Mens Health Flashcards
What condition gives a negative cremasteric reflex?
Testicular torsion
What condition gives a positive cremasteric reflex?
Epididymitis
What condition plagues truck drivers or people that sit for prolonged periods of time?
Epididymitis
A firm, smooth, And symmetrically enlarged prostate is associated with?
BPH
An enlarged, boggy, and tender prostate is indicative of?
Acute prostatitis
A hardened, asymmetric, and nodular prostate is associated with?
Prostate cancer
What condition is a risk factor for testicular cancer?
Cryptorchidism
Male complains of a pro long and painful erection of the penis for several hours. Males with sickle cell disease already very high-risk. Otherwise factors are high doses of erectile dysfunction drugs, cocaine, quadriplegia, and others.
Priapism
Noncancerous enlargement of the prostate gland
BPH
BPH almost never occurs and then prior to age
30 years
Lower urinary tract symptoms are associated with
BPH
Decrease in force or caliber of urine stream, hesitancy, post void dribbling, incomplete bladder emptying, incontinence, urinary retention, frequency, urgency, nocturia, painless hematuria/microscopic, firm, smooth, symmetrically enlarged prostate
Assessment findings of lower urinary tract symptoms and BPH
Lower urinary tract sit symptoms are due to
BPH, prostate infection, UTI
What are factors affecting PSA
Ejaculation (resolved within 24 hours)
Cycling
Prostate infection
Massage
A protein produced in the prostate gland when it’s active
PSA
What can be the causes of an elevated PSA
BPH, prostate cancer, prostate infection
How do you manage BPH
Alpha blockers such as Terszosin, Tamsulodin, and Doxazosin
5 alpha reductase inhibitors such as Dutasterude and Finasteride
PDE-5 Inhibitor such as Tadalafil (Cialis)
Alpha blockers can cause what when taken at night
Orthostatic hypotension
-zosin
If you are allergic to sulfa what alpha blocker can you not take
Flomax or tamsulosin
What type of Alpha blockers need Reno and hepatic dose adjustments
Uroxatral (Alfuzosin)
Silodosin (Rapaflo)
Pain in the perineum, lower abdomen, testes, or penis. Pain with ejaculation, voiding difficulty. think bacterial, consider STD
Acute prostatitis
What can cause acute prostatitis
It is usually unknown ideology, however gram-negative organisms such as E. Coli & Proteus are most common. Sexually transmitted with chlamydia or trichomonas or Ureaplasma
Spiking a fever, chills, malaise, myalgias, pelvic perineal pain, pain at tip of penis, enlarged, boggy or could be firm and tender prostate, cloudy urine, frequency, urgency, dysuria, nocturia, pain with defecation, hematuria, PSA elevated are all acute findings of
Acute prostatitis
How do you evaluate acute prostatitis
Rectal exam and the prostate gland is usually very tender and exquisitely tender, urinalysis to rule out UTI and look for hematuria, get culture but treat empirically and hospitalization maybe necessary
Why should gentle prostate exam be performed in the setting of likely bacterial prostatitis
Increases risk of bacteremia
How do you manage bacterial prostatitis
Antibiotics such as Bactrim and ciprofloxacin or Levaquin for six weeks or other is STD is present. Analgesics such as NSAIDs and antipyretics,stool softeners and adequate fluids, should see improvement in symptoms in 2-6 days. if not refer to urologist. PSA will rise in response to infection, defer PSA screening by one month after treatment for infection
Symptoms or recurrent UTI are common, pain in perineum, lower abdomen or back, testicles, with ejaculation. Prostate exam is usually normal. Diagnosis maybe presumptive when persistent or recurrent bacteriuria
Chronic prostatitis
How do you treat Chronic prostatitis
Antibiotics as for acute prostate -itis which are Bactrim and a quinolone such as Levaquin. Refer to urology
What are risk factors for prostate cancer
Older age, African-American males and Jamaican males, family history of prostate cancer especially before age 65, known or likely BRCA1 & 2 gene mutations
What are assessment findings for prostate cancer
Most patients are asymptomatic, however A symmetry, induration, hard nodularity suspicious of prostate cancer even if normal PSA. Localized prostate cancers are rarely with bothersome symptoms. Prostate feels hard and or nodular during digital rectal exam. New onset erectile dysfunction
Is digital rectal exam recommended
No it is not recommended alone or with PSA. No production in morbidity or mortality you when detected by digital rectal exam. If prostate cancer is detected by digital rectal exam, it is pathologically advanced
What diagnostic studies are needed for prostate cancer
PSA elevated, Transrectal ultrasound of prostate, MRI and biopsy
What is a normal PSA
Less than 4.0
PSA greater than 10 needs
Biopsy
PSA a 4 to 10 means
Lots of overlap with BPH, almost always biopsied, referred to urology
How do you manage prostate cancer
Referred to urology
Acute scrotum is associated with
Epididymitis and testicular torsion
If a patient had bladder cancer should they be screened for prostate cancer
Yes
Inflammation of the epididymis usually occurring from ascent Of pathogens or urine from urethra. Also due to sitting for long periods of time such as truck driver, biker, computer programmer
Epididymitis
What is the most common ideology of epididymitis
Reflux of urine through the ejaculatory docs and vas into epididymis. Prolonged sitting upper body workouts, long distance runners, heavy lifting, desk job, car or plane trip.
Infectious 75% of the time chlamydia or gonorrhea but chlamydia is the most common
What assessment findings are associated with epididymitis
Gradual development of scrotal pain, epididymis very tender, enlarged, and indurated i.e. epididymis is located posterior to testicle. Urethral discharge, dysuria
What diagnostic studies are needed for epididymitis
Urine analysis which is normal in noninfectious epididymitis. Urine analysis with Pyuria think infectious. Urethral swab for discharge, ultrasound if acute onset
How do you manage noninfectious epididymitis
Treatment is conservative rest, oral fluids, scrotal support, ice, NSAIDs/analgesics
How do you treat infectious epididymitis
Ceftriaxone or Rocephin 250 mg IM plus doxycycline 100 mg b.i.d. for 10 days. Based on culture
What is the timeframe of noticing an improvement in symptoms for epididymitis
Improvement should be seen within three days. Or 72 hours. If not referred to urology. Infection and pain resolves over 2 to 4 weeks with appropriate treatment
A 26-year-old male has a scrotal mass with mild tenderness. There are bowel sounds in the scrotum. What is a likely diagnosis?
Inguinal hernia
Bowel through muscular wall
Inguinal hernia
Positive cremasteric reflex with tenderness in the epididymitis.
Epididymitis . Culture or swab to see if etiology is STI
Twisting of testes and spermatic cord resulting in testicular ischemia is not corrected
Testicular torsion
Negative cremasteric reflex. Urologic emergency. Testicular swelling and high riding testicle
Testicular torsion
Sudden onset of testicular pain, may occur after a vigorous exercise or testicular trauma. Nausea and vomiting. Testicular swelling. Tender and high riding testicle. Awakening in the middle of the night is common in children. Absent ipsilateral cremasteric reflex.
Testicle torsion
If a patient is suspected of having left testicular torsion and they have a negative Cremasteric reflex, when the Left side is stroked what should happen
Neither testicles rise
What does ipsilateral mean
Same side
What does contralateral mean
Opposite side
When should a testicular torsion they fixed and and how many hours does it take
Must correct in less than 4-6 hours. It reversible damage after 12 hours.
Testicular cancer is most common in what age group
15-35 year olds
What are some risk factors for testicular cancer
History of cryptorchidism which is undescended testes even if repaired.
Solid, firm, nontender testicular mass or nodule, sensation of fullness or heaviness in scrotum or lower abdomen, previous small testicle enlarging to size of normal testicle, hydrocele maybe present, Mass does not transilluminate
Assessment findings for testicular cancer
What diagnostic studies are given for testicular cancer
Scrotal ultrasound, biopsy. Examine using the thumb and two first fingers of the examining hands
How do you manage testicular cancer
Refer to urologist for a evaluation and treatment. Surgical intervention i.e. radical orchiectomy, radiation therapy, chemotherapy
What is the expected course for testicular cancer
Usually complete cure in patients with limited disease. Five-year survival rate greater than 90%
What is the health promotion for testicular cancer
Monthly self testicular exam starting in adolescence
What is the fastest medication for BPH symptoms with lower urinary tract symptoms
Alpha blockers are the fastest
-zosin
A 22-year-old male patient presents with a complaint of scrotal pain after a minor car accident. What must be part of the differential diagnosis?
Testicular torsion
Older to elderly male complains of a new onset of low back pain, rectal area/perennial pain and discomfort accompanied by obstructive voiding symptoms such as weaker stream and nocturia. Maybe asymptomatic. More common in older males greater than 50 years old, obese males, men with the family history of prostate cancer, and black males
Prostate cancer
School age boy complains of the abrupt onset of a blue colored round mass located on the testicular surface. The mass resembles a blue dot. The appendix testis is a round, small, pedunculated polyp like structure that is attached to the testicular surface. The blue dot is caused by infarction and necrosis of the appendix testis due to torsion. More common in childhood.
Tortious of the appendix testis
Refer to ED
What is the ideal temperature for sperm production
1 to 2°C lower than core body temperature
Where is sperm produced
Seminiferous tubules of the testes
How many days are required for sperm to mature
64 days or three months
What is cryptoorchidism
Undescended testes
Increases the risk of testicular cancer
Production of testosterone/androgens is stimulated by release of
Luteinizing hormone
Spermatogenesis is stimulated by what hormones
Testosterone and follicle-stimulating hormone
Which testicle usually hangs lower
Left
What fluid help the sperm survive in the vagina
Prostatic fluid
What is the storage area for immature sperm
Epididymis
How many months does it take for sperm to mature
Three month
Testicular torsion is common in males with which deformity
Bell clapper deformity
What drugs can worsen symptoms of BPH
Cold medications such as antihistamines, decongestants, and Caffeine
What herbal medication is used for BPH
Saw Palmetto which gives a mild improvement for some and does not work for everyone.
What is an example of a 5-alpha reductase Inhibitor
Proscar
The prostate shrinks by 50% while on which medication for BPH
Proscar
PSA has to be doubled
How can you determine the effectiveness of Proscar
Obtain PSA and multiply value by two. The value should be below baseline
What category classification is Proscar
It is a category X drug. Teratogemic. Should not be touched with bare hands of reproductive aged female
Elderly male with history of several weeks of suprapubic or perennial discomfort that is accompanied by irritative voiding symptoms such as dysuria, nocturia, and frequency. Not accompanied by systemic symptoms. Some men are asymptomatic
Chronic bacterial prostatitis
What bacteria could be found in the urine of a patient with chronic bacterial prostatitis
E. coli
What labs are needed for chronic bacterial prostatitis
Urine and prostatic fluid cultures. Use three tubes: first, urethra; second, bladder; third, urine with prostatic fluid (obtained after prostatic massage). PSA will be elevated due to inflammation
What is the most common non-sexually transmitted bacteria that causes acute prostatitis
Enterobacter
If acute prostatitis occurs in a male under 35 years old, it is treated like
Gonococcal or chlamydial urethritis
Adult to older male complains of sudden onset of high fever and chills with suprapubic and or perennial pain/discomfort. Pain sometimes radiates to back or rectum. Accompanied by UTI symptoms such as dysuria, frequency, nocturia with cloudy urine. Digital rectal exam reveals extremely tender prostate that is warm and boggy
Acute prostatitis
If a prostate is warm and tender what is this usually associated with
Acute prostatitis
What must you be careful of while examining the prostate of a patient with acute prostatitis
Septicemia because vigorous palpation and massage of an infected prostate can cause this
What labs are needed for acute prostatitis
CBC which will show leukocytosis with shift to the left. Urine analysis will show large amounts of white blood cells i.e. pyuria and hematuria. Urine culture and sensitivity
How do you treat a patient under the age of 35 with acute prostatitis
Treat with ceftriaxone 250 mg I M and doxycycline 100 mg b.i.d. for 10 days
How do you treat a patient greater than 35 years of age for acute prostatitis
Treat with ciprofloxacin PO twice daily or levofloxacin PO daily for 4 to 6 weeks
Can treat with Bactrim if allergic to quinolone
In what kind of prostatitis does the prostate feel normal and it occurs with a gradual onset
Chronic prostatitis
In what kind of prostatitis is it a sudden onset with the prostate that is swollen and very tender in younger males
Acute prostatitis
With acute bacterial epididymitis what also must be ruled out
Testicular torsion
And males less than 35 years old what is the most likely cause of acute bacterial epididymitis
Chlamydia or gonorrhea
In males more than 35 years of age what is the most likely cause of acute bacterial epididymitis
E. coli
Adult to older male complains of acute onset of a swollen red scrotum that hurts. Accompanied by unilateral testicular tenderness with urethral discharge. Scrotum is swollen and erythematous with induration of the Posterior epididymis. Sometimes may be accompanied by a hydrocele, and symptoms of UTI. Some will have some systemic symptoms such as fever.
Acute bacterial epididymitis
Relief of pain with scrotal elevation
Positive Prehn’s sign
Found with acute bacterial epididymitis
What medications cause erectile dysfunction
SSRIs and beta blockers
What is the first line drug for erectile dysfunction
Phosphodiesterase type 5 inhibitors
Viagra & Levitra which must be taken on an empty stomach.
What are adverse effects of Viagra, Levitra and cialis
Headache, facial flushing, dizziness, hypotension, nasal congestion, Priapism
What are contraindications for viagra, levitra and cialis
Nitrates. Caution with alpha blockers, recent post myocardial infarction, post CVA, major surgery, or any condition where exertion is contra indicated
An inflammatory and localized disorder of the penis that results in fibrotic plaques on the Tunica albuginea. Results in penile pain that primarily occurs during erection, palpable nodule’s, and penile deformity i.e. crooked penile erection. May resolve spontaneously or worsen over time
Peyronies Disease
Refer to urology
Candidal infection of the glans penis that is more common in uncircumcised men, diabetics, and immunocompromise males. Male yeast infection
Balantis
Treated with -Azole creams. If partner has candidiasis treat at the same time
Foreskin cannot be pushed back from the glans penis because of edema; usually seen in the neonates
Phimosis
If varicocele is found in a patient, what test should be ordered
Ultrasound
What instructions should be given to a patient that is taking Viagra or Levitra
Take on an empty stomach
What is the sequence of obtaining specimens when prostate infection is suspected
Voided urethral urine
Voided mid stream bladder urine
Voided post prostate massage urine
An 86-year-old Caucasian male requests screening for prostate cancer. What is the best approach to his request?
Give him objective information about the potential benefits of early detection and treatment
The most commonly recommended method for prostate cancer screening in a 55-year-old male is
Digital rectal exam and PSA
