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Men's Health Flashcards

1
Q

Exams to do for BPH

A

Digital rectal exam
PSA
U/S

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2
Q

BPH meds and their mechanism of action

A

alpha blockers - relax smooth muscle (Tamsulosin/Flomax)

5-alpha reductase inhibitors - block DHT production (Finasteride/Propacia)

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3
Q

Surgery for BPH

A

TURP = transurethral resection of prostate

Prostatectomy

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4
Q

Difference in DRE findings of BPH and prostate cancer

A

BPH - smooth, enlarged

cancer - firm nodules

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5
Q

Who should be screened with DRE? How often?

A

annually for males over 50

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6
Q

Most common cancer in men

A

prostate cancer

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7
Q

Most common benign cancer in men

A

BPH

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8
Q

A relatively common defect where the urethra ends on the underside of the penis.

A

Hypospadias

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9
Q

Hallmark PE findings of varicocele

A

“bag of worms” on palpation of testes

negative transillumination

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10
Q

Which condition of the scrotum will transilluminate?

A

hydrocele

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11
Q

Benign cyst within the scrotum which contains spermatozoa

A

Spermatocele

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12
Q

Which condition of the scrotum will NOT transilluminate?

A

varicocele and spermatocele

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13
Q

Cryptorchidism causes higher risk for what?

A

infertility, testicular cancer, testicular torsion

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14
Q

How is cryptorchidism treated?

A

orchiopexy before 12-24 months

hcG injections may also be helpful as it increases testosterone

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15
Q

Treatment of erectile dysfunction

A

Phosphodiesterase-5 inhibitors: Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra)

Alprostadil (MUSE) injections

Penile implants

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16
Q

Underlying medical conditions that may cause erectile dysfunction

A

diabetes

peripheral neuropathy

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17
Q

3 types of incontinence

A

Stress incontinence
Urge incontinence
Overflow incontinence

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18
Q

Stress incontinence

A

Leaking of urine due to physical stress. Coughing, jumping, laughing etc. This is often due to urethral incompetence.

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19
Q

Urge incontinence

A

A sudden feeling of urgency and an associated loss of urine. Often associated with an overactive detrusor muscle. This may be due to neurologic disease.

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20
Q

Overflow incontinence

A

Involuntary voiding without an urge to urinate typically secondary to urinary retention. This is often due to an outlet obstruction (think BPH) or an underactive detrusor muscle

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21
Q

Work-up of urinary incontinence

A

U/A and culture looking for signs of infection
U/S for postvoid residual volume
Full bladder standing cough
Possible cystoscopy

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22
Q

Urinary incontinence management

A 
Schedule for bladder emptying
Reduce caffeine and alcohol
D/C meds which may be cause, especially cholinergics
Kegel maneuvers
Straight catheter
Suprapubic pressure

Meds:

  • Topical estrogens may help with urethral incompetence
  • Alpha blockers may help for BPH

Surgical: Urethral sling for stress incontinence

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23
Q

paraphimosis

A

foreskin is trapped behind the glans of the penis and can not be reduced

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24
Q

foreskin can not be retracted over the glans of the penis

A

phimosis

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25
Phimosis treatment
Steroid cream | Circumcision
26
I came in to see my physician assistant because of… Severe acute abdominal pain Firm and tender testes Absent cremasteric reflex
testicular torsion
27
How is cremasteric reflex tested?
Lightly stroke the superior medial thigh and the cremaster muscle should pull the testis up on the side that was stroked
28
How is Prehn's sign tested?
elevating testes gives pain relief
29
+Prehn's seen in what male conditions
testicular torsion and epididymitis
30
Testicular torsion treatment
Manual detorsion of the testis – opening a book Surgical emergency
31
Gram stain and culture results of Gonorrhea and Chlamydia discharge?
G- diplococci = N. gonorrhoeae No visible organism but lots of WBCs = Chlamydia
32
I came in to see my physician assistant because of… ``` My scrotum hurts Urethral discharge Pain with voiding Fever + Prehn's sign ```
epididymitis
33
Etiologies of epididymitis
Chlamydia Gonorrhoeae G- rods
34
Epididymitis/orchitis treatment
Antibiotics which cover Gonorrhea (Ceftriaxone) and Chlamydia (Azithromycin) Treat sexual partners as well Scrotal elevation, ice, NSAIDs
35
Mumps is cause of ________ in men.
orchitis
36
acute vs chronic prostatitis presentation
Acute: fever, dysuria, tenderness with rectal exam Chronic: no fever, rectal exam may be normal or have boggy prostate
37
Causes of prostatitis
acute: E. coli, Pseudomonas chronic: G- rods, enterococci less than 35: STI children and elderly: E. col
38
Prostatitis treatment
Acute patient may require hospitalization: IV abx, +/- catheterization ABX: TMP-SMX (Bactrim) Fluoroquinolones (Cipro) x 4-6 wks for acute and 6-12 wks for chronic`
39
How is urethritis caused by Neisseria differentiated from Chlamydia?
Purulent urethral discharge (think Neisseria) Clear discharge (think Chlamydia)
40
Abx dose for gonorrhea
Cefriaxone 250 mg IM x 1 dose | *also treat for Chlamydia
41
Abx dose for Chlamydia
Azithromycin 1 g (or doxy) | *also treat for Gonorrhea
42
How to dx Gonorrhea and Chlamydia in lab?
NAAT (nucleic acid amplification) of dirty urine or urethral swab
43
I came in to see my physician assistant because of… It hurts when I pee! (dysuria) Frequency Urgency
Cystitis
44
#1 cause of cystitis
E. coli
45
Risk factors for prostate cancer
African American FHX High fat diet
46
What level of PSA makes you suspicious of prostate cancer?
PSA > 4.0
47
I came in to see my physician assistant because of… - I feel a painless lump on my testicle - Acute pain in the scrotum What must be ruled out?
testicular cancer
48
Blood markers for testicular cancer
hcG AFT = alpha fetoprotein LDH = lactate dehydrogenase
49
Testicular cancer management
One of the highest cure rates of all cancers!!! Radical orchiectomy Adjuvant chemotherapy may be required
50
#1 risk factor for bladder cancer
smoking
51
Bug that causes syphilis
Treponema pallidum
52
What are the classifications of syphilis and typical onset?
primary (within 3 months of contact) secondary (4-10 wks after primary) latent - no sx's tertiary (3-15 yrs after initial infection)
53
What is latent syphilis?
having serologic proof of syphilis infection without symptoms of disease
54
Signs of primary syphilis
Chancre lesions - single PAINLESS ulceration with clean base and clear borders Lymph node enlargement
55
Signs of secondary syphilis
RASH: symmetrical, reddish-pink, non-itchy maculopapular rash on trunk and extremities, including palms and soles of feet
56
_________ is diagnostic of primary syphilis.
Darkfield microscopy | + if treponemes seen
57
Serology tests for primary and secondary syphilis
Non-treponemal: VDRL or RPR (positive at 4-6 weeks and during primary and secondary, but negative during tertiary) Treponemal: FTA-ABS (used after VDRL to confirm results of a positive test)
58
Testing for tertiary syphilis
Lumbar puncture Joint aspiration Tissue biopsy
59
Signs of tertiary syphilis
Gummatous lesions Late neurosyphilis Cardiovascular sx's
60
Jarisch–Herxheimer reaction
Immune response to materials released by destruction of spirochetes in anti-treponeme (syphilis) therapy sx's: fever/chills, muscle pain, HA No need to stop treatment Resolves in 24 hours
61
How can early stages of syphilis be treated?
primary, secondary, and early latent: IM Benzathine penicillin G 2.4 million units x 1 dose * if PCN allergic, then doxy or tetracycline
62
Abnormal discharge from the penis – yellow, creamy, and excessive, blood-tinged. Dx?
Gonorrhea
63
What is gram negative diplococci STI? How is it treated?
Gonorrhea | Tx: IM Ceftriaxone
64
Condyloma acuminatum is bug of what pathology?
Human Papilloma Virus (HPV)
65
Condyloma acuminatum treatment
Podofilox 0.5% gel applied to warts BID x 3 days Prevent with HPV vaccine (Gardisil)
66
First line for male pattern (androgenic) baldness treatment
Minoxidil (Rogaine)
67
Physiologic mechanism of penile erection
Nitric oxide into corpus cavernosum → increase cGMP → decreased Ca2+ → vasodilation → more blood to penis
68
Meds that cause ED? How to alter meds to reduce side effects?
SSRI, beta blockers, H2 blockers, antihistamines, opiates SSRI → Wellbutrin or Buspar BB → CCB or ACE
69
Healthy young adult comes in with pearly, umbilicated papules on groin region. Dx?
Molluscum Contagiosum
70
Molluscum Contagiosum treatment
Imiquimod (Aldara) 5% x 1-3 mon on lesions | Cryotherapy, curettage, or electrodessication if painful
71
All patients with syphilis should be tested for _______.
HIV
72
Uncircumsized boy under 5 yo with small red erosions and swelling of glans and foreskin. Started to have discharge. DX?
balanitis
73
Collection of thick whitish discharge under foreskin?
smegma
74
Trichomonas treatment
Metronidazole 2 g PO x 1 dose * No alcohol x 24 hrs after treatment
75
How is pubic lice treated?
Permethrin (Elimite) rinse 1% x 10 min OR cream 5% x 8 hr | treat sexual partners
76
Causes of elevated PSA
enlarged prostate infection prostate cancer
77
What are the roles of FSH and LH in men?
FSH stimulates Sertoli cells in testes to produce inhibin and germ cells that mature into spermatozoa LH stimulates Leydig cells in testes to produce testosterone
78
HSV treatment for first episode, episodic, and chronic suppression?
First episode (w/i 24 hrs of sx's): ◦ Acyclovir 800 mg TID x 7-10 d ◦ Valacyclovir 1000 mg BID x 7-10 d Episodic: ◦ Acyclovir x 3-5 d ◦ Valacyclovir x 5 d ◦ Famciclovir x 1 d Chronic suppression (1-2 episodes per month): ◦ Acyclovir (safe for 5 yrs) ◦ Famiciclovir (1 yr) ◦ Valacyclovir (1 yr)
79
Man is asymptomatic but has noticed grayish green penile discharge and some mild dysuria. What test should be ordered? Why?
Wet mount to look for trophozoites Likely Trichomonas

PANCE review (18 decks)

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