MEN's HEALTH Flashcards
presentation of BPH
hx of gradual onset obstructive voiding symptoms, weaker stream, dribbling, incomplete emptying, nocturia
DRE signs with a person with BPH
prostate = firm/rubbery diffusely loarge non tender
prostate feels firm and uniformly enlarged
1 st line tx for BPH
Alpha blockers
Terazosin ( hytrin) at bedtime, Watch hypotension when moving
use with pt with HTN
Other alpha blockers (Tamsulosin/Flomax) considerations
dont give prior to eye sugery
watch for dizziness, hypotension, blurred vision
5-alpha-reductase inhibitors Proscar
dont give to pt who are trying to get pregnant
this med will redice prostate by 50 % so when checking PSA you have to double it
Herbal tx for BPH
saw palmetto
Prostate cancer screening
against regular screening
high risk: AA, + fm hx
PE: indurated/hard areas or nodule on the surface w/ DRE
Acute Bacterial Prostatitis ( P/key/labs)
Acute onset of fevers, suprapubic / perineal pain w/ urinary symptoms. Perineal pain may radiate to the back/rectum/penis
Key: do not vigorously massage prostate could cause urosepsis
Labs: CBC, UA. UC, fractional urine x 3
ABP ( tx and organisms)
Organism : e.coli
For sexual active men : STD’s - Chlamydia, Gonorhhea
TX for uncomplicated m< 35 with increased prob of STD
- Ceftriazone 250 mg X once + Doxy for 10 days
Uncomplicated w/ lower risk for STD
- Cipro BID or Levofloxacin
Chronic Bacterial Prostatis (age, organism, PE,
common in older men
caused by e.coli
usually asympotmatic
DRE: may be normal
labs: UA, UC after light massage
TX: Cipro or Levoflocin for 4 weeks
Testicular Torsion
Peak age : 12 -18
acute onset scrotal pain , red swollen scrotum. N/V, afebrile
PE: very tender , warm tetes “ that high riding”
missing cremasteric reflex
UA: negative
TX; ED
Blue dot sign
may be seen in torsion of tesicular appendage (which is benign condition in children)
will see a blue nodule on spuerior aspect of testicle. non tender testicle
refer to ED to r/o testicular torsion
Hydrocele
Painless, enlarged scrotum due to serous fluid trapped in tunica vaginalis
will have + transilluniation is affected scrotum
Testicular Cancer
young male discovers painless nodule or swelling on one testicle. May see evelated LDH, HCG, AFP
PE: nodules found on lower half of testicular
Risk factors: family hx and crytorchism ( undescended testicles)
next step: order scrotal US and refer
Acute Bacterial Epidimyitisis
sexually active males < 40. acute onset of fever w/ red swollen scrotum that is tender w/ urinary symptoms
PE: indurated and very tender epididmyitis w/ swollen red scrotum. + phrens sign, may have green discharge
Phrens sign: pain releived w/ elevation of scrotum
Labs: CBC , UA ( with wbc and blood)
ABE organism and tx
if suspected STD - ceftriazone + doxy
lower risk - e.coli - levofloxacin for 10 days
pain releif : scrotal elevation and scrotal ice packs
Erectile Dysfunction organic verse non organic
no time time erections- r/o organic cause
which means inability to have erection under any circumstances
may be caused by vascular insuffiency, neuropathy, smoking
meds : SSRI, beta blockers, alcohol
ED treatment
Viagra take one dose 1 hour prior to sex
contraindiacted : when taking - nitrates, unstable agina, some aphla blockers
Peyronie’s dx
pain crooked erections
Balanits
infection of glans ( DM)
Phimosis
foreskin can not be pushed back from the penis
Priapism
abnormal, painful prolonged erection > 4 hours
Varicocele
varicose / veins , may cause infertility, bag of worms
Indirect hernia
intestines slip through the internal inguinal ring, can drop down into the scrotum ( through the tunica vaginalis)
Direct Hernia
intestines protrude through a weak area in the fascia of anterior abdominal wall ( middle age and older men)
PE for hernias
when you gently slip finer throught scrotum into inguinal ring tell pt to cough if + pain = indirect if - pain = direct
order a US
most common type of hernia in female?
femoral hernia and it is at higher risk for strangulation
What are sliding hernias?
hiatal or diaphragmatic hernia
Strangulated Hernia
Emergency
gradual onset of abdominal pain that worsens into severe colicky pain. vomits bile, incarcerated hernia feels warm and tender
hyperactive and high pitched bowels sound that eventually become hypoactive, distended abdomen
percussion : tympany
complication is a obstructed bowel
