Mens Health

Question 1

undescended testes. ↑ risk of testicular cancer.

Answer 1

Cryptorchidism

Question 2

Inflammation of the testicle

Answer 2

Orchitis

Question 3

stimulated by the release of testosterone and
follicle stimulating hormone (FSH).
Where does it take place?

Answer 3

Spermatogenesis

seminiferous tubules of the testes.

Question 4

produced by the release of luteinizing
hormone (LH)

Answer 4

testosterone/ Androgens

Question 5

Coiled tubular structure
located posteriorly to the testis. Stores
sperm for maturation

Answer 5

Epididymis

Question 6

• Walnut size.
• Secretes fluid to protect and nourish sperm.
• PSA: 2.5-4.

Answer 6

Prostate

Question 7

Normal DRE finding

Answer 7

smooth, rubbery, symmetrical.

Question 8

BPH DRE finding

Answer 8

Enlarged, smooth, firm

Question 9

Prostatitis DRE finding

Answer 9

bogginess, tender

Question 10

Prostate Cancer DRE Findings

Answer 10

irregular borders, firmness, nodular

Question 11

Inflammation of the penis, candida infection,
most common uncircumcised, DM,
immunocompromised.

Answer 11

Balanitis

Question 12

Absence of one or two testicles from
scrotum. Usually resolve after 1 year.

Answer 12

Cryptorchidism

Question 13

Fluid filled testicle.
Transillumination.

Answer 13

Hydrocele

Question 14

Foreskin can not be pulled back over glans
penis due to penile edema.

Answer 14

Phimosis

Question 15

Varicose veins on testicles.
“Bag of worms”

Answer 15

Varicocele

Question 16

Enlargement of the prostate
gland.
* Symptoms: urinary frequency,
trouble starting urination, weak
stream, nocturia = urinary tract
infections (UTI), bladder stones,
chronic kidney problems.
* Cause: unclear.
* Risk factors: family hx, obesity,
DM, ↓exercise, erectile dysfunction.
Education:
* ↓BP = dizziness, orthostatic hypotension. Take meds PM.
* Herbal supplement: Saw palmetto.

Answer 16

BPH

Question 17

Tx for BPH

Answer 17

• alpha blockers => terazosin (Hytrin), Tamsulosin (Flomax).(take at night to decrease sx)
• 5-alpha-reductase inhibitors (blocktes tosterone): Finasteride (Proscar).
• Surgery.
• Other: ↓alcohol, ↓weight.

Question 18

Shrinks the prostate by 50%. If you stop taking, prostate enlarges.

Answer 18

Finasteride (Proscar).

Question 19

Drugs that can worsen BPH symptoms:

Answer 19

pseudoephedrine, anticholinergics, CCB, caffeine.

Question 20

Penis unable to stay erect during sexual
intercourse. Vascular insufficiency.
* Causes: Drugs (SSRIs like Paxil), neuropathy
(DM), alcohol, smoking, hypogonadism, psychiatric

Answer 20

Erectile Disfunction

Question 21

Meds for ED

Answer 21

Sildenafil citrate (Viagra): take 30-60min before sex, duration 4 hrs.
* Vardenafil (Levitra): same.
* Tadalafil (Cialis): take 2 hrs before sex, lasts 36hrs!

Education
* May cause HA, facial flushing, dizziness,
hypotension, priapism.
* WARNING: nitrates, alpha-blockers, hx MI, post
cerebrovascular accident, major surgery.

Question 22

> 6 weeks, gradual.
Symptoms: weeks worth of suprapubic or perineal pain, dysuria, frequency, nocturia. (No systemic symptoms).
May be asymptomatic.
DRE: normal or slightly boggy, non tender.
UA: normal (unless cystitis)
PSA: elevated (inflammation)
Organism: E.coli, Proteus

Answer 22

Chronic Bacterial Prostatitis

Question 23

Tx for Chronic Bacterial Prostatitis

Answer 23

Bactrim PO BID 4-6 weeks
Fluoroquinolone (Floxin, Levaquin) daily 4-6 weeks.

Question 24

<6 weeks, sudden.
Symptoms: sudden onset of high fever, chills,
suprapubic pain, perineal pain, dysuria, frequency,
nocturia, cloudy urine.
DRE: tender, warm, boggy.
Accompanied by cystitis or epididymitis.
UA: pyuria, hematuria
Organism: E.coli, Proteus
WARNING: vigorous palpation of infected prostate can lead to bacteremia.

Answer 24

Acute Bacterial Prostatitis

Question 25

Tx for Acute Bacterial Prostatitis

Answer 25

<35 yr: Ceftriaxone 250 mg IM and Doxy 100mg BID x 10 days >35 yr: Fluoroquinolone PO x 4-6 weeks (Cipro, Levaquin, Floxin)

Question 26

Penile plaque formations that interfere with erection. Fibrotic plaques, palpable nodules. Penile pain, crooked penis. * Tx plan: referral to urologist

Answer 26

Peyronie’s Disease

Question 27

Inflammation of the epididymis caused by bacteria (E.coli), STI. <35yo.

Answer 27

Epididymitis

Question 28

Swollen, painful/tender testicle (usually one side > than the other), red, warm scrotum, urethral discharge . Labs: leukocytosis (CBC), pyuria/hematuria/nitrites (UA). + gonorrhea, chlamydia? *Positive Prenh’s sign: relief of pain w/scrotum elevation

Answer 28

Epididymitis

Question 29

tx for Epididymitis

Answer 29

Tx: <35 yo STI; Doxy PO BID x 10 days + Ceftriaxone 250mg IM >35 yo; fluoroquinolone (Floxin, Levaquin). Symptomatic management: ice, elevate, bed rest, stool softener.

Question 30

relief of pain w/scrotum elevation

Answer 30

Positive Prenh’s sign

Question 31

Ischemic: blood does not drain properly from the penis. Non-ischemic:↑arterial flow, disruption of parasympathetic nervous system. Causes: Sickle cell disease, antipsychotics, SSRIs, blood thinners, cocaine, cannabis.

Answer 31

Prolonged penile erection (Priapism)

Question 32

Most common in white males ages 15-30 y.o. * Findings: testicular nodule/s that are fixed, “heaviness", aching, one testicle larger, tenderness on one side. Can be painless and asymptomatic when early. Hydrocele common. Diagnostics: * US= solid mass * Biopsy= gold standard Tx: * Referral to urologist for orchiectomy. * Chemotherapy.

Answer 32

Testicular Cancer

Question 33

Most common cancer in men. Slow growing. Risk factors * Age >50 * African American * Obesity * + Fam Hx Findings * PSA >4.0 ng/mL * DRE: Fixed hard nodule or indurated area on gland * Dx: Biopsy Tx * Antiandrogens (Proscar) * Hormone blockers (Lupron)

Answer 33

Prostate Cancer

Question 34

Usually school age boy. * Abrupt onset of a blue-colored round mass. (blue dot sign) * Necrosis of the appendix testis due to torsion.

Answer 34

Torsion of the Appendix Testis

Question 35

Usually adolescent. * Abrupt onset of extreme testicular pain. * N&V. * Affected testicle is higher than non-affected. * Cremasteric reflex missing

Answer 35

testicular torsion * emergency!

Question 36

risk factors associated with benign prostatic hyperplasia

Answer 36

Family hx obesity HTN

Question 37

risk factors associated with benign prostatic hyperplasia

Answer 37

Family hx obesity HTN

Question 38

What patient education is important when the patient is prescribed Hytrin?

Answer 38

Take med at night as it decreases BP (is an alpha blocker)