Lecture 11 - Men's Health Flashcards
Transilluminates
hydrocele
Hydrocele
reassure parents
will probably go away on its own within a year
monitor
transilluminates
Varicocele
always wonder “why did this form?”
a cenous varicosity within the pampiniform plexus occurs more often on the left than the right
does NOT illuminate
“Bag of worms”
Bag of worms
varicocele
What is the most common type of kidney stone?
calcium oxalate or calcium phosphate (75-85%)
radioopaque
second most common is struvite (10-15%)(calcium/ammonium/magnesium salt)
When are kidney stones most common?
3rd to 4th decade of life
M > W
may recur in 30-50% of patients within 5 years
What are the signs and sxs of urolithiasis?
CVAT (not as sensitive as pyelonephritis) tachycardia tachypnea restlessness hematuria (85%)
Do we need to get imagining on every pt with kidney stones?
no —probably the very first time we’d get a non contrast abdomen and pelvis
but these commonly recur so we don’t want to do this every single time —look at their hx of kidney stones and how they passed
stone must me 5mm or smaller to pass on its own
What is the treatment of kidney stones?
hydration (IV only if PO isn’t tolerate)
Pain control (TORADOL IV/IM, high dose ibuprofen)
When do pts with kidney stones get admitted to the hospital?
only if they are infected
even if the stone is too big they still go home (on pain meds) and follow up SOON with urologist
Phimosis
inability to retract the foreskin
congenital
acquired (usually d/t chronic balanitis)
not an emergency
treat underlying infection if there is one (commonly fungal)
Paraphimosis
entrapment of the foreskin behind the glans
commonly iatrogenic when doing foley catheters
tx: squeeze to displace edema, then you should be able to move the foreskin –if that doesnt work –> urology consult!
Who gets testicular torsion?
urologic EMERGENCY
12-18 years old
Testicular torsion
urologic EMERGENCY
testis twists on its spermatic cord
sudden onset of severe unilateral pain and swelling, N/V
urgent US with doppler! —if this takes too long you need to just try and untwist it yourself before the US (manual detorsion)
Urethritis
discharge
painful urination
typically following sexual intercourse –> you need to ask if it was a male or female partner
THIS IS REPORTABLE – so encourage pt to tell their partner –or else the department of health has to
don’t focus on blame –both men and women can be asymptomatic for a long time before presenting with STI
most commonly gonorrhea and chlamydia (if >35yo probably E.coli)
Epidiymitis
> 35 e. coli
<35 chlamydia and gonorrhea
heaviness unilaterally
fever, chills
unilateral enlarged and swollen epidiymis
we tx based on assumption from hx (age) and PE
if they don’t get better then we do studies
What is the treatment for epiddiymitis for a man >35 yo?
ciprofloxacin 50mg bid for 10-14 days
Orchitis
if bacterial, caused by ascending infection from urinary tract
can be viral from mumps
dx: urinalysis shows pyuria and bacteriuria
tx:
tx like epididymitis
if mumps: tx with ice and pain meds
Prostatitis
urinary frequency, urgency, dysuria, fever, rigors, and low back pain or perineal pain
pain or bleeding with ejaculation may be present
dx:
pyuria on UA
prostate swollen on exam
tx:
fluoroquinolone or bactrim for 6 weeks
What is the treatment for prostatitis?
fluoroquinolone or bactrim for 6 weeks
Priapism
erection lasting >4hours
bimodal distribution: 5-10 years and 20-50 years of age
ischemic vs non ischemic
ischemic(MC): pills; more acute
non ischemic: trauma like biking; more slowly
tx: urology needle aspirate
Scrotal pain
is this epididymitis? is this orchitis? is this Fourniers gangrene? Is this torsion? Is this CA?
have a chaperone (document in your chart who it was and that they were present when you were doing the exam)
do the exam!
Fournier’s gangrene
surgical emergency
dead tissue on scrotum and/or perineum
don’t miss this
do a full head to toe
this pt might come in with AMS, don’t let this get missed –> high risk (~100%) of mortality
Why do we see BPH in the ER?
acute urinary retention
tx: try twice with foley catheter –if that fails then you need to get urology down to help
