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X Clin Med II Exam 3 > Men's Health > Flashcards

Men's Health Flashcards

1
Q

What causes BPH?

A

Androgens cause proliferation of fibrosomal tissue in the transitional zone that can lead to compression of the prostatic urethra

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2
Q

Most common benign tumor in mens ages 40-80

A

BPH

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3
Q

4 zones of prostate

A

Transitional (where BPH occurs most)
Central
Peripheral
Fibromuscular

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4
Q

History to consider with BPH

A

Type 2 DM (causes nocturia and risk factor for it)
Sxs of neurologic disease (neurogenic bladder)
Sexual dysfunction
Gross hematuria/pain suggesting bladder tumor/calculi
Trauma, urethritis or instruments
Family history
Meds that impair bladder function or increase outflow resistance

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5
Q

How long must sxs persist to be considered BPH?

A

3 mos (bothersome urinary sxs)

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6
Q

Who has BPH most often?

A

Blacks

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7
Q

Diagnostic labs for BPH

A

DRE (symmetry, firmness, nodules)
UA to r/o blood and infection
Prostate specific antigen
BUN/creatinine

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8
Q

When do you need to avoid taking a prostate specific antigen?

A

After ejaculation, trauma or urethral catheterization

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9
Q

Options for tx of BPH

A

Behavior modification
Alpha blockers (first line)
5-alpha reductase inhibitors
(can also do surgeries)

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10
Q

Behavior modification for BPH

A

Avoiding caffeine, alcohol or meds that exacerbate
Fluid restriction before bed or going out
Double voiding to promote complete emptying

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11
Q

What do alpha blockers do in BPH?

A

Zosins
Relax smooth muscle in urinary tract and prostate
Side effects: orthostatic hypotension, dizziness, ejaculatory dysfunction

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12
Q

What do 5-alpha reductase inhibitors do in BPH?

A

Finasteride or dutasteride
Decreases prostate size via antiandrogen effects
Side effects: decreased libido, sexual dysfunction

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13
Q

Who gets acute bacterial prostatitis?

A

Young and middle aged men

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14
Q

What causes acute bacterial prostatitis?

A

Typical ones like e coli or proteus

Can be sexually transmitted like gonorrhea or chlamydia

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15
Q

When do you have an increased risk for acute bacterial prostatitis?

A

Urogenital instrumentation, catheterization, prostate biopsy

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16
Q

Features of acute bacterial prostatitis

A

Acute onset of urinary frequency, urgency and dysuria with obstructive voiding sxs
Perineal/pelvic pain
Fever/chills, myalgia, malaise

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17
Q

How to diagnose acute bacterial prostatitis?

A

DRE (gently) reveals tender and edematous prostate
Use this to differentiate from UTI
(can also urine gram stain/culture)
-may also see leukocytosis, pyuria, elevated PSA and ESR

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18
Q

Tx for acute bacterial prostatitis

A

(Debate in or out patient)
Fluoroquinolone or Bactrim for 6 weeks (can gram stain or culture to help guide abx)
Repeat urine culture after 7 days of abx (want to consider an infection in the prostate)

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19
Q

How to tell when there is chronic bacterial prostatitis?

A

Chronic or recurrent urogenital sxs with evidence of bacterial infection of prostate

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20
Q

Feature of chronic bacterial prostatitis

A

Sxs can be subtle or recurrent UTI
May have pelvic pain, bladder outlet obstruction or hematuria
Usually normal prostate exam (may have tenderness)
Labs probably normal but may be elevated for inflammation

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21
Q

How to diagnose chronic bacterial prostatitis?

A

Prostatic fluid analysis (gold standard)

But most often presumptive

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22
Q

Tx for chronic bacterial prostatitis

A 
Fluoroquinolone for minimum 6 wks (first line)
Bactrim alternate (recurrent episodes are same way)
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23
Q

How to define chronic prostatitis/chronic pelvic pain syndrome?

A

Chronic pelvic pain for at least 3 of the preceding 6 mos in the absence of other identifiable causes

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24
Q

What constitutes the majority of prostatitis diagnoses?

A

Chronic prostatitis/pelvic pain syndrome

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25
Q

Features of chronic prostatitis

A

Pain (perineum, lower abdomen, testicles, penis etc)
Voiding difficulty
Blood in semen
Relapsing-remitting pattern over many mos

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26
Q

How to diagnose chronic prostatitis

A

Diagnosis of exclusion (consider bacterial prostatitis, urethritis, urogenital cancer, strictures, neurologic disease)

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27
Q

Most effective meds chronic prostatitis

A

Alpha blockers, abx and 5 alpha reductase inhibitors (combos)

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28
Q

Most common cancer in men age 60-79

A

Prostate cancer

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29
Q

When does prostate cancer usually get diagnosed?

A

Mostly after elevated PSA and the rest can be an abnormal DRE

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30
Q

Who do you target screening of prostate cancer to?

A

Greater than 10 yrs life expectancy, fmaily hx of prostate cancer and black men

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31
Q

Ways to screen for prostate cancer

A

DRE
PSA
PCA3 (prostate cancer antigen 3 gene-urine test)

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32
Q

Features of prostate cancer

A

Urinary frequency, urgency, nocturia and hesitancy are common (concomitant BPH)

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33
Q

What might you see in advanced prostate cancer

A

Bone pain, fatigue, weight loss

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34
Q

What might be seen on the DRE in prostate cancer?

A

Nodular or asymmetric prostate

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35
Q

Where does a DRE detect tumors in the prostate?

A

Posterior and lateral aspects of the gland

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36
Q

What do you do with an abnormal prostate exam and abnormal PSA?

A

Prostate biopsy (transrectal u/s guided)

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37
Q

What is the Gleason score?

A

Determine treatment and prognosis of prostate cancer (staging etc)

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38
Q

Options for tx of prostate cancer

A

Observation
Radical prostatectomy
Radiation therapy
Androgen deprivation therapy

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39
Q

When do you refer with prostate cancer?

A

Check with total PSA every 6-12 mos for 5 years and then annually and if it rises then refer

40
Q

Risk factors of ED

A 
Male
DM
Obesity
HTN
Hyperlipidemia
CVD
Smoking
Meds
Age
41
Q

How to distinguish psychogenic vs organic cause in ED

A

Nocturnal tumescence test

42
Q

How to identify arterial obstruction or venous leak in ED

A

Duplex doppler

43
Q

First line medication for ED

A

PDE5 inhibitors (sildenafil, vardenafil, tadalafil, avanafil)

44
Q

Second line tx for ED

A

Vacuum erection device
Penile self injectables
Intrauretrhal suppository (MUSE)
(third line is penile prosthesis or surgery)

45
Q

When is urethritis most common?

A

Young sexually active males

46
Q

2 types of urethritis

A

Gonococcal (from Neisseria)

Non-gonococcal (chlamydia, mycoplasma genitalium, trichomonas vaginalis etc)

47
Q

Presentation of urethritis

A

May be asymptomatic
Onset of dysuria and urethral discharge
Maybe an inflamed meatus

48
Q

What will a gram stain show in gonococcal urethritis?

A

Polymorphonuclear cells and gram negative diplococci in the urethral exudate

49
Q

Other diagnostic studies for urethritis

A

Purulent discharge

First void urine for NAAT

50
Q

Tx for gonococcal urethritis

A

Ceftriaxone 250 mg IM + Azithro 1000mg x 1 dose
PCN allergy: GEntamycin 240mg IM + Azithro 2 g x 1 dose
*no retest needed if treat with first (sometimes partner too)

51
Q

Tx for non-gonococcal urethritis

A

Azithro 1 g orally OR Doxy 100 mg PO BID x 7 days (hold the sex)

52
Q

Association with epididymitis for different ages

A

Young: STDs
Old: urinary pathogens

53
Q

Presentation of epididymitis

A

Acute and unilateral, dull to severe scrotal pain radiating ipsilateral flank
Hemi-scrotal swelling and tenderness which may become an erythematous fluctuant mass (postero-lateral teticle)
Prehn’s sign (elevate scrotum for relief)

54
Q

What can happen if epididymitis is not treated?

A

Can cause orchitis, abscess or infertility

55
Q

How to diagnose epididymitis

A

PE
Urinalysis or urethral swab
Scrotal US (torsion or abscess)

56
Q

Tx of epididymitis when suspicious for Chlamydia or gonorrhea

A

Ceftriaxone 250 mg IM x 1 and Doxy 100 mg BID x 10 days

NSAIDs for pain relief

57
Q

Tx of epididymitis for an enteric organism

A

Levofloxacin 500 mg QD x 10 days or Ofloxacin 300 mg BID for 10 days
(NSAIDs for pain relief)

58
Q

How does epididymoorchitis happen?

A

Involvement of testicle by retrograde infection

May have seen mumps/parotitis first

59
Q

Features of epididymoorchitis

A

Acute, ipsilateral testicular swelling with tenderss

Maybe fever or bothersome urinary sxs

60
Q

Tx for epididymoorchitis

A

If mumps then supportive

If bacterial then treat similar to epididymitis

61
Q

Where does a varicocele happen?

A

Typically left due to longer left spermatic vein (can be bilaterally)
-Venous varicosity in the pampiniform plexus (spermatic vein)

62
Q

What do you suspect with a right sided only varicocele?

A

Pelvic/abdominal malignancy (especially if rapid onset)

63
Q

Who do you suspect a varicocele in ?

A

Post pubertal male with a reported history of scrotal swelling

64
Q

Classic presentation of a varicocele

A

“Bag of worms” (increases in size with valsalva and decreases in size when supine or if scrotum elevated)
Dull, achy testicular pain relieved with support or supine

65
Q

What can a varicocele cause?

A

Testicular atrophy and infertility

66
Q

How to diagnose a varicocle

A

PE (if no decompression in recumbet position then CT scan for outlet obstruction)
Doppler scrotal US

67
Q

Tx of varicocele

A

Ligate spermatic vein if symptomatic, infertility concers or testicular atrophy
Supportive care if mild

68
Q

When is testicular torsion more common?

A

Neonates and post-pubertal boys

69
Q

Presentation of testicular torsion

A

Acute onset of scrotal pain, unilateral with hemi scrotal swelling
Pain on palpation with no relief with elevation
Bell-clapper deformity
Absent cremasteric reflex

70
Q

How to diagnose testicular torsion

A

Scrotal “US and see limited or loss of flow to spermatic cord or testis

71
Q

Tx of testicular torsion

A

Manual detorsion

Emergency and need surgical detorsion and orchiopexy

72
Q

When is testicular cancer more common?

A

Males 15-35

73
Q

Risk factors for testicular cancer

A

History of it
Cryptorchidism
Klinefelter
Family Hx

74
Q

Presentation of testicular cancer

A

Painless solid testicular swelling or nodule
Dull ache of heavy sensation in lower abdomen, perianal area of scrotum
Inguinal or para-aortic LAD
May see other sxs based on mets

75
Q

PE for testicular cancer

A

Examine the unaffected one first
Firm, hard, fixed area is suspicious until prove not
Check for supraclavicular LAD
Abd exam for nodules

76
Q

Tumor markers in testicular cancer

A

Beta-human chorionic gonadotropin, lactate dehydrogenase, alpha fetoprotein

77
Q

Tx of testicular cancer

A

Radial inguinal orchietomy
Radiation and chemo based on staging (seminatous tumors less common but radiosensitive and nonseminatous are radioresistant)
Nerve sparing retroperitoneal lymph node dissection for nonseminatous

78
Q

Surveillance for testicular cancer

A

Office visits every 3 mos for 2 years and then 6 mos and then yearly after 5 yrs
Always do CXR, tumor markers and CT AB/pelvis
*self exams!!

79
Q

Why does an direct inguinal hernia occur?

A

Weakness in floor of inguinal canal

80
Q

Why does an indirect inguinal hernia occur?

A

Most congenital but not til later in life (most common an d seen more on the right)

81
Q

Fermoral hernias

A

Least common but seen mostly in women (most likely to become incarcerated/strangulated)

82
Q

Presentation of an inguinal hernia

A

Heaviness or discomfort with straining
Painless bulge
N/v, abd distention and pain, redness

83
Q

Presentation of incarcerated/strangulated hernia

A

Fever

May see bowel obstruction, peritonitis or toxic appearing

84
Q

Definitive tx for all hernias

A

Surgery (repair must happen when strangulated)

Watchful waiting if inguinal hernai with minimal or no sxs

85
Q

What is bladder cancer associated with?

A

Tobacco use or chemical dyes (mostly transitional cell carcinoma)

86
Q

Presentation of bladder cancer

A

Painless gross hematuria or microscopic hematuria is most common
May see obstructive or irritative urinary sxs
Pain consistent with areas of invasion or metastasis

87
Q

Gold standard diagnosis of bladder cancer

A

Cystourethroscopy (also for staging)

Can also use UA, urine cytology, tumor markers, CT with urography (evaluate upper tracts)

88
Q

Tx of bladder cancer

A

Transurethral resection of bladder tumor
Intra-vesical chemo for high grade tumors
Muscle invasive tumors need systemic chemo before the cystectomy

89
Q

What is urge incontinence?

A

Uncontrolled loss of urine that is proceeded by a strong unexpected urge to void
Involves uninhibited bladder contractions

90
Q

What is stress incontinence?

A

Leakage with exertion or valsalva (when pressure on bladder)
Due to urinary sphincter dysfunction
Most common cause of prostate surgery

91
Q

What is mixed incontinence?

A

Feelings of urgency and exertional leakage

92
Q

Typical presentation of incomplete emptying incontinence (overflow)

A 
Nocturnal enuresis (impaired detrusor contractility or bladder outlet obstruction)
Less common
93
Q

Tx for urgency incontinence

A

Antimuscarinic (tolterodine, fesoterodine, oxybutynin)

Alpha blockers if BPH

94
Q

Tx for stress incontinence

A 
Condom catheters, penile clamp
Surgical options (transurethral bulking agents, perineal sling, artificial urinary sphincter)
95
Q

Tx for overflow incontinence

A

Alpha blockers

96
Q

When to refer to urologist with complicated incontinence

A 
Severe sxs
Pelvic pain
Hematuria
Elevated PSA/abnormal prostate exam
Recurrent urologic infections
Previous pelvic radiation or surgery
Neurologic disease

X Clin Med II Exam 3 (6 decks)

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