Male Reproductive System Flashcards
A 24 yr old man comes with dry cough for the past 2 months. He also has dull aching back pain with no apparent cause. Imaging studies reveal several pulmonary nodules and retroperitoneal LAP. Which of the ff would most likely establish the primary source of this patient’s findings?
Scrotal U/S
- In a young man with nonspecific back or lower abdominal pain, evidence of pulmonary metastasis, retroperitoneal LAP - most likely Dx is testicular cancer
A young man presenting with a painless hard nodule in the left testicle. u/s shows a solid hypoechoic 5cm left testicular mass. The next step in the mx is?
Radical inguinal orchiectomy - which confirms the dx and provides definitive mx.
- scrotal orchiectomy, transscrotal biopsy, FNA promote spread through the lymphatics - not used to confirm the dx.
A 35 yr old man comes with gynecomastia with mild bilateral tenderness, there is 1cm nodule on the rt testis. LH, FSH, TESTOSTERONE levels r low, estradiol is high. Dx?
Leydig cell tumor
Penile fracture is managed as? Ix, Rx
Clinical Dx followed by surgical repair.
- but, if signs of urethral injury are seen ( blood at meatus, hematuria , dysuria, urinary retention)- RETROGRADE URETHROGRAPHY is needed
Chronic pelvic pain, perineal and back pain, pain with ejaculation, irritative LUTs, urinalysis May show leukocytosis but negative urine culture. Normal PSA, prostate May b a little tender or no tenderness at all
Dx?
Mx?
Chronic prostatitis/ chronic pelvic pain syndrome
- unknown etiology.
- mx- alpha 1 blockers like tamsulosin or 5- alpha reductase inhibitors like fenastride
Acute bacterial prostatitis
- most cases r caused by which organism?
- Rx - which abx r preferred (2)?
- coliform bacteria like e.coli
- fluoroquinolones like levofloxacin or co-trimoxazole for 6wks
Young or middle aged adult with sxs of recurrent UTI that resolve transiently with a short course of abx; pain with ejaculation; normal prostate examination (often)
Dx?
Chronic prostatitis
A 74 yr old man comes with sxs of BPH. He has had 2episodes of hematuria that cleared spontaneously in the past two months. U/A is normal except 2-3 RBC/hpf. PSA is normal.
The best next step in the evaluation of this patient is?
Cystoscopy
Because he has hematuria with no evidence of infection or glomerular disease
A 32 yr old man comes for infertility evaluation. Bilateral normal sized testes are palpable in the scrotum. The left testis is positioned lower than the right n superior to it, there is a nontender clustered mass. Does not transilluminate and it decreases in size when the pt is supine.
Dx?
Cause of infertility ?
Mx?
Varicocele
-usually asymptomatic but can b associated with decreased fertility likely due to increased scrotal temperature.
Testicular atrophy, decreased sperm production, impaired sperm motility can b seen.
-mx -pts who desire fertility- surgical
- older pts- NSAIDs n scrotal support
In a pt with clinical features of BPH, no signs of infection or hematuria, normal PSA, the next step in the mx is?
Alpha 1 blockers like tamsulosin- first line therapy.
- 5-alpha reductase inhibitors r used additionally for persistent sxs or as alternate therapy for those who can’t tolerate alpha blockers.
Dorsal penile plaque, pain/curvature with erection likely indicate?
Peyronie disease. - arises due to repeated blunt trauma to the penis during sexual intercourse with subsequent abarrent wound healing.
The greatest risk factor for prostate cancer is?
Advanced age
Rapid onset skin infection of the lower abdomen, scrotum, perineum with crepitus and significant systemic manifestations (fever, hypotension, leukocytosis)
Is consistent with?
In addition to abx, the best next step is?
Fournier gangrene, a life threatening necrotizing fasciitis that quickly progresses to sepsis n death
- early surgical exploration n debridment
