tumors
germ cell tumors of testicular cancers - comprised of what two categories?
seminomas
nonseminomatous
Which is MC? Seminomas or nonseminomatous?
seminomas
What are the four types of nonseminomatous?
- emryonal carcinoma
- choriocarcinoma
- teratoma
- yolk sac carcinoma
Which of the nonseminomatous testicular cancers is MC in young boys?
yolk sac carcinoma
Which of the nonseminomatous testicular cancers is most aggressive?
choriocarinoma
Which of the nonseminomatous testicular cancers rarely metastasizes?
teratoma
Which of the nonseminomatous testicular cancers has a high malignancy and has hemorrhage/necrosis?
embryonal carcinoma
What are the two subtypes of non-germ cell tumors of testicular cancer?
- leydig cell tumors
2. sertoli cell tumors
Why do a CT scan and/or CXR for testicular cancer?
CT scan (metastasize to head, chest, abdomen, pelvis)
CXR (metastasize to chest)
Painless mass/lump or firmness of testicle
testicular cancer
testicular cancer subtype that is hormonally active and common in precocious puberty
leydig cell tumors (non-germ cell type)
testicular cancer tumor marker of beta HCG
seminoma
nonseminoma, subtypes choriocarcinoma and embryonal (embryonal also has AFP)
testicular cancer tumor marker of alpha fetal protein
nonseminoma, subtypes yolk sac and embryonal (also has beta HCG)
testicular cancer tumor marker for teratoma
NONE! Its made up of hair, teeth, and nails….
low testosterone, androgen deficiency in aging male (ADAM) AKA
hypogonadism
Clinical presentation for hypogonadism
Most are ASx and have no problems
Contraindication to testosterone replacement therapy for hypogonadism
polycythemia as testosterone thickens the blood (no one with HCT > 55%)
Hypogonadism that you decide to treat with testosterone and you see a Rapid rise in PSA in first 3-6 months = ________?
early prostate cancer that was preexisting
Balanitis
Inflammation of superficial tissues of glans
Balanoposthtis
inflammation of foreskin and glans
1) Infections due to poor hygiene, erosion of tissues with erythema and yeast overgrowth
2) Pruritius, tenderness, pain, dysuria, localized edema
Can see ulceration and lymphadenopathy
Balanitis/Balanoposthtis
MCC of erectile dysfunction
decreased arterial flow due to peripheral vascular disease
Meds that can cause ED (3)
antihypertensives (beta blockers)
antidepressants (TCAs)
opioid analgesics
_______ is key neurotransmitter for erectile production
Nitric oxide
Erection lasting > 4 hours
priapism
Diagnostics of priapism
penile ABG
CBC
Dupuytren’s contracture
Peyronie’s disease
Abnormal curvature and shortening of penis during erection due to scarring of tunica albuginea of the corpora cavernosa
Peyronie’s disease
Penile cancer peaks in the ___ decade of life
seventh
penile cancer is linked with HPV strain ___
18
Penile cancer is very rare in those that are _____
circumcised
