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Clin Med 2 > Male GU disorders > Flashcards

Male GU disorders Flashcards

1
Q

Cause of ST epididymitis

A

chlamydia or gonorrhea

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2
Q

Cause of non-ST epididymitis

A

seen in older men, GNR

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3
Q

CP of epididymitis

A

pain in scrotum and may radiate to the flanks and along the spermatic cord
usually fever and swelling
+/- prostate tenderness

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4
Q

Labs of epididymitis

A

CBC: left shift
Gram stain: N gonorrhea or white cells with no organisms (chlamydia)
UA: pyuria, bacteriuria, varying hematuria

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5
Q

Imaging of epididymitis

A

scrotal U/S to confirm diagnosis

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6
Q

DDx of epididymitis

A 
tumor (usually painless)
testicular torsion (Prehn's sign-elevation- makes tortion worse and epididymitis better)
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7
Q

tx for epidiymitis

A

bed rest, scrotal elevation

STD suspected: Rocephin (ceftriaxone) and doxycycline (10 days) or zithromax

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8
Q

Non-ST tx of epididiymitis

A

Levofloxacin x 10 days
NSAIDs
treat promptly to avoid orchitis, abscess, infertility

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9
Q

Most common cause of STD? age group? Sx?

A

Gonorrhea, 15-29, yellowish discharge and urethral pain

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10
Q

CP of gonorrhea in men? Women?

A

dysuria and clear to yellow discharge; less severe or asymptomatic but with dysuria, fq, urgency, and vaginal discharge, + chandelier’s sign. Look for eyes, throat, anal, or blood stream infection

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11
Q

diagnosis of gonorrhea in men? Women?

A

gram stain; women purely clinical

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12
Q

DDx for gonorrhea

A

chlamydia, trichomonas, gardnerella, candida

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13
Q

Tx of gonorrhea

A

rocephin IM

cefixime po

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14
Q

Chlamydia

A

usually an insidious infection, may spread to the lymph

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15
Q

CP of chlamydia in men? Women?

A

clear to white d/c, lymphadenopthy, or asymptomatic, possibly epidid or prostatitis;
PID, cervicitis, etc or asymptomatic

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16
Q

most reliable dx for chlamydia? Most used?

A

Culture (takes too long); immunoflourescence assay, enzyme-linked assay, and DNA PROBE (best)

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17
Q

What is the DDx for chlamydia

A

all other STDs

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18
Q

tx for chlamydia

A

zithromax (uncomp) or erythromycin (10 days) or doxycycline 7-10 days plus rocephin IM

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19
Q

Prognosis for chlamydia

A

if left untreated, females have probability of infertility

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20
Q

What is the one radiolucent stone? Most common type?

A

Uric acid; calcium

21
Q

Labs of stones

A

possible hematuria

22
Q

most common symptom of urinary stones

A

pain, won’t stop moving (unlike appendicitis)

23
Q

What medications may cause ED?

A

beta blockers and thiazides

24
Q

diagnostic studies for ED?

A

CBC, UA, glucose, Lipids, testosterone, Prolactin (endocrine consult indicated)

25
Q

What are the treatments used for ED?

A

vascular reconstruction, etc
MEDICAL: injections…. OR DRUGS
Viagra, Cialis, Levitra

26
Q

What drugs should you not use ED meds with?

A

Nitrates or vasodilators!

FATAL

27
Q

When is infertility work up indicated?

A

after 6 months of unprotected intercourse

28
Q

What are some common causes of inferility in men?

A

Testicular trauma, MUMPS, epididymitis, radiation, chemo, use of lubricants

29
Q

What are important causes of mostly reversible infertility?

A

Meds: Steroids, cimetidine, spiro, phenytoin, sulfa, nitrofurantoin, marijuana, ETOH

30
Q

What may indicate a pituitary tumor?

A

Loss of libido, HA, bitemporal hemiopsia

31
Q

Labs for infertility

A

semen analysis after 72 hours of abstinence, analyzed within 1 hour

32
Q

Lab testing for infertility

A

FSH, LH, testosterone, and serum prolactin

33
Q

Imaging for infertility

A

scrotal U/S may reveal varicocele

34
Q

Tx for infertility

A

hypogonadotropic hypogonaism: tx with chorionic gonadotropin IM 3x a week
Imipramine TID

35
Q

Most common age of testicular torsion

A

10-20, usually with physical activity, some during sleep

36
Q

SUDDEN ONSET OF SEVERE TESTICULAR PAIN

A

Testicular torsion

37
Q

DIAGNOSTIC STUDY FOR TESTICULAR TORSION

A

DOPPLER U/S

38
Q

If testicular torsion is ruled out, what are other causes of testes pain?

A

epididymitis, varicocele, hydrocele

39
Q

Treatment for testicular torsion

A

SURGICAL EMERGENCY, scrotal exploration

40
Q

CP of varicocele

A

get out of supine position, valsalva or standing: the veins of the plexus become dilated and feel like a “bag of worms”
DETERMINE THAT THE VARICOCELE REDUCES WHEN THE PATIENT IS SUPINE

41
Q

Diagnostics for varicocele

A

None indicated unless there is infertility, then semen analysis (transillumination)
If it doesn’t reduce: venography

42
Q

Ddx for varicocele

A

inguinal hernia

43
Q

Treatment for varicocele

A

watch and wait/surgery

44
Q

Hernia that comes down into the inguinal canal and occurs lateral of inferior epigastric vessels

A

indirect; do occur in women, often become incarcerated

45
Q

hernia that protrudes through Hesselbach’s triangled

A

direct, rarely incarcerate

46
Q

What is the second leading cause of bowel obstruction?

A

incarcerated hernias

47
Q

Pt presents with an indirect inguinal hernia and pain. What diagnostics are indicated?

A

CBC: elevated WBC with a left shift
Electrolytes and elevated BUN=dehydration and toxic state
acute abdominal series to r/o free air and obstruction, +/- barium enema

48
Q

DDx for inguinal hernia

A

LYMPH NODE ENLARGEMENT
Hydrocele (non-tender, transillumination)
Testicular torsion (acute incarcerated hernia)
RULE OUT TORSION FIRST

49
Q

Tx for acute incarceration? Chronic?

A

Acute: attempt reduction
Chronic: DON’T ATTEMPT IF THERE IS ANY QUESTION OF DURATION! Do surgery with hydration and antibiotics pre-op

Clin Med 2 (13 decks)

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