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ICA > Men's health > Flashcards

Men's health Flashcards

1
Q

what is phimosis?

A

Prepuce (foreskin) cannot be retracted fully as an adult.

*physiological until puberty.

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2
Q

what are some consequences of phimosis?

A
  • poor hygiene and STD incidence.
  • pain on intercourse leading to splitting or bleeding.
  • Balantis.
  • Urinary retention.
  • Penile cancer.
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3
Q

what is paraphimosis? and what causes it?

A

the painful constriction of glans penis by retracted prepuce.
- phimosis, catheterisation (elderly), penile cancer.

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4
Q

how would you treat phimosis?

A

circumcision!

*beware if elderly and has phimosis and balantis (glans penis inflammation and tightness of prepuce)

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5
Q

how would you treat paraphimosis?

A

reduction by puncturing holes into oedematous foreskin, or dorsal slit.

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6
Q

what are the risk factors for squamous cell carcinoma?

A
  • phimosis.
  • hygiene.
  • smegma.
  • HPV 16 & 18
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7
Q

what are the key indications for circumscision?

A
  • paediatric: religious or recurrent balantis/ UTIs.

- adults: recurrent balantis, phimosis, recurrent paraphimosis, penile cancer, BXO.

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8
Q

how would testicular torsion present?

A
  • younger patient with unilateral pain with nausea and vomiting and to lower urinary tract symptoms.
  • very tender and lying high in scrotum with horizontal line of examination.

EMERGENCY SCROTAL EXPLORATION without wasting time on USS etc.

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9
Q

what in a patients history could suggest epididymo-orchitis?

A
  • gradual onset, unilateral.

- with recent history of UTI, unprotected intercourse, catheter or urethral instrumentation, mumps.

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10
Q

how would epididymo-orchitis present on examination?

A
  • pyrexial, septic possibly.
  • erythematous scrotum.
  • testis. epididymis enlarged and tender.
  • rarely necrotic.
  • investigate with bloods for sepsis, urine mid stream, radiology for abscess.
  • treat antibiotics, drain also if abscess, gangrene debridement also.
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11
Q

what could a painless scrotal lump suggest as opposed to a painful one?

A
  • painless: testis tumour, epididymal cyst, hydrocele or varicocele aches at end of day.
  • pain: epididymitis, epididymo-orchitis, strangulated inguino-scrotal hernia.
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12
Q

how would testicular tumour present?

A
  • painless.
  • germ cell tumours (seminoma/ teratoma) in 45yr men with history of undescended testes.
  • older men could be lymphoma.
  • on examination testis body abnormal (firm and hard) and ‘can get above testes’.
  • urology checks for tumour markers, USS.
  • treatment - inguinal orchidectomy.
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13
Q

how would hydrocele present?

(caused by imbalance of fluid production and resorption between tunica albuginea and vaginalis).

A

slow/ sudden onset, uni/bilateral scrotal swelling.
on examination testis not palpable separately, can usually above, transilluminates.

*treated with reassurance if normal testes, surgical removal if large and symptomatic.

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14
Q

how would an epididymal cyst present?

A
  • painless.
  • separate from testis, can get above mass, transilluminates.

*treated with reassurance or excision if large.

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15
Q

how would a varicocele present?

A
  • dull ache, end of day.
  • left more than right, associated with reduced fertility esp. in bilateral.
  • on examination bag of worms above testes, NOT tender, palpable abdo/renal mass.

*reassure, radiological embolisation if symtomatic, infertile, adolescent.

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16
Q

how would you treat an inguino-scrotal hernia?

A

surgery if strangulated especially.

17
Q

what causes urinary retention in males?

A
  • prostatic enlargement in BPH, cancer.
  • phimosis/ stenosis/ stricture.
  • constipation, UTI.
  • drugs like anti-choligernics.
  • neurological.
18
Q

how would you treat acute/ chronic retention?

A
  • acute painful: drain with catheter, trial without catheter addressing cause first.
  • chronic painless: abdo swelling, kidney insult could cause, learn to self-catheterise.
  • if painful and trial without catheter wont work then long term catheter or surgical intervention.
19
Q

what could cause LUT other than prostate?

A
  • irritative infections or inflammations.
  • overactive bladder idiopathic or neuropathic like MS.
  • low compliance in scarring like post TB.
  • polyuria.
20
Q

what could cause voiding symtoms?

A
  • obstruction physical like in urethra or prostate, dynamic in bladder neck or prostate or neurological loss of sphincter coordination in upper motor lesion.
  • reduced contractility lower motor lesion.
21
Q

how would LUT present?

A
  • examination: DRE, bladder palpable, neurological?

- investigations: dipstick, PSA

22
Q

LUT inteventions?

A
  • lifestyle: reduce caffeine, avoid fizzy, don’t drink more than 2.5L.
  • alpha blockers like tamsulosin to relax smooth muscle.
  • 5ARI’s to shrink prostate via androgen deprivation like finasteride.
  • BPH: TURP if above fails.

ICA (8 decks)

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