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Maddie’s Integrative > Men’s Health > Flashcards

Men’s Health Flashcards

1
Q

List three things that are more likely in men. (3)

A

Cancer
Diabetic complications
Obesity.

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2
Q

Name the biggest killer of men under 45.

A

Suicide.

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3
Q

Describe the health seeking trends in men’s health. (2)

A

Men are less likely than women to visit the GP.
Men taking time off work for mental illness are more likely to feel embarrassed than those taking time off for physical illness.

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4
Q

List the factors used for evaluating CVS risk in order of their importance. Describe which extreme of the factor increases risk.

There are 15 total. The ones starred (*) are the most important.

A

*Age - older
*Gender - male
*Smoking
*Diabetes
Angina / MI in a first degree relative under 60
*Hypertension
*BMI - obese
*Total cholesterol - higher
Chronic conditions eg RA, CKD, AF
Ethnicity - Asian
Postcode - measure of deprivation
Long term antipsychotic use
Corticosteriod use
Erectile dysfunction
Migraine

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5
Q

Describe the occurrence of erectile dysfunction in diabetics. (2)

A

25% of diabetic men 30-34

75% of diabetic men 60-64

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6
Q

Describe the important things to ask about when taking away history about erectile dysfunction. (5)

A

ICE - how the patient views the problem and what they think the cause is.
Duration of the problem?
Does it relate to partner, place or time?
Explore sources of stress, anxiety, anger or guilt.
Physical problems?

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7
Q

List 6 illnesses that could cause erectile dysfunction. (6)

A

CVD
Testosterone or thyroid deficiency.
Pelvic or spinal trauma
Arthritis.

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8
Q

Describe 7 common physical factors that can contribute to erectile dysfunction. (7)

A

Atherosclerosis
Smoking
Cycling - damage to blood vessels
Side effects of prescribed drugs - hypertension, heart disease, depression, cancer.
Radical prostatectomy
Spinal cord injury
Regular heavy drinking - nerve damage and increased oestrogen.

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9
Q

Describe 5 emotional causes of ED. (5)

A 
Stress / anxiety. 
Depression 
Relationship difficulties 
Sexual boredom 
Unresolved sexual orientation.
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10
Q

Describe the treatments available for ED. (7)

A

Oral drugs.
Alprostadil - can be injected and will cause an erection in ~15 mins.
Medicated urethral system for erection (MUSE) - a “tampon” or alprostadil.
Vacuum pumps
Penile implants.

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11
Q

Describe the occurrence of LUTS and the relationship of this to BPH. (2)

A

30% of men over 50 suffer from LUTS, and only 1/3 of these are related to BPH.

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12
Q

Describe the risk factors for men developing LUTS. (5)

A 
Increased serum testosterone. 
Obesity 
Elevated fasting glucose (diabetes) 
Increased fat / red meat intake 
Inflammation.
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13
Q

Describe the types of LUTS and give examples of specific symptoms of each type. (8)

A 
Voiding:
- hesitancy
- poor flow 
- post micturition dribble 
Storage: 
- frequency 
- urgency 
- nocturia
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14
Q

Describe 4 categories of things that can cause storage LUTS and examples of each that can cause that.

4 categories, at least 2 examples for each.

A

Irritation - infection, inflammation, stones, cancer.
Overactive bladder - idiopathic, neuropathic (Parkinson’s, MS)
Low bladder compliance - TB, schistosomiasis, radiotherapy.
Polyuria - global (diabetes) or nocturnal (CHF).

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15
Q

Describe 3 categories of things that can cause voiding LUTS and give examples of each.

3 categories, at least 2 examples for each.

A

Physical:
Urethra - phimosis, stricture
Prostate - benign or malignant
Dynamic obstruction: prostate, increased bladder neck tone.
Neurological: lower or upper motor neurone lesion

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16
Q

Describe the stages of assessment of LUTS undertaken in primary care. (5)

A

Internal prostate symptom score.
Examinations: DRE, palpable bladder, neurological if suggested.
Investigations: dipstick, consider PSA.

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17
Q

Describe the management of LUTS offered in primary care. (11)

A

Lifestyle changes - reduced caffeine, reduced fizzy drinks, front loading of fluid.
Bladder training / pelvic floor training.
Tamsulosin - Alpha blocker that acts as symptomatic relief of LUTS by relaxing smooth muscle.
Finasteride or Dutasteride - 5alpha-reductase inhibitors which block testosterone conversion so will shrink the prostate over years.

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18
Q

Describe the managements offered to treat LUTS in secondary care. (2)

A

Flow rate monitoring.

TURP (trans-urethral resection of prostate).

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19
Q

Describe the indications for a TURP. (3)

A

Failed lifestyle and medical management

Urinary retention.

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20
Q

Define urinary retention. (2)

A

Inability to pass urine while the ability to make urine is unimpaired.

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21
Q

Describe 7 causes of urinalysis retention. (7)

A 
Prostatic enlargement 
Outflow isssues - Phimosis / urethral stenosis / meatal stenosis 
Constipation 
UTI
Drugs - anticholinergics 
Overdistension 
Neurological damage.
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22
Q

Describe the presentation of acute urinary retention. (3)

A

Painful, relieved by drainage
Residual volume <1000ml
No kidney insult

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23
Q

Describe the treatment of acute urinary retention. (1)

A

TWOC after addressing exacerbating factors.

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24
Q

Define TWOC (1)

A

Trial without catheter.

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25
Q

Describe the presentation of chronic urinary retention. (4)

A

Painless, may often notice abdominal swelling or bed wetting
Residual volume definitely over 300ml
May have kidney insult.

26
Q

Describe the common treatment of chronic urinary retention. (1)

A

Learning to self catheterise.

27
Q

Describe the presentation of acute on chronic urinary retention. (4)

A

Painful
Residual volume over 1000ml
Usually with kidney insult.
Can present with post-catheterisation diuresis.

28
Q

Describe the treatment options for acute on chronic urinary retention. (2)

A

Long term catheter.

Surgical intervention.

29
Q

Name the commonest cause of an older man with nocturnal enuresis (3)

A

Bed wetting at night.

Chronic retention with overflow incontinence.

30
Q

Describe phimosis and it’s occurrence. (3)

A

A foreskin that cannot be fully retracted in adults.

Occurs in about 1% of the uncircumcised male population.

31
Q

Describe the occurrence of physiological phimosis. (3)

A

50% at 1 year
10% at 3 years
1% at 17 years.

32
Q

Describe the sequelae of phimosis. (8)

A

Poor hygiene - increased STD risk.
Splitting / bleeding - pain on intercourse.
Balanitis (inflamed glans) or posthitis (inflamed foreskin)
Balanitis Xerotica Obliterans - scarred foreskin.
Paraphimosis - foreskin retracts and inflames, cutting off blood supply to glans.
Urinary retention
Penile cancer.

33
Q

Describe the difference between balanitis and posthitis. (2)

A

Balanitis is inflammation of the glans, posthitis is inflammation of the foreskin.

34
Q

Describe the causes of paraphimosis. (3)

A

Caused by phimosis, catheterisation and penile cancer.

35
Q

Describe paraphimosis. (2)

A

Foreskin retracts and cuts off the blood supply to the glans.

36
Q

Describe the treatments for phimosis and paraphimosis. (3)

A

Phimosis - circumcision

Paraphimosis - manual reduction most common, sometimes with a dorsal slit.

37
Q

Describe the paediatric indications for circumcision. (3)

A

Religious
Recurrent UTIs
Recurrent balanitis

38
Q

Describe the adult indications for circumcision. (5)

A 
Recurrent balanitis 
Phimosis 
Recurrent paraphimosis 
BXO 
Penile cancer
39
Q

Describe penile cancer:
Type (1)
Risk factors (2)
Prognosis (2)

A

Squamous cell carcinoma
Phimosis, HPV 16 + 18 infection
If untreated, most die in 2 years, all in 5 years.

40
Q

List 5 common causes of acute testicular pain. (5)

A 
Testicular torsion 
Epididymo-orchitis 
Torsion of the hydatid of Morgani
Trauma
Ureteric calculus
41
Q

Describe testicular torsion:
Presentation (4)
Examination (2)
Treatment (2)

A

Usually under 30, came on suddenly, unilateral, no LUTS.
Testicle is tender, often has horizontal lie.
Do surgery immediately without USS.

42
Q 
Describe epididymo-orchitis / epididymitis / orchitis. 
Causes (3)
Presentation (2)
Associated symptoms (5)
Complications (1)
A

20-50y: chlamydia. 50y+: UTI esp E. Coli.
Gradual onset, unilateral.
Pyrexia, erythematous scrotum, tender, hydrocoele. Check for history of mumps.
Fournier’s gangrene - necrotic scrotal skin.

43
Q

Describe Fournier’s gangrene. (3)

A

Necrotic scrotal skin with a 50% mortality rate and an association with diabetes.

44
Q

Describe the investigations of epididymo-orchitis. (3)

A

Bloods, urine dip, USS in abscess suspected.

45
Q

Describe the treatments of:
Epididymo-orchitis (1)
Scrotal abscess (2)
Fournier’s Gangrene. (3)

A

Abx
Drainage and abx
Surgical debridement (scrotum, penis, testicle, colostomy) and abx.

46
Q

Describe torsion of the hydatid of Morgani. (3)

A

Twisting of the embryological remnant on top of the testicle, leaving the testicle tender only on the top.

47
Q

Explain the type of testicular pain seen in ureteric calculi. (2)

A

Referred - pain with no tenderness.

48
Q

Describe 5 important questions and what their answers indicate if a patient presents with scrotal lumps. (8)

A

Is it painful?
How quickly did it appear?
Can I get above it? - no + cough reflex = hernia
Is it in the body of the testicle? - yes + painless = tumour
Does it transilluminate? - hydrocoele

49
Q

Describe 4 possible causes of an opportunistic presentation of a painless but not tender lump. (4)

A

Testicular tumour
Epididymal cyst
Hydrocoele
Reducible inguino-scrotal hernia.

50
Q

Describe a possible cause of an opportunistic presentation of a scrotal lump that aches at the end of the day but is non-tender. (1)

A

Varicocele.

51
Q

Describe two possible causes of an acute presentation of a scrotal lump that is painful and tender. (2)

A

Epididmo-orchitis

Strangulated inguino-scrotal hernia

52
Q

Describe the common history associated with testicular tumours. (2)

A

History of either testicle undescended.

Usually painless.

53
Q

Describe the findings on examination of a testicular tumour. (2)

A

Body of testis normal

Can “get above” mass.

54
Q

Describe the investigations undertaken when tumour is suspected. (4)

A

USS

Check tumour markers - alpha feroprotein and beta hCG.

55
Q

Describe the treatments for a testicular tumour. Explain why. (3)

A

Inguinal orchidectomy - through groin not scrotum to avoid seeding another lymph node set.

56
Q

Describe the UK testicular screening program. (1)
Give 2 advantages to a screening program for testicular cancer. (2)
Give 4 disadvantages to a screening program for testicular cancer. (4)

A

Does not exist.
Pros: pick up cancer earlier (less testicles removed); could lead to better outcomes.
Cons: expensive to USS all men; rare cancer; still treatable even if presenting late; potential uptake may be low.

57
Q 
Describe a hydrocoele. 
Pathophysiology (3)
Presentation (2)
Examination (2)
Treatment (4)
A

Caused by an imbalance of fluid production and resorption between the tunica albuginea and the tunica vaginalis.
Can be slow or sudden onset, and uni- or bilateral.
Testis not palpable separate to mass, will transiluminate.
Treatment is surgical removal only if large / symptomatic / visible on USS / affecting testicular health.

58
Q

Describe an epididymal cyst.
Presentation (3)
Treatment (1)

A

Usually painless, separate from testes and transilluminates.
Excise only if large.

59
Q

Describe a varicocoele.
Presentation (4)
Consequences (1)
Treatments (5)

A

Dull ache, more common on left, “bag of worms” above testes, not tender.
Associated with reduced fertility if bilateral.
Treated with radiological embolisation if symptomatic, reducing fertility, present in adolescents or restricting testicular growth.

60
Q

Explain why a varicocele is more common on the left side. (3)

A

Left testicular vein joins the left renal vein instead of directly onto the IVC like the right, so there’s more chance for dilation.

Maddie’s Integrative (5 decks)

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