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Clin Med II > Mens Health > Flashcards

Mens Health Flashcards

1
Q

Proliferation of fibrostromal tissue in the transitional zone that can lead to compression of the prostatic urethra is known as what?

A

BPH

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2
Q

What is the most common benign tumor in men 40-80 yo?

A

BPH

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3
Q

What condition that can cause nocturia is a RF for BPH?

A

T2DM

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4
Q

Pt presents with at least 3 months of bothersome urinary symptoms and recurrent UTIs with gross hematuria. What are you concerned for?

A

BPH

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5
Q

What tests are used for the diagnosis of BPH?

A

DRE, UA, PSA (prostate specific antigen), BUN/ creatinine

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6
Q

What is 1st line tx for BPH?

A

Alpha-1-adrenergic antagonists (alpha blockers) Tamsulosin, doxazosin, terazosin

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7
Q

Besides alpha blockers, what other things are used for the tx of BPH? (2)

A

Behavior modification (decrease factors that will limit frequency of urination) 5-alpha reductase inhibitors

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8
Q

What are common SE’s of alpha blockers (tx of BPH)? (3)

A

Orthostatic hypotension, dizziness, ED

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9
Q

What are common SE’s of 5-alpha reductase inhibitors (tx of BPH)? (2)

A

↓ libido, sexual dysfunction

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10
Q

TURP, TUNA, TUMT, prostatic stent, suprapubic prostatectomy are all surgical tx options for what condition?

A

BPH

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11
Q

What disease is characterized as an acute infection of the prostate that typically occurs in young and middle-aged men via the urethra and is usually caused by typical urinary pathogens?

A

Acute bacterial prostatitis

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12
Q

Delay of therapy for acute bacterial prostatitis can lead to what complications?

A

Sepsis, abscess, metastatic infection

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13
Q

How can acute bacterial prostatitis be differentiated from a UTI?

A

Tender and edematous prostate on DRE (gentle)

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14
Q

What is the treatment for acute bacterial prostatitis if toxic?

A

Admit to hospital and start IV abx

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15
Q

If a pt is stable and reliable, they are treated outpatient for the tx of acute bacterial prostatitis. What meds should be prescribed?

A

Fluoroquinolone (levo, cipro) or Bactrim for 6 weeks

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16
Q

Should you receive a repeat urine culture after abx treatment of acute bacterial prostatitis?

A

Yes, after 7 days

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17
Q

What disease is classified as chronic or recurrent urogenital sxs (recurrent UTI) with evidence of bacterial infection of the prostate but generally subtle sxs?

A

Chronic bacterial prostatitis

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18
Q

What will prostate exam of a pt with chronic bacterial prostatitis reveal?

A

Usually normal (may reveal tenderness or hypertrophy)

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19
Q

What is the gold standard for dx of chronic bacterial prostatitis?

A

Prostatic fluid analysis (but more often dx based on hx)

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20
Q

What is the 1st line treatment for chronic bacterial prostatitis?

A

Fluoroquinolone for minimum of 6 weeks (Bactrim is alt and recurrent treated the same)

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21
Q

What condition is defined as chronic pelvic pain for at least 3 of the preceding 6 months in the absence of other identifiable causes?

A

Chronic prostatitis/ chronic pelvic pain syndrome

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22
Q

Prevalence of chronic prostatitis/ chronic pelvic pain syndrome?

A

Peaks in 5th decade

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23
Q

What is the etiology for chronic prostatitis/ chronic pelvic pain syndrome?

A

Unknown

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24
Q

What will be found on PE (complete genital and rectal exam) of a pt with chronic prostatitis/ chronic pelvic pain syndrome?

A

Prostate non-tender or mildly tender

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25
Q

What tests should be performed if you are suspicious for chronic prostatitis/ chronic pelvic pain syndrome?

A

UA, culture, imaging (to r/o other etiologies)

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26
Q

Chronic prostatitis/ chronic pelvic pain syndrome is typically considered a dx of what?

A

Dx of exclusion

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27
Q

Pt presents with hx of pain, blood in semen with relapsing-remitting pattern over many months. What should you be concerned for?

A

Chronic prostatitis/ chronic pelvic pain syndrome

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28
Q

Although there is no uniformly accepted treatment regimen for chronic prostatitis/ chronic pelvic pain syndrome, what is typically considered?

A

Alpha blockers, abx, 5-alpha-reductase inhibitors (used in combo)

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29
Q

What is the most common cancer diagnosed in men in the age group of 60-79 yo?

A

Prostate cancer

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30
Q

The majority of prostate cancers are diagnosed subsequent to what?

A

Elevated PSA or abn DRE

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31
Q

Who should be screened for prostate cancer?

A

> 10 years life expectancy, FH, black men

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32
Q

Sxs of urinary frequency, urgency, nocturia, and hesitancy (concomitant to BPH) are concerning for what?

A

Prostate caner

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33
Q

What are the sxs of advanced prostate cancer?

A

Bone pain, fatigue, weight loss

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34
Q

If on DRE you note a nodular prostate or asymmetric prostate, what might you be concerned about?

A

Prostate caner

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35
Q

If a pt has an abnormal prostate exam/ abnormal PSA, what should your next step be for possible dx of prostate cancer?

A

Prostate bx (transrectal US guided)

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36
Q

DRE can only detect tumors in which aspects of the gland?

A

Posterior and lateral

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37
Q

What 2 methods are used for staging of prostate cancer?

A

Tumor node metastases (TNM) system Gleason score (histological grading)

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38
Q

Although treatment of prostate cancer is patient specific, what are some of the more common options? (4)

A

Observation Radical prostatectomy (RP) Radiation therapy Androgen deprivation therapy

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39
Q

How often should surveillance be performed after treatment of prostate cancer?

A

Total PSA every 6-12 mos x 5 yrs then annually

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40
Q

If PSA rises on surveillance after treatment of prostate cancer, what should you do?

A

Refer

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41
Q

What is the procedure for recurrence of prostate cancer or for metastatic work-up?

A

PSA every 3-6 mos

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42
Q

What is defined as the inability to attain or maintain a penile erection that is satisfactory for sexual performance?

A

ED

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43
Q

The lowest prevalence of ED is found in what population?

A

Active males, no chronic medical conditions, healthy lifestyle

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44
Q

DRE, evaluation of secondary sex characteristics, femoral and peripheral pulses, breast exam and testicular volume should be included on exam for what?

A

ED

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45
Q

What additional tests can be preformed if trying to determine if ED is psychogenic or organic cause? (2)

A
  1. Nocturnal tumescence (if you get erection while asleep, ED is due psychogenic cause) 2. Duplex doppler: ID arterial obstruction or venous leak
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46
Q

First line treatment for ED?

A

Tx underlying cause (psychotherapy, T therapy, meds, lifestyle)

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47
Q

First line medication for ED?

A

PDE-5 inhibitors (sildenafil, vardenafil, tadalafil, avanafil)

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48
Q

What are the 2nd line txs for ED? (3)

A

Vacuum erection device Penile self injections Intraurethral suppository

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49
Q

What is 3rd line tx for ED?

A

Penile prosthesis/surgery

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50
Q

In what population is urethritis most common?

A

Young, sexually active males

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51
Q

What is the pathogen that causes Gonococcal urethritis

A

Neisseria gonorrhoeae

52
Q

25 y/o sexually active male presents with dysuria and urethral discharge, what disease are you concerning about?

A

Urethritis: inflammation or infection of the urethra

53
Q

What two tests do you do to DX urethritis?

A

Gram stain of urethral secretions (purulent discharge) –> Gram-negative diplococci First void urine for NAAT

54
Q

If pt w/ gonococcal urethritis what is the tx?

A

Ceftriaxone 250 IM + Azithromycin 1000 mg X 1 dose (If PCN allergy, Gentamycin 240 mg IM _ Azithromycin 2 g X 1 dose) * Also tx partner

55
Q

TX for non-gonococcal urethritis?

A

Azithromycin 1 gm orally or Doxyclycine 100 mg PO BID x 7 days * Also tx partner

56
Q

Is retest needed if tx w/ 1st line regimen?

A

No

57
Q

Infection of epididymis via vas deferens is what?

A

Epididymitis

58
Q

In young men, what is the likely cause of epididymitis?

A

STD (chlamydia, gonorrhhea)

59
Q

In older men, what is the likely cause of epididymitis?

A

Urinary pathogens

60
Q

35 y/o M pt presents with acute, unilateral, severe scrotal pain radiating to ipsilateral flank what are you concerned for? What test will be positive on exam?

A

Epididymitis (PE: + hemi-scrotal swelling, TTP, can progress to erythematous fluctuant mass) + Prrehn’s sign

61
Q

If epididymitis is NOT tx, what can result?

A

Orchitis (viral/bacterial inflammation of the testicles), abscess, infertility

62
Q

DX test of choice for epididymitis?

A

Scrotal US (eval for testicular torsion, abscess)

63
Q

TX for for epididymitis if suspicious for Chlamydia, N. gonorrhea?

A

Ceftriaxone 250 mg IM x 1 and Doxycycline 100 mg BID x 10 days

64
Q

TX for for epididymitis if suspicious for enteric organism?

A

Levofloxacin 500 mg QD x 10 days or Ofloxacin 300 mg BID for 10 days

65
Q

What adjunct therapy can you recommend for pain relief w/ epididymitis?

A

NSAIDS

66
Q

Infection is caused by retrograde infection into the testicles?

A

Epidiymoorchitis

67
Q

M pt presents w/ mumps, acute, ipsilateral testicular swelling and tenderness? What are concerned about?

A

Epidiymoorchitis

68
Q

If pt with mumps, what is the tx?

A

Supportive care

69
Q

If pt w/ bacterial epidiymoorchitis how do you treat?

A

SAME as epididymitis: Chlamydia, N. gonorrhea: Ceftriaxone 250 mg IM x 1 and Doxycycline 100 mg BID x 10 days Enteric organism: Levofloxacin 500 mg QD x 10 days or Ofloxacin 300 mg BID for 10 days

70
Q

Varicocele is typically more common in left or right spermatic vein?

A

Left (b/c longer, but can occur bilaterally)

71
Q

If pt w/ presents w/ varicocele only to right spermatic cord, what should you be concerned about?

A

Pelvic/abd malignancy

72
Q

What is imaging of choice for varicocele if no decompression in recumbent position?

A

CT scan (evaluating for outlet obstruction) Also: Doppler Scrotal US

73
Q

What is the tx for varicocele?

A

Ligation of spermatic vein if sx, infertility concerns, testicular atrophy Supportive care if mild sx, no reproductive concern

74
Q

Testicular torsion is concerning for what with regards to the testicle?

A

Compromised circulation –> ischemia

75
Q

What populations are at greatest right for testicular torsion?

A

Neonates, post-pubertal boys

76
Q

2 most common precipitating factors of testicular torsion?

A

Vigorous physical activity, minor trauma

77
Q

19 y/o M presents with acute onset of unilateral scrotal pain w/ hemi scrotal swelling what are you concerned about?

A

Testicular torsion

78
Q

On exam of scrotum you find TTP, bell-clapper deformity, - prehn’s, and negative cremasteric reflex on left testicle. What is you suspected dx?

A

Testicular torsion?

79
Q

What imaging is used to dx testicular torsion?

A

Scrotal US (limited or loss of BF to spermatic cord)

80
Q

TX for testicular torsion?

A

Urologic emergency –> Surgery Last ditch effort: manual detorsion (if successful, pt will have pain relief)

81
Q

What is the most common cancer of young men?

A

Testicular cancer? HINT: YMCA “Young men CA”

82
Q

Hx of testicular CA, cryptorchidism, Klinefelter syndrome and + FHX are risk factors for what form of cancer?

A

Testicular cancer

83
Q

30 y/o M presents w/ painless, solid testicular swelling/nodule. He reports dull arch/heavy sensation in lower abd and scrotum. On exam you find inguinal or para-aortic lymphadenopathy. What is your presumed DX?

A

Testicular CA (Always examine unaffected testicle first)

84
Q

If you find a firm, hard, fixed area on testicular exam, what is your concern until proven otherwise?

A

Testicular CA

85
Q

What lymph node locations should you check if you are concerning about testicular CA?

A

Inguinal, para-aortic, supraclavicular

86
Q

beta HCG, LDH, and AFP are tumor markers for what?

A

Testicular CA

87
Q

Imaging for dx of testicular CA?

A

Scrotal US, CT abd/pelvis

88
Q

Testicular tumors are primary made of what cell type?

A

Germ cells

89
Q

Are seminoma or nonseminoma tumors more common in testicular cancer?

A

Nonseminoma: 65% (radiosensitive) Seminoma 35% (radioresistant)

90
Q

Are seminoma or nonseminoma tumors radiosensitive? What is this used for?

A

Seminatous Used w/ nerve sparing retroperitoneal lymph node dissection for tumor staging

91
Q

What should you offer to a pt prior to starting tx for testicular CA?

A

Sperm banking

92
Q

Radical inguinal ochiectomy, radiation and chemo are used in the treatment of what?

A

Testicular CA

93
Q

What condition is characterized as involuntary leakage of urine and has an increased prevalence as age increases?

A

Incontinence

94
Q

What are the 4 groups of incontinence?

A

Urge incontinence, stress incontinence, mixed, incomplete emptying incontinence (overflow)

95
Q

Which group of incontinence is uncontrolled loss of urine preceded by a strong, unexpected urge to void that involves uninhibited bladder contractions?

A

Urge incontinence

96
Q

Stress incontinence is defined as leakage with exertion (Valsalva) due to dysfunction of what structure?

A

Urinary sphincter

97
Q

What is the most common cause of stress incontinence?

A

Prostate surgery

98
Q

Feelings of urgency and exertional leakage is defined as what group of incontinence?

A

Mixed incontinence

99
Q

Impaired detrusor contractility and/or bladder outlet obstruction can lead to what group of incontinence and typically present with what sx?

A

Incomplete emptying incontinence (overflow), nocturnal enuresis

100
Q

If a pt presents with incontinence, in additional to a detailed genital and rectal exam, what other systems would you want to evaluate on PE?

A

CV, abdominal, neuro

101
Q

The following labs/ studies would be ordered if you were suspicious of what condition? UA, culture, BUN/ creatinine, PSA, postvoid residual volume, urine flow rate, urodynamic testing, bladder diary

A

Incontinence

102
Q

What is the treatment for urgency incontinence? With or without BPH?

A

No BPH = antimuscarinic (tolterodine, fesoterodine, oxybutynin) BPH = alpha blockers (tamulosin, doxazosin, terazosin)

103
Q

What is the treatment for stress incontinence?

A

Condom catheters, penile clamp, surgery (surgical options = transurethral bulking agents, perineal sling, artificial urinary sphincter)

104
Q

What is the treatment for overflow incontinence?

A

Alpha blockers

105
Q

Incontinence with presence of any of the following is considered what and is managed how? Severe sxs, pelvic pain, hematuria, elevated PSA/ abn prostate exam, recurrent urologic infections, previous pelvic radiation/ surgery, neurologic disease

A

Complicated incontinence, refer to urologist

106
Q

What is the second most common urologic malignancy that is most common in men and associated with tobacco use and exposure to chemical dyes?

A

Bladder cancer

107
Q

What are the most to least common types of bladder cancer? (3)

A

Transitional cell carcinoma > SCC > adenocarcinoma

108
Q

Why is dx of bladder cancer often delayed?

A

Misdx of other urinary pathology

109
Q

Although PE of a pt with bladder cancer is usually unremarkable, what should be performed to look for induration of prostate?

A

DRE (also lymph system and abd exam)

110
Q

If a pt presents with painless gross hematuria or microscopic hematuria +/- obstructive or irritative urinary sxs, what should you be concerned for?

A

Bladder cancer

111
Q

Local advancement of bladder cancer may present with what condition?

A

Para-aortic lymphadenopathy

112
Q

Pt with bladder cancer and hepatomegaly, supraclavicular lymphadenopathy, or periumbilical nodules is concerning for what?

A

Metastasis (with pain consistent with areas of invasion or metastasis)

113
Q

What is the gold standard for dx and staging of bladder cancer?

A

Cystourethroscopy

114
Q

Although cystourethroscopy is gold standard for dx of bladder cancer, what other tests can be helpful?

A

UA, urine cytology/ urine-based tumor markers, CT w/ urography

115
Q

What is the treatment for bladder cancer? What if it is high grade? What is muscle invasive?

A

Transurethral resection of tumor High grade require intra-vesical chemo Neoadjuvant systemic chemo prior to radical cystectomy

116
Q

What condition is defined as a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it?

A

Hernia

117
Q

What type of inguinal hernia protrudes through Hesselbach’s triangle and is due to weakness in the floor of the inguinal canal?

A

Direct

118
Q

What type of inguinal hernia develops at the internal inguinal ring and can travel through inguinal canal into the scrotum?

A

Indirect

119
Q

Where does a femoral hernia occur?

A

Medial aspect of femoral canal

120
Q

What type of inguinal hernia is most common, most common the R side, and is commonly congenital (although doesn’t present until later in life)?

A

Indirect

121
Q

What type of inguinal hernia is the least common (although more common in women) and is most likely to become incarcerated/ strangulated?

A

Femoral

122
Q

If a pt presents with heaviness/ discomfort with straining, N/V, abd distension, pain, redness, and a painless bulge on PE, what should you be concerned for?

A

Inguinal hernia

123
Q

Aside from typical inguinal hernia findings, what additional findings will be noted for a pt with an incarcerated/ strangulated hernia?

A

Fever, +/- bowel obstruction, peritonitis, toxic appearance

124
Q

What should be used to help with dx of an inguinal hernia if in doubt or you are trying to r/o other conditions?

A

US

125
Q

What is the definitive treatment for inguinal hernias?

A

Surgical (repair urgent if incarcerated/ strangulated)

126
Q

If an inguinal hernia is reducible, what is the next step of treatment/ management?

A

Elective surgery is viable

127
Q

When is watchful waiting appropriate for the management of an inguinal hernia?

A

Minimal or no sxs

Clin Med II (12 decks)

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