Mens health

Question 1

s when the foreskin cannot be returned back to its original position because of swelling of the head (glans) of the penis.

Answer 1

Paraphiimosis

Question 2

Male complains of a prolonged and painful erection for several hours (≥2–4 hours) that is not associated with sexual stimulation or desire. Patient may awaken with an erection.

Answer 2

Priapism

Question 3

Older to elderly man complains of a new onset of low-back pain and rectal area/perineal pain or discomfort accompanied by obstructive voiding symptoms such as weaker stream and nocturia. May be asymptomatic. More common in older men (>50 years), African Americans, and those with obesity, as well as men with a family history of prostate cancer.

Answer 3

Prostate cancer

Question 4

Most common solid malignancy affecting males between the ages of 15 and 35 years.

Answer 4

Testicular cancer

Question 5

what is the survival rate with testicular cancer

Answer 5

95%

Question 6

when does sperm production begin what tanner stage

Answer 6

IV

Question 7

where is sperm produced

Answer 7

in the seminiferous tubules

Question 8

the left testicle usually hangs _____ than the right

Answer 8

Lower than the right

Question 9

Tubular structures that transport sperm from the epididymis toward the urethra in preparation for ejaculation. These tubes are cut/clipped during a vasectomy procedure.

Answer 9

Vas Deferens (Ductus Deferens)

Question 10

varicocele feels like a

Answer 10

bag of worms

Question 11

Finasteride is a category

Answer 11

X drug (teratogenic). Requires special handling. It should not be touched with bare hands by pregnant people.

Question 12

In a male with BPH and hypertension, start with

Answer 12

Alpha blockers (terazosin and doxazosin)

Question 13

Gold standard of dx for testicular cancer is

Answer 13

testicular biopsy

Question 14

what is considered an elevated PSA level

Answer 14

> 4

Question 16

highest risk for ED with SSRI is

Answer 16

Paxil

Question 17

most common cause of chronic bacterial prostatitis is

Answer 17

E coli

Question 18

First line therapy for chronic prostatitis is

Answer 18

Fluoroquinolone such as cipro
alternative is Bactrim DS

Question 19

Normal PSA leve is

Answer 19

0-4

Question 20

The prostate shrinks by 50% while on Proscar

Answer 20

(so PSA must be doubled or multiplied by 2).

Question 21

Finasteride (Proscar) inhibits type II 5-alpha-reductase

Answer 21

directly on the prostate gland to shrink it (temporarily) while on the medication. If patient stops taking Proscar, the size of the prostate gland returns back to its original size.

Question 22

Treat acute bacterial prostatitis treatment is

Answer 22

Outpatient empiric therapy is fluoroquinolone (e.g., ciprofloxacin 500 mg PO BID) or trimethoprim-sulfamethoxazole (one double-strength tablet PO BID).
Narrow antibiotic once culture has identified class of organism.

Question 23

A patient with benign prostatic hyperplasia presents with overactive bladder symptoms such as frequency, urgency, and incontinence. The patient’s post-void residual averages more than 300 mL. Which of the following medical therapies would be indicated for symptom relief in this patient?

A.Phosphodiesterase type 5 (PDE5) inhibitors
B.Anticholinergics
C.Beta-3 adrenergic agonists
D.5-alpha reductase inhibitors

Answer 23

Beta-3 adrenergic agonists

Question 24

An older adult male patient presents with the inability to sustain an erection for sexual intercourse. The patient has a history of benign prostatic hyperplasia with reports of urgency, nocturia, and hesitancy. Which of the following agents would be helpful for this patient?

A.Tadalafil
B.Sildenafil
C.Avanafil
D.Vardenafil

Answer 24

Tadalafil
Phosphodiesterase type 5 (PDE5) inhibitors are recommended for initial therapy for men with erectile dysfunction.

Question 25

Which of the following conditions is a possible effect of the mumps virus, which can affect male fertility?

A.Salivary gland inflammation
B.Cryptorchidism
C.Epididymo-orchitis
D.Prostatitis

Answer 25

Epididymo-orchitis
Epididymo-orchitis, inflammation of the epididymis and ipsilateral testis, is the most common complication of mumps infection.

Question 26

Which of the following anatomical structures provides a space for the storage and maturation of sperm?

A.Epididymis
B.Vas deferens
C.Testis
D.Prostate gland

Answer 26

Epididymis

Question 27

first line med for BPH

Answer 27

Terazosin all zosin

Question 28

what medication shrinks prostate

Answer 28

proscar (finasteride)

Question 29

PSA screening

Answer 29

55-75 based on shared decision making

Question 30

PSA level we refer

Answer 30

> 4

Question 31

treatment epididymitis

Answer 31

doxy and ceftriaxone less than 35 years old and risk for STI’s

Question 32

Treatment epididymtitis for older than 35 is

Answer 32

levofloxacin and doxy

Question 33

First line med for ED is

Answer 33

PDE - F (viagra)
Think penis does erect

Question 34

what drug is contraindicated with viagra

Answer 34

nitrate

Question 35

Alpha Blockers

Answer 35

first lien for quick relief of BPH
all end in Zosin
Terazosin (hytrin)
first dose can cause possible hypotension/possible syncope take at bedtime

Question 36

5 alpha reductase inhibitor (

Answer 36

finasteride (proscar)
Take a long time like 6 months to work
Teratogenic

Question 37

Herb supplment for BPH is

Answer 37

saw palmetto

Question 38

Tadalafil has been approved for

Answer 38

treatment of lower urinary tract sx secondary to BPH

Question 39

The USPSTF recommends screening for HIV in

Answer 39

all patients age 15 to 65 years, as well as in younger and older patients who are at increased risk.

Question 40

spermatogenesis begins at

Answer 40

puberty

Question 41

prostate gland secretes fluid that is

Answer 41

alkaline - which helps sperm survive in the acitic envirnoment

Question 42

pt with localized prostate cancer will present with

Answer 42

hesitancy, frequency, dysuria

Question 43

nongonococcal urthritis main cause is

Answer 43

chlamydia

Question 44

common clinical presentation of genital herpes is

Answer 44

vesicular leions on a erythemthous base

Question 44

what is the test marker tumor marker for testicular cancer

Answer 44

alpha fetoprotien - AFP

Question 45

A older adult male patient presents with a unilateral right-sided scrotal mass that feels like a “bag of worms” on physical examination. The patient reports a dull, aching, right-sided scrotal pain. Based on this presentation, which of the following is indicated next?

A.Transillumination
B.MRI
C. CT scan of the abdomen
D.Biannual semen analysis

Answer 45

Answer: C. CT scan of the abdomen

The patient is likely presenting with a varicocele based on the scrotal fullness that has the feel of a “bag of worms” and the dull, aching pain. Usually, varicoceles occur on the left side; unilateral right varicoceles are uncommon and are suspicious for an underlying pathology causing inferior vena cava obstruction. An abdominal and scrotal ultrasound is appropriate, along with a CT of the abdomen with contrast for further workup. An MRI may be indicated after the CT and ultrasound if the diagnosis remains unclear. Most varicoceles do not require intervention; in older men who desire continued fertility, a semen analysis is recommended every 2 years. Transillumination of the scrotum would be helpful to identify a hydrocele.

Question 46

Which of the following conditions is a possible effect of the mumps virus, which can affect male fertility?

A.Salivary gland inflammation
B.Cryptorchidism
C.Epididymo-orchitis
D.Prostatitis

Answer 46

Answer: C. Epididymo-orchitis

Epididymo-orchitis, inflammation of the epididymis and ipsilateral testis, is the most common complication of mumps infection. Among males post puberty who get a mumps infection, 15% to 30% develop epididymo-orchitis. Cryptorchidism is testes/testicle that are/is inside the abdominal cavity, which increases the risk of testicular cancer. Prostatitis and salivary gland inflammation do not increase male infertility.

Question 47

Which of the following is the current recommendation for screening of prostate cancer?

A.All men age 55 to 69 years should engage in shared decision-making regarding screening.
B.All men 50 years or older should be screened with a prostate-specific antigen (PSA) test and digital rectal examination.
C.All men age 55 to 69 years should undergo a digital rectal examination.
D.All men older than 70 years should be screened due to increased risk of advanced disease.

Answer 47

A.All men age 55 to 69 years should engage in shared decision-making regarding screening.

Question 47

An adult male patient presents with an acute onset of fever, chills, and fatigue. The patient reports dysuria, frequency, and urgency, along with pelvic pain. Based on this presentation, which of the following is essential in the diagnostic evaluation of this patient?

A.Blood cultures
B.Urine culture
C.Vigorous prostate massage
D.Complete blood count (CBC) with differential

Answer 47

Answer: B. Urine culture

Patients with acute bacterial prostatitis are often acutely ill with fever, chills, malaise, irritative urinary symptoms, and pelvic or perineal pain. These classic symptoms of prostatitis often prompt a digital rectal exam, which should be performed gently. Avoid vigorous prostate massage as it is uncomfortable, provides no benefit, and increases the risk of bacteremia. A urine Gram stain and culture should be obtained in all patients with concern for acute prostatitis to establish the microbial etiology. Blood cultures are not routinely recommended or necessary for diagnosis; they may be useful to assess for complications in patients with underlying cardiac valvular disease or concern for sepsis. A CBC with differential may be helpful to identify leukocytosis; however, this finding is nonspecific to the diagnosis. Other common laboratory findings include pyuria and bacteriuria on urinalysis, elevated inflammatory markers, and elevated prostate-specific antigen (PSA) level.

Question 48

An older adult male patient presents with the inability to sustain an erection for sexual intercourse. The patient has a history of benign prostatic hyperplasia with reports of urgency, nocturia, and hesitancy. Which of the following agents would be helpful for this patient?

A.Tadalafil
B.Sildenafil
C.Avanafil
D.Vardenafil

Answer 48

Answer: A. Tadalafil

Phosphodiesterase type 5 (PDE5) inhibitors are recommended for initial therapy for men with erectile dysfunction. Sildenafil, vardenafil, tadalafil, and avanafil have similar efficacy; the choice of drug depends on patient’s preferences, cost, and adverse effects. However, only tadalafil has been approved for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia

Question 49

To assess a newborn for cryptorchidism, the nurse practitioner will:

A.Check testosterone level
B.Assess cremasteric reflex
C.Order pelvic ultrasound
D.Massage the inguinal canal

Answer 49

Solution: D

Massage the inguinal canal.

If cryptorchidism (an undescended testicle) is suspected, the nurse practitioner should massage the inguinal canal to check for the presence of an undescended testicle. The massage is a diagnostic maneuver and does not cause the testicle to descend. Hormonal therapy is not a recommended treatment; therefore, a testosterone level is unnecessary. The cremasteric reflex is a test for a superficial reflex and is not specific to cyptorchidism. Imaging for cryptorchidism is not the initial diagnostic intervention.

Question 50

A patient presents with penis swelling and severe pain. Upon physical examination, the retracted foreskin cannot be returned to its normal condition. The glans penis and distal foreskin appear swollen, pink, and soft. No blue or black skin discoloration of the glans penis is noted. The patient has been provided pain relief, but manual reduction has failed. Which of the following is indicated to help relieve pressure with this condition?

A.Advise patient to apply cold packs and to provide updates the following day
B.Refer patient to ED for invasive reduction in the operating room (OR)
C.Prepare the patient for emergent circumcision.
D.Consult urology and prepare for dorsal slit procedure

Answer 50

Answer: D. Consult urology and prepare for dorsal slit procedure

Question 51

What is the mostcommon cause of balanitis?

A.Pseudomonas
B.Candida albicans
C.Staphylococcus aureus
D.Trichomonas vaginalis

Answer 51

Answer: B. Candida albicans

Balanitis is inflammation of the glans penis. It can be caused by an infection, an allergic reaction to a soap, or poor hygiene. The most common infectious organism is the yeast C. albicans. The glans penis develops erythema, shallow ulcers with a white base, and curd-like discharge. Risk factors include diabetes, obesity, and uncircumcised penis. Less common etiologies include other bacterial infections such as Gardnerella vaginalis, group A streptococcus, S. aureus, and sexually transmitted pathogens, including T. vaginalis. Pseudomonas is not associated with balanitis.

Question 52

Which of the following anatomical structures provides a space for the storage and maturation of sperm?

A.Epididymis
B.Vas deferens
C.Testis
D.Prostate gland

Answer 52

Answer: A. Epididymis

The epididymis is a highly convoluted duct formed from a singular tubular structure that is estimated to be up to 20 feet in length, which allows space for storage and maturation of sperm. The testes are primarily responsible for testosterone and sperm production. The prostate is a male exocrine accessory gland that consists of exocrine glandular tissue and fibromuscular tissue, with the primary function of secretion of fluid that facilitates sperm motility and survival. The vas deferens is associated with the arteries, veins, lymphatics, muscle fibers, and nerves to form the spermatic cord; it merges with seminal vesicles to form the ejaculatory duct, which empties into the urethra.

Question 53

A male patient with a past medical history of diabetes mellitus presents with severe pain that started on the anterior abdominal wall and migrated to the scrotum and penis. Physical examination reveals tense edema, blisters, and crepitus. The patient has a fever and is tachycardic and hypotensive. This presentation raises concern for which surgical emergency?

A.Testicular torsion
B.Torsion of the appendix testes
C.Fournier’s gangrene
D.Paraphimosis

Answer 53

Answer: C. Fournier’s gangrene

Fournier’s gangrene is a rare, rapidly progressing polymicrobial necrotizing fasciitis of the external genitalia and the perineum. It is common in patients who are immunocompromised or who have diabetes mellitus, longstanding indwelling catheters, or urethral trauma with associated urinary infection. Clinical features include severe pain that starts on the anterior abdominal wall and migrates to the gluteal muscles, scrotum, and penis. The outside of the involved area may present as tense edema, blisters, crepitus, and subcutaneous gas. Systemic findings such as fever, tachycardia, and hypotension are often present. Testicular torsion, torsion of the appendix testes, and paraphimosis are all concerning for danger signals but do not have this clinical presentation. Torsion of the appendix testes has a sudden onset of pain, like the pain of testicular torsion, but it is often less severe. A “blue dot” sign may be apparent due to infarction and necrosis of the appendix testis. Testicular torsion usually presents with a swollen red scrotum with associated nausea and vomiting. Paraphimosis is when the foreskin cannot be returned to the original position; untreated, it can lead to ischemia.

Question 54

A patient with a history of Dupuytren’s contracture presents with penile pain, hourglass deformity, and sexual dysfunction. The penile examination reveals a penile plaque and curvature. Based on the history and presentation, this patient is most likely presenting with which of the following conditions?

A.Peyronie’s disease
B.Balanitis
C.Varicocele
D.Phimosis

Answer 54

Answer: A. Peyronie’s disease

This patient is presenting with Peyronie’s disease based on the penile pain, curvature, indentation, hourglass deformity, shortening, and sexual dysfunction. Balanitis is inflammation of the glans penis and presents as pain, tenderness, or pruritis with erythematous lesions. Varicocele describes varicose veins in the scrotal sac and often feels like a “bag of worms.” Phimosis is the inability to retract the foreskin.

Question 55

A patient with benign prostatic hyperplasia presents with overactive bladder symptoms such as frequency, urgency, and incontinence. The patient’s post-void residual averages more than 300 mL. Which of the following medical therapies would be indicated for symptom relief in this patient?

A.Phosphodiesterase type 5 (PDE5) inhibitors
B.Anticholinergics
C.Beta-3 adrenergic agonists
D.5-alpha reductase inhibitors

Answer 55

Answer: C. Beta-3 adrenergic agonists

Patients with overactive bladder symptoms (e.g., frequency, urgency, incontinence) may benefit from the use of beta-3 adrenergic agonists or anticholinergics. In particular, beta-3 adrenergic agonists are effective in those with concurrent overactive bladder symptoms secondary to detrusor overactivity to promote relaxation. Anticholinergic agents can be used to treat irritative symptoms due to overactive bladder in patients with benign prostatic hyperplasia who do not have increased post-void residual. Due to the concern for urinary retention, anticholinergics should be avoided when post-void residuals are greater than 300 mL. PDE5 inhibitors can be used as initial therapy in men with BPH and erectile dysfunction. The class, 5-alpha reductase inhibitors, is used to prevent benign prostatic hyperplasia progression rather than treat acute symptoms.

Question 56

A 55-year-old male patient presents with complaints of a swollen, painful right testicle and burning on urination. Examination reveals edematous scrotum with tenderness, and there is a positive Prehn sign. The patient states that they are heterosexual and have been in a monogamous relationship for the past 5 years and denies practicing anal intercourse. The nuclear acid amplification testing (NAAT) is negative. The nurse practitioner will prescribe:

A.Ceftriaxone (Rocephin) × 1 injection
B.Levofloxacin (Levaquin) × 10 days
C.Doxycycline (Vibramycin) × 7 days
D.Azithromycin (Zithromax) × 1 dose

Answer 56

Solution: B

Levofloxacin (Levaquin) × 10 days.

The results of the nuclear acid amplification test (NAAT) indicate that the patient is negative for chlamydia and gonorrhea. In males aged 35 years and older, acute epididymitis is commonly caused by enteric organisms, particularly gram-negative Escherichia coli. A 10-day regimen of levofloxacin or ofloxacin is the proper treatment. Given that the NAAT is negative, treatment for gonorrhea (ceftriaxone) and chlamydia (doxycycline or azithromycin) is not needed.

Question 57

The nurse practitioner is preparing to assess a 66-year-old male patient who has a smoking history of 20 pack-years, as well as a history of phimosis. The patient is at risk for what type of cancer?

A.Penile
B.Scrotal
C.Prostate
D.Testicular

Answer 57

Solution: A

Penile.

Phimosis increases the risk for developing penile cancer 7- to 10-fold. Given the patient’s history of this condition, coupled with the smoking habit, the patient is at risk for carcinoma of the penis. Smoking increases the risk of all types of cancers; however, the patient does not present with a history or risk factors for scrotal, prostate, or testicular cancer. Testicular cancer primarily occurs in younger males.

Question 58

A 60-year-old male patient presents with a sudden onset of fever, chills, dysuria, and pelvic pain. On physical examination, the prostate is firm, edematous, and tender. The patient denies high-risk sexual behavior. Based on this presentation, which of the following empiric antimicrobial therapies should be initiated?

A.Nitrofurantoin
B.Ceftriaxone
C.Doxycycline
D.Ciprofloxacin

Answer 58

Answer: D. Ciprofloxacin

This patient is presenting with symptoms concerning for acute bacterial prostatitis; the patient has a fever, chills, dysuria, and pelvic pain. These patients may also present with perineal pain and cloudy urine. The prostate is often firm, edematous, and tender on exam. Empiric antibiotic therapy should be directed against gram-negative organisms (frequent cause of acute bacterial prostatitis). Unless drug resistance is suspected, empiric treatment often includes a fluroquinolone (e.g., ciprofloxacin, levofloxacin) or trimethoprim-sulfamethoxazole until susceptibility data from the culture results are available. Nitrofurantoin is often avoided in those with prostatitis because of the poor tissue penetration and risk of adverse effects. Sexually active men younger than 35 years and men older than 35 years who engage in high-risk sexual behavior should be treated with regimens that cover Neisseria gonorrhoeae (e.g., ceftriaxone) and Chlamydia trachomatis (e.g., doxycycline).

Question 59

The nurse practitioner is preparing to perform a routine physical assessment on an adult male. Which reproductive system assessment finding will the nurse practitioner identify as a normal finding?

A.Palpable prostate gland
B.Absent cremasteric reflex
C.Nonpalpable vas deferens
D.Thickened skin surrounding the testes

Answer 59

Solution: A

Palpable prostate gland.

The prostate gland is palpable during a digital rectal exam (DRE) and, if normal, feels firm and approximates the size of a walnut. Unexpected abnormal findings include an absent cremasteric reflex, nonpalpable vas deferens, and thickened skin surrounding the testes. An absent cremasteric reflex is an abnormal finding associated with testicular torsion. Other healthy assessment findings for a male patient’s reproductive anatomy include a palpable vas deferens and thin scrotal skin

Question 60

Which of the following is a common complication of sickle cell disease?

A.Priapism
B.Testicular cancer
C.Benign prostatic hyperplasia
D.Prostate cancer

Answer 60

Answer: A. Priapism

Priapism (penile erection in the absence of sexual activity or desire) is a common complication in males with sickle cell disease. Most cases are ischemic; over time, recurrent episodes can lead to permanent damage and erectile dysfunction. While there are many complications associated with sickle cell disease, it is not associated with an increased risk for testicular or prostate cancer or benign prostatic hyperplasia.