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Genitourinary > MDT's Part 2 > Flashcards

MDT's Part 2 Flashcards

1
Q

Normal male erection is a neurovascular event that relies on what?

A
  • Intact autonomic and somatic nervous system
  • Arterial blood flow
  • Smooth and striated musculature of corpora cavernosa and pelvic floor
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2
Q

Erection is caused and maintained by?

A
  • Increase in arterial flow
  • Active relaxation in smooth muscle
  • Increase in venous resistance
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3
Q

What is a key neurotransmitter that initiates and sustains erections?

A

Nitric oxide

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4
Q

What is Peyronie disease?

A

A fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile pain, curvature, or deformity

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5
Q

What is anejaculation?

A

inability to ejaculate

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6
Q

What are signs and symptoms of ED?

A
  • History
  • Lifestyle factors
  • Sexual orientation
  • Quality of relationship
  • Alchohol
  • Tobacco
  • use of porn
  • Medication
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7
Q

What may be the first sign of endothelial dysfunction?

A

Ability to achieve but not maintain an erection

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8
Q

Physical exam for erectile dysfunction?

A
  • Vitals
  • Obesity?
  • Cardio
  • Neuro
  • Genitalia
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9
Q

Treatment of ED?

A
  • Lifestyle modification and reduction of cardiovascular risk factors
  • If psychogenic component, therapy or counseling
  • Hormonal replacement
  • Oral agents (Sildenafil, Vardenadil, Tadalafil)
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10
Q

Refer to Urology for ED?

A
  • Priapism (MEDEVAC)
  • Initial oral therapy
  • Inadequate response to medication
  • Unable to tolerate side effects
  • Peyronie disease
  • Hx of pelvic/perineal trauma, surgery, or radiation
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11
Q

What are some general considerations for benign prostatic hypertrophy?

A
  • Hyperstatic process = increased number of cells
  • Most common benign tumor in men
  • At 55 yrs, approx 25% of men report obstructive voiding Sx
  • At 75, 50% report decreased force and caliber of urinary system
  • Risk factors are poorly understood
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12
Q

Obstructive symptoms associated with benign prostatic hypertrophy?

A
  • Hesitancy
  • Decreased force and caliber of stream
  • Sensation of incomplete bladder emptying
  • Double voiding (urinating twice within 2 hours)
  • Straining to urinate
  • Postvoid dribbling
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13
Q

Irritative symptoms associated with benign prostatic hypertrophy?

A
  • Urgency
  • Frequency
  • Nocturia
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14
Q

What is the most important tool and should be calculated for all patients before starting benign prostatic hypertrophy?

A

American Urological Association (AUA) index

- Seven questions that quantify severity of Sx’s on a 0-5 scale

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15
Q

Treatment for benign prostatic hypertrophy?

A
  • Watchful waiting (for mild Sx, AUA scores 0-7)

- Medical Therapy ( Alpha blockers, 5-alpha-reductase inhibitor)

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16
Q

Absolute surgical indications for benign prostatic hypertrophy?

A
  • Refractory urinary retention
  • Large bladder diverticula
  • Sequela of benign prostatic hyperplasia
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17
Q

When to refer to urology for benign prostatic hypertrophy?

A
  • AUA score greater than 7
  • Urinary retention
  • Hematuria
  • Recurrent UTI
  • Evidence of kidney disease
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18
Q

What is the most common non-cutaneous cancer in American men and second leading cause of cancer related death in men?

A

Prostate Cancer

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19
Q

What are risk factors for prostate cancer?

A
  • African American
  • Family Hx of prostate cancer
  • Hx of high dietary fat intake
  • Known or likely to have BRAC1 or BRAC2 mutations
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20
Q

Signs and symptoms of prostate cancer?

A
  • Most cases detected due to elevated serum PSA
  • May manifest as focal nodules or areas of induration on DRE
  • Can cause obstructive symptoms
  • Lymph node metastases (axial skeleton most common)
21
Q

Lab finding for prostate cancer?

A
  • PSA > 4.0 ng/mL
  • Prostate biopsy
  • Misc labs:
  • BUN and creatinine
  • Alkaline phosphate and calcium
  • CBC
22
Q

Imaging for Prostate cancer?

A
  • Transrectal U/S
  • MRI
  • Bone scan (eval for bony metastases)
23
Q

What is the screening for prostate cancer?

A
  • DRE
  • PSA testing
  • Transrectal U/S
24
Q

What is the treatment for prostate cancer?

A
  • As dictated by urology and oncology
  • Active surveillance
  • Radical Prostatectomy
  • Radiation therapy
  • Cryosurgery
  • Androgen deprivation therapy for advanced disease
25
Q

Complications of prostate cancer?

A
  • Urinary retention
  • Renal failure
  • Metastatic bone pain
  • Thromboembolic events
  • Neuro Sx’s
  • Pathologic fractures
26
Q

Who must be referred to urology with suspicion of prostate cancer?

A

All patients with:

  • Focal nodule
  • Induration on DRE
  • Elevated PSA
27
Q

What are some signs and symptoms of scrotal trauma?

A
  • Evaluate Airway/breathing, circulation for all blunt/penetrating trauma
  • TTP
  • Ecchymosis
  • Swelling
  • Laceration
  • Bleeding
28
Q

Imaging for scrotal trauma?

A
  • Scrotal and testicular U/S

* colored doppler study to determine extent of testicular involvement

29
Q

Treatment of scrotal trauma?

A
  • Blunt/penetrating testicular injuries require MEDEVAC

- Lacerations/avulsions just involving skin can be repaired by IDC

30
Q

What is Fournier’s Gangrene?

A

Necrotizing fasciitis of the subcutaneous tissues of the perineum often involving the scrotum
- typically begins as benign infection or simple abscess

31
Q

Signs/symptoms of fournier’s gangrene?

A
  • Tense edema of scrotum and other skin
  • Blisters/bullae
  • Crepitus
  • Fever
  • Pain (out of proportion)
  • Tachycardia
  • Hypotension
32
Q

Imaging for Fournier’s gangrene?

A
  • CT Scan and MRI
33
Q

Treatment for Fournier’s gangrene?

A
  • Aggressive Surgical exploration and debridement
  • Broad spectrum antibiotics
  • Ertapenem
  • Fluid resuscitation
  • MEDEVAC
34
Q

What is varicocele?

A

Dilation of the pampiniform plexus of spermatic veins and is generally left sided

35
Q

Signs and symptoms of varicocele?

A
  • Usually asymptomatic mass
  • Mass separate from testis
  • Feels like “bag of worms”
  • Size increased by valsalva
36
Q

What should right sided varicocele raise suspicion of?

A

Inferior Vena cava and intraabdominal pathology

37
Q

What should left sided varicocele raise suspicion of?

A

Left renal vein obstruction or renal tumor

38
Q

What is a hydrocele?

A

Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord

39
Q

Signs/symptoms of hydrocele?

A

Gradually enlarging painless cystic mass that transilluminates

40
Q

What is a spermatocele?

A

Fluid filled cyst at the head of the epididymitis that may contain nonviable sperm

41
Q

Signs/symptoms of spermatocele?

A
  • Painless
  • Palpated as distinct from testis
  • Typically transilluminated as cystic in nature
42
Q

Imaging for scrotal/testicular abnormalities?

A

Scrotal and testicular U/S

43
Q

What are some general consider for testicular cancer?

A
  • Malignancy is often painless
  • Most common neoplasm in age 20-35
  • Orchiectomy necessary for diagnosis
44
Q

What are some signs and symptoms of testicular cancer?

A
  • Painless enlargement of testis
  • Pt first to recognize abnormality but waits 3-6 months
  • Sensations of heaviness
  • Acute testicular pain
45
Q

Lab findings for testicular cancer?

A
  • HCG
46
Q

Imaging for testicular cancer?

A
  • Scrotal U/S
  • Clinical staging (upon Dx)
  • Chest, abdomen, pelvic CT scan
47
Q

Treatment of testicular cancer?

A
  • Radical orchiectomy
  • Retroperitoneal irradiation
  • Potential chemotherapy
48
Q

Referrals for testicular cancer?

A
  • Urology

- Oncology (if metastatic disease suspected)

Genitourinary (6 decks)

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