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GP FELLOWSHIP RNZGP > Men's Health > Flashcards

Men's Health Flashcards

1
Q

Epididymoorchitis
Treatment (no STI/not sexually active)

A

Treat like prostatitis

Trimethoprim 300mg nocte 14 days

or cephalexin 500mg Q6H for 14 days

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2
Q

Epididymoorchitis
Treatment (sexually active)

A

Treat like STI

Ceftriaxone 500mg in 2mL 1% lignocaine IM
PLUS
1g Azithromycin oral STAT
PLUS
1g Azithromycin 7 days later

OR Doxy 100mg BD for 7 days instead of azithro

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3
Q

Steps for genital exam (male)

A
  • Vitals
  • Inspection: Size, swelling, skin, colour, discharge)
  • Herniae and groin (LN)
  • Scrotum (varico/hydrocoele)
  • Testes& epi (size, lie, tenderness, lumps) prehns sign
  • DRE
  • CREMASTERIC REFLEX!!
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4
Q

DDX for Epididmyoorchitis or testicular pain

A

Epididymoorchitis

Torsion

Prostatitis

Hernia

Varicocoele, hydrocoele

Mumps orchitis (7-10 days post infection)

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5
Q

Overactive bladder conservative management

A
  • Bladder retraining
  • Pelvic floor physiotherapy
  • Reduce caffeine
  • Reduce risk factors: etOH, obesity, spicy foods, bladder stones
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6
Q

Overactive bladder pharmacological management (specifics) 3 options

A

Oxybutynin 5mg TDS
non selective anticholinergic

Solifenacin 5-10mg daily
Selective anticholinergic

Mirabegnon 25-50mg daily
Beta 3 agonist

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7
Q

Contraindication for Oxybutynin

A

Glaucoma

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8
Q

Minimally invasive options for detrusor overactivity (specialist level)

A

Botox A

Sacral nerve stimulation

Peripheral tibial nerve stimulation

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9
Q

DDX for overactive bladder

A

UTI
Cancer
urolithiasis
Neurogenic cause: MS, Diabetic neuropathy
OSA
outlet obstruction
CCF, DM polyuria

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10
Q

Risk factors for overactive bladder (modifiable and non modifiable)

A

Modifiable
- etOH
- Caffeine
- obesity
- smoking
- spicy food

NON modifiable
- Female
- age
- POP
- BPH-
- Post menopausal

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11
Q

Macroscopic haematuria managment and investigations

A
  1. CT IVP (gold standard) or US KUB in low risk <50
  2. referral for cystoscopy
  3. Cytology x3
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12
Q

Microscopic haematuria with UTI

A

Repeat urine test in 6 weeks

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13
Q

Microscopic haematuria - when to consider for further evaluation

A
  • > 50
  • Smoker
  • occupational exposure: benzene, dyes, amines
  • cyclophosphamide
  • pelvic irradiation
  • irritative LUTS
  • recurrent UTIs

IF these then refer for:
CT IVP
Cystoscopy
Cytology

IF NONE of these then repeat urine in 6 months

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14
Q

Urine cytology collection

A

Morning
3 consecutive days
3 samples

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15
Q

Causes of haematuria

A

TIP think top down

  • IgA nephritis
  • pyelonephritis
  • Renal Stones
  • Renal cell carcinoma
  • Urothelial carcinoma
  • Bladder stones
  • Cystitis
  • BPH
  • Caruncle

Other: exercise, trauma, POP, vaginal atrophy

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16
Q

LUTS causes

A

Cystitis
BPH
Stones
Overactive bladder syndrome
Urothelial carcinoma
Diabetes- polyuria
Stricture
Phimosis
Vaginal atrophy

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17
Q

BPH investigations

A

US KUB (hydronephrosis and size of prostate)

Urine MCS/urinalysis (haematuria

EUCs

Consider PSA
Consider cytology

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18
Q

Non pharmacological management of BPH

A

Reduce Caffeine
Reduce spice
Reduce evening fluids
Reduce constipation
Bladder retraining

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19
Q

BPH pharmacology

A

Tamsulosin 400microg daily
Silodosin
(alpha blocker)

Prazosin 0.5 to 2 mg orally, BD

Dutasteride 500microg daily
Finasteride
(5alpha reductase inhibitor)
GOOD IF >40mL prostate
Can take moths to get max benefit

Sildenafil
(phosphodiasterase 5 inhibitors)
(less common)

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20
Q

Dose of tamsulosin for BPH
Dose of dutaseride for BPH

A

400mcg daily
500mcg daily

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21
Q

Bilateral impalpable undescended testes

A

URGENT REFERRAL to paediatric surgeon

Plus
EUC for hyponatraemia in CAH
Internal genitalia US
Karyotype

22
Q

Unilateral undescended testes

A

Routine referral to paediatric surgeon for elective orchidopexy/repair at 6 months

23
Q

Bilateral undescended BUT palpable testes (with Abnormal genitalia)

A

URGENT referral

24
Q

Bilateral BUT palpable testes (with normal genitalia)

A

Routine referral to paeds surgeon
(no need for US )

25
Q

Acquired or ascending descended testes.. What to do?

A

Urgent referral to Paeds surgeon

26
Q

Retractile testes what to do

A

Annual review, if when you manipulate them down they stay then continue annual review
OR
if they do not stay post exam then REFER

27
Q

Age group for retractile testes

A

2-6 yrs old usually

28
Q

Age to review undescended testes

A

3 months (as only 1-2% not descended by then)

29
Q

Testing for male infertility

A

Semen analysis
Morning testosterone
FSH
US

If abnormal then add Free testosterone, LH, prolactin and repeat morning testosterone

30
Q

Counselling for semen analysis

A

Abstinence 2-3 days
Sample to lab within 1 hr

Abnormal
then repeat 1-3 months

grossly abnormal then 2-4 weeks

31
Q

Side effects of Alphablockers (eg tamsulosin)

A

Nasal congestion
Retrograde ejaculation
Hypotension
Tachycardia

32
Q

Heamatospermia first line investigations

A

Urine MCS and cytology (plus baseline bloods)

33
Q

Abnormal semen analysis - where to from here?

A
  • Repeat in specialised andrology lab
  • Mildy deranged in the next 3 months
  • Very deranged in the next 2-4 weeks
34
Q

Leukocyte count >1x10^6 in semen analysis next step ?

A

Needs urine MCS

35
Q

Male infertility blood tests

A

FSH and morning testosterone
If abnormal then
Repeat morning, LH and prolactin

36
Q

Hypogonatotropic hypogonadism: blood pattern

A

LH low
FSH low
Testosterone Low
Prolactin normal or high

37
Q

Testicular failure/ hypergonatotrophic hypogonadism: blood pattern

A

FSH and LH HIGH
testosterone LOW
Prolactin normal

38
Q

History questions for haematospermia

A
  • Recent urological procedure
  • Prolonged masterbastion or intercourse
  • Prolonged abstinence
  • Pain on ejaculation (prostatits)
  • TB
  • anticoagulants
39
Q

Ural cautions

A
  • Reduces efficacy of nitrofurantoin
  • Crystalluria with quinolones
40
Q

Chronic bacterial prostatitis managment

A

Ciprofloxacin 500mg BD 4 weeks

or trimethorpim 300mg nocte 4 weeks
or norflox 400mg BD 4 weeks

41
Q

Klinefelter syndrome hormonal findings

A

Primary hypogonadism:
Low testosterone
Raised LH and FSH

Karyotype 47XXY

42
Q

Examination findings for erectile dysfunction

A
  • Penile plaques
  • Small testicular volume
  • Lack of secondary sexual characteristics (lack of body hair)
  • Weak peripheral pulses
  • Lower limb neuro signs (decreased anal tone)
  • Gynaecomastia
43
Q

Risk factors for erectile dysfunction

A
  • Peyronie’s disease (fibrous plaques)
  • Recreational drug use (etOH)
  • Age
  • CVD and risk factors
  • Endocrine: androgen deficiency
  • Diabetes
  • Medications: BB, antidepressants
  • Prostate cancer therapy
44
Q

First line treatment for erectile dysfunction

A

Sildenafil 50mg 1hour before sex

45
Q

Paraphimosis management

A
  • Transfer to emergency department with urology cover
  • Anaesthetise penis with penile nerve block
  • Apply circumferential pressure to the glans of the penis to disperse oedema (eg gloved hand)
  • Intermittent ice to head of the penis
  • Aspiration of blood from the head of the penis with a needle
  • Apply granulated sugar to the head of the penis
46
Q

Premature ejaculation pharmacology

A

Dapoxetine 30mg 1-3 hrs prior to intercourse

OR
Emla cream to glans and shaft 15-30 mins prior

47
Q

Androgenic Alopecia treatment & side effects

A

Oral finasteride 1mg daily
OR
Topical minoxidil
(can use combo)

  • Impotence
  • Loss of libido
  • Gynaecomastia
  • Infertility
48
Q

History questions for erectile disfunction

A
  • Rapid onset
  • Morning or spontaneous erections
  • Sufficient for penetrative intercourse
  • Premature ejaculation
  • Changes to appearance of penis (peyronie’s )
  • Reduced facial hair/gynaecomastia (Andgrogen insufficency)
  • Low mood/anhedonia
  • ## Inter-partner conflict
49
Q

Klinefelter hormonal test results:

A

Low testosterone
HIGH FSH LH

Karyotype 47XXY

50
Q

Most common adverse outcome of a TURP

A

Retrograde Ejaculation

51
Q

Vasectomy counselling

A
  • Permanent nature of procedure
  • Need 3 months to be effective
  • risk of infection
  • risk of haematoma
  • risk of failure
  • risk of anti-sperm antibody
52
Q

History questions for male infertility causes:

A
  • Chemotherapy or radiotherapy
  • Previous cryptoorchidism (undescended testicle)
  • Previous torsion
  • Delayed puberty
  • Previous genital surgery/ pelvic surgery
  • Spinal cord disease
  • Erectile dysfunction
  • Family history of infertility
  • Exogenous testosterone use

GP FELLOWSHIP RNZGP (20 decks)

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