Male GU Disorders

Question 1

Epididymitis categorization?

Answer 1

U infectious

1) STD: U 40yo, C trach or N gono
2) Non-STD: U old, G- rods

Question 2

Epididymitis presentation?

Answer 2

Scrotal pain w/ P radiation to cord/flank
Fever
Swelling of epididymis
Tender prostate

Question 3

Epididymitis labs?

Answer 3

CBC = L shift

Gram stain = N gono or WBC w/o visible org (chlamydia)

UA = pyuria, bacter, hemat

Question 4

Epididymitis imaging?

Answer 4

scrotal US confirms dx

Question 5

Prehn’s sign is?

Answer 5

lift scrotum -> elevation stops pain is epidid

pain won’t stop if torsion

Question 6

Epididymitis tx?

Answer 6

scrotal elevation
NSAIDS
If STD: Rocephin + Doxy
Otherwise: Levoflox

Question 7

Urethritis in men U caused by?

Answer 7

Gonorrhea

Chlamydia

Question 8

Gonorrhea presentation: men?

Answer 8

dysuria

clear/yellow d/c

Question 9

Gonorrhea presentation: women?

Answer 9

same but U less severe

+ chandelier sign (painful cervix)

Question 10

Gonorrhea labs?

Answer 10

Men: cx, gram stain
Women: cx, gram not helpful

Question 11

Gonorrhea tx?

Answer 11

Rocephin or Cefixime

Question 12

Chlamydia presentation: men?

Answer 12

clear/white d/c

LAD

Question 13

Chlamydia presentation: women?

Answer 13

Pelvic/cervical inflamm sxs

Question 14

Chlamydia labs?

Answer 14

cx best but too slow

DNA probe, next best
immunoflour assay
enz-linked assay

Question 15

Chlamydia tx?

Answer 15

Uncomplicated: zythro

Question 16

Urinary Stone types? (5)

Answer 16

1) Ca2+ oxalate
2) Ca2+ phos
3) Struvite
4) Uric acid
5) Cystine

Question 17

What type of stone is radiolucent?

Answer 17

Uric acid

*all others are radiopaque

Question 18

Stone presentation?

Answer 18

severe pain

Question 19

Erectile Dysfxn caused by?

Answer 19

Organic: neuro, vasculature
Psychogenic
Meds

Question 20

Sign that ED is not organic?

Answer 20

nocturnal or a.m. erections

Question 21

ED hx should include? (7)

Answer 21

Hyperlipidemia
HTN
DM
Renal fail
Neuro dz
Thyroid/adrenal dz
Trauma/surgery

Question 22

ED exam should include?

Answer 22

2º sex characteristics
Neuro/vascular fxn
Genital scarring
Scrotal content
PROSTATE EXAM

Question 23

ED labs?

Answer 23

CBC
UA
Glu/Lipids
Testosterone
Prolactin

Question 24

ED pharm tx?

Answer 24

test inject
prostagl inject
prostagl suppository
viagra/cialis/levitra

Question 25

Viagra + what med (P) fatal?

Answer 25

nitrates

Question 26

Spermatogenesis takes how long?

Answer 26

74 days

Question 27

Causes of infertility: infections?

Answer 27

mumps epididymitis orchitis

Question 28

Causes of infertility: environment?

Answer 28

heat radiation chemo

Question 29

Causes of infertility: meds?

Answer 29

``` steroids cimetidine (antacid) spironolactone (aldost antag) phenytoin (anti-convulsant) sulfasalazine (abx colitis/crohns) nitrofurantoin (abx UTI) marijuana ETOH ```

Question 30

Signs of pituitary tumor?

Answer 30

↓ libido HA visual disturbances

Question 31

Infertility physical exam should include?

Answer 31

2º sex characteristics scrotum prostate

Question 32

Infertility labs? Imaging?

Answer 32

Semen (72 hrs post) = 60% normal morph and motility Endocrine levels scrotal US

Question 33

Retrograde ejaculation tx?

Answer 33

imipramine

Question 34

Testicular Torsion epidemiology?

Answer 34

10-20yo | U hx of strain or while sleeping

Question 35

Testicular Torsion presentation?

Answer 35

severe pain (constant or intermit) *testicular pain always torsion till proven otherwise

Question 36

Testicular Torsion imaging?

Answer 36

doppler US

Question 37

Testicular Torsion tx?

Answer 37

emergency surgery

Question 38

Varicocele is?

Answer 38

varicose vv of spermatic cord

Question 39

Varicocele NOT a/w?

Answer 39

family hx | environmental risks

Question 40

Varicocele presentation on physical exam?

Answer 40

↓ when supine ↑ when standing/vasalva *(P) mimics inguinal hernia

Question 41

Varicocele diagnostics?

Answer 41

No labs | Venogaphy if doesn't resolve

Question 42

Varicocele tx?

Answer 42

watch/wait w/ scrotal support | surgical

Question 43

Direct Inguinal Hermia is?

Answer 43

hernia thru Hesselbach triangle (ingu lig, inf epigastric vessel, lat rectus adbominis) U not incarcerate (can move back into abd)

Question 44

Indirect Inguinal Hermia is?

Answer 44

thru inguinal canal, lateral to epigast vessels U incarcerated (do not move back into abd)

Question 45

Inguinal Hernia presentation?

Answer 45

U asympt (found on exam) Incarcerated -> abrupt pain, N/V Strangulated -> pt becomes toxic *can present as LAD, hydrocele, torsion

Question 46

Primary cause of bowel obstruction? Second cause?

Answer 46

postop adhesion incarcerated hernia

Question 47

Inguinal Hernia labs?

Answer 47

``` CBC = (P) WBC L shift Electro = abnorm BUN = shows hydration/toxic status ```

Question 48

Inguinal Hernia imaging?

Answer 48

Acute abdominal series (r/o air, obstruction)

Question 49

Inguinal Hernia tx?

Answer 49

reduction ONLY if very recent onset (don't introduce dead bowels back into abdomen) surgery