GU (the fun stuff) Flashcards
When should you start routine rectal exams to screen for prostatic disease
Age 40
Is a rectal screening sensitive of specific
Very (94%) specific but not very sensitive
Where are the seminal vessels located
Just lateral to the prostate
What are the dimensions of a normal prostate
4cm wide x 3cm long x 2cm deep
Size of a walnut
What is the prostate made up of
Capsule made of CT & fascia with smooth muscle interior
What receptors are in the prostate
Alpha 2 receptors
How many sphincters does the prostate have? Which one is important in prostate CA
2 (internal and external) and the exterior one is important in prostate CA
What is a danger of BPH
Constriction of urethra backing up urine to the kidney and causing renal failure
Is a digital rectal exam (DRE) good at ruling prostate CA in or out?
Good at ruling out
What are the purposes of a DRE
Evaluation of symptoms Prostate CA screening Colorectal CA screening Evaluation of a retroverted uterus Rectal complaints (like bleeding)
What is the difference between hematachezia and melena
Melena = dark bloody stool, bleeding higher in GI tract Hematachezia = bright red bloody stool, bleeding in the distal GI tract
What is the MC male CA
Prostate CA
Prostate CA is most common over what age
50 y/o
How is prostate CA staged
Gleeson score (based on histology)
For prostate CA screening what is the biopsy cut point in terms of PSA level
PSA > 4mg/dL
What are the ACS prostate CA screening recommendations
Age 50 for baseline risk
45 for high risk (1st degree relative)
40 with multiple affected relatives
DRE & PSA q 2 years if PSA < 2.5mg/dL
What is the importance of Finasteride in prostate CA screening
It reduces the PSA levels by > 50%
What are the findings in BPH
Rubbery, nontender, symmetrically enlarged prostate w/o nodules
Does BPH increase the risk of prostate CA
No, not by itself
What are the obstructive SxS of BPH
Nocturia, hesitency, dribbling, weak stream
What is acute prostatitis
Inflammation of prostate; febrile condition caused by bacterial infection
In acute prostatitis in pt < 35 y/o what might be the cause
GC/chlamydia
In acute prostatitis in pt > 40 y/o what might be the cause
GNR - Enterobacteraciae
What are the SxS of acute prostatitis
Dysuria, pelvic & rectal pain, fever
What are the prostate findings in acute prostatitis
Prostate is swollen, firm, warm, & VERY TTP
Why should you not massage the prostate in suspected prostatitis
Will precipitate bacteremia
Where do internal hemorrhoids originate and what do the arise from
Originate above the pectinate line
Arise from the internal rectal veins
What might internal hemorrhoids indicate
Liver disease
These hemorrhoids will not be painful or bleed…internal or external
Internal
Where do external hemorrhoids originate and what do they look like
Originate below the pectinate line
Appearance = small, blue, olive-shaped mass at anal margin
What is the danger of an external hemorrhoid
It can thrombose
What might external hemorrhoids indicate
Portal hypertension
What are 2 things you always need to use for a DRE
Lube & gloves
What do you need to note regarding the prostate upon DRE
Size, symmetry, nodularity, & median sulcus
What position is most comfortable for the pt during a DRE
Pt in left lateral decubitus
AKA Simm’s position
When should testicular screening be started
Recommend to your pts to start doing them monthly at age 15
When is it best to do a testicular exam
After a hot shower
When should mammogram be done
Ages 40-75 then based on pt
When should clinical breast exams be done and how often
Start at age 20 then q 3 years till 40 then annually
When should self breast exams be done
Promoted starting in pt’s 20’s and monthly 5-7 days after menses
Dimpling of breast tissue is consistent with…
Underlying malignancy
Where is most breast CA found
In the tail of the breast (where it goes over to the axilla)
What HPV causes 90% of genital warts
HPV 6 & 11
What HPV causes most cervical CAs
HPV 16 & 18
Guardasil vaccine covers what HPV strands
HPV 16 & 18
In women 40+ y/o with new IBS/GI SxS what do you have to be suspicious of and test for? Why?
Ovarian CA
B/c it is HIGHLY deadly
Varicosities of the spermaticord; scrotum doesn’t elevate as much as it normally does –> poor temp control, sperm distruction, may lead to infertility; can be corrected with Sx
Varicocele
Fluid accumulation around the testes
Hydrocele
Infectious inflammation of epididymis, may be due to STD, pt reports pain and tenderness in the posterior of the testicle
Epididymitis
Relief of pain with elevation of the testicles
Phren’s sign
Development of feminine characteristics due to hormonal causes; may cause enhancement of breast tissue, production of breast secretions
Gynecomastia
Cryptochidism leads to higher risk of ______ later in life
Testicular CA
Strawberry cervix is associated with…
Trichomonas
Tx with Flagyll
Chandelier sign (extreme TTP of the cervex) is associated with…
Cervicitis/PID
Pelvic/thigh heaviness, menorrhagia
Fibroids
What do you need to r/o with mastitis in a non-lactating woman or with persistent dermatitis of the nipple
Inflammatory breast carcinoma
Nipple retraction, dimpling, edema (orange peel sign), unilateral bloody nippledischarge suggests…
Ductal breast CA
Acanthosis nigricans
Internal malignancy
Post-menopausal vaginal bleeding = ________ until proven otherwise
Endometrial CA
