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PANCE review > Men's Health > Flashcards

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
Q

Phimosis treatment

A

Steroid cream

Circumcision

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26
Q

I came in to see my physician assistant because of…

Severe acute abdominal pain
Firm and tender testes
Absent cremasteric reflex

A

testicular torsion

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27
Q

How is cremasteric reflex tested?

A

Lightly stroke the superior medial thigh and the cremaster muscle should pull the testis up on the side that was stroked

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28
Q

How is Prehn’s sign tested?

A

elevating testes gives pain relief

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29
Q

+Prehn’s seen in what male conditions

A

testicular torsion and epididymitis

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30
Q

Testicular torsion treatment

A

Manual detorsion of the testis – opening a book

Surgical emergency

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31
Q

Gram stain and culture results of Gonorrhea and Chlamydia discharge?

A

G- diplococci = N. gonorrhoeae

No visible organism but lots of WBCs = Chlamydia

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32
Q

I came in to see my physician assistant because of…

My scrotum hurts
Urethral discharge
Pain with voiding
Fever
\+ Prehn's sign
A

epididymitis

33
Q

Etiologies of epididymitis

A

Chlamydia
Gonorrhoeae
G- rods

34
Q

Epididymitis/orchitis treatment

A

Antibiotics which cover Gonorrhea (Ceftriaxone) and Chlamydia (Azithromycin)

Treat sexual partners as well

Scrotal elevation, ice, NSAIDs

35
Q

Mumps is cause of ________ in men.

A

orchitis

36
Q

acute vs chronic prostatitis presentation

A

Acute: fever, dysuria, tenderness with rectal exam

Chronic: no fever, rectal exam may be normal or have boggy prostate

37
Q

Causes of prostatitis

A

acute: E. coli, Pseudomonas
chronic: G- rods, enterococci

less than 35: STI
children and elderly: E. col

38
Q

Prostatitis treatment

A

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
Q

How is urethritis caused by Neisseria differentiated from Chlamydia?

A

Purulent urethral discharge (think Neisseria)

Clear discharge (think Chlamydia)

40
Q

Abx dose for gonorrhea

A

Cefriaxone 250 mg IM x 1 dose

*also treat for Chlamydia

41
Q

Abx dose for Chlamydia

A

Azithromycin 1 g (or doxy)

*also treat for Gonorrhea

42
Q

How to dx Gonorrhea and Chlamydia in lab?

A

NAAT (nucleic acid amplification) of dirty urine or urethral swab

43
Q

I came in to see my physician assistant because of…

It hurts when I pee! (dysuria)
Frequency
Urgency

A

Cystitis

44
Q

1 cause of cystitis

A

E. coli

45
Q

Risk factors for prostate cancer

A

African American
FHX
High fat diet

46
Q

What level of PSA makes you suspicious of prostate cancer?

A

PSA > 4.0

47
Q

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?

A

testicular cancer

48
Q

Blood markers for testicular cancer

A

hcG
AFT = alpha fetoprotein
LDH = lactate dehydrogenase

49
Q

Testicular cancer management

A

One of the highest cure rates of all cancers!!!

Radical orchiectomy

Adjuvant chemotherapy may be required

50
Q

1 risk factor for bladder cancer

A

smoking

51
Q

Bug that causes syphilis

A

Treponema pallidum

52
Q

What are the classifications of syphilis and typical onset?

A

primary (within 3 months of contact)
secondary (4-10 wks after primary)
latent - no sx’s
tertiary (3-15 yrs after initial infection)

53
Q

What is latent syphilis?

A

having serologic proof of syphilis infection without symptoms of disease

54
Q

Signs of primary syphilis

A

Chancre lesions - single PAINLESS ulceration with clean base and clear borders

Lymph node enlargement

55
Q

Signs of secondary syphilis

A

RASH: symmetrical, reddish-pink, non-itchy maculopapular rash on trunk and extremities, including palms and soles of feet

56
Q

_________ is diagnostic of primary syphilis.

A

Darkfield microscopy

+ if treponemes seen

57
Q

Serology tests for primary and secondary syphilis

A

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
Q

Testing for tertiary syphilis

A

Lumbar puncture
Joint aspiration
Tissue biopsy

59
Q

Signs of tertiary syphilis

A

Gummatous lesions
Late neurosyphilis
Cardiovascular sx’s

60
Q

Jarisch–Herxheimer reaction

A

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
Q

How can early stages of syphilis be treated?

A

primary, secondary, and early latent: IM Benzathine penicillin G 2.4 million units x 1 dose

  • if PCN allergic, then doxy or tetracycline
62
Q

Abnormal discharge from the penis – yellow, creamy, and excessive, blood-tinged. Dx?

A

Gonorrhea

63
Q

What is gram negative diplococci STI? How is it treated?

A

Gonorrhea

Tx: IM Ceftriaxone

64
Q

Condyloma acuminatum is bug of what pathology?

A

Human Papilloma Virus (HPV)

65
Q

Condyloma acuminatum treatment

A

Podofilox 0.5% gel applied to warts BID x 3 days

Prevent with HPV vaccine (Gardisil)

66
Q

First line for male pattern (androgenic) baldness treatment

A

Minoxidil (Rogaine)

67
Q

Physiologic mechanism of penile erection

A

Nitric oxide into corpus cavernosum → increase cGMP → decreased Ca2+ → vasodilation → more blood to penis

68
Q

Meds that cause ED? How to alter meds to reduce side effects?

A

SSRI, beta blockers, H2 blockers, antihistamines, opiates

SSRI → Wellbutrin or Buspar
BB → CCB or ACE

69
Q

Healthy young adult comes in with pearly, umbilicated papules on groin region. Dx?

A

Molluscum Contagiosum

70
Q

Molluscum Contagiosum treatment

A

Imiquimod (Aldara) 5% x 1-3 mon on lesions

Cryotherapy, curettage, or electrodessication if painful

71
Q

All patients with syphilis should be tested for _______.

A

HIV

72
Q

Uncircumsized boy under 5 yo with small red erosions and swelling of glans and foreskin. Started to have discharge. DX?

A

balanitis

73
Q

Collection of thick whitish discharge under foreskin?

A

smegma

74
Q

Trichomonas treatment

A

Metronidazole 2 g PO x 1 dose

  • No alcohol x 24 hrs after treatment
75
Q

How is pubic lice treated?

A

Permethrin (Elimite) rinse 1% x 10 min OR cream 5% x 8 hr

treat sexual partners

76
Q

Causes of elevated PSA

A

enlarged prostate
infection
prostate cancer

77
Q

What are the roles of FSH and LH in men?

A

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
Q

HSV treatment for first episode, episodic, and chronic suppression?

A

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
Q

Man is asymptomatic but has noticed grayish green penile discharge and some mild dysuria. What test should be ordered? Why?

A

Wet mount to look for trophozoites

Likely Trichomonas

PANCE review (18 decks)

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