Module 7 common health concerns middle aged man

Question 1

Prostate and urethra

Answer 1

urethra runs through the center of the prostate

Question 2

BPH s/s

Answer 2

urinary frequency
urgency 
urinary difficulty
nocturia
difficulty starting urination/hesitancy 
dribbling
decreased force
straining WITH incomplete bladder emptying

Question 3

Dx of BPH

Answer 3

through symptoms scores/tools
physical exam: GU including DRE
UA to exclude UTI
Bladder scan for post-void residual

Question 4

BPH labs

Answer 4

UA
creatinine
PSA

Question 5

BPH behavior modifications

Answer 5

dec. fluids before bed
look at current medication regimen
limit use of ETOH and caffeine

Question 6

BPH Rx

Answer 6

alpha blockers: smooth muscle relaxers
a-adrenergic antagonist
5a reductase inhibitors
phosphodiesterase type 5 inhibitors

Question 7

Etiologies of sexual dysfunction

Answer 7

vascular: 40%
diabetes: 30%
medication: 15%
pelvic surgery, radiation or trauma: 6%
neurological: 5%
endocrine: 3%
other: 1%

Question 8

sexual dysfunction hx

Answer 8

onset, duration, circumstances
erection quality
changes to libido, curvature
multiple partners? 
PMH

Question 9

sexual dysfunction dx

Answer 9

Hx and physical exam
physical exam
- genital anatomy and identify any abnormalities
– testicular atrophy, gynecomastia, hyper/hypothyroidism
– pulses in BLE, vascular skin changes, femoral bruit
Diagnostic
- treat any underlining cause: hormone, A1C, testosterone

Question 10

sexual dysfunction Rx

Answer 10

phosphodiesterase-5 inhibitors
Referral: urology, counseling
Lifestyle: no ETOH/drugs before sex

Question 11

male hypogonadism s/s

Answer 11

Low Testosterone 
reduced libido/erectile dysfunction 
reduced muscle mass and strength 
inc. adiposity: around trunk
osteoporosis/low bone mass
depressed mood 
fatigue

Question 12

male hypogonadism causes

Answer 12

Primary
- injury, infection, loss of testicles
- chemo or radiation 
- genetic: klinefelter
Secondary
- age
- genetic conditions
- pituitary tumors
- medications
- alcohol 
- corticosteroids
- chronic disease

Question 13

male hypogonadism dx

Answer 13

testosterone levels
- bound vs unbound
FSH and LH

Question 14

Hypogonadism management

Answer 14

pharmacologic:
- injectable meds, gels, patches
Contraindications:
- breast/prostate cancer
Caution:
- BPH, LUTS, cardiac/renal/hepatic disease
- Can worsen sleep apnea
Other considerations
- expensive
- mood swings

Question 15

testosterone hormone replacement

Answer 15

initially hormone levels will decrease because testicles stop production of testosterone

Question 16

Disorders of desire

Answer 16

reduced libido
- biologic
- psychologic
- sociocultural factors
Testosterone, androgen, and DHEA hormones
- screening for hypogonadism at 50

Question 17

pathophysiology of erection

Answer 17

chemical mediators cause relaxation and perfusion of the corpora cavernosa and corpus spongiosum

• > vein compression to prevent venous outflow
• > maintained erection

Question 18

disorders of excitement psychogenic

Answer 18

performance anxiety
guilt
strict religious constraints
significant life events
mood
past traumas

Question 19

disorders of excitement hormonal

Answer 19

testosterone deficiency 
- hypothalamic or pituitary tumors 
- suppressed testosterone tx: prostate cancer
hyperprolactinemia
hyperthyroidism
hypothyroidism
cushing syndrome
addison disease

Question 20

disorders of excitement CV

Answer 20

CV disorders can lead to

• failure to initiate erections
• failure to achieve erection
• failure to sustain erection

Question 21

disorders of excitement pharmacologic

Answer 21

antiHTN
antidepressants
major tranquilizers

Question 22

disorders of excitement surgical

Answer 22

radical prostatectomy
radical cystectomy
abdominal-perineal resection

Question 23

disorders of excitement alcohol/opioid use

Answer 23

men with heroin addiction or who are on methadone or buprenorphine show higher rate of sexual dysfunction

Question 24

Disorders of orgasm

Answer 24

low testosterone 
neurologic diseases
head and spinal cord injuries 
Medications: 
- HTN
- antidepressants
- anxiolytics
- antipsychotics
Alcohol