Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical Medicine II > Male GU disorders > Flashcards

Male GU disorders Flashcards

1
Q

most cases of epididymitis are ? and can be divided into what ?

A

INFECTIOUS
can divide epididymitis into:
1. STD: usually M<40, C trachomatis, N gonorrhea
2. Non STD: usually older M, G- rod

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

Sx of epipdidymitis may follow

A
  • acute physical strain
  • trauma
  • sexual acitivty
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ROS and PE of pt with epididymitis might reveal

A

Pain that develops in scrotum and radiates to flanks or along spermatic cord

  • usually fever and swelling of epididymis present
  • Prostate may be tender
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are typical lab findings of epididymitis

A

LEFT shift (elevated neutrophils)

  • Urethral Gram stain: n gonorrhea or white cells w/o visible organisms (chlamydia)
  • UA: pyuria, bacteriuria and varying hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Imaging for epididymitis …helpful?

A

scrotal US may be helpful to confirm dx

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

Ddx for epididymitis includes

A 
Tumor (but these are generally painless)
Testiculor torsion (most important to r/o, usually seen in young M)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is phrens sign suggestive of?

A

EPIDIDYMITIS… testicular torsion has neg phrens sign meaning, pain does not improve with elevation of scrotum

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

what is tx for epididymitis

A

bed rest with scrotal elevation
*if STD suspected:
ROCEPHIN 250 mg IM (3rd gen ceph DOC to cover N gonorrhea) &
DOXYCYCLINE or ZITHROMAX to cover chlamydia

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

tx for N. gonorr

A

Rocephin 250 mg IM (Cefriaxone) or Cefixime 400 mg oral

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

Tx for chlamydia

A

*macrolide or tetraycycline ie

Azithromycin (zithromax) 1 gm po or Doxycycline 100mg BID

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

what should you always do when treating for gonorr

A

treat for his friend chlamydia

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

IF STD is not the suspected cause of the epididymitis, what should you do?

A

empiric tx towards suspected pathogen - Levofloxacin 500-750 mg po qd x 10d
&NSAIDS may help the pain and inflammation

*Note: most likely pathogens are G- rod (e coli, proteus, klebsiella)

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

Prognosis for tx of epididymitis?

A

if prompt, good

delayed –> may result in orchitis, abscess or infertility

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

What are some important considerations for gonorrheal (GC) urethritis

A

GC is most common of STD
most prevalent in 15-29 yo
incubates 2-8 d
characterized by yellow dc and urethral pain

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

what are the common clinical findings for GC urethritis in men

A

burning pain w/ urination

clear to yellow urethral dc

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

what are common clinical finding for GC urethritis in women?

A

less severe or asymp sx compared to Males
generally complain of dysuria, freq, urgency and vaginal dx
*chandelier sign on pelvic exam

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

T/F.. GC is only in the genitals

A

False.. can be found in eyes, throat, anus or blood

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

How do you dx urethritis

A

Men: culture, Gram stain, tests for other likely STD in addition to GC (ie chlamydia, trich, garnerella, candida)
Women: dx from culture, hx, presentation (gram is of no use)

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

ddx for urethritis

A

in addition to NC, chlamydia, Trichomonas, gardnerella, candida

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

What are some general considerations for Chlamydia causing urethritis

A
  • chlamydia generally causes insidious, silent and latents states of infection
  • 5-21 d incubation
  • spread via sexual contact and can enter lymph
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

s/sx of urethritis (chlamydia) M and F

A

M: clear to white dc, LAD or asymp
*chlamydia may spread from urethra to epididymis or prostate

Female: s/sx of pelvic inflammatory disease (PID), cervicitis, salpingitis or asymp

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

what is the most reliable way to dx chlamydia urethritis

A

culture- but too long and expensive

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

Instead of culture (too long/expensive) what are the 3 alternatives for dx chlamydial urethritis

A
  1. immunofluorescence assay
  2. enzyme linked assay
  3. DNA probe (95% sensitive and specific, relatively quick, less costly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

of the 3 alternatives for dx chlamydia urethritis (immmunofluorescence assay, enzyme assay, DNA probe) which seems best

A

DNA probe - 95% sensitive and specific, relatively quick and cheap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
ddx for chlamydial urethritis
bc chlamydia is a STD, all other STD are ddx!! GC, gardnerella, candida, trich
26
What is the recommended tx for Urethritis due to chlamydia
zithromax 1 g po (uncomplicated) or erythromycin OR Doxycycline 100 mg bid X 7-10 d *also want to empirically co-treat GC: Rocephin 250 mg IM
27
What is the prognosis for chlamydia infections
if left untreated of infection is chronic, FEMALES have PROBABILITY of INFERTILITY
28
what are the 5 major types of urinary stones
``` Calcium Phosphate Calcium Oxalate Struvite Uric Acid (radiolucent) Cystine *all radiopaque except uric acid with Ca being most common ```
29
What might labs reveal in urinary stone disease and what are presenting sx in a patient with stones
hematuria | PAIN, severe, pt moving around/unable to sit
30
Define impotence and what is ED usually due to
impotence: inability to maintain erection sufficient for sexual intercourse * most ED is organic not psychogenic etiology
31
Loss of libido may indicate
androgen deficiency
32
What are the various etiologies of ED
neurogenic, psychogenic, ARTERIAL/VENOUS *important to determine if nocturnal or early morning erection are occurring (STAMP test), if not, problem is probably organic
33
What information should be obtained in a pt with ED
* If pt is on medications (esp antihypertensive Beta blockers or diuretics) that can be cause of ED * find out if nocturnal or morning erections are occurring * hyperlipidemia, HTN, DM, renal failure, neurologic dz, thyroid and adrenal disorders, hx trauma/surgery to pelvic area
34
What clinical hx is important to obtain from pt with ED?
``` if the pt has: Hyperlipidemia HTN DM Renal Failure Neuro dz Thyroid/adrenal disorders Hx trauma or surgery to pelvic area ```
35
On PE, what should be assessed in pt presenting with ED
``` secondary sex characteristics** Neurologic, vascular function Genitalia - scarring? Scrotal Content (Orchiectomy?) *PROSTATE EXAM is essential in work-up ```
36
What are some dx studies to order in pt with ED?
``` CBC UA Glu (DM) Lipids (hyperlipidemia) Testosterone (androgen def, libido) Prolactin (pituitary adenoma) *if testosterone, FSH, LH or prolactin are abn then REFER to ENDOCRINOLOGIST ```
37
What are tx options for ED
vascular reconstruction prostheses medical and vacuum constriction devices meds
38
What does ED med tx consist of
Testosterone injection (200 mg IM q 3wk) Prostaglandin injections into penis Prostaglandin urethral suppository Viagra (sildanefil), Cialis, Levitra
39
What is the risk with Viagra like medications and nitrates
can be fatal | is this bc reflex tachycardia?
40
What is the prognosis for men with ED
depending on extent of dz, ORGANIC ED is generally TREATABLE
41
What percent of married couples are affected by infertility and what warrants clinical evaluation?
15-20% of couples * clinical eval indicated after 6 mth unprotected intercourse w/o successful conception * review eval in 3 mth bc spermatogenesis takes 74 days
42
how long does spermatogenesis take (thus when should infertility evaluations be reviewed)
spermatogenesis is a 74 d process | THUS review couples infertility 3 mo post initial eval
43
What should be included in the hx in a male troubled with infertility
* prior insults - torsion, trauma, cryptorchism * Infection - MUMPS*, epididymitis, orchitis * environmental factors - heat, radiation, chemo * meds - anabolic steroids, cimetidine, spironolactone, phenytoin, sulfasalazine, nitrofurantoin * marijuana, ETOH * sexual habits, frequency, timing, lubricant use * libido loss, HA, visual disturbances ie bitemporal hemianopsia (may indicate pituitary tumor)
44
libido loss, HA, bitemporal hemianopsia indicate...
potential pituitary tumor
45
What might past med or surgical hx reveal in a male with infertility
thyroid or liver disease DM Pelivc or retroperitoneal surgery Hernia repair
46
What do we need to look for on PE in a male presenting with infertility
secondary sex characteristics (lack may suggest hypogonadism) * examine scrotal contents (testicle is normally 4.5x2.5 cm) * palpate vas deferens, epididymis, prostates
47
labs to order for M infertility
SEMEN ANALYSIS after at least 72 hr abstinence *analyze semen w/in 1 hr collection *normal volume should be 1.5-5 mL Normal: at least 50-60% motile cells and >60% normal morphology *endocrine eval is low sperm count or suspicious hx *FSH, LH, Testosterone, serum prolactin
48
What might a scrotal ultrasound reveal in a male with infertility
varicocele
49
how do you treat a M with infertility
* educate on timing and technique * if hypogonadrotopic hypogonadism: treat w/ hcG * If Retrograde Ejaculation: Imipramine 25 mg TID * If varicocele or ductal obstruction: surgery
50
what should you be aware of regarding testicular torsion
* any age but usually age 10-20 yo | * results from fixation bw enveloping tunica vaginalis and posterior scrotal wall --> shuts off blood t
51
Testicular Torsion usually involves hx of...
strenuous physical activity (but some happen when pt is asleep)
52
What actually causes the torsion in testicular torsion?
Unilateral contraction of the cremaster muscle
53
sx in pt with testicular torsion?
sudden onset SEVERE PAIN (lower abdomen, groin or testis) *pain can be constant or intermittent
54
PE findings in a patient with testicular torsion may reveal
sudden onset severe pain * Palapation of cord may reveal twist or kink * cord may be shortened w/epididymis lateral or anterior (normally posterior/superior/lateral)
55
What study must you do in pt suspected with testicular torsion
radionuclide study or DOPPLER ULTRASOUND bc need to see how much blood supply is cut off *but no clinical or dx parameters to judge degree or duration of testicular ischemia
56
testicular pain is considered...
torsion till proven otherwise! | If torsion r/o --> ddx: epididymitis, varicocele, hydrocele
57
how do you treat testicular torsion
it is a SURGICAL EMERGENCY and demands IMMEDIATE referral for scrotal exploration
58
what is the prognosis for pt with testicular torsion?
depends on amt of ischemia | *early intervention = good outcome; delayed = incrementally morbid
59
how frequently do varicoceles occur in men and what are varicoceles associated with
15% adult males have varicocele * important when associated with infertility * there are no genetic or environmental risk factor for varicoceles
60
What are Clinical findings in a Male pt who has a varicocele
Abnormal scrotal exam *varicocele may not show if pt supine; have pt valsalva or stand (veins of pampiniform plexus dilate, feel like bag of worms)
61
In clinical exam, what MUST be determined in pt with varicocele
whether or not the varicocele reduces when the pt is supine
62
Diagnostics for M pt with varicocele include
* routine lab studies are not indicated * semen analysis maybe if infertility and varicocele * if varicocele DOES NOT REDUCE, then the gold standard is VENOGRAPHY
63
If there is no reduction in varicocele when the pt patient lies supine, what should you do
gold standard: VENOGRAPHY to investigate venous anatomy
64
ddx for varicocele and why is this difficult
varicocele, inguinal hernia (often difficult to distinguish bw these two)
65
how do you treat a varicocele
surgery | or watch and wait + scrotal support
66
what is the usual prognosis for pt with a varicocele
5-10% surgically repaired varicoceles are recurrent | *Surgical risks: hydrocele and damage to surrounding structure
67
How do you differentiate bw a direct and indirect inguinal hernia
Direct: protrudes through Hesselbach's triangle (through abdominal wall) *boundaries: inguinal ligament, inferior epigastric vessels, lateral border of rectus abdominis m Indirect: comes down inguinal canal and occurs lateral to inferior epigastric vessels (more common in men bc descent of testes)
68
Indirect vs direct hernias: which tend to become incarcerated
INDIRECT often become incarcerated | *direct rarely incarcerate
69
Ways to remember direct/indirect hernia
Direct goes DIRECTLY through wall/triangle INdirect: down INguINal canal, lateral to INferior epigastric vessels more common IN meN
70
What would you find clinically on a Male with a hernia
majority asymptomatic and detected inadvertently on PE or by pt
71
if the hernia is incarcerated, pain...
may develop suddenly | *incarcerated = won't be able to flatten the bulge bc intestine is trapped
72
if the hernia is strangulated, the patient may become
TOXIC *strangulated = intestine is so tightly trapped that it loses blood supply and dies.. can block digestion resulting in a Toxic pt
73
Pt with incarcerated hernia would describe it as...? And what is their pain like
hx of hernia for extended period but can't return hernia/bulge to normal position (won't flatten) *acute incarcerations = PAINFUL, pt may have N/V
74
Incarcerated hernias are a leading cause of what? they are second to which condition
Incarcerated hernias are 2nd most common cause of BOWEL OBSTRUCTION *second to POSTOP adhesions
75
what PE findings are indicative of pt with a hernia
``` abnormal swelling (consistency of swelling varies depending on contents) *potential tachycardia and mild temp ```
76
What might come of an undetected incarcerated or strangulated hernia
abscess, obstruction, perforation, peritonitis and septic shock
77
What are diagnostics for a hernia?
* CBC: elevated WBC with left shift (^neutrophil) * electrolyte abn and ^BUN: hydration & toxic state * acute abdominal series (AAS) should be obtained to r/o free air and obstruction * barium enema may be useful
78
Ddx for hernias
could be confused with lymph nodes (but different locations!) * hydrocele could have similar presenting s/sx, but hydrocele = non tender and transilluminates * testicular torsion: may be confused with acute incarcerated hernia
79
how do you treat a hernia
If hx indicates recent onset incarceration: reduce it If questionable duration of incarceration: do NOT reduce it.... dead bowel should NOT be re-introduced into the abdomen Hernias that are non-reducable or strangulated need SURGERY Hydration and antibiotics pre-op
80
What is the general prognosis for a pt with a hernia
good if emergent surgery

Clinical Medicine II (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions