Q6 Male GU Flashcards
Things needed for an erection
NO -> generating cGMP
Vascular flow - increased pressure with decreased venous outflow.
What is Detumescence? What makes it happen.
Penis returning to flaccid state after an erection
5-cyclic GMP phosphodiesterase to metabolize the cGMP.
Organic and _______ causes for ED
Psychogenic. Usually a mix of both.
Vascular, neurological, local penile factors, hormonal, drug induced, psychogenic are all factors that play into ED.
If someone has ED with no overt cause, what should you screen for?
How can you screen the patient before perscribing meds?
CVD. Princeton III criteria and making sure Exercise tolerance is established.
Difference between phimosis and paraphimosis.
Phimosis - unable to retract foreskin. (Normal in children and 1st 3 years of life. Can be risk for infection
Paraphimosis - foreskin stuck back , unable to pull forward - medical emergency!!
What is peyronie disease?
Abnormal curvature of penis +/- plaque/pain due to fibrosis of tunica albuginea. Potential cause of problems with sexual intercourse.
Erection can be painful, 50% spontaneous resolution.
Hemodialysis, metabolic problems (gout), anti-depressants, spinal cord injury, SCD, trauma, drugs can all cause priapism.
Balanitis is an infection of the _________
Glans. Poor hygiene, phimosis, candidiasis.
Risk factors for penile cancer
HPV, smoking, UV treatment for psoriasis, h/o phimosis, AIDS.
HYDROCELE is fluid within the _______. Common in newborns, usually resolve in 1st year. Usuallly ______ (painless/painful). Transilluminates with light.
Tunica vaginalis.
Painless.
95% of varicoceles located on the _____ side. What other questions do you want to ask? Usually pain______(less/full)
Left.
Resolution with recumbent position? (Lack of/poor valves)
R side only? (more likely for venous obstruction/renal mass?)
Rapid onset? (Get CT to check for mass)
PainFULL.
Spermatocele is an _________. Contains ________ fluid. Tx?
Epididymal cyst.
Benign, sperm-containing, milky fluid.
Scrotal support/excision.
Cryptorchidism - with hypospadias or bilateral, think?
Mixed gonadal dysgenesis or other genetic disorders.
Increased risk of _____, ______ and ______ with Cryptorchidism.
Inguinal hernia, torsion and testicular cancer.
What is Prehn Sign?
Pain does NOT resolve when lifting the scrotum - torsion!
Testicular torsion must be corrected w/in _______
6hrs.
Most likely cause of acute epididymitis in men <35 and men >35?
< 35 = STI (gonorrhea or Trichomonas), anal intercourse
>35 = UTI/prostatitis/BPH - reflux of urine into the vas deferens.
Epididymitis pain is ______ by lifting the testes
IS relieved.
Prehn sign
What is fournier’s gangrene?
Nec fasc of the perineum!! Emergency!!
Orchitis - usually co-infection with _______
Epididymitis or mumps.
Testicular cancer most often miss diagnosed (up to 25% of the time) as epididymitis. Most common in _______
Young white men aged 15-35.
Klinefelter syndrome is a risk factor for ________
Testicular cancer - XXY chromosome disorder.
Less incidence of BPH in ________ or ________
Castrated individuals or those with low androgens.
Causes of LUTS in a man
Lower urinary tract symptoms.
BPH, prostate cancer, UTI, prostatitis, neurogenic bladder, urethral stricture, bladder stone, bladder cancer.
5alpha reductase: most important androgen-metabolizing enzyme.
BPH mainly occurs in the ________ zone of the prostate, while prostate cancer usually occurs in the ___________zone.
Transition zone (life transition-BPH comes with transition to older age)
Peripheral zone.
AUA/IPSS - prostate BPH symptoms assessment tool.
When should you NOT do a DRE for prostate assessment?
Suspicion of prostatitis, HIV,
PVR > _______ usually indicative of pathology.
100-200ml
