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Clinical Med II Exam 3 (Annie and Lauren) > Men’s Health 🕴🎩👔 > Flashcards

Men’s Health 🕴🎩👔 Flashcards

1
Q

What part of the prostate proliferates in BPH

A

Transitional zone

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2
Q

What is the most common benign tumor in men 40-80 yrs old

A

BPH

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3
Q

What kind of sx will a guy with BPH experience

A

Frequency

Urgency

Hesitancy

Weak stream

Dribbling

(All due to the tumor pressing on the prostatic urethra)

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4
Q

Type 2 diabetes = risk factor for BPH?

A

True

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5
Q

How long must urinary symptoms continue before a dx of BPH can be made?

A

At least 3 months*

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6
Q

What can you do in the primary care setting to diagnose BPH?

A

DRE- symmetry, firmness, nodules

UA- r/o blood, infection

PSA

BUN/Creat- check kidney function

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7
Q

What kinds of things might change a PSA?

What will not?

A

Avoid checking PSA after ejaculation, trauma, or catheterization **

DRE will not affect PSA levels

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8
Q

What behavior modifications may help BPH

A

Avoid caffeine/alcohol

Fluid restriction before bed or going out

Double voiding to promote complete emptying

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9
Q

What 2 classes of meds can treat BPH

A

Alpha 1 blockers **first line- tamsulosin, doxazosin, etc

5-alpha reductase inhibitors- finasteride, dutasteride

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10
Q

What do alpha 1 blockers do to help BPH

A

Relax smooth muscle in urinary tract and prostate

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11
Q

What are the common side effects of alpha-1-blockers?

A

Orthostatic hypotension

Dizziness

Ejaculatory dysfunction

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12
Q

What do 5-alpha reductase inhibitors do to help BPH

A

Decrease prostate size via antiandrogen effects

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13
Q

What are the common side effects of 5-alpha reductase inhibitors

A

Decreased libido

Sexual dysfunction

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14
Q

What are the kinds of surgical options available to men with BPH?

A

TURP= transurethral radical prostatectomy

TUNA- Transurethral needle ablation

TUMT- transurethral microwave thermotherapy

Prostatic stent

Suprapubic prostatectomy

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15
Q

What age men get acute bacterial prostatitis

A

Young and middle aged men via the urethra (sexy bugs or poopy bugs swim up)

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16
Q

What may come along with acute bacterial prostatitis

A

UTI

Urethritis

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17
Q

What can happen if you dont treat acute bacterial prostatis right away

A

Sepsis

Abscess

Metastatic infection

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18
Q

Is acute bacterial prostatis a big deal

A

Yes it is a very serious infection and thsse people are very sick

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19
Q

What are the sx of acute bacterial prostatitis

A

UTI symptoms

Fever, myalgia, malaise

Perineal/pelvic pain

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20
Q

What will a gentle DRE on a pt with acute bacterial prostatitis reveal

A

Tender and edematous prostate 🤮

Will help differentiate this from a UTI

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21
Q

How do you treat acute bacterial prostatitis?

A

If toxic=admit to hospital

If stable and reliable=
Fluoroquinolone or Bactrim for 6 weeks***

TAKES A LONG TIME

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22
Q

When should you repeat the urine culture when you treat acute bacterial prostatits

A

After 7 days of antibiotic therapy

But still treat for the whole 6 weeks

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23
Q

What is chronic bacterial prostatitis

A

Chronic/recurrent urogenital symptoms with evidence of bacterial infection of the prostate

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24
Q

What will you find on physical exam of chronic bacterial prostatits ?

A

Recurrent UTI

Pelvic pain, bladder obstruction, hematuria

Prostate usually NORMAL, but might be tender

Labs are frequently NORMAL, but might be elevated

A bunch of vague SHIT

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25
Q

What is the gold standard for diagnosing chronic bacterial prostatits

A

Prostatic fluid analysis***

Usually diagnosed presumptively though based on hx of symptoms

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26
Q

How do you treat chronic bacterial prostatitis

A

Fluoroquinolone for 6 weeks

Bactrim is alternate

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27
Q

What is the other name for chronic prostatitis

A

Chronic pelvic pain syndrome

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28
Q

What is the definition of chronic prostatits/chronic pelvic pain syndrome

A

Chronic pelvic pain for at least three of the last 6 months with no identifiable cause

(Diagnosis of exclusion)

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29
Q

Is prostatits/chronic pelvic pain syndrome a common problem

A

Yes, affects 10% of men

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30
Q

Why do men with prostatits/chronic pelvic pain syndrome come in to see their PA

A

Pain

Hard to pee

Blood in semen

…in a Relapsing-remitting pattern over many months!

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31
Q

How do you treat prostatits/chronic pelvic pain syndrome?

A

No uniformly accepted regimen

Alpha blockers, antibiotics, and 5-alpha reductase inhibiots are the most effective meds

Psychological support

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32
Q

What is the most common cancer diagnosed in men in the age group of 60-79 yrs

A

Prostate cancer

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33
Q

Does prostate cancer grow fast

A

Slow growing

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34
Q

What kind of cells are in prostate cancer

A

Slow-growing, malignant neoplasm of adenomatous cells of the prostate gland

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35
Q

What usually leads to the discovery of prostate cancer?

A

80% diagnosed after elevated PSA

20% after abnormal DRE *** NEVER SKIP THE DRE

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36
Q

What is the prognosis for prostate cancer

A

Its the 2nd leading cause of cancer death in men, but only a 3% chance of killing you

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37
Q

Who needs to be screened for prostate cancer

A

> 10 yrs life expectancy

Family hx of prostate cancer

Black men

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38
Q

What will you feel on DRE if they have prostate cancer?

A

Nodular

Asymmetric

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39
Q

Would you expect to see hematuria or hematospermia in prostate cancer

A

NO, very rare

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40
Q

What kinds of sx do people with prostate cacner have

A

Usually asymptomatic middle aged men

Might have urinary sx due to concomitant BPH

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41
Q

How is prostate cancer diagnosis confirmed

A

Prostate biopsy (transrectal ultrasound guided)

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42
Q

DRE can only detect tumors in what parts of the prostate

A

Posterior and lateral

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43
Q

What is the threshold of PSA to determine when a biopsy is needed

A

There isnt an absolute threshold

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44
Q

How is Prostate cancer staged?

A

Tumor Node Metastases (TMN system)

Gleason score

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45
Q

Is it an easy straightforward approach to treating prostate cancer

A

No, it is dependent on many factors, and there are whole websites with nomograms that help you figure it out

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46
Q

After someone is treated for prostate cancer, how often do they need to be screened for cancer?

A

Total PSA every 6-12 months x 5 yrs, then annually

If PSA rises, refer to onco

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47
Q

Most cases of erectile dysfunction have a_______ cause

A

Organic

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48
Q

What age do men start having trouble with ED

A

Early 40s

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49
Q

How do you get an erection

A

Primary a vascular phenomenon triggered by neurological signals and facilitated only in the presence of appropriate hormonal conditions and psychological mindset

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50
Q

What type of men have the LOWEST prevalence of ED

A

Active males without chronic medical conditions who maintain healthy life choices

⛹️‍♂️🚴🏻‍♂️🤽🏼‍♂️🧗🏻‍♂️

51
Q

What are some possible etiologies of ED?

A

Vascular- cardiovascular dz, HTN, DM, HLD, smoking, major surg

Neurological- spinal cord/brain injury, parkinson, Alzheimer’s, MS, stroke

Local penis factors- Peyronies dz, cavernous fibrosis, fracture

Hormonal- hypogonadism, hyperprolactinemia, hyper/hypothyroidism, hyper/hypocortisolism

Drug induced- HTN drugs, antidepressant,s antipsychotics, antiandrogens, recreational drugs

Psychogenic- performance anxiety, traumatic past experiences, relationship probs, anxiety, depression, stress

(he said “I really like this table” but idk if this would actually be on the test)

52
Q

What is a nocturnal tumescence test?

A

It is a way to see if the patient gets erections at night.

If he does, you can determine that the ED is of a psychogenic origin, not organic.

53
Q

What needs to be in the work up of a pt with ED

A

Detailed history

DRE, Secondary sex characteristics, femoral and peripheral pulses, breast exam, testicular volume

Fasting glucose/HbA1C

CBC/CMP

TSH

Lipid profile

Serum total testosterone

JSUT READ IT ONCE OR TWICE

54
Q

What is the FIRST line management for ED?

A

PDe-5 inhibitors:

sildenafil, Vardenafil, Tadalafil, Avanafil

55
Q

What are the 2nd line treatments for ED

A

Vacuum ejection device

Penile Self Injectables

Intraurethral suppository- MUSE (alprostadil)

56
Q

What is the 3rd line treatment for ED

A

Penile prosthesis surgery

57
Q

Who usually gets urethritis?

A

Young sexually active males

58
Q

What are the 2 types of urethritis

A

Gonococcal (caused by N. Gonorrehae)

Non-gonococcal- chlamydia, mycoplasma, trichomonoas

59
Q

Why will a man with urethritis come in to see his PA

A

Dysuria

Urethral discharge

inflamed meatus

(May be asymptomatic too)

60
Q

How do you diagnose urethritis?

A

Gram stain of urethral secretions

First void urine for NAAT (nucleic acid amplification testing)

61
Q

What will you see on gram stain if the partients urethritis is caused by Gonorrhea (gonococcal urethritis)

A

PMN cells and Gram negative diplococci

62
Q

How do you treat Gonococcal urethritis?

A

Ceftriaxone 250mg IM + Azithromycin 1000mgx 1 dose

If PCN allergy: Gentamycin 240mg IM + Azithromycin 2g x 1 dose

(Treat partners if appropriate, no sex for 7 days. No retest needed)

63
Q

Howe do you treat non-gonococcal urethritis

A

Azithromycin 1 gram PO

OR

Doxycycline 100mg PO BIDx 7 days

(Treat partners if appropriate, no sex for 7 days. No retest needed)

64
Q

What is this:

Infection of the epididymis via vas deferens

A

Epididymitis

65
Q

How do young men vs old men get epipdidymitis?

A

Young: STDs

Old: urinary pathogens

66
Q

What will a guy with epipdidymitis complain about

A

Acute, UNILATERAL scrotal pain that radiates to the flank.

Hemiscrotal swelling and tenderness which might progress to a red, fluctuant mass.

Fever, chills

67
Q

What is Prehns sign

A

Elevation of the scrotum provides relief of pain

68
Q

Will Prehns sign be positive or negative in epipdidymitis?

A

POSITIVE*****

Elevating scrotum will make the pain better

69
Q

How do you treat epipdidymitis if you think it was caused by Chlamydia/Gonorrhea? (Young patient)

A

Ceftriaxone 250mg IM and Doxycycline 100mg BID x 10 days

+NSAIDS for pain relief

70
Q

How do you treat epipdidymitis if you think an enteric organism caused it? (Old guy_

A

Levofloxacin 500mg QD x 10 days

OR

Ofloxacin 300mg BID x 10 days

(+ NSAIDS for pain relief)

71
Q

What is epididymoorchitis?

A

epipdidymitis that spread to the testicle

72
Q

What is a possible viral cause of epidydymoorchitis?

A

Mumps

73
Q

How do you treat epididymoorchitis?

A

If mumps caused it: supportive care

If bacterial: treat same way as epipdidymitis

74
Q

What is this:

Venous varicosity in the pampiniform plexus (spermatic vein)

A

Varicocele

75
Q

Which side of the scrotum do varicoceles usually appear

A

LEFT due to LONGER spermatic vein

Could also be bilateral
**

76
Q

What should you think if a patient has an isolated varicocele on the RIGHT side of their scrotum

A

CANCER***

77
Q

What does a varicocele feel like

A

Bag of worms

78
Q

What will make a varicocele change size

A

Increases in size with Valsalva

Gets smaller when supine or scrotum is elevated

79
Q

What are the risks of a varicocele?

A

Testicular atrophy

Infertility

(Compare both testes if you suspect atrophy of one)

80
Q

If your patient has a varicocele and they lay down and it doesnt get any smaller, what do you need to do

A

CT scan for outlet obstruction

81
Q

How do you treat varicocele?

A

Ligation of spermatic vein only if symptomatic, infertility concerns, or testicular atrophy

82
Q

What ages usually get testicular torsion

A

Neonates

Post-pubertal boys

83
Q

What kinds of activities can cause testicular torsion

A

Vigorous physical activity

Trauma

84
Q

What are the signs/sx of testicular torsion

A

Acute onset of unilateral scrotal pain with hemp scrotal swelling

Pain on palpation, without relief with elevation

Bell-clapper deformity

Absent cremasteric reflex

85
Q

How do you diagnose testicular torsion

A

Doppler ultrasound

86
Q

What is the treatment for testicular torsion

A

Usually requires surgery

While waiting for OR, attempt manual detorsion (turn the testicle LATERALLY)

87
Q

What ages usually get testicular cancer

A

15-35

88
Q

What are the risk factors for testicular cancer?

A

Cryptorchidism

Klinefelter (47XXY)

Family hx

89
Q

What are the signs/sx of testicular caner?

A

PAINLESS, solid, nodule on testicle

Dull ache or heavy sensation in lower abdomen, perianal area, or scrotum

Inguinal lymphadenopathy

Para-aortic lymphadenopathy

90
Q

What do you need to do on physical exam if you suspect testicular cancer

A

assume that all firm, hard, fixed areas are cancer until proven otherwise

Check for supraclavicular lymphadenopathy

Abdominal exam for para-aortic LAD

Chest exam to look for gynecomastia or thoracic involvement

(Basically always look for SPREAD and lymph node involvement)

91
Q

How do you diagnose testicular cancer?

A

ultrasound/CT

Tumor markers: β-HCG, LDH, α-fetoprotein (AFP)

92
Q

Most primary testicular tumors are _________cell tumors

A

Germ (95%)

Two types of germ cell tumors:
Seminoma-35%

Nonseminoma-65%

93
Q

What is the treatment of testicular caner?

A

Radical inguinal orchiectomy

Radiation and chemotherapy (only seminoma tumors respond to radiation)

Offer sperm banking prior to tx

94
Q

Since only seminoma testicular tumors respond to radiation, what do you do for nonseminoma tumors?

A

Nerve-sparing retroperitoneal lymph node dissection

NOT SURE IF THIS SI IMPORTANT

95
Q

How often after testicular cancer tx do you need to do surveillance

A

Checkups every 3 months for 2 years then every 6 months, then every year after 5 years

(Not sure if this is important)

96
Q

What is the prognosis for testicular cancer

A

94% survival with treatment for low risk

60-80% survival with treatment for disseminated cancer

97
Q

What do you need to tell all your male patients to do

A

Self testicle exams

98
Q

What are the two types of inguinal hernia

A

Direct

Indirect

99
Q

Where do femoral hernias occur

A

Medial aspect of femoral canal

100
Q

Where do direct hernias protrude through

A

Hesselbach’s triangle

101
Q

Where do indirect hernias go

A

Through internal inguinal ring, through inguinal canal and into the scrotum

102
Q

What is the most common type of hernia

A

Indirect, especially on the R side

103
Q

What is the least comon type of hernia?

A

Femoral- more common in women

104
Q

Which kind of hernia is most likely to become strangulated

A

Femoral

105
Q

What will happen if a hernia strangulates?

A

Bowel obstruction

Peritonitis

Toxic appearance (pt will look v sick)

106
Q

What is the treatment for hernias?

A

Definitive treatment for ALL hernias is surgery.

If reducible: elective surgery is viable

Watchful waiting if the inguinal hernia has minimal/no symptoms

107
Q

Bladder cancer is more common in (men/women)

A

Men (7x)

108
Q

What two things increase risk for bladder caner

A

Smoking*

Chemical dyes

109
Q

What are the 3 types of bladder cancer

A

Transitional cell 90%

Squamous cell 7%

Adenocarcinoma 2%

110
Q

Why is bladder cancer often a delayed diagnosis

A

Misdiagnosed as UTI

111
Q

What to look for on DRE of bladder cancer pt

A

Induration of prostate

112
Q

What are the sign/sx of bladder cancer

A

A bunch of blood in the urine, no pain

Obstructive urinary sx

If spreading: para-aortic LAD, hepatomegaly, supraclavicaulr LAD, periumbilical nodules

113
Q

What is the gold standard for diagnosis and staging of bladder cancer?

A

Cystourethroscopy***

114
Q

What are the treatment options for bladder cacner?

A

Transurethral resection of Tumor

Intra-vesical chemotherapy (inject drug right into bladder)

If muscle invasive- systemic chemotherapy and radical cystectomy (remove entire bladder)

115
Q

What are the 4 types of incontinence?

A

Urge

Stress

Mixed

Incomplete emptying (overflow)

116
Q

What kind of incontinence:
Uncontrolled loss of urine that is preceded by a strong i unexpected urge to void

Involves uninhibited bladder contractions

A

Urge incontinence

“All of a sudden i have to pee and then it all comes out”

117
Q

What type of incontincenc:

Leakage with exertion, Valsalva

A

Stress

118
Q

What causes stress incontinence ?

A

Urinary sphincter dysfunction, usually due to prostate surgery

119
Q

What causes incomplete emptying incontinence?

A

Impaired detrusor contractility and/or bladder outlet obstruction

120
Q

What is the typical presentiatin of incomplete emptying incontinecne (overflow)?

A

Nocturnal enuresis

121
Q

What is the treatment for URGENCY incontinence

A

Antimuscarinic (tolterodine, fesoterodine, oxybutynin)

α-blockers if BPH present (tamsulosin, etc)

122
Q

What is the treatment for STRESS incontincenc

A

Condom catheters

Penile clamp

Surgery

123
Q

What is the treatment for overflow incontinence

A

α-blockers

124
Q

What are some red flags of incontoinence that should make you refer to urology

A

Severe sx

Pelvic pain

Hematuria

Elevated PSA/abnormal DRE

Recurrent urinary infections

Previous pelvic radiation/surgery

Neurological disease

Clinical Med II Exam 3 (Annie and Lauren) (5 decks)

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