Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med Exam 4 > Male GU > Flashcards

Male GU Flashcards

1
Q

What is a consistent inability to maintain an erect penis with sufficient rigidity to allow for intercourse?

A

Erectile dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

More than ____% of men ages 40-70 have?

A

50% of men ages 40-70 have ED. Incidence increases with increasing age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is required for an erection? (5)

A

Intact parasympathetic + somatic nerve supply

Unobstructed arterial flow

Adequate venous constriction

Hormonal stimulation

Psychological desire.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Sedentary lifestyle, obesity, smoking, medical comorbidities such as diabetes, HTN, OSA, dyslipidemia, CV disease, smoking, RLS, watching TV and lower frequency of sexual activity are risk factors for what?

A

ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What’s the most common cause of ED?

A

Decrease in arterial flow from progressive vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What medications can cause ED?

A

Antidepressants - SSRIs - MC

Beta blockers

Spironolactone

Thiazide diuretics

Clonidine

Ketoconazole

Cimetidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What psychosocial factors cause ED?

A

depression and stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are neurologic causes of ED?

A

Stoke, MS, SCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What activity causes ED?

A

Bicycling - prolonged pressure on pudendal and cavernosal nerves/ compromises blood flow to cavernosal artery

Leads to penile numbness and impotence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What endocrine disorders cause ED?

A

Testosterone deficiency

Hypo/Hyper thyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some important considerations regarding H&P you should think about when your pt has ED?

A

Ability to masturbate? Timing of dysfunction? Morning wood? Chronic illnesses?

Pelvic or prostate radiation, peripheral vascular dz, medications,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should you look for in a physical exam for ED?

A

Look for scarring, plaque formatio nof peyronie disease, testicular atrophy, peripheral neuropathy, HTN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some diagnostic tests to run for ED?

A

Depends on suspected cause but

CBC, UA, TSH, lipid panel, Serum testosterone, Glucose, prolactin, nocturnal penile tumescence testing, direct injection of vasoactive substances (ie prostaglandins E1) will erect if vascular system is intact.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If you inject prostaglandin E1 into the penis and no erection occurs what should you evaluate next?

A

Arterial and venous vasculature

Ultrasound of cavernous arteries, pelvic arteriography, cavernosonography.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment for ED if psychogenic causes?

A

Behaviorally oriented sex therapy. –> Those with organic causes will also benefit from counseling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is treatment for ED if low T? S/e of treatment?

A

May benefit from testosterone replacement

Injection, gel, patches

s/e: HTN (increase CV events), worsen BPH, worsen CHF, increased breast cancer, hepatic toxicitiy, VTE, prostate cancer, applicatoin site pruritus, virilization in those exposed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for ED if obese?

A

Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What medication is the mainstay of treatment for ED?

A

Phosphodiesterase-5 inhibitors (PDE-5)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do PDE5 inhibitors work? What are examples?

A

Work by sustaining levels of cGMP within the penile corpora cavernosa to allow for erections in response to appropriate sexual stimuli.

Sildenafil (viagra), vardenafil (levitra), tadalafil (Cialis) - 45-60 minutes prior to anticipated sexual activity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when are PDE-5 inhibitors contraindicated?

A

On patients on nitrates. If a man on a PDE5 inhibitor develops CP, delay giving nitrate by 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Combo of PDE5 inhibitors and what can result in decrease blood pressure?

A

A-blockers

nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What medication is used for penile injections for ED?

A

Alprostadil (caverject)

Prostaglandin E1 injected into base of penis –> smooth muscle relaxation into corpus cavernosum - inject 10-20 minutes before sex. Erection can last >60 mins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Alprostadil can be injected, but it also comes in tablet form. What do you do with the tablet?

A

Insert tablet into the urethra –> massage penis for 1 minute to equally distribute the medication.

s/e: penile pain and bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When should you not use intraurethral alprostadil?

A

In those who have sickle cell anemia, sickle cell trait, leukemia, multiple myeloma, or any conditions that increase risk for a priapism.

25
Q

This device is used in conjunction with a penile ring, uses pressure to encourage increased arterial flow and limit venous blood loss from the corpora cavernosa by holding blood in penis.

A

Vacuum erection device.

26
Q

S/E of vacuum erection device?

A

Difficulty ejaculating.

27
Q

What are surgical option treatments for ED?

A

Penile prosthesis - rigid and inflatable

or

Vascular reconstruction, arterial bypass if arterial system is culprit.

28
Q

This is a dilation of the pampiniform plexus of spermatic veins. It is usually left sided and first appears at puberty and enlarges overtime.

A

Variocele

29
Q

S/s of a variocele?

A

Asymptomatic

but can have dull, aching scortal discomfrot worse with standing, and relieved by sitting down/laying down.

Atrophy of the left testicle

Decreased fertility

Left sided scortal fullness on valsalva

30
Q

Patient presents with a large left-sided scrotal mass with “bag of worms” appearence, that decompresses/disappears in the recumbent position. What is his dx?

A

Varicocele.

31
Q

Most men don’t need treatment for varicocele, but if younger (under 21) when should you treat?

A

If evidence of testicular atrophy and/or abnormal semen analysis –> surgical ligation or percutaneous venous embolization.

32
Q

If a patient has a normal semen analysis with varicocele when should you reevalulate?

A

1-2 years.

33
Q

If older men desire fertilitiy with varicocele, what should you do?

A

Semen analysis 1-2 years.

Scrotal support

NSAIDS

34
Q

Your patient presents with a collection of peritoneal fluid between the parietal fluid and visceral layers of the tunica vaginalis. What is your assessment?

A

Hydrocele

35
Q

What is the most common cause of hydrocele? Other causes?

A

Idiopathic - arises over a long period of time

Acute reactive - from inflammatory conditions of scroal contents - epididymitis, torsion, appendiceal torsion.

36
Q

What are the clinical s/s of hydrocele?

A

soft, small, to massive collections of several liters of fluid.

Pain/disability usually depending on the size

Transilluminates well.

37
Q

You’re not sure if your patient has hydrocele or potential other dangerous thing like torsion. What should you do?

A

Ultrasound

38
Q

Hydroceles typically do not require intervention, but is indicated in some. What are the indications and what is the treatment?

A

Surgery - excision of the hydrocele sac

Indicated in those who are symptomatic with pain/pressure sensation, or have scrotal irritation.

39
Q

Your patient presents with an epidermal cyst in the head of the epididymis that is greater than 2 cm. Your patient is asymptomatic but you palpate a soft, round mass in the head of the epidiymis. What is this?

A

Spermatocele.

40
Q

After inquiring with your spermatocele patient you found out his mother used what medication during pregnancy?

A

Diethylstilbestrol

41
Q

Your spermatocele patient is concerned about having the mass removed, but you tell him.

A

They generally don’t require treatment. We only surgically excise them if it is causing chronic pain.

42
Q

What are risk factors that lead to BPH? What decreases risk?

A

Obesity

Heart disease

Black men

Alcohol consumption (greater than 3 drinks a day), Decreases RISK as this reduces androgen levels.

43
Q

BPH develops in the _____ zone of the prostate. This is from increase in stromal tissue and glandular components

A

Develops in the periurethral or transitional zone.

44
Q

What are clinical manifestations of BPH?

A

Asymptomatic

or

Lower urinary tract symptoms (LUTS) - “storage symptoms” increased daytime frequency, nocturia, urinary incontinence.

Voiding symptoms

Slow urinary stream, splitting/spraying of stream, intermittent stream, hesitancy, straining to void, terminal dribbling.

45
Q

What is the physical exam for diagnosis of BPH?

A

DRE to assess prostate size and consistency

Normal prostate is approximately the size of a walnut, firm, nontender.

Also assess rectal sphincter tone.

46
Q

Tender prostate =

Nodules on the prostate =

A

Tender = prostatitis

nodules = possible malignancy

47
Q

What are three lab tests you can order for BPH differential?

A

UA - hematuria, UTI

PSA - pitfalls

BMP - creatinine - if renal failure/obstruction is suspected.

48
Q

Your patient with BPH doesn’t wish to take a medication. So you tell him to start with these lifestyle modifications

A

Avoid fluids prior to bedtime

Reduce consumption of caffeine, alcohol

Double voiding for mroe complete bladder emptying.

49
Q

Your patient with BPH desires to use medication, so you start him on?

A

Alpha-1 adrenergic antagonist (terasozin) (doxazosin/Cardura), (Tamsulosin/Flomax). Good for initial therapy for symptomatic BPH

Relaxes smooth muscle in the bladder neck, prostate capsule, and prostatic urethra.

50
Q

Terazosin, doxazosin(Cardura), Tamsulosin (Flomax), silodosin (Rapaflo) are all alpha-1 adrenergic antagonists. What are their side effects? When are they typically given?

A

S/e: hypotension, dizziness, interaction with PDE5 inhibitors, ejaculatory dysfunction

Give at bedtime to avoid some of the side effects.

51
Q

What medication reduces the size of the prostate?

A

5-alpha reductase inhibitors

Finasteride (Proscar), dutasteride (Avodart)

52
Q

5-alpha reductase inhibitors like Finasteride (Proscar), and Dutasteride (avodart) generally need to be given for how long for symptomatic relief?

A

Generally need to treat for 6-12 monts before the prostate size is reduced enough to provide symptomatic relief.

53
Q

What medication decreases the incidence of prostate cancer and can shrink the size of the prostate?

A

Finasteride (proscar), and dutasteride (avodart)

5-alpha reducatase inhibitors.

54
Q

What lab value should you expect to go down on a 5-alpha reductase inhibitor? What s.e can people expect?

A

Expect PSA concentrations to decrease

s/e: decreased libidio, ED, ejaculatory dysfunction, pregnant people shouldn’t touch.

55
Q

Your patient doesn’t want to take medications for BPH, but is okay taking supplements. Although you don’t recommend them, you give him 4 options of.

A

Saw palmetto

Beta-sitosterol

Cermilton

Pygeum africanum.

56
Q

Your patient wishes to surgically manage his BPH. Before his procedure he needs to have persistent or progressive symptoms despite combo therapy for how long?

A

12-24 months.

57
Q

What are 4 surgical management options for BPH?

A
  • Transurethral resection of the prostate (TURP)
  • Transurethral ablation
  • Simple prostatectomy
    • open, laparoscopic, robotic assisted
  • Prostatic arterial embolization
    • feeding arteries are selectively embolized to induce ischemic necrosis and volume reduction of the prostate

S/e: sexual dysfunction, postpractectomy syndrome, bleeding, urethral strictures, urinary incontinence.

58
Q

Acute urinary retention, recurrent UTIs, hydronephrosis, renal failure are all complications of?

A

BPH

59
Q
A

Clin Med Exam 4 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions