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