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AGPC 4 > Men's Health > Flashcards

Men's Health Flashcards

1
Q

What are the most common pathogens in prostatitis?

A
  • older men: E coli, Proteus, other Gram- bacteria

- younger men: chlamydia and gonorrhea

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2
Q

What is the difference between hyperplasia and hypertrophy?

A

hyperplasia = increase in number of cells

hypertrophy = increase in size of cells

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3
Q

What are the signs and symptoms of benign prostatic hyperplasia?

A
  • early symptoms (obstructive - insidious onset):
    => weak stream, intermittent flow, straining, incomplete emptying, hesitancy, diffusely enlarged prostate (loss of median sulcus)
  • late symptoms (irritative):
    => frequency, urgency, nocturia
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4
Q

What are the signs and symptoms of chronic bacterial prostatitis?

A

frequent UTIs; no fever; prostate is non-tender/minimally tender, “boggy,” diffusely enlarged

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5
Q

What are the signs and symptoms of prostate cancer?

A

often asymptomatic, asymmetric prostate enlargement (outer/posterior edge of prostate), can be detected via digital rectal exam, prostate is hard

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6
Q

What are the signs and symptoms of bladder cancer?

A

painless/gross hematuria (without blood in urine, bladder cancer is not possible), physical exam is normal

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7
Q

How does diabetes cause urinary frequency?

A

due to high osmolarity of urine (osmotic diuresis)

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8
Q

What differentiates BPH from prostate cancer?

A

both:
- incidence increases with age (cancer prevalence higher in African American men), androgens (testosterone and dihydrotestosterone) play a significant role

BPH:
- obstructive symptoms initially followed by irritative symptoms, DRE = diffuse enlargement, Dx = exclusion, Tx = alpha blockers/5 alpha reductase inhibitors/prostatectomy

Cancer:
- often asymptomatic, DRE = asymmetric enlargement, Dx = biopsy, Tx = prostatectomy (radiation) for local disease/anti-androgen therapy for metastatic disease

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9
Q

What is the role of 5 alpha reductase in prostate disease?

A

testosterone is converted to dihydrotestosterone (DHT) (much more potent - affects prostate growth to greater extent) via 5 alpha reductase => with age, testosterone decreases and 5 alpha reductase increases (produces more DHT)

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10
Q

What is the effect of 5 alpha reductase inhibitors in prostate disease?

A

used to decrease levels of DHT - cause decrease in prostate size (more effective in men with large volume prostate)

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11
Q

What is the best initial test for BPH?

A

clinical diagnosis (diagnosis of exclusion) - start with urinalysis and creatinine:
- urinalysis to r/o pyuria (chronic prostatitis)
- creatinine to exclude complications of BPH (post-renal insufficiency) => perform renal ultrasound if creatinine is increased
=> PSA will be increased (can’t distinguish BPH from prostate cancer)

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12
Q

What is the difference between cancer grading and staging?

A

grading = histological appearance of cells

staging = indicates degree of spread (metastasis)

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13
Q

How are grading and staging determined with prostate cancer?

A

grading - prostate biopsy (only used in presence of nodularity and asymmetric enlargement)

staging - MRI of abdomen and pelvis
=> PSA will determine prognosis

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14
Q

What is the mechanism of action of Luprone?

A

GnRH antagonist - results in chemical castration (reduces testosterone levels)

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15
Q

What is the best initial treatment for BPH?

A

Tx is based on symptoms - watchful waiting if not bothering patient (avoid irritants, voiding schedule)

  • 1st line: alpha-1 adrenergic antagonists/alpha blockers (cause relaxation of bladder neck - tamsulosin/Flomax is most uroselective) => risk for hypotension (avoid in PT on nitrates)
  • 5 alpha reductase inhibitors (Finasteride) - reduce the size of the prostate
  • PDE-5 inhibitors (Viagra/Cialis) - relax bladder and prostatic smooth muscle => only for mild symptoms
  • surgery - only if other Tx fail (risk erectile dysfunction and urinary insufficiency)
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16
Q

What are the harms of PSA screening?

A
  • false positive rate of 70% for PSA > 4 ng/dl

- radical prostatectomy: 11% increased risk for urinary incontinence and 37% increased risk of ED

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17
Q

Which groups of men should never be screened for prostate cancer?

A

< 40 years of age

life expectancy < 10 years

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18
Q

What are the signs and symptoms of acute prostatitis?

A

pelvic/rectal pain, extremely tender prostate (don’t do rigorous rectal exam), prostate boggy (not firm), Hx of UTIs, high fever, irritative and obstructive symptoms, symmetrical enlargement

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19
Q

What are the signs and symptoms of cystitis/UTI?

A

frequency, urgency, dysuria, fever (no rectal pain, no flank pain, no discharge, no scrotal swelling)

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20
Q

What are the signs and symptoms of pyelonephritis?

A

flank pain, high fever, chills, N/V, CVA tenderness

21
Q

What are the signs and symptoms of urethritis?

A

irritative symptoms in young/sexually active men, penile discharge

22
Q

What is the best initial test for acute prostatitis?

A

urinalysis (WBCs > 10 cells/microL) and urine culture (PT has to be on Tx for 4-6 weeks - have to know which bug is causing)

  • NAAT by PCR for GC and chlamydia: for young/sexually active men
  • CT (with contrast) of abdomen/pelvis: only if not improving
  • renal/bladder US: only with recurrent infection (to r/o anatomical obstruction)
23
Q

What is the best initial Tx for acute prostatitis?

A

non-respiratory fluoroquinolones (ciprofloxacin or levofloxacin) for 6 weeks

24
Q

What are the signs and symptoms of epididymitis?

A

testicular pain/swelling/tenderness, fever, dysuria, (+) cremasteric reflex, (+) Prehn’s sign (scrotal elevation relieves pain)

25
Q

What are the signs and symptoms of testicular torsion?

A

testicular pain/swelling/tenderness, high-riding testicle, N/V, * (-) cremasteric reflex,(-) Prehn’s sign*

26
Q

What is the best diagnostic test for testicular torsion?

A

no diagnostic tests are needed with classic symptoms - send to ED

  • urinalysis and urine culture: if s/s unclear and epididymitis is suspected
  • scrotal US with arterial Doppler: if s/s unclear
27
Q

What is the best initial therapy for testicular torsion?

A

surgical de-torsion and attachment

28
Q

What are the signs and symptoms of testicular cancer?

A

unilateral/immobile/painless/firm mass that can’t be separated from testicle (may metastasize along lymphatic system)

29
Q

What are the signs and symptoms of a varicocele?

A

varicose veins, “bag of worms,” can be separated from the testicle, usually on left side (longer drainage pathway) - can be acute in the setting of kidney cancer
- need to treat in young patients to prevent infertility (increase in temp due to veins) => most common cause of infertility

30
Q

What are the signs and symptoms of a hydrocele?

A

abdominal fluids in scrotum, unilateral swelling, fluctuating mass, transluminates - in older man can be sign of testicular cancer (need to do US)

31
Q

What are the signs and symptoms of an inguinal hernia?

A

swelling that does not transluminate

adults: protrudes from abdomen/does not protrude into scrotum - perform abdominal x-ray if suspect incarceration
children: protrudes into scrotum

32
Q

What is the best initial test for testicular cancer?

A

scrotal US - never do transcrotal biopsy => have to remove the testicle and do staging (cancer spreads rapidly through lymphatics and can be seeded via transcrotal biopsy)

33
Q

What is the Tx for testicular cancer?

A

orchiectomy - chemotherapy only with metastasis

34
Q

What is the primary risk of erectile dysfunction?

A

early predictor of death from coronary artery disease - may be the presenting symptom

35
Q

What is the physiology of an erection?

A

erotic stimuli/cortex arousal => activation of parasympathetic nuclei (S3-S4) => release of acetylcholine and nitric oxide (potent vasodilator) from endothelial cells => increase in blood flow within sinusoidal spaces => compression of small veins/decrease in venous outflow => high inter-cavernosal pressure (erection)

36
Q

What is the most common type of sexual dysfunction in men?

A

early ejaculation

37
Q

What is Peyronie’s disease?

A

formation of fibrotic scar on the penis of unknown etiology - limited therapies available

38
Q

What are the most common causes of sexual dysfunction?

A

=> psychogenic: sudden onset, dysfunction in certain settings/normal function in others, presence of spontaneous erection during sleep, non-sustained erection after penetration

=> vascular: gradual decline of function over time with preserved libido

=> testosterone deficiency (Kleinfelters): gradual decline of function with loss of libido

39
Q

Which findings on physical exam support the diagnosis of sexual dysfunction?

A

=> vascular: weak peripheral pulses, (+) abdominal/femoral bruit

=> hormonal (low testosterone): small testes, loss of body hair, gynecomastia

=> neurological: loss of cremasteric reflex, reduced deep tendon reflexes, reduced peripheral sensation

40
Q

What is the workup for a male patient with sexual dysfunction?

A

=> vascular: A1c, lipids, BP, BMI, smoking Hx

=> hormonal: morning testosterone

=> general: screen for depression/substance abuse/anxiety

41
Q

What are the treatments for sexual dysfunction?

A

=> lifestyle modification: weight reduction, smoking cessation, limit alcohol intake
=> medications: SSRIs (Bupropion), diuretics (ACEIs)
=> glycemic control
=> BP control
=> specific therapies: PDE-5 inhibitors, intra-cavernosal injections (prostaglandin), penile implants, testosterone (intradermal)

42
Q

What is the mechanism of action of phosphodiesterase Type 5 (PDE-5) inhibitors?

A

increase nitric oxide in endothelial cells => dilation (do NOT affect libido)

43
Q

What are the instructions for patients taking sildenafil (Viagra)?

A

PDE-5 inhibitor, take PRN (30-60 min before sex - lasts 4 hours), take on empty stomach (high fat foods decrease absorption), side effects include headaches and hot flushes, do not take with nitro glycerin (can cause severe hypotension if taken together)

44
Q

What are the instructions for patients taking vardenafil (Levitra)?

A

PDE-5 inhibitor, take PRN (30-60 min before sex - lasts 8 hours), take on empty stomach (high fat foods decrease absorption), side effects include headaches and hot flushes, do not take with nitro glycerin (can cause severe hypotension if taken together)

45
Q

What are the instructions for patients taking tadalafil (Cialis)?

A

PDE-5 inhibitor, do NOT take PRN (30-60 min before sexual activity/taken on a daily basis), can be taken with or without food (high fat foods do NOT affect absorption), side effects include headaches and hot flushes, do not take with nitro glycerin (can cause severe hypotension if taken together)

46
Q

What is Prehn’s sign?

A

scrotal elevation relieves pain - (+) in epididymitis but (-) in testicular torsion

47
Q

What are the differences in scrotal swelling in testicular cancer versus varicocele versus hydrocele?

A
  • testicular cancer: unilateral, immobile, painless, firm mass that can’t be separated from the testicle
  • varicocele: “bag of worms” that can be separated from the testicle (usually in left testicle)
  • hydrocele: unilateral swelling, fluctulant mass, can be transluminated
48
Q

What is the distinction between acute and chronic prostatitis?

A
  • acute: complication of UTI, acute onset and severe symptoms, Dx with urine culture, Tx = FQ for 6 weeks
  • chronic: complication of acute prostatitis, asymptomatic or recurrent UTIs, Dx presumptive based on Hx and bacteruria, Tx = FQ for 6 weeks

AGPC 4 (22 decks)

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