Issues in Men's Health/Gynecologic Concerns

Question 1

Enlargement, often benign of the male breasts that usually resolves naturally:

Answer 1

Gynecomastia

Question 1

What medication can cause gynecomastia?

Answer 1

spironolactone (Aldactone)

Question 2

A collection of dilated veins around the spermatic cord is?

Answer 2

Variocele
“Bag of worms feel on physical exam”

Question 2

Management for variocele includes:

Answer 2

NSAIDs
Surgical ligation, venous embolization

Question 3

Acute inflammation or infection of the scrotum, secondary to an inflamed epididymis:

Answer 3

Epididymitis

Question 4

A positive Prhen’s sign is indicative of?

Answer 4

Epididymitis

Question 5

Treatment for epididymitis caused by chlamydia and gonorrhea in a heterosexual man?

Answer 5

Ceftriaxone 500 mg IM in a single dose
Plus
Doxycycline 100 mg BID x 10 days

Question 5

Lifting the scrotum and there is relief of pain indicating epididymitis not testicular torsion is what sign?

Answer 5

Prhen’s sign

Question 6

Treatment for epididymitis caused by chlamydia and gonorrhea in men who have anal sex?

Answer 6

Ceftriaxone 500 mg IM in a single dose
Plus
Levofloxacin 500 mg IM q-day x 10 days

Question 7

Inflammatory infection of the prostate

Answer 7

Acute Bacterial Prostatitis

Question 8

What Gram-negative bacteria is the usual cause prostatitis?

Answer 8

E. Coli

Question 9

Non-bacteria prostatitis likely causes include (3)?

Answer 9

Chlamydia
Mycoplasma
Gardnerella

Question 10

What is seen on a physical exam/palpation of the prostate in prostatitis?

Answer 10

Edematous prostate which may be warm, TENDER/BOGGY, pain

Question 11

Diagnostic tests for prostatitis

Answer 11

Urinalysis
Urine culture: Positive for causative agent

Question 12

Would you have a normal or abnormal cremasteric reflex in epididymitis?

Answer 12

Normal

Question 13

Diagnostic tests for epididymitis

Answer 13

STI testing
Culture of urine
Scrotal ultrasound to rule out testicular torsion

Question 14

Treatment for Acute Bacterial Prostatitis (4)?

Answer 14

ceftriaxone (Rocephin) 250 mg IM X1 OR
cefixime (Suprax) 400 mg x1 OR
Ciprofloxacin 500 mg BID x 10-14 days OR
Levofloxacin (Levaquin) 500-750 mg q-day x 10-14 days

Question 15

Progressive, benign hyperplasia of prostate:

Answer 15

Benign Prostatic Hypertrophy (BPH)

Question 16

What Prostate-specific antigen (PSA) level would indicate BPH or possibly Prostate cancer

Answer 16

> 4 ng/ml

Question 17

What is the most common cause of bladder obstruction in men?

Answer 17

BPH

Question 18

Benign neoplasm of prostate gland:

Answer 18

Prostate cancer

Question 19

What is the second most common cancer among men in the United States?

Answer 19

Prostate cancer

Question 20

Palpation of the prostate is harder than normal with obscure boundaries, and nodules may be present in?

Answer 20

Prostate cancer

Question 21

Breast buds with areola enlargement is Tanner stage?

Answer 21

2

Question 22

Breast enlargement without separate nipple contour is Tanner stage?

Answer 22

3

Question 23

Areola and nipple project as secondary mound in Tanner stage?

Answer 23

4

Question 24

The absence of menstrual flow?

Answer 24

Amenorrhea

Question 25

Absence of menarche by age 16 is?

Answer 25

Primary Amenorrhea "Refer to Endocrinologist"

Question 26

Cessation of menstrual flow after the establishment of normal menstrual cycling is?

Answer 26

Secondary Amenorrhea "Always get a pregnancy test (HCG)"

Question 27

Detects the presence of abnormal and/or precancerous cells on the cervix of the uterus?

Answer 27

Papanicolaou Test (PAP)

Question 28

At what age should the initial cervical cancer screening with cytology alone be done?

Answer 28

21 years old

Question 29

For patients 21-29 and 30-65 years old how often should cancer screening with cytology alone be done?

Answer 29

Every 3 years

Question 30

For patients 30-65 years old how often should high-risk human papillomavirus (hrHPV) testing done alone or in combination with cytology (cotesting)?

Answer 30

Every 5 years

Question 31

At what age would you cease cervical cancer screenings in patients who have had adequate prior screening and low risk for cervical cancer?

Answer 31

> 65 years old

Question 32

What is the leading cause of cancer related death in men and women?

Answer 32

Lung cancer

Question 33

What is the leading GYN-associated cancer, cause of death in women?

Answer 33

Ovarian

Question 34

What kind of cancer has the highest incidence other than skin cancer in women?

Answer 34

Breast

Question 35

Inflammation or infection of the vulva and vagina most commonly caused by bacteria, protozoa, and/or fungi?

Answer 35

Vulvovaginitis

Question 36

What are 3 common causes of vulvovaginitis?

Answer 36

Trichomoniasis Bacterial Vaginosis Candidiasis

Question 37

Only this is often asymptomatic in men and is considered to be sexually transmitted:

Answer 37

Trichomoniasis

Question 38

Malodorous, frothy, yellowish-green discharge, pruritis, vaginal erythema, "strawberry patches" on cervix and vagina, dyspareunia, and dysuria seen in?

Answer 38

Trichomoniasis

Question 39

Watery, gray, "fishy" smelling discharge, vaginal spotting seen in?

Answer 39

Bacterial Vaginosis

Question 40

Thick, white, curd-like discharge; vulvovaginal erythema with pruritis seen in?

Answer 40

Candidiasis

Question 41

Microscopic wet-prep with normal saline shows motile trichomonads in?

Answer 41

Trichomoniasis

Question 42

Microscopic wet-prep with normal saline shows clue cells; KOH added positive whiff test (fishy smell) in?

Answer 42

Bacterial Vaginosis

Question 43

Microscopic wet-prep with KOH shows pseudohyphae in?

Answer 43

Candidiasis

Question 44

Treatment for Trichomoniasis in women:

Answer 44

Metronidazole 500 mg BID x 7 days

Question 45

Treatment for Trichomoniasis in men:

Answer 45

Metronidazole 2 grams in a single dose

Question 46

Treatment for Bacterial Vaginosis

Answer 46

Metronidazole 500 mg BID x 7 days OR Metronidazole gel 0.75% 5 grams intravaginally q-day x 5 days OR Clindamycin cream 2% 5 grams intravaginally at bedtime x y days

Question 47

Treatment for Candidiasis

Answer 47

OTC intravaginal agents: Clotrimazole, Miconazole, or tioconazole intravaginally Oral agent: Fluconazole (contraindicated in pregnancy)

Question 48

General term for inflammation and infection involving the uterus, fallopian tubes, ovaries, and surrounding tissues

Answer 48

Pelvic Inflammatory Disease (PID)

Question 49

Most prevalent polymicrobial causative agents for PID?

Answer 49

C. trachomatis N. gonorrhoeae E. coli G. vaginalis H. influenzae Streptococcus agalactiae

Question 50

Diagnostic tests for PID (2)?

Answer 50

STI testing Ultrasound documentation of ovarian cyst

Question 50

What physical exam finding is found in PID?

Answer 50

Positive cervical motion tenderness (CMT)

Question 51

Treatment for PID

Answer 51

Ceftriaxone 500 mg IM single dose Plus Doxycycline 100 mg orally BID x 14 days WITH Metronidazole 500mg orally BID for 14 days

Question 52

Cramping pain occurring with menstruation

Answer 52

Dysmenorrhea

Question 53

Occurs in adolescent women as a result of high levels of prostaglandin

Answer 53

Primary Dysmenorrhea

Question 54

Occurs in women greater than age 20; more likely associated with some form of pelvic disease

Answer 54

Secondary Dysmenorrhea

Question 55

Pelvic pain plus GI Issues think?

Answer 55

Endometriosis

Question 56

Management for primary dysmenorrhea

Answer 56

Prostaglandin synthetase inhibitors (PGSIs) -Ibuprofen -Naproxen -Indomethacin Oral Contraceptives

Question 57

Abnormal bleeding is usually a result of?

Answer 57

An endocrine dysfunction

Question 58

What is the initial approach to abnormal vaginal bleeding?

Answer 58

Evaluate for pregnancy Evaluate the cervix, vagina, urethra, and annus for non-uterine bleeding