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Test 2 PC1 > Male Genitourinary Disorders > Flashcards

Male Genitourinary Disorders Flashcards

1
Q

Cryptorchidism

A

undescended testis

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2
Q

Rectractile testis

A

testis out of scrotum but can be brought down into scrotum and they will stay

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3
Q

Gliding testis

A

testis is out of the scrotum, when moved into scrotum they return when released

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4
Q

Ectopic testis

A

lying outside the normal path of descent

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5
Q

Ascended testis

A

has fully descended but has reascended (outside scrotum)

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6
Q

Trapped testis

A

dislocated after herniorrhaphy

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7
Q

Development of testes

A

occurs during 7th month in upper growing of the abdomen

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8
Q

Reasons of failure to descend

A

mechanical

secondary to hormonal, chromosomal and anatomic disorders

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9
Q

Most common genitourinary disorder in boys

A

cryptorchidism

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10
Q

At risk for cryptorchidism

A 
preterm infants
low birth weight infants
first born
toxemia
hypospadias
subluxation of hip
winter conception
down's
maternal age 35
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11
Q

Self correction of cryptochidism

A

majority will descend by 6 months

if >6 months the rate of spont. descend rare

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12
Q

Most often affected teste with cryptochidism

A

left (can be bilateral)

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13
Q

Most common location of undescended testes

A
  1. just outside external ring
  2. inguinal canal
  3. abdomen
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14
Q

Position for exam of testis

A

cross-legged
frog-legged
squat
standing

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15
Q

Appearance of scrotal rugae with cryptochidism

A

less full

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16
Q

Reason for early dx of cryptochidism

A

preserve fertility and detect malignancy

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17
Q

Risk of observation >1 year

A

delays tx
lowers rate of success
affects sperm

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18
Q

Possible complications of undescended testicles

A 
poor development
infertility
malignancy (repair does not decrease risk)
trauma
torsion (50%)
inguinal hernia
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19
Q

Testicular Torsion

A

pain and swelling

EMERGENCY

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20
Q

<6 years old with testicular pain

A

almost always torsion

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21
Q

7-12 years old with testicular pain

A

50% torsion

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22
Q

19-24 years old with testicular pain

A

80% epididymitis

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23
Q

most common cause of testicular loss

A

torsion

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24
Q

bell-clapper

A

used to describe torsion

testes swing and can twist at spermatic cords

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25
Q

Pain manifestation with torsion

A

acute onset

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26
Q

abnormal and should rule out abruption or torsion

A

testicular pain lasting >1 hr following trauma

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27
Q

General exam with torsion

A

swelling, red, warm, TENDER

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28
Q

transillumination of testes

A

reveals a solid mass

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29
Q

cremasteric reflex

A

pinch the skin of the upper thigh and watch for testicular reflex.
absent in torsion

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30
Q

Prehn Sign

A

elevate the scrotal contents, if pain relieved most likely epididymitis. If pain persists, torsion.

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31
Q

torsion of a testicular appendage

A

tenderness limed to upper pole

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32
Q

Blue dot sign

A

small bluish discoloration visible through the skin of the testes indicating torsion

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33
Q

Torsion signs

A 
absence of cremaster reflex
abnormal positioning of testes
absent prehn's sign
absent dysuria
absent erythema
neg UA
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34
Q

Epididymitis signs

A 
positive cremaster reflex
normal position of testes
prehn's sign present
can have dysuria
erythema present
pos UA
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35
Q

If torsion suspected

A

refer immediately

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36
Q

CBC with torsion

A

leukocytosis may be present with this and with epididymitis as well

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37
Q

doppler ultrasonography

A

perform if unsure of diagnosis
assesses blood flow of testicular artery
can see torsion and hydrocele

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38
Q

Nuclear Scintigraphy

A

takes 1-2 hours

can have false negative

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39
Q

Orchiopexy

A

surgical procedure for torsion

if surgery put up for >12 hours could require removal.

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40
Q

Testicular salvage rate with torsion

A

within 3 hours 100%
6 hours 92%
6-12 hours 62%
12-24 hours 38%

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41
Q

Trauma to testes

A

can lead to torsion, but more commonly scrotal hematoma and ecchymosis
pain caused by compression against pelvic bones

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42
Q

hydrocele

A

common cause of scrotal swelling

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43
Q

Cause of hydrocele in infants

A

caused by peritoneal fluids extending through a patent processus vaginalis

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44
Q

Cause of hydrocele in older kids

A

result from inflammatory processes, torsion, trauma or tumors

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45
Q

types of hydroceles

A

communicating

noncommunicating

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46
Q

communicating hydrocele

A

failure of the processus vaginalis to close during development and fluid is peritoneal (often hernia)
may increase in size during the day or with valsalva

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47
Q

noncommunicating hydrocele

A

fluid only in scrotum
fluid comes from the mesothelial lining of the tunica vaginalis
is not reducible and does not change size

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48
Q

To confirm hydrocele

A

transillumination

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49
Q

Tx of hydrocele

A

surgery for those persisting beyond one year

50
Q

Scrotal masses in adult been best described

A

by anatomic origin

51
Q

Mass in tunica vaginalis testis

A

hydrocele

hematocele

52
Q

Mass in processus vaginalis testis

A

inguinal hernia

hydrocele

53
Q

Mass in pampiniform plexus

A

varicocele

54
Q

Mass in epididymis

A

epididymitis

spermatocele

55
Q

Test of choice for evaluation of mass

A

color doppler untrasonography

56
Q

Swelling of testis tender

A

torsion

orchitis

57
Q

Swelling of testis nontender

A

hydrocele

carcinoma

58
Q

Swelling of spermatic cord

A

hydrocele- smooth, transilluminates
varicocele- bag of worms
inguinal hernia- swelling into ingiunal ring

59
Q

Irregular swelling of skin

A

rule out carcinoma

60
Q

welling of skin that is smooth, cystic

A

sebaceous cyst

61
Q

indirect inguinal hernia

A

follow the path of processus vaginalis thru the internal inguinal ring and into scrotum

62
Q

can hernia’s be reduced

A

yes unless incarcerated

63
Q

swelling in hernia vs hydrocele

A

will extend up spermatic cord into ring with hernia

will not extend up spermatic cord

64
Q

a new hydrocele or one that hemorrhages may signal

A

cancer

65
Q

varicocele

A

most common scrotal swelling in adult men
dilation of veins of pampiniform plexus
may ache or “drag”
more common on left side

66
Q

Grade 1 varicocele

A

observed only with valsalva

67
Q

Grade 2 varicocele

A

palpable but not visible

68
Q

Grade 3 varicocele

A

visible

69
Q

Refer varicocele if

A

if there is hypertrophy of testicle
if symptomatic
sudden left-sided in older adult (renal tumor)
sudden right-sided in older adult (vena cava obstruction)

70
Q

Young men with varicocele and normal semen analyses

A

do analysis every 1-2 years

71
Q

Causes of dysuria

A 
infections
malformations
neoplasms
inflammatory conditions
psychogenic
72
Q

Infections with dysuria

A 
pyelo
cystitis
prostatitis
urethritis
orchitis
73
Q

Malformations with dysuria

A

BPH

urethral strictures

74
Q

Neoplams with dysuria

A

renal cell tumor

bladder or prostate cancers

75
Q

Inflammatory with dysuria

A

spondyloarthropathies

drug S/E

76
Q

pain after voiding

A

infection

77
Q

Physical exam for dysuria

A

abdominal
costovertebral angle (pyelo)
penile (d/c)
DRE

78
Q

Positive nitrate with UA

A

suggests UTI

79
Q

Acute epididymitis

A

lasts <6 weeks

80
Q

Causes of epididymitis

A

Chlamydia and gonorrhea in those <35

UTI in over 35

81
Q

Evaluation of epididymitis

A

Gram stain of urethral secretions (perferred and highly sensitive)
Leukocye esterase

82
Q

Tx of Epididymitis

A

Ceftriaxone 250 IM once
plus
Doxy 100 BID x 10 days

83
Q

Adjunct therapy with epididymitis

A

bed rest
scrotal elevation
analgesics

84
Q

Goal of tx with epididymitis

A

cure
improve symptoms
decrease transmission
decrease long term effects

85
Q

Tx for acute epididymitis most likely caused by enteric organisms

A

Levofloxacin 500mg PO daily x 10 days

86
Q

Type I prostatitis

A

acute bacterial prostatitis (UTI with systemic involvment)

Abx therapy for 2-4 weeks

87
Q

Type II prostatitis

A

chronic bacteria prostatitis with or without symptoms
perineal, inguinal or suprapubic pain may be present with erectile dysfx
Fluroquinolones
TMP-Sulfa (Bactrum)

88
Q

Type III prostatitis

A

chronic abacterial prostatitis
(Pelvic pain syndrome either inflammatory or noninflammatory)
pain with ejaculation
hesitancy
tx with muscle relaxants, NSAIDS, fluroquinolones

89
Q

Type IV prostatitis

A 
asymptomatic inflammatory prostatitis
postvoid dribbling
lumbar pain, penile and urethral pain
must take biopsy
Abx, NSAIDS
90
Q

Chlamydia (c. trachomatis)

A

most common reportable STD among adolescents

91
Q

Incubation period of chlamydia

A

7-21 days

92
Q

Clinical manifestations of chlamydia

A

urethritis
epidymitis
Reiters syndrome
mucopurulent, mucoid or clear d/c

93
Q

Reiters syndrome

A

post-inflammatory autoimmune disease

94
Q

Dx chlamydia

A

culture
nucleic acid amplification
serology

95
Q

Tx chlamydia

A

Azithromycin 1g once
plus
doxy 100mg BID x 7 days
No sex within 7 days

96
Q

Evaluated partners for chlamydia

A

if sex with someone 60 days prior to onset of symptoms

97
Q

Gonorrhea (Neisseria) risk factors

A 
south
black
hispanic
native americans
ages 15-29
multiple sex partners
lower socioeconomic status
98
Q

transmission of gonorrhea

A

male-to-female at 50-70%/intercourse episode
female-to-male at 20%/episode but >4 60-80%
pharyngeal
increased risk for HIV

99
Q

common indicator of gonorrhea in men

A

urethritis

100
Q

incubation period for gonorrhea

A

7-14 days

101
Q

inflammation of liver capsule with right upper quadrant pain from gonorrhea

A

perihepatitis (Fitx-Hugh)

102
Q

Evaluation of gonorrhea

A

culture

oxidase pos gram-neg diplococcus

103
Q

Tx for gonorrhea

A 
Ceftriaxone 250 IM once
plus
azithromycin 1g once
or
doxy
104
Q

Avoid in pregnancy for tx gonorrhea

A

quinolones

tetracyclines

105
Q

Syphilis

A

Treponema Pallidum

106
Q

incubation of syphilis

A

10-90 days

107
Q

early manifestations of syphilis

A

involve skin and mucosal

108
Q

late manifestations of syphilis

A

affect organ system and neurosphilis

109
Q

syphilis most infective

A

during primary and secondary stages

110
Q

syphilis spread

A

sexually and vertical (pregnancy)

111
Q

view of syphilis under microscope

A

cork-screw shaped motile

112
Q

lesions with syphilis

A

chancre

secondary and primary syphilis can overlap

113
Q

clinical finding with secondary syphilis

A 
rash on palmes and soles
macular
papular
squamous
pustular
114
Q

other clinical manifestations in syphilis

A 
lymphadenopathy
malaise
mucous patches
condylomata lata
liver and kidney involvment
alopecia
115
Q

Tertiary (late) syphilis

A

within 1-20 years but very rare and typically involves cardiovascular

116
Q

early dx of syphilis

A

darkfield microscopy

117
Q

other dx of syphilis

A

nontreponemal (VDRL, RPR, TRUST)

treponemal (TP-PA) can be pos for life

118
Q

Tx of latent syphilis

A

PCN G 2.4 IM

if PCN allergic to doxy or tetracycline 500 QID x14 days

119
Q

Tx of teriary syphilis

A

PCN G 2.4 IM x 3 doses

120
Q

normal reaction to tx with PCN G

A

Jarisch-herxheimer reaction

121
Q

F/U syphilis

A

6 months and 1 year for primary and secondary

12 and 24 montsh for latent

Test 2 PC1 (4 decks)

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