Male GU

Question 1

which prostatic lobe most common for cancer

Answer 1

posterior lobe (one palpated during DRE)

Question 2

indirect hernia

Answer 2

• most common for both sexes
• above the inguinal ligament
• often into the scrotum

Question 3

direct hernia

Answer 3

• less common, usually in men
• above the inguinal ligament
• rarely into the scrotum

Question 4

femoral hernia

Answer 4

• least common
• more common in women than men
• never into the scrotum

Question 5

inspection of penis

Answer 5

• compress the glands to express any discharge from urethral meatus
• can put the sample on a glass slide or send for culture

Question 6

testicular self-exam

Answer 6

• best performed during or after a bath/shower
• exam each testicle with both hands. gently roll the testicle b/w the thumbs and fingers
• locate the epididymis on the posterior surface of the testicle
• follow up with doc if any lumps or tenderness

Question 7

prostate cancer

Answer 7

• most common non-skin cancer
• 2nd leading cause of cancer death in men in US
• screening test: DRE and PSA
• PSA screening can detect some cases of prostate cancer (also detect false pos)

Question 8

prostate cancer - current recommendation

Answer 8

• insuff evidence in prostate cancer screening in men 75y/o

Question 9

testicular cancer - current recommendation

Answer 9

• recommends against routine screening for testicular cancer

Question 10

hypospadias

Answer 10

• congenital displacement of the urethral meatus on the inf surface of the penis along the urethral groove
• assoc with congenital renal abnormalities

Question 11

phimosis

Answer 11

• foreskin can’t be retracted over the penis
• very painful with an erection
• hygiene issues
• treatment - circumcision

Question 12

hydrocele

Answer 12

• fluid filled mass within the tunica vaginalis

- transilluminated with a light

Question 13

cryptorchidism

Answer 13

• undescended testicle
• usually atrophied
• increased risk for cancer

Question 14

primary syphilis

Answer 14

• treponema palldium - causative organism

- syphilitic chancre - painless round or oval erosion or ulcer. non-tender enlarged inguinal lymph nodes are common

Question 15

secondary syphilis

Answer 15

any unexplained rash on body, palms of the hands, and soles of the feet

Question 16

syphilis - lab tests

Answer 16

• non-treponemal tests (common false pos)
  1. RPR - rapid plasma regain
  2. VDRL - venereal disease research lab
• confirmatory tests
  1. FTA-ABS - fluorescent treponemal Ab absorbed
  2. TP-PA - T. pallidum particle agglutination
  3. dark field microscopy

Question 17

syphilis - current recommendation

Answer 17

• strongly recommends screening patients at increased risk for syphilis infection
• strongly recommends screening all pregnant women for syphilis infection
• recommends against routine screening of asymptomatic patients who are not at increased risk

Question 18

high risk sexual behavior

Answer 18

• all sexually active persons 24 y/o and younger
• PMH of STD
• new or multiple sexual partners
• inconsistent condom use
• exchanging sex for money or drugs
• early onset of sexual activity

Question 19

genital herpes

Answer 19

• cluster of small vesicles. burning and painful. progress to ulcers or a erthymic base
• dx: viral culture of the fluid in the vesicle
• herpes simplex virus 1 and 2 - causative organism

Question 20

genital herpes - primary infection

Answer 20

1. painful lesions
2. lymphadenopathy
3. fever
4. maliase

Question 21

genital herpes - recurrent infection

Answer 21

1. localized lesions and less symptoms

2. viral shedding is usually asymp

Question 22

genital herpes - pregnant women

Answer 22

• can vertically transmit HSV to infant during birth

- recommend C-section so child won’t go through vaginal canal

Question 23

genital herpes - diff b/w HSV-1 and 2

Answer 23

serological testing

Question 24

genital herpes - tx

Answer 24

acute and suppressive therapy

Question 25

genital herpes - recommendation

Answer 25

strongly recommends against routine serological screening for HSV in asymp adolescents and adults

Question 26

venereal warts

Answer 26

• caused by HPV
• grow in clusters
• difficult to test - cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara (imiquimod) surgery

Question 27

genital scabies

Answer 27

• contagious disease caused by mite (Sarcoptes scabiel)
• direct skin contact
• nocturnal pruritus is very charactertistic progressing to intense pruritus
• liner curved or S-shaped burrows

Question 28

genital scabies - dx

Answer 28

• clinical suspicion

- slide mount prep

Question 29

genital scabies - tx

Answer 29

• permethrin cream (elimite)
• lindane
• oral steroids or antihistamines for pruritus

Question 30

gonococcal urethritis

Answer 30

• purulent discharge of gonorrhea
  1. gran-neg IC diplococci of GC
  2. WBC = neutrophils
• onset - abrupt
• dyuria - burning
  discharge - purulent

Question 31

nongonococcal urethritis

Answer 31

• onset - gradual
• dysuria - smarting feeling
• discharge - mucoid or purulent
• gram stain - PMN leukocytes
• NGU = chlamydia