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My PCM 2 > Male genitourinal > Flashcards

Male genitourinal Flashcards

1
Q

Prostate Gland lobes

A

Anterior lobe
Posterior lobe
Middle lobe
2 Lateral lobes

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2
Q

Which prostate lobe most common for cancer?

A

posterior

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3
Q

Hernias

A

Indirect – most common for both
sexes. Above the inguinal
ligament. Often into the
scrotum.

Direct – less common, usually in men,
rare in women. Above the
inguinal ligament. Rarely into
the scrotum.

Femoral – least common. More common
in women than men. Below the
inguinal ligament. Never into
the scrotum.

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4
Q

components of male GU exam

A 
Penis
Scrotum and its contents
Hernias
Prostate examination
Special techniques
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5
Q

Penis inspection

A

Skin – lesions or rashes.

Hair – distribution. Lesions, infections,
parasites.

Prepuce or foreskin – if present, need to
retract.

Glans – ulcers, scars, rashes or signs of
inflammation.

Meatus – lesions or inflammation, discharge

Gently compress the glans to express any discharge from the urethral meatus.
Also can “milk” or “strip” the penis.

Can put the sample on a glass slide or send for culture.

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6
Q

STD labs

A

Chlamydia - WBC
Gonorrhea - WBC with Gm(-) intracellular diplococcic
Trichomonas - WBC with moving organisms
GEN Probe – Chlamydia & GC

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7
Q

Penis- palpation

A

Palpate from the glans to the base.

Note any tenderness, nodules, masses,
inflammation.

Palpate the inguinal areas for lymph
nodes, masses, hernias or tenderness.

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8
Q

Scrotum- inspection and palpation

A

Inspection of the skin and scrotal contours.
Palpation of the testes and epididymis.

Palpate the spermatic cord

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9
Q

hernia palpation

A

Proper technique for evaluating a hernia. Finger slides up the inguinal canal.
Also palpate the inguinal areas.
Ask the patient to cough or bear down.

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10
Q

positions to examine the prostate

A 
Sim's = left lateral decubitus
modified lithotomy (like feet in stirrups position)
standing and leaning forward
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11
Q

rectal & prostate exam

A

Palpation or Digital Rectal Examination (DRE)
Inform the patient of what is going to happen.
Lubricate your gloved index finger.
Place your finger pad on the external sphincter and ask the patient to relax the sphincter muscles.
Slowly roll and insert the finger as the sphincter relaxes as far as possible.

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12
Q

prostate - how it should feel

A

bi-lobed, heart shaped, consistency of a rubber ball. The inferior aspect of the posterior lobe is best palpated on DRE.
Note size, tenderness, consistency, nodules, etc.

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13
Q

Testicular self-exam

A

Best performed during or after a bath
or shower.

Examine each testicle with both hands.
Gently roll the testicle between the
thumbs and fingers.

Locate the epididymis on the posterior
surface of the testicle.

Follow up with a physician if you find any
lumps or tenderness.

Educate your patients.

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14
Q

US Preventive task force grade definitions

A

A- strongly recommends the service, benefit substantial (offer this!)
B- recommends, moderate to subst. benefit
C- recommends against routinely providing, benefit is small
D- recommend against; no net benefit
I- insufficient evidence that benefit outweighs the harm. If offered, patients should understand the uncertainty

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15
Q

Prostate Cancer

A

Most common non-skin cancer.
2nd leading cause of cancer death in men in the U.S.
Screening tests:
Digital rectal exam (DRE).
PSA – more sensitive than DRE.
PSA screening can detect some cases of prostate cancer. False Positives

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16
Q

prostate cancer screenings recommendations

A

Rating : I recommendation
The current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than 75 years old.
Rating : D recommendation
Recommends against screening for prostate cancer in men 75 years or older.

17
Q

testicular cancer screening recommendations

A

Rating : D recommendation

Recommends against routine screening for testicular cancer.

USPSTF found no new evidence that screening with clinical examination or testicular self-exam is effective in reducing mortality from testicular cancer.

18
Q

testicular cancer clinical considerations

A

Low incidence of testicular cancer and favorable outcomes make it unlikely that clinical testicular screening would provide health benefits.
Most testicular cancers are discovered by patients or their partners, there is no evidence teaching young men how to examine themselves improves health outcomes.
Clinicians should be aware of testicular cancer as a possible diagnosis when young men present with suggestive signs and symptoms.

19
Q

phimosis

A

the foreskin cannot be retracted over the penis.
Very painful with an erection.
Hygiene issues.
Treatment – circumcision

20
Q

hydrocele

A

fluid filled mass within the tunica vaginalis.

Transilluminates with a light.

21
Q

cryptorchidism

A

undescended testicle.

Usually atrophied. Increased risk for cancer.

22
Q

Primary syphilis

A

Syphilitic Chancre – painless round or oval erosion or ulcer. Non-tender enlarged inguinal lymph nodes are common.
RPR and VDRL are positive, screening test, many false positives.
FTA- ABS is positive or Dark Field Microscopy (spirochetes), confirmatory test.

23
Q

secondary syphilis

A

Secondary Syphilis – Any unexplained rash on the body, palms of the hands and soles of the feet.
“Think Syphilis”

24
Q

syphilis clinical considerations

A

Primary and secondary syphilis reported in the U.S. = 2.4 cases/100,000.
Congenital syphilis = 11.1 cases/100,000 live births.
Laboratory tests:
Non-treponemal tests (common false positives)
RPR (Rapid Plasma Regain)
VDRL (Venereal Disease Research Lab)
Confirmatory tests
FTA-ABS (fluorescent treponemal antibody absorbed)
TP-PA (T. pallidum particle agglutination)
Dark field microscopy

25
Q

syphilis screening recommendations

A

Rating: A recommendation
Strongly recommends screening patients at increased risk for syphilis infection.
Rating: A recommendation
Strongly recommends screening all pregnant women for syphilis infection.
Rating: D recommendation
Recommends against routine screening of asymptomatic patients who are not at increased risk.

26
Q

high risk sexual behavior

A 
All sexually active persons 24 years old and younger.
Previous history of other STD. 
New or multiple sexual partners.
Inconsistent condom use.
Exchanging sex for money or drugs.
Early onset of sexual activity.
27
Q

genital herpes

A

– cluster of small vesicles. Burning and painful. Progress to ulcers on a erthymic base. Dx – viral culture of the fluid in the vesicle.
Herpes simplex virus 1 and 2 – causative organism

28
Q

herpes - clinical considerations

A

Virus: Herpes simplex 1 and Herpes simplex 2.

- Primary infection – painful lesions, lymphadenopathy, fever, malaise.
- Recurrent infections – localized lesions and less symptoms.
- Viral shedding is usually asymptomatic.  
- Pregnant women can vertically transmit HSV to the infant during birth.
- Serological testing can differentiate between HSV-1 and  HSV-2.
- Viral culture of vesicle fluid can confirm active infection.
- Treatment – acute and suppressive therapy.
29
Q

herpes screening recommendations

A

Rating: D recommendation
Strongly recommends against routine serological screening for herpes simplex virus (HSV) in asymptomatic adolescents and adults.

There is no evidence that screening asymptomatic adults with serological tests for HSV antibody improves the health outcomes or symptoms or reduces the transmission of the disease.

30
Q

venereal warts

A

warts (Condyloma acuminatum) - caused by HPV (human papillomavirus. Grow in clusters.
Difficult to treat – cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara(imiquimod), surgery.

31
Q

genital scabies

A

Contagious disease caused by a mite (Sarcoptes scabiei)

  • Direct skin contact.
  • Nocturnal pruritus is very characteristic progressing to intense pruritus.
  • Linear, curved or s-shaped burrows.
  • Diagnosis: clinical suspicion, slide mount preparation.
  • Treatment: Permethrin cream (Elimite), Lindane; oral steroids or antihistamines for pruritus.
32
Q

gonorrhea

A

Gram-negative intracellular diplococci of GC

WBC = neutrophils

33
Q

NGU

A

nongonococcal urethritis = chlamydia

34
Q

Gonococcal vss nongonococcal urethritis

A

Nongon Gono
incubation period: 7-28 days vs 3-5 days
Onset gradual abrupt
dyrusia smarting burning
discharge mucoid/ purulent purulent
gram stain polymorpho leukos gram neg intracellular diplococci

My PCM 2 (5 decks)

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