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Clin Med II - Exam 4 > Paulson - Male GU > Flashcards

Paulson - Male GU Flashcards

1
Q

consistent inability to maintain an erect penis w. sufficient rigidity to allow for intercourse

A

erectile dysfunction

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2
Q

mc sexual problem in men

A

erectile dysfunction

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3
Q

5 things required for an erection

A

intact parasympathetic and somatic nerve supply

unobstructed arterial inflow

adequate venous constriction

hormonal stimulation

psychological desire

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4
Q

rf for ED (6)

A
  1. sedentary
  2. obesity
  3. smoking
  4. medical comorbidities
  5. watching TV
  6. lower frequency of sexual activity
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5
Q

comorbities associated w. ED (8)

A

DM

HTN

obesity

OSA

dyslipidemia

CVD

smoking

RLS

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6
Q

sexual activity < __ / week is associated w. ED

A

once

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7
Q

mc cause of ED

A

decrease in arterial flow from progressive vascular dz

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8
Q

mc medication associated w. ED

A

SSRIs

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9
Q

besides SSRIs, 3 common meds related to ED

A

beta blockers

spironolactone

thiazide diuretics

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10
Q

psychological factors associated w. ED

A

dpn

stress

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11
Q

neuro causes of ED (3)

A

stroke

SCI

MS

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12
Q

sport related to ED

A

bicycling

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13
Q

endocrine d.o related to ED (2)

A

testosterone deficiency

hypo/hyperthyroidism

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14
Q

examples of questions to ask ED pt

A

chronic, occasional, situational?

normal erections (ex early morning)?

trauma to pelvis?

pelvic/prostate xrt?

drugs/etoh/tobacco?

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15
Q

what might you see on pe for ED (5)

A

scarring

plaque formation

testicular atrophy

peripheral neuropathy

HTN

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16
Q

why might you see plaque formation on ED pt

A

peyronie dz

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17
Q

what labs might be helpful for ED dx (7)

A

CBC

UA

TSH

lipid panel

serum testosterone

glucose

prolactin

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18
Q

what test might be helpful to dx ED (2)

A

nocturnal penile lumescence testing

direct injxn of vasoactive substances

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19
Q

ex of vasoactive substance

A

prostaglandin E1

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20
Q

if prostaglandin E1 does not produce erection what is next step in dx of ED (3)

A

US of cavernous arteries

pelvic arteriography

cavernosonography

studies to evaluate arterial/venous vasculature

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21
Q

tx for psychogenic ED (2)

A

behaviorally oriented sex therapy

counseling

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22
Q

tx options for ED (8)

A

behavior sex therapy

T replacement

wt loss

PDE-5

penile injxns

intraurethral alprostadil

vacuum erection device

surgery

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23
Q

tx for low T ED

A

testosterone replacement

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24
Q

how can T be administered (3)

A

injxn

gel

patches

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25
Q

s.e of T replacement

A

HTN

worsens BPH

worsens CHF

increased breast ca risk

hepatic toxicity

VTE

prostate ca

application site pruritis

virilization in other exposed (ex nurse, kids)

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26
Q

mainstay of ED tx

A

phosphodiesterase-5 inhibitors (PDE-5)

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27
Q

ex of PDE-5 (3)

A

sildenafil (viagra)

vardenafil (Levitra)

todalafil (Cialis)

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28
Q

when should PDE-5 be taken

A

45-60 min before anticipated sexual activity

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29
Q

absolute contraindication to PDE-5

A

nitrates

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30
Q

if a man on PDE-5 develops CP you should

A

delay nitrate by 24 hr

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31
Q

PDE-5 plus alpha blockers can result in

A

decreased bp

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32
Q

s.e of PDE-5 (2)

A

blue vision

sudden hearing loss

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33
Q

which PDE-5 causes blue vision

A

sildenafil (viagra)

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34
Q

what is a penile injection

A

PDE-5 injected into base of penis → causes smooth m relaxation in corpus cavernosum

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35
Q

penile injxns should be administered __ minutes before sex,

and the erection an last > __

A

10-20

60 min

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36
Q

what drug is used in intraurethral alprostadil

A

prostaglandin E1 tablet inserted into urethra → massage penis for 1 min

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37
Q

s.e of intraurethral alprostadil

A

penile pain and bleeding

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38
Q

contraindications for intraurethral alprostadil

A

SSA/sickle cell trait

leukemia

MM

any conditions that increase risk for a priapism

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39
Q

what is a priapism

A

prolonged erection

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40
Q

vacuum erection devices are used in conjunction w. (2)

A

occlusive penile rings

+/- PDE-5 inhibitors

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41
Q

vacuum erection devices may cause difficulty with

A

ejaculation

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42
Q

max application of vacuum erection device

A

30 min

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43
Q

how long does erection last w. vacuum erection device

A

until elastic ring is removed

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44
Q

s.e of vacuum erection device

A

penile bruising

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45
Q

surgical options for ED

A

penile prosthesis

vascular reconstruction

arterial bypass

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46
Q

2 types of penile prosthesis

A

rigid

inflatable

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47
Q

ejaculation that always or almost always occurs w.in or prior to 1 minute of vaginal penetration

A

premature ejaculation

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48
Q

3 negative consequences of premature ejaculation

A

distress

frustration

avoidance of sexual intimacy

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49
Q

what % of male population has premature ejaculation

A

~4%

30% based on community surveys

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50
Q

30% of men w. premature ejaculation have concurrent

A

ED

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51
Q

3 pharm tx for premature ejaculation

A

SSRIs

PDE-5 inhibitors

tramadol

52
Q

__ are first line tx for premature ejaculation

and also a major cause of __

53
Q

SSRI suffix (2)

54
Q

SSRI dosing for premature ejaculation

A

lowest dose → titrate up PRN q 3-4 weeks

55
Q

most effective SSRI for premature ejaculation

A

paxil (paroxetine)

56
Q

tx for premature ejaculation w. coexisiting ED

A

pde-5 inhibitors

57
Q

last line tx for premature ejaculation

A

tramadol (ultram)

58
Q

topical options for premature ejaculation

A

topical anesthetics → lidocaine

topical alprostadil cream

59
Q

s.e of topical alprostadil cream (4)

A

burning and erythema

meatal/glandular pain

prolonged painful erection

vaginal burning/itching in female partner

60
Q

behavioral therapy for premature ejaculation (5)

A

squeeze technique

start/stop technique

sensate focus

pelvic floor rehab

psychotherapy and/or relationship counseling

61
Q

focusing on touch other than genitals to encourage body awareness while reducing performance anxiety

A

sensate focus behavioral therapy

62
Q

what improves pharm tx of premature ejaculation

A

behavioral therapy

63
Q

4 scrotal abnormalities

A

varicoele

hydrocele

spermatocele

testicular ca

64
Q

sx of scrotal abnormalities

A

generally asymptomatic

65
Q

dilatation of pampiniform plexus of spermatic veins

A

varicocele

66
Q

varicoceles are usually __ sided

67
Q

varicoceles usually appear at __ and enlarge over time

68
Q

varicoceles are usually asymptomatic, 5 symptoms if not

A

dull, aching scrotal discomfort

atrophy of left testicle

decreased fertility

left sided scrotal fullness on valsalva

69
Q

scrotal discomfort w. varicocele is worse w. __

and relieved w. __

A

standing

sitting/laying down

70
Q

what do you think when you see: large left sided scrotal mass “bag of worms” that decompresses/disappears in recumbent position

A

varicocele

71
Q

do varicoceles commonly need intervention

72
Q

indications for intervention w. varicocele (2)

A

21 yo or younger

e.o testicular atrophy and/or abnormal semen analysis

73
Q

intervention for younger pt w. varicocele if e.o testicular atrophy and/or abnormal semen analysis (2)

A

surgical ligation

or

percutaneous venous embolization

74
Q

if semen analysis is normal in previous pt,

A

monitor w. semen analysis q 1-2 years

75
Q

intervention (if any) for older pt w. varicocele (3)

A

semen analysis q 1-2 years to assess fertility

scrotal support

NSAIDs

76
Q

collection f peritoneal fuid btw parietal and visceral layers of tunica vaginalis

77
Q

mc cause of hydrocele

A

idiopathic over a long period of time

78
Q

if not idiopathic, hydrocele can be caused by

A

acute reactive inflammatory conditions of scrotal contents

79
Q

3 ex of acute reactive causes of hydrocele

A

epididymitis

torsion

appendiceal torsion

80
Q

sx of hydrocele

A

soft small-massive collections of several liters

+/- pain/disability

81
Q

what do you think when you see, large scrotum that transilluminates well

82
Q

definitive dx for hydrocele

83
Q

do hydroceles commonly need intervention

84
Q

indication for surgical excision of hydrocele (2)

A

symptomatic w. pain/pressure sensation

scrotal irritation

85
Q

epidermal cyst in head of epididymis that is > 2 cm

A

spermatocele

86
Q

spermatoceles have increased frequency in pt whose mom used

A

diethylstilbestrol during pregnancy

87
Q

do spermatoceles commonly require intervention

88
Q

surgical excision of spermatocele is indicated if pt has

A

chronic pain

89
Q

what condition presents in 50% of men 40-50 yo and >80% of men over 80 yo

A

benign prostatic hyperplasia (BPH)

90
Q

what decreases risk for bph

A

excessive etoh

91
Q

rf for bph (3)

A

obesity

heart dz

aa

92
Q

what pt population requires tx more often for bph

93
Q

where does bph develop (2)

A

periurethral zone

transitional zone

94
Q

what 2 things are needed for bph

A

older age

functioning lyedig cells

95
Q

bph is generally

A

asymptomatic

96
Q

2 types of lower urinary tract symptoms (LUTS) of bph

A

strorage

voiding

97
Q

storage sx of bph (3)

A

increased daytime frequency

nocturia

urinary incontinence

98
Q

voiding sx of bph (6)

A

slow urinary stream

spitting/spraying of stream

hesitancy

straining to void

terminal dribbling

99
Q

pe for bph should include

100
Q

normal prostate is the size of a __, and texture is

__

and __

A

walnut

firm, nontender

101
Q

tender prostate suggests

A

prostatitis

102
Q

mc cause of prostatitis in older men

103
Q

mc cause of prostatitis in younger men

104
Q

nodules in prostate suggest

A

malignancy

105
Q

3 dx labs for bph

A

ua

psa

bmp → creatinine

106
Q

ua for bph may show

A

hematuria

UTI

107
Q

elevated creatinine in bph eval may suggest

A

renal failure

obstruction

108
Q

behavior mods for bph (3)

A

avoid fluids prior to bedtime

reduce caffeine/etoh

double voiding

109
Q

2 pharm tx for bph

A

alpha-1 adrenergic antagonists

5-alpha reductase inhibitors

110
Q

initial pharm therapy for bph

A

alpha-1 adrenergic antagonists

111
Q

ex of alpha-1 adrenergic antagonists

A

tamsulosin (flomax)

terazosin

doxazosin (cardura)

silodosin (rapaflo)

112
Q

when are alpha-1 adrenergic antagonists taken

A

at bedtime

113
Q

s.e of alpha-1 adrenergic antagonists (3)

A

hypotn

dizziness

ejaculatory dysfxn

114
Q

what drug do alpha-1 adrenergic antagonists interact w.

A

PDE-5 inhibitors

115
Q

what pharm reduces size of prostate

A

5-alpha reductase inhibitors

116
Q

tx w. 5-alpha reductase inhibitors usually lasts __

before symptomatic relief is seen

117
Q

ex of 5-alpha reductase inhibitors (2)

A

finasteride (proscar)

dutasteride (avodart)

118
Q

5-alpha reductase inhibitors reduce risk of

A

prostate ca

119
Q

s.e of 5-alpha reductase inhibitors (3)

A

decreased libido

ED

ejaculatory dysfxn

120
Q

5-alpha reductase inhibitors are dangerous for

A

pregnant women → shouldn’t touch tablets

121
Q

PSA concentrations will __ w. 5-alpha reductase inhibitors

122
Q

tx for severe bph

A

combo of 5-alpha reductase inhibitors PLUS alpha-1 adrenergic antagonists

123
Q

what tx is not recommended for bph

A

herbal →

saw palmetto, beta-sitosterol, cermilton,

pygeum africanum

124
Q

indication for surgical intervention in bph

A

persistent/progressive sx despite combo tx for 12-24 mo

125
Q

4 surgical options for bph

A

transurethral resection of prostate (TURP)

transurethral ablation

simple prostatectomy

prostatic arterial embolization

126
Q

5 complications of bph surgery

A

sexual dysfxn

postprostatectomy syndrome

bleeding

urethral strictures

urinary incontinence

acute urinary retention

recurrent UTIs

hydronephrosis

renal failure

Clin Med II - Exam 4 (20 decks)

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