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NP Prep > Mens Health > Flashcards

Mens Health Flashcards

1
Q

What condition gives a negative cremasteric reflex?

A

Testicular torsion

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2
Q

What condition gives a positive cremasteric reflex?

A

Epididymitis

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3
Q

What condition plagues truck drivers or people that sit for prolonged periods of time?

A

Epididymitis

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4
Q

A firm, smooth, And symmetrically enlarged prostate is associated with?

A

BPH

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5
Q

An enlarged, boggy, and tender prostate is indicative of?

A

Acute prostatitis

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6
Q

A hardened, asymmetric, and nodular prostate is associated with?

A

Prostate cancer

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7
Q

What condition is a risk factor for testicular cancer?

A

Cryptorchidism

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8
Q

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.

A

Priapism

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9
Q

Noncancerous enlargement of the prostate gland

A

BPH

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10
Q

BPH almost never occurs and then prior to age

A

30 years

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11
Q

Lower urinary tract symptoms are associated with

A

BPH

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12
Q

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

A

Assessment findings of lower urinary tract symptoms and BPH

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13
Q

Lower urinary tract sit symptoms are due to

A

BPH, prostate infection, UTI

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14
Q

What are factors affecting PSA

A

Ejaculation (resolved within 24 hours)
Cycling
Prostate infection
Massage

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15
Q

A protein produced in the prostate gland when it’s active

A

PSA

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16
Q

What can be the causes of an elevated PSA

A

BPH, prostate cancer, prostate infection

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17
Q

How do you manage BPH

A

Alpha blockers such as Terszosin, Tamsulodin, and Doxazosin

5 alpha reductase inhibitors such as Dutasterude and Finasteride

PDE-5 Inhibitor such as Tadalafil (Cialis)

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18
Q

Alpha blockers can cause what when taken at night

A

Orthostatic hypotension

-zosin

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19
Q

If you are allergic to sulfa what alpha blocker can you not take

A

Flomax or tamsulosin

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20
Q

What type of Alpha blockers need Reno and hepatic dose adjustments

A

Uroxatral (Alfuzosin)

Silodosin (Rapaflo)

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21
Q

Pain in the perineum, lower abdomen, testes, or penis. Pain with ejaculation, voiding difficulty. think bacterial, consider STD

A

Acute prostatitis

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22
Q

What can cause acute prostatitis

A

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

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23
Q

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

A

Acute prostatitis

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24
Q

How do you evaluate acute prostatitis

A

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

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25
Q

Why should gentle prostate exam be performed in the setting of likely bacterial prostatitis

A

Increases risk of bacteremia

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26
Q

How do you manage bacterial prostatitis

A

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

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27
Q

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

A

Chronic prostatitis

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28
Q

How do you treat Chronic prostatitis

A

Antibiotics as for acute prostate -itis which are Bactrim and a quinolone such as Levaquin. Refer to urology

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29
Q

What are risk factors for prostate cancer

A

Older age, African-American males and Jamaican males, family history of prostate cancer especially before age 65, known or likely BRCA1 & 2 gene mutations

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30
Q

What are assessment findings for prostate cancer

A

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

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31
Q

Is digital rectal exam recommended

A

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

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32
Q

What diagnostic studies are needed for prostate cancer

A

PSA elevated, Transrectal ultrasound of prostate, MRI and biopsy

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33
Q

What is a normal PSA

A

Less than 4.0

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34
Q

PSA greater than 10 needs

A

Biopsy

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35
Q

PSA a 4 to 10 means

A

Lots of overlap with BPH, almost always biopsied, referred to urology

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36
Q

How do you manage prostate cancer

A

Referred to urology

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37
Q

Acute scrotum is associated with

A

Epididymitis and testicular torsion

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38
Q

If a patient had bladder cancer should they be screened for prostate cancer

A

Yes

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39
Q

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

A

Epididymitis

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40
Q

What is the most common ideology of epididymitis

A

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

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41
Q

What assessment findings are associated with epididymitis

A

Gradual development of scrotal pain, epididymis very tender, enlarged, and indurated i.e. epididymis is located posterior to testicle. Urethral discharge, dysuria

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42
Q

What diagnostic studies are needed for epididymitis

A

Urine analysis which is normal in noninfectious epididymitis. Urine analysis with Pyuria think infectious. Urethral swab for discharge, ultrasound if acute onset

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43
Q

How do you manage noninfectious epididymitis

A

Treatment is conservative rest, oral fluids, scrotal support, ice, NSAIDs/analgesics

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44
Q

How do you treat infectious epididymitis

A

Ceftriaxone or Rocephin 250 mg IM plus doxycycline 100 mg b.i.d. for 10 days. Based on culture

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45
Q

What is the timeframe of noticing an improvement in symptoms for epididymitis

A

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

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46
Q

A 26-year-old male has a scrotal mass with mild tenderness. There are bowel sounds in the scrotum. What is a likely diagnosis?

A

Inguinal hernia

47
Q

Bowel through muscular wall

A

Inguinal hernia

48
Q

Positive cremasteric reflex with tenderness in the epididymitis.

A

Epididymitis . Culture or swab to see if etiology is STI

49
Q

Twisting of testes and spermatic cord resulting in testicular ischemia is not corrected

A

Testicular torsion

50
Q

Negative cremasteric reflex. Urologic emergency. Testicular swelling and high riding testicle

A

Testicular torsion

51
Q

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.

A

Testicle torsion

52
Q

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

A

Neither testicles rise

53
Q

What does ipsilateral mean

A

Same side

54
Q

What does contralateral mean

A

Opposite side

55
Q

When should a testicular torsion they fixed and and how many hours does it take

A

Must correct in less than 4-6 hours. It reversible damage after 12 hours.

56
Q

Testicular cancer is most common in what age group

A

15-35 year olds

57
Q

What are some risk factors for testicular cancer

A

History of cryptorchidism which is undescended testes even if repaired.

58
Q

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

A

Assessment findings for testicular cancer

59
Q

What diagnostic studies are given for testicular cancer

A

Scrotal ultrasound, biopsy. Examine using the thumb and two first fingers of the examining hands

60
Q

How do you manage testicular cancer

A

Refer to urologist for a evaluation and treatment. Surgical intervention i.e. radical orchiectomy, radiation therapy, chemotherapy

61
Q

What is the expected course for testicular cancer

A

Usually complete cure in patients with limited disease. Five-year survival rate greater than 90%

62
Q

What is the health promotion for testicular cancer

A

Monthly self testicular exam starting in adolescence

63
Q

What is the fastest medication for BPH symptoms with lower urinary tract symptoms

A

Alpha blockers are the fastest

-zosin

64
Q

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?

A

Testicular torsion

65
Q

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

A

Prostate cancer

66
Q

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.

A

Tortious of the appendix testis

Refer to ED

67
Q

What is the ideal temperature for sperm production

A

1 to 2°C lower than core body temperature

68
Q

Where is sperm produced

A

Seminiferous tubules of the testes

69
Q

How many days are required for sperm to mature

A

64 days or three months

70
Q

What is cryptoorchidism

A

Undescended testes

Increases the risk of testicular cancer

71
Q

Production of testosterone/androgens is stimulated by release of

A

Luteinizing hormone

72
Q

Spermatogenesis is stimulated by what hormones

A

Testosterone and follicle-stimulating hormone

73
Q

Which testicle usually hangs lower

A

Left

74
Q

What fluid help the sperm survive in the vagina

A

Prostatic fluid

75
Q

What is the storage area for immature sperm

A

Epididymis

76
Q

How many months does it take for sperm to mature

A

Three month

77
Q

Testicular torsion is common in males with which deformity

A

Bell clapper deformity

78
Q

What drugs can worsen symptoms of BPH

A

Cold medications such as antihistamines, decongestants, and Caffeine

79
Q

What herbal medication is used for BPH

A

Saw Palmetto which gives a mild improvement for some and does not work for everyone.

80
Q

What is an example of a 5-alpha reductase Inhibitor

A

Proscar

81
Q

The prostate shrinks by 50% while on which medication for BPH

A

Proscar

PSA has to be doubled

82
Q

How can you determine the effectiveness of Proscar

A

Obtain PSA and multiply value by two. The value should be below baseline

83
Q

What category classification is Proscar

A

It is a category X drug. Teratogemic. Should not be touched with bare hands of reproductive aged female

84
Q

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

A

Chronic bacterial prostatitis

85
Q

What bacteria could be found in the urine of a patient with chronic bacterial prostatitis

A

E. coli

86
Q

What labs are needed for chronic bacterial prostatitis

A

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

87
Q

What is the most common non-sexually transmitted bacteria that causes acute prostatitis

A

Enterobacter

88
Q

If acute prostatitis occurs in a male under 35 years old, it is treated like

A

Gonococcal or chlamydial urethritis

89
Q

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

A

Acute prostatitis

90
Q

If a prostate is warm and tender what is this usually associated with

A

Acute prostatitis

91
Q

What must you be careful of while examining the prostate of a patient with acute prostatitis

A

Septicemia because vigorous palpation and massage of an infected prostate can cause this

92
Q

What labs are needed for acute prostatitis

A

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

93
Q

How do you treat a patient under the age of 35 with acute prostatitis

A

Treat with ceftriaxone 250 mg I M and doxycycline 100 mg b.i.d. for 10 days

94
Q

How do you treat a patient greater than 35 years of age for acute prostatitis

A

Treat with ciprofloxacin PO twice daily or levofloxacin PO daily for 4 to 6 weeks
Can treat with Bactrim if allergic to quinolone

95
Q

In what kind of prostatitis does the prostate feel normal and it occurs with a gradual onset

A

Chronic prostatitis

96
Q

In what kind of prostatitis is it a sudden onset with the prostate that is swollen and very tender in younger males

A

Acute prostatitis

97
Q

With acute bacterial epididymitis what also must be ruled out

A

Testicular torsion

98
Q

And males less than 35 years old what is the most likely cause of acute bacterial epididymitis

A

Chlamydia or gonorrhea

99
Q

In males more than 35 years of age what is the most likely cause of acute bacterial epididymitis

A

E. coli

100
Q

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.

A

Acute bacterial epididymitis

101
Q

Relief of pain with scrotal elevation

A

Positive Prehn’s sign

Found with acute bacterial epididymitis

102
Q

What medications cause erectile dysfunction

A

SSRIs and beta blockers

103
Q

What is the first line drug for erectile dysfunction

A

Phosphodiesterase type 5 inhibitors

Viagra & Levitra which must be taken on an empty stomach.

104
Q

What are adverse effects of Viagra, Levitra and cialis

A

Headache, facial flushing, dizziness, hypotension, nasal congestion, Priapism

105
Q

What are contraindications for viagra, levitra and cialis

A

Nitrates. Caution with alpha blockers, recent post myocardial infarction, post CVA, major surgery, or any condition where exertion is contra indicated

106
Q

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

A

Peyronies Disease

Refer to urology

107
Q

Candidal infection of the glans penis that is more common in uncircumcised men, diabetics, and immunocompromise males. Male yeast infection

A

Balantis

Treated with -Azole creams. If partner has candidiasis treat at the same time

108
Q

Foreskin cannot be pushed back from the glans penis because of edema; usually seen in the neonates

A

Phimosis

109
Q

If varicocele is found in a patient, what test should be ordered

A

Ultrasound

110
Q

What instructions should be given to a patient that is taking Viagra or Levitra

A

Take on an empty stomach

111
Q

What is the sequence of obtaining specimens when prostate infection is suspected

A

Voided urethral urine
Voided mid stream bladder urine
Voided post prostate massage urine

112
Q

An 86-year-old Caucasian male requests screening for prostate cancer. What is the best approach to his request?

A

Give him objective information about the potential benefits of early detection and treatment

113
Q

The most commonly recommended method for prostate cancer screening in a 55-year-old male is

A

Digital rectal exam and PSA

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