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AANP Study Cards > Men's Health > Flashcards

Men's Health Flashcards

1
Q

What is priapism

A

Prolonged and painful erection for several hours that is not associated with sexual stimulation or desire

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2
Q

The 2 types of priapism are

A

Ischemic and non-ischemic

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3
Q

What are causes of priapism

A
  • idiopathic
  • medications (ie. intracavernosal injections, medications for ED)
  • Cocaine
  • Quadrapelgia
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4
Q

Does sickle cell increase or decrease risk for priapism

A

Increase

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5
Q

What is paraphimosis?

A

-When the foreskin cannot be returned back to iuts original position because of swelling of the head (glans) of the penis

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6
Q

What are sx of paraphimosis

A

-Red, swollen and painful glans of the penis

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7
Q

Who is at highest risk of paraphimosis

A

Uncircumcised infants and toddlers

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8
Q

What is the management of paraphimosis

A
  • Refer to ED
  • Requires a small slit in the foreskin to relieve pressure or circumcision
  • Is a urological emergency
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9
Q

What are sx of testicular cancer

A
  • nodule in the testicle
  • sensation of heaviness or aching
  • one larger testicle
  • tenderness in the testicle
  • new onset hydrocele (from tumor pressing on vessels)
  • Affected testicle feels heavier and more solid
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10
Q

At what tanner stage does sperm production begin?

A

Tanner stage IV

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11
Q

Where are sperm produced?

A

seminiferous tubules of the testes

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12
Q

What is fournier’s gangrene

A

-rare, rapid progressing polymicrobial necrotizing fasciitis of the external genitalia and perineum

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13
Q

What are risk factors for fournier’s gangrene

A
  • DM
  • Trauma to the urethral/penile area
  • Use of SGLT2i
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14
Q

What are sx of fournier’s gangrene

A

-acute severe pain
-redness
-swelling
of perineum

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15
Q

What are sx of testicular torsion?

A
  • abrupt onset of extremely painful and swollen red scrotum
  • acute hydrocele
  • inguinal pain
  • lower abdominal pain
  • nausea
  • vomiting
  • affected testicle sits higher and closer to the body
  • blue dot sign
  • absent cremasteric reflex
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16
Q

Cryptorchidism increases patient’s risk for

A

Testicular cancer

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17
Q

Spermatogenesis is stimulated by the following 2 hormones:

A

Testosterone and follicle stimulating hormone

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18
Q

What is the function of the epididymis

A

Storage of immature sperm cells

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19
Q

What is the cremasteric reflex

A

Testicle is elevated towards the body in response to stroking or lightly pinching the ipsilateral inner thigh (thigh that is on the same side as the testicle)

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20
Q

What is the role of transillumination of the scrotum

A

-useful for evaluating undescended testicles, hydrocele, spermatocele and other scrotal masses

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21
Q

Which will not transilluminate?

a) Hydrocele
b) Variocele
c) Spermatocele
d) Tumors

A

Varicocele, and tumors

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22
Q

What is the most common tumor in males age 15-30

A

Testicular

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23
Q

What is the gold standard diagnosis for testicular cancer?

A

Testicular biopsy

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24
Q

Regarding testicular torsion, permanent testicular damage results if not corrected in ____ hours and the testicle will need to be surgically removed if not corrected in ____ hours

A

<6 hours and 24 hours

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25
Q

What is the most common cancer in Men?

A

Prostate

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26
Q

What are risk factors for prostate cancer

A
  • 50 years +
  • Black
  • Obesity
  • 1st degree relative (2x the risk)
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27
Q

What is the current recommendation for Prostate cancer screening

A

Routine screening is not recommended as studies have shown that absolute risk reduction with screening is minimal

-individualize based on risk and discuss risk with testing (bleeding, infection, impotence, psychological trauma)

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28
Q

What are sx of prostate cancer

A
  • Often asymptomatic
  • Painless and hard fixed nodule or indurated area on the prostate gland on an older man that is deteceted by DRE
  • frequent urination
  • urinary hesitancy
  • nocturia
  • decreased force of urination
  • incomplete emptying
  • hematuria
  • elevated PSA >4.0ng/mL
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29
Q

What is the diagnostic test for prostate cancer

A

biopsy via transurethral ultrasound

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30
Q

How should you management urinary symptoms of prostate cancer?

A

-alpha blockers (terazosin/hytrin)

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31
Q

What are questionnaires to assess the severity of a patient’s BPH sx

A
  • American urological association urinary symptom score

- International prostate symptom score

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32
Q

What are sx of BPH

A

Gradual onset of urinary obstructive symptoms such as:

  • weak stream
  • post void driblling
  • feelings of incomplete emptying
  • urinary retention
  • nocturia

PSA is elevated
Prostate is symmetrically enlarged on DRE

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33
Q

What are some lifestyle changes that may decrease symptoms of BPH

A
  • reduce/eliminate caffeine and alcohol
  • avoid fluids after dinner before bed
  • avoid use of diuretics if possible
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34
Q

What are the first line medications for BPH

A

Alpha-adrenergic antagonists

  • Tamsulosin (flomax)
  • Terazosin (Hytrin)
  • Doxazosin (cardura)
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35
Q

What medications should be avoided in patients with BPH

A
  • anticholinergics

- sympathomimetics (cause urinary retention)

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36
Q

Besides alpha-adrenergic antagonists, what are medications including herbal remedies can be used in BPH

A

1) 5-alpha-reductase inhibitors: FInasteride (proscar)

2) Saw-palmetto

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37
Q

What is an adverse effect of alpha blockers

A

orthostatic hypotension

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38
Q

While on Proscar (Finasteride) the prostate shrinks by ___ %, so in obtaining a PSA on a patient you must ____ the result

A

50%, double

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39
Q

In a male patient with BPH and hypertension what medication can you consider to help both conditions

A

Hytrin

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40
Q

What happens to the prostate gland when you stop taking finasteride (proscar)

A

-Proscar inhibits type 2 5-alpha-reductase (blocks androgen receptor) and acts directly on the prostate gland to shrink it temporally when on the medication, if a patient stops taking the medication the prostate will return to its original size

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41
Q

Proscar is a category ___ drug. Can it be handled by reproductive aged females?

A

X; NO Teratogenic and adversely affect male fetus

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42
Q

What is chronic bacterial prostatitis

A

Chronic >6 week infection of the prostate gland

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43
Q

Causes of chronic bacterial prostatitis

A

E.Coli and Proteus

44
Q

What are sx of chronic bacterial prostatits

A

> 6 week history of suprapubic or perineal discomfort accompanied by irritative voiding symptoms:

  • dysuria
  • nocturia
  • frequency

Prostate may feel normal or boggy; non tender

  • Not systemically ill
  • may be asymptomatic
45
Q

What is the treatment of chronic prostatitis?

A

Ciprofloxacin 500mg PO BID x 4 weeks

Alternatively
Bactrim 1 tab PO BID x 1-3 months

Refer to urology

46
Q

What is acute prostatitis

A

Acute infection of the prostate

47
Q

What are the sx of acute prostatitis

A

Sudden onset:

  • fever
  • chills
  • suprapubic/perineal pain
  • radiation of pain to back or rectum
  • urinary symptoms: Frequency, dysuria, nocturia
  • DRE: Prostate boggy and tender and warm
  • cloudy urine
  • pain with bowel movements
48
Q

What lab tests should you order for prostatitis

A

CBC, UA, C&S

49
Q

What are expected findings of labs when a patient has acute prostatitis?

A
  • CBC: Leukocytosis with left shift
  • UA: Large amounts of WBC, hematuria
  • Urine C&S
50
Q

What is the medical treatment for acute prostatitis

A

If <35 or high risk for STI: Ceftriaxone 250mg IM and Doxycycline 100mg BID x 10 days

If >35 years or unlikely STI: Ciprofloxacin/Ofloxacin PO BID or Levofloxacin daily x 10-14 days, or up to 6 weeks

51
Q

What SSRI has the highest risk of erectile dysfunction?

A

Paxil

52
Q

What is the difference between acute and chronic prostatitis?

A
  • Acute is sudden where chronic is gradual
  • DRE: Acute= painful, warm, boggy; Chronic= often normal
  • Labs: Acute will show changes in CBC, UA where chronic will be likely normal
53
Q

What is acute bacterial Epididymitis

A

-infection where bacterial ascends into urethra and reaches the epididymis

54
Q

What is the likely causes of acute bacterial epididymitis

A

Noninfectious is the most common:

  • Prolonged sitting
  • Underlying congenital defect

Infectious

  • Chlamydia
  • Gonorrhea
55
Q

What are the sx of acute bacterial epididymitis

A
  • acute onset of a swollen red scrotum that hurts
    • Prehn’s sign: Relief of pain with scrotal elevation
  • Unilateral testicular tenderness with urethral discharge
  • induration of the posterior epididymis
  • May have hydrocele
  • systemic symptoms like fever
56
Q

What is Prehn’s sign

A

Relief of pain with scrotal elevation

57
Q

What lab tests should you order in suspected acute bacterial epididymitis?

A

CBC- leukocytosis
UA- Leuks, blood, nitrites
C&S
Urine NAAT chlamydia and gonorrhea

58
Q

What is the treatment for acute bacterial epididymitis?

A

If <35 or high risk for STI: Ceftriaxone 250mg IM and Doxycycline 100mg BID x 10 days

If >35 years or unlikely STI: Ofloxacin PO BID or Levofloxacin daily x 10-14 days

Non-infectious think: fluids

59
Q

What caution should you provide to a patient taking a fluoroquinolone?

A

Risk of achilles tendon rupture, advise against intense lower extremity activity

60
Q

What are the causes of erectile dysfunction

A

Organic
Drug induced
Psychogenic
Reduced libido

61
Q

What are organic causes of ED

A
  • Aging
  • neurological (DM, MS, spinal cord injury)
  • Vascular
  • Hormonal (Hypogonadism)
62
Q

What are medication causes of ED

A
  • SSRI esp Paxil
  • antipsychotics
  • recreational drugs
  • ETOH
  • Beta blockers
  • Thiazides
  • smoking
63
Q

What would make you think the cause of ED is psychogenic

A
  • If pt reports sponatenous early morning erection or normal nocturnal tumescence or can achieve erection with masturbation
  • often r/t anxiety, depression, relationship issues, stress
64
Q

What strategies can help pain management with acute bacterial epididymitis?

A
  • Scrotal elevation
  • ice packs
  • scrotal rest
  • NSAIDs
65
Q

What labs do you want to check in a pt complaining of ED

A
  • Check for DM (A1C, FBG)
  • TSH
  • Morning serum testosterone
66
Q

What is first-line medications for ED

A

phosphodiesterase type 5

-Sildenafil (Viagra), Tadalafil (Cialsis)

67
Q

What education should you provide patients regarding administration of Viagra

A
  • Take 1 dose 30-60 minutes before sex; duration of 4 hours; use only 1 dose in 24 hours
  • take on empty stomach
  • avoid fatty foods for ptimal effectiveness
68
Q

What are side effects, warnings of CI of viagra

A
  • Caution use with alpha blockers, hx of MI in past 6 months, unstable angina: High risk for hypotension
  • Do not use with meds that prolong QT interval (ie. macrolides)
  • Can decrease blood to optic nerve causing sudden vision loss
69
Q

What is the education you provide patients regarding administration of cialis

A

can be taken several hours before sex due to long duration (lasts up to 36 hours)

70
Q

Aside from ED what can cialis also be useful for?

A

BPH

71
Q

What are CI of ED treatments?

A
  • Concomittant nitrates
  • Use of alpha blockers
  • Post MI
  • Post CVA
  • Major surgery
  • Avoid combination with grapefruit juice or ETOH
72
Q

What are AE of ED treatments

A
  • Headache
  • Flushing
  • Dizziness
  • Hypotension
  • Nasal congestion
  • Priapism
  • Visual changes
73
Q

What is peyronie’s disease?

A

an inflammatory and localized disorder of the penis that results in fibrotic plaques on the tunica albuginea

74
Q

What are sx of peyronie’s disease? And what is the managment

A
  • penile pain with erection
  • palpable nodules and penil deformity
  • 1/2 will spontaneously resolve
  • 1/2 will require surgery
75
Q

What is balanitis

A

A candidal infection of the glans penis

76
Q

What are risk factors for balanitis

A
  • Uncircumcised men
  • DM
  • Immunocompromised states
  • Use of SGLT2i
77
Q

What are sx of balantis

A
  • redness
  • pain
  • tenderness
  • pruritis of the glans

develops over 3-7 days
-exam shows: redness, shallow ulcers with curd-like discharge on the glans

78
Q

What is the tx of balantis

A

OTC topical azole creams like clotrimazole 1% or miconazole 2% BID x 7-14 days

79
Q

What is cryptorchidim

A

Testicle that does not descend spontaneously by 4 months of age

80
Q

When will the majority of male testicles descend by

A

12 months

81
Q

What is a varicocele

A

Varicose veins in the scrotal sac

82
Q

What may a unilateral right-sided varicocele indicate?

A

A tumor inside the chest, abdomen or pelvis that is compressing a large vein

83
Q

When in the supine position a benign varicocele should ____ while a pathological varicocele will

A

Drain; while pathological varicoceles will not drain

84
Q

What feels like a bag of worms in the scrotal sac

A

A varicocele

85
Q

What is a hydrocele

A

A collection of serous fluid inside the tunica vaginalis

86
Q

Do varicoceles affect fertility

A

They can if large enough as they can increase temperature in the scrotum

87
Q

What is a spermatocele

A

A fluid filled cyst that contains nonviable sperm

88
Q

Do spermatoceles affect fertility

A

NO

89
Q

What is the imaging of choice with suspected hydroceles, varicoceles or spermatocele

A

Ultrasound

90
Q

A 13-year-old male is brought to an outpatient clinic by his father with a c/o sudden onset severe left testicular pain. The pt is nauseated, has vomited. On exam, he has a red, swollen, and tender left scrotum. Absent cremasteric reflex. The abdomen is soft with no rebound or local tenderness, + bowel sounds. Which of the following is recommended?

a) Recommend increased fluids and the BRAT diet
b) Order an ultrasound of the left scrotum
c) Refer to urology
d) Refer to ED

A

D) Refer to ED

91
Q

Which of the following is a possible effect of the mumps virus, which can affect male fertility?

a) Salivary gland inflammation
b) Cryptorchidism
c) Orchitis
d) Prostatitis

A

C) Orchitis

92
Q

What is the most common cause of balanitis?

a) Pseudomonas
b) Candida albicans
c) Bacteria
d) Virus

A

b) Candida albicans

93
Q

A 37-year-old male complains of swelling on the right scrotum that is mildly tender for a few weeks, there is a pressure-like sensation, the right is larger than the left scrotum. Which of the following test is appropriate for this patient

a) Transillumination
b) CBC with diff
c) Ultrasound
d) UA

A

a) Transillumination

94
Q

Which of the following meds increased ED

a) Amox
b) Paroxetine
c) Levothyroxine
d) Aspirin

A

b) Paroxetine

95
Q

What is the most common clinical manifestation of BPH

A

Lower urinary tract symptoms:

  • weakened stream
  • hesitancy
  • post-void dribble
  • incomplete emptying
  • incontinence
  • urinary retention
  • frequency, urgency, nocturia
  • painless hematuria
96
Q

How is the BPH prostate described

A

firm, smooth and symmetrically enlarged

97
Q

Mr. B is 78 years old and is having LUTS. What findings would make you suspect prostate malignancy instead of BPH?
(Select all that apply)

  1. Urinary retention
  2. Nodular Prostate gland
  3. Asymmetrical enlargement
  4. Hematuria
  5. Elevated PSA
  6. Bacteria in urine
A
  1. Nodular Prostate gland

3. Asymmetrical enlargement

98
Q

Mr. B has been dx with symptomatic BPH. His PSA is elevated at 4.0. What can cause a clinically significant elevation in PSA?

1) Ejaculation
2) DRE
3) Cycling
4) Exercise
5) Enlarged prostate gland

A

1) Ejaculation
3) Cycling
5) Enlarged Prostate gland

99
Q

Education for pt taking Flomax

A
  • take at bedtime

- watch for lightheadedness

100
Q

An enlarged boggy warm and tender prostate signifies

A

Acute Prostatitis

101
Q

30 year old has suspected acute prostatits. What labs should NOT be part of the initial evaluation?

  1. PSA
  2. UA
  3. C&S
  4. urethral Swab
A
  1. PSA bc it will be elevated r/t to inflammation
102
Q

Why should gentle prostate exam be performed in setting of likely bacterial prostatitis? Select all that apply

  1. May cause penile burning
  2. Increases risk of bacteremia
  3. Increases risk of UTI
  4. Increases risk of prosatic abscess
  5. Its painful
A
  1. Increases risk of bacteremia

5. Its painful

103
Q

An asymmetric, induration, nodularity of a prostate gland is suspicious for prostate cancer

A

Prostate cancer

104
Q

If you have a PSA of >4 in a symptomatic male what should you do?

A

Refer to urology

105
Q

A 26-year-old male has acute scrotal pain and presents to the clinic. He is diagnosed with epididymitis what is a likely finding?

  1. He has a hernia
  2. He has a positive cremasteric reflex
  3. He has a swollen tender scrotum
  4. He is running a fever
A
  1. He has a + cremasteric reflex (also means he does not have a torsion)
106
Q

How is an inguinal hernia most commonly diagnosed

A

Physical exam

107
Q

What is the only treatment for a hernia

A

Surgery

AANP Study Cards (20 decks)

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