MEN's HEALTH

Question 1

presentation of BPH

Answer 1

hx of gradual onset obstructive voiding symptoms, weaker stream, dribbling, incomplete emptying, nocturia

Question 2

DRE signs with a person with BPH

Answer 2

prostate = firm/rubbery diffusely loarge non tender

prostate feels firm and uniformly enlarged

Question 3

1 st line tx for BPH

Answer 3

Alpha blockers
Terazosin ( hytrin) at bedtime, Watch hypotension when moving

use with pt with HTN

Question 4

Other alpha blockers (Tamsulosin/Flomax) considerations

Answer 4

dont give prior to eye sugery

watch for dizziness, hypotension, blurred vision

Question 5

5-alpha-reductase inhibitors Proscar

Answer 5

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

Question 6

Herbal tx for BPH

Answer 6

saw palmetto

Question 7

Prostate cancer screening

Answer 7

against regular screening

high risk: AA, + fm hx

PE: indurated/hard areas or nodule on the surface w/ DRE

Question 8

Acute Bacterial Prostatitis ( P/key/labs)

Answer 8

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

Question 9

ABP ( tx and organisms)

Answer 9

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

Question 10

Chronic Bacterial Prostatis (age, organism, PE,

Answer 10

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

Question 11

Testicular Torsion

Answer 11

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

Question 12

Blue dot sign

Answer 12

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

Question 13

Hydrocele

Answer 13

Painless, enlarged scrotum due to serous fluid trapped in tunica vaginalis

will have + transilluniation is affected scrotum

Question 14

Testicular Cancer

Answer 14

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

Question 15

Acute Bacterial Epidimyitisis

Answer 15

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)

Question 16

ABE organism and tx

Answer 16

if suspected STD - ceftriazone + doxy
lower risk - e.coli - levofloxacin for 10 days

pain releif : scrotal elevation and scrotal ice packs

Question 17

Erectile Dysfunction organic verse non organic

Answer 17

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

Question 18

ED treatment

Answer 18

Viagra take one dose 1 hour prior to sex

contraindiacted : when taking - nitrates, unstable agina, some aphla blockers

Question 19

Peyronie’s dx

Answer 19

pain crooked erections

Question 20

Balanits

Answer 20

infection of glans ( DM)

Question 21

Phimosis

Answer 21

foreskin can not be pushed back from the penis

Question 22

Priapism

Answer 22

abnormal, painful prolonged erection > 4 hours

Question 23

Varicocele

Answer 23

varicose / veins , may cause infertility, bag of worms

Question 24

Indirect hernia

Answer 24

intestines slip through the internal inguinal ring, can drop down into the scrotum ( through the tunica vaginalis)

Question 25

Direct Hernia

Answer 25

intestines protrude through a weak area in the fascia of anterior abdominal wall ( middle age and older men)

Question 26

PE for hernias

Answer 26

when you gently slip finer throught scrotum into inguinal ring tell pt to cough if + pain = indirect if - pain = direct

order a US

Question 27

most common type of hernia in female?

Answer 27

femoral hernia and it is at higher risk for strangulation

Question 28

What are sliding hernias?

Answer 28

hiatal or diaphragmatic hernia

Question 29

Strangulated Hernia

Answer 29

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