Male Flashcards
A patient presents with localized testicular pain with tenderness and swelling. Upon physical examination, the scrotum is swollen and erythematous with induration of the posterior epididymis. The patient denies high-risk sexual behavior and reports a monogamous relationship. Which of the following treatment regimens is indicated based on this presentation?
A.Ceftriaxone plus levofloxacin
B.Levofloxacin
C.Azithromycin
D.Ceftriaxone plus doxycycline
Answer: B. Levofloxacin
The patient is presenting with clinical features concerning for acute epididymitis: Localized testicular pain with tenderness and swelling on palpation of the affected epididymis. For patients at low risk of sexually transmitted infections (STIs), treatment includes coverage for enteric pathogens with a fluoroquinolone (e.g., levofloxacin) or trimethoprim-sulfamethoxazole. For patients at risk of STIs who do not practice anal intercourse, treatment should include coverage for Neisseria gonorrhoeae and Chlamydia trachomatis with ceftriaxone plus doxycycline. Alternatively, if the patient is unable to tolerate doxycycline, a single dose of azithromycin can be used. For patients at risk of STIs who practice anal intercourse, therapy should include coverage for N. gonorrhoeae, C. trachomatis, and enteric pathogen infections with ceftriaxone plus a fluroquinolone (e.g., levofloxacin).
A older adult male patient presents with a unilateral right-sided scrotal mass that feels like a “bag of worms” on physical examination. The patient reports a dull, aching, right-sided scrotal pain. Based on this presentation, which of the following is indicated next?
A.Transillumination
B.MRI
C. CT scan of the abdomen
D.Biannual semen analysis
Answer: C. CT scan of the abdomen
The patient is likely presenting with a varicocele based on the scrotal fullness that has the feel of a “bag of worms” and the dull, aching pain. Usually, varicoceles occur on the left side; unilateral right varicoceles are uncommon and are suspicious for an underlying pathology causing inferior vena cava obstruction. An abdominal and scrotal ultrasound is appropriate, along with a CT of the abdomen with contrast for further workup. An MRI may be indicated after the CT and ultrasound if the diagnosis remains unclear. Most varicoceles do not require intervention; in older men who desire continued fertility, a semen analysis is recommended every 2 years. Transillumination of the scrotum would be helpful to identify a hydrocele.
A patient with a past medical history of chronic obstructive pulmonary disease (COPD) asks for recommendations on managing his lower urinary tract symptoms secondary to his new diagnosis, benign prostatic hyperplasia (BPH). Which of the following is the most appropriate treatment strategy?
A.Recommend the use of saw palmetto to treat symptoms of BPH
B.Increase intake of mild diuretics (e.g., caffeine) to ensure adequate urine output
C.Trial the use of a timed voiding regimen
D.Reduce fluid intake in the morning
Answer: C. Trial the use of a timed voiding regimen
The use of a timed voiding regimen can be helpful in patients who exhibit obstructive complaints or carry a high post-void residual. This technique prompts the patient to empty their bladder based on a time interval (e.g., every 90 to 120 minutes) rather than by the usual sensations, which can be helpful to reduce lower urinary tract symptoms. While herbal remedies may appeal to many patients, there is little data to support their safety and efficacy, and they are not recommended for this patient. Additional lifestyle recommendations include limiting fluid intake before bedtime or prior to travel, limiting intake of mild diuretics (e.g., coffee, alcohol), limiting intake of bladder irritants (e.g., highly seasoned or irritative foods), avoiding constipation, increasing physical activity, practicing Kegel exercises at the time of urinary urgency, and using double-voiding techniques.
A patient presents with localized testicular pain with tenderness and swelling noted while palpating the epididymis. Scrotal wall erythema is noted, and a positive Prehn sign is seen. The patient denies both a monogamous relationship and anal intercourse. Which of the following treatment regimens is indicated based on this presentation?
A.Ceftriaxone plus levofloxacin
B.Levofloxacin
C.Trimethoprim-sulfamethoxazole
D.Ceftriaxone plus doxycycline
Answer: D. Ceftriaxone plus doxycycline
This patient is presenting with clinical features concerning for acute epididymitis: Localized testicular pain with tenderness and swelling on palpation of the affected epididymis. A positive Prehn sign may be seen (relief of pain with scrotal elevation). For patients at risk for sexually transmitted infections (STIs) who do not practice anal intercourse, treatment should include coverage for Neisseria gonorrhoeae and Chlamydia trachomatis with ceftriaxone plus doxycycline. For patients at risk of STIs who practice anal intercourse, therapy should include coverage for N. gonorrhoeae, C. trachomatis, and enteric pathogen infections with ceftriaxone plus a fluroquinolone (e.g., levofloxacin). For patients at low risk of STIs, treatment includes coverage for enteric pathogens with a fluoroquinolone (e.g., levofloxacin) or trimethoprim- sulfamethoxazole.
A 60-year-old male patient presents with a sudden onset of fever, chills, dysuria, and pelvic pain. On physical examination, the prostate is firm, edematous, and tender. The patient denies high-risk sexual behavior. Based on this presentation, which of the following empiric antimicrobial therapies should be initiated?
A.Nitrofurantoin
B.Ceftriaxone
C.Doxycycline
D.Ciprofloxacin
Answer: D. Ciprofloxacin
This patient is presenting with symptoms concerning for acute bacterial prostatitis; the patient has a fever, chills, dysuria, and pelvic pain. These patients may also present with perineal pain and cloudy urine. The prostate is often firm, edematous, and tender on exam. Empiric antibiotic therapy should be directed against gram-negative organisms (frequent cause of acute bacterial prostatitis). Unless drug resistance is suspected, empiric treatment often includes a fluroquinolone (e.g., ciprofloxacin, levofloxacin) or trimethoprim-sulfamethoxazole until susceptibility data from the culture results are available. Nitrofurantoin is often avoided in those with prostatitis because of the poor tissue penetration and risk of adverse effects. Sexually active men younger than 35 years and men older than 35 years who engage in high-risk sexual behavior should be treated with regimens that cover Neisseria gonorrhoeae (e.g., ceftriaxone) and Chlamydia trachomatis (e.g., doxycycline).
Which of the following is contraindicated while taking a phosphodiesterase type 5 (PDE5) inhibitor?
A.Alpha-blockers
B.Beta-blockers
C.Nitrates
D.Angiotensin receptor blockers
Answer: C. Nitrates
PDE5 inhibitors are contraindicated in patients prescribed any form of nitrate therapy due to risk of severe hypotension. Caution should be used when combining alpha-blockers with PDE5 inhibitors. Patients on an alpha-blocker for benign prostatic hyperplasia should be on a stable dose prior to initiating the PDE5 inhibitor, which should be started at the lowest dose due to the risk of hypotension. Beta-blockers and angiotensin II receptor blockers should also be used with caution but are not contraindicated with the use of PDE5 inhibitors. PDE5 inhibitors should be avoided with drugs that are cytochrome P450 3A inhibitors and inducers (e.g., certain antivirals, antifungals, calcium channel blockers, anti-epileptic drugs).
A 13-year-old male patient is brought to an outpatient clinic by his parent with a complaint of a sudden onset of severe left testicular pain. The patient is very nauseous and has already vomited a few times. Physical exam reveals a red, swollen, and tender left scrotum. There is no cremasteric reflex. The abdomen is soft, with no rebound or localized tenderness. Bowel sounds are present. Which of the following is recommended for this patient?
A.Increased fluid intake and the BRAT diet (bananas, rice, applesauce, and dry toast)
B.Ordering of ultrasound of the left scrotum
C.Referral to a urologist by giving the patient’s parent the contact information
D.Referral to the ED
Answer: D. Referral to the ED
The sudden onset of testicular pain, with a missing cremasteric reflex accompanied by nausea and vomiting, is highly suggestive of testicular torsion. This is a urologic emergency, so the patient should be referred to the ED. After 6 hours of onset, the risk of ischemia increases. The ED will consult the urology service and obtain an ultrasound of the left scrotum; getting to the ED is the most time-sensitive priority.
Which of the following is true regarding prostate-specific antigen (PSA) testing?
A.A normal PSA result rules out prostate cancer.
B.There is no single threshold for defining an abnormal PSA value.
C.Reference ranges are based on height and weight.
D.Certain medications, such as finasteride, can increase serum PSA levels.
Answer: B. There is no single threshold for defining an abnormal PSA value.
The most commonly used and valuable test for the early detection of prostate cancer is PSA testing. While the likelihood of prostate cancer increases with elevated values, an elevated PSA can also occur in a number of other conditions. Additionally, a PSA result in the normal range does not rule out the possibility of prostate cancer. Certain medications, such as 5-alpha-reductase inhibitors (e.g., finasteride), can reduce PSA levels by about 50% or greater, limiting sensitivity for diagnosing prostate cancer. There is no single threshold for defining an abnormal PSA level; the patient’s PSA result should be compared with the age-specific reference range, as well as the prior year’s PSA, if available.
An older adult male patient presents with the inability to sustain an erection for sexual intercourse. The patient has a history of benign prostatic hyperplasia with reports of urgency, nocturia, and hesitancy. Which of the following agents would be helpful for this patient?
A.Tadalafil
B.Sildenafil
C.Avanafil
D.Vardenafil
Answer: A. Tadalafil
Phosphodiesterase type 5 (PDE5) inhibitors are recommended for initial therapy for men with erectile dysfunction. Sildenafil, vardenafil, tadalafil, and avanafil have similar efficacy; the choice of drug depends on patient’s preferences, cost, and adverse effects. However, only tadalafil has been approved for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.
