Men's Health Flashcards
Exams to do for BPH
Digital rectal exam
PSA
U/S
BPH meds and their mechanism of action
alpha blockers - relax smooth muscle (Tamsulosin/Flomax)
5-alpha reductase inhibitors - block DHT production (Finasteride/Propacia)
Surgery for BPH
TURP = transurethral resection of prostate
Prostatectomy
Difference in DRE findings of BPH and prostate cancer
BPH - smooth, enlarged
cancer - firm nodules
Who should be screened with DRE? How often?
annually for males over 50
Most common cancer in men
prostate cancer
Most common benign cancer in men
BPH
A relatively common defect where the urethra ends on the underside of the penis.
Hypospadias
Hallmark PE findings of varicocele
“bag of worms” on palpation of testes
negative transillumination
Which condition of the scrotum will transilluminate?
hydrocele
Benign cyst within the scrotum which contains spermatozoa
Spermatocele
Which condition of the scrotum will NOT transilluminate?
varicocele and spermatocele
Cryptorchidism causes higher risk for what?
infertility, testicular cancer, testicular torsion
How is cryptorchidism treated?
orchiopexy before 12-24 months
hcG injections may also be helpful as it increases testosterone
Treatment of erectile dysfunction
Phosphodiesterase-5 inhibitors: Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra)
Alprostadil (MUSE) injections
Penile implants
Underlying medical conditions that may cause erectile dysfunction
diabetes
peripheral neuropathy
3 types of incontinence
Stress incontinence
Urge incontinence
Overflow incontinence
Stress incontinence
Leaking of urine due to physical stress. Coughing, jumping, laughing etc. This is often due to urethral incompetence.
Urge incontinence
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.
Overflow incontinence
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
Work-up of urinary incontinence
U/A and culture looking for signs of infection
U/S for postvoid residual volume
Full bladder standing cough
Possible cystoscopy
Urinary incontinence management
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
paraphimosis
foreskin is trapped behind the glans of the penis and can not be reduced
foreskin can not be retracted over the glans of the penis
phimosis
Phimosis treatment
Steroid cream
Circumcision
I came in to see my physician assistant because of…
Severe acute abdominal pain
Firm and tender testes
Absent cremasteric reflex
testicular torsion
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
How is Prehn’s sign tested?
elevating testes gives pain relief
+Prehn’s seen in what male conditions
testicular torsion and epididymitis
Testicular torsion treatment
Manual detorsion of the testis – opening a book
Surgical emergency
Gram stain and culture results of Gonorrhea and Chlamydia discharge?
G- diplococci = N. gonorrhoeae
No visible organism but lots of WBCs = Chlamydia
I came in to see my physician assistant because of…
My scrotum hurts Urethral discharge Pain with voiding Fever \+ Prehn's sign
epididymitis
Etiologies of epididymitis
Chlamydia
Gonorrhoeae
G- rods
Epididymitis/orchitis treatment
Antibiotics which cover Gonorrhea (Ceftriaxone) and Chlamydia (Azithromycin)
Treat sexual partners as well
Scrotal elevation, ice, NSAIDs
Mumps is cause of ________ in men.
orchitis
acute vs chronic prostatitis presentation
Acute: fever, dysuria, tenderness with rectal exam
Chronic: no fever, rectal exam may be normal or have boggy prostate
Causes of prostatitis
acute: E. coli, Pseudomonas
chronic: G- rods, enterococci
less than 35: STI
children and elderly: E. col
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`
How is urethritis caused by Neisseria differentiated from Chlamydia?
Purulent urethral discharge (think Neisseria)
Clear discharge (think Chlamydia)
Abx dose for gonorrhea
Cefriaxone 250 mg IM x 1 dose
*also treat for Chlamydia
Abx dose for Chlamydia
Azithromycin 1 g (or doxy)
*also treat for Gonorrhea
How to dx Gonorrhea and Chlamydia in lab?
NAAT (nucleic acid amplification) of dirty urine or urethral swab
I came in to see my physician assistant because of…
It hurts when I pee! (dysuria)
Frequency
Urgency
Cystitis
1 cause of cystitis
E. coli
Risk factors for prostate cancer
African American
FHX
High fat diet
What level of PSA makes you suspicious of prostate cancer?
PSA > 4.0
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
Blood markers for testicular cancer
hcG
AFT = alpha fetoprotein
LDH = lactate dehydrogenase
Testicular cancer management
One of the highest cure rates of all cancers!!!
Radical orchiectomy
Adjuvant chemotherapy may be required
1 risk factor for bladder cancer
smoking
Bug that causes syphilis
Treponema pallidum
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)
What is latent syphilis?
having serologic proof of syphilis infection without symptoms of disease
Signs of primary syphilis
Chancre lesions - single PAINLESS ulceration with clean base and clear borders
Lymph node enlargement
Signs of secondary syphilis
RASH: symmetrical, reddish-pink, non-itchy maculopapular rash on trunk and extremities, including palms and soles of feet
_________ is diagnostic of primary syphilis.
Darkfield microscopy
+ if treponemes seen
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)
Testing for tertiary syphilis
Lumbar puncture
Joint aspiration
Tissue biopsy
Signs of tertiary syphilis
Gummatous lesions
Late neurosyphilis
Cardiovascular sx’s
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
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
Abnormal discharge from the penis – yellow, creamy, and excessive, blood-tinged. Dx?
Gonorrhea
What is gram negative diplococci STI? How is it treated?
Gonorrhea
Tx: IM Ceftriaxone
Condyloma acuminatum is bug of what pathology?
Human Papilloma Virus (HPV)
Condyloma acuminatum treatment
Podofilox 0.5% gel applied to warts BID x 3 days
Prevent with HPV vaccine (Gardisil)
First line for male pattern (androgenic) baldness treatment
Minoxidil (Rogaine)
Physiologic mechanism of penile erection
Nitric oxide into corpus cavernosum → increase cGMP → decreased Ca2+ → vasodilation → more blood to penis
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
Healthy young adult comes in with pearly, umbilicated papules on groin region. Dx?
Molluscum Contagiosum
Molluscum Contagiosum treatment
Imiquimod (Aldara) 5% x 1-3 mon on lesions
Cryotherapy, curettage, or electrodessication if painful
All patients with syphilis should be tested for _______.
HIV
Uncircumsized boy under 5 yo with small red erosions and swelling of glans and foreskin. Started to have discharge. DX?
balanitis
Collection of thick whitish discharge under foreskin?
smegma
Trichomonas treatment
Metronidazole 2 g PO x 1 dose
- No alcohol x 24 hrs after treatment
How is pubic lice treated?
Permethrin (Elimite) rinse 1% x 10 min OR cream 5% x 8 hr
treat sexual partners
Causes of elevated PSA
enlarged prostate
infection
prostate cancer
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
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)
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
