Q6 Male GU

Question 1

Things needed for an erection

Answer 1

NO -> generating cGMP
Vascular flow - increased pressure with decreased venous outflow.

Question 2

What is Detumescence? What makes it happen.

Answer 2

Penis returning to flaccid state after an erection
5-cyclic GMP phosphodiesterase to metabolize the cGMP.

Question 3

Organic and _______ causes for ED

Answer 3

Psychogenic. Usually a mix of both.

Question 4

Vascular, neurological, local penile factors, hormonal, drug induced, psychogenic are all factors that play into ED.

Question 5

If someone has ED with no overt cause, what should you screen for?
How can you screen the patient before perscribing meds?

Answer 5

CVD. Princeton III criteria and making sure Exercise tolerance is established.

Question 6

Difference between phimosis and paraphimosis.

Answer 6

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!!

Question 7

What is peyronie disease?

Answer 7

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.

Question 8

Hemodialysis, metabolic problems (gout), anti-depressants, spinal cord injury, SCD, trauma, drugs can all cause priapism.

Question 9

Balanitis is an infection of the _________

Answer 9

Glans. Poor hygiene, phimosis, candidiasis.

Question 10

Risk factors for penile cancer

Answer 10

HPV, smoking, UV treatment for psoriasis, h/o phimosis, AIDS.

Question 11

HYDROCELE is fluid within the _______. Common in newborns, usually resolve in 1st year. Usuallly ______ (painless/painful). Transilluminates with light.

Answer 11

Tunica vaginalis.
Painless.

Question 12

95% of varicoceles located on the _____ side. What other questions do you want to ask? Usually pain______(less/full)

Answer 12

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.

Question 13

Spermatocele is an _________. Contains ________ fluid. Tx?

Answer 13

Epididymal cyst.
Benign, sperm-containing, milky fluid.
Scrotal support/excision.

Question 14

Cryptorchidism - with hypospadias or bilateral, think?

Answer 14

Mixed gonadal dysgenesis or other genetic disorders.

Question 15

Increased risk of _____, ______ and ______ with Cryptorchidism.

Answer 15

Inguinal hernia, torsion and testicular cancer.

Question 16

What is Prehn Sign?

Answer 16

Pain does NOT resolve when lifting the scrotum - torsion!

Question 17

Testicular torsion must be corrected w/in _______

Answer 17

6hrs.

Question 18

Most likely cause of acute epididymitis in men <35 and men >35?

Answer 18

< 35 = STI (gonorrhea or Trichomonas), anal intercourse
>35 = UTI/prostatitis/BPH - reflux of urine into the vas deferens.

Question 19

Epididymitis pain is ______ by lifting the testes

Answer 19

IS relieved.
Prehn sign

Question 20

What is fournier’s gangrene?

Answer 20

Nec fasc of the perineum!! Emergency!!

Question 21

Orchitis - usually co-infection with _______

Answer 21

Epididymitis or mumps.

Question 22

Testicular cancer most often miss diagnosed (up to 25% of the time) as epididymitis. Most common in _______

Answer 22

Young white men aged 15-35.

Question 23

Klinefelter syndrome is a risk factor for ________

Answer 23

Testicular cancer - XXY chromosome disorder.

Question 24

Less incidence of BPH in ________ or ________

Answer 24

Castrated individuals or those with low androgens.

Question 25

Causes of LUTS in a man

Answer 25

Lower urinary tract symptoms.
BPH, prostate cancer, UTI, prostatitis, neurogenic bladder, urethral stricture, bladder stone, bladder cancer.

Question 26

5alpha reductase: most important androgen-metabolizing enzyme.

Question 27

BPH mainly occurs in the ________ zone of the prostate, while prostate cancer usually occurs in the ___________zone.

Answer 27

Transition zone (life transition-BPH comes with transition to older age)
Peripheral zone.

Question 28

AUA/IPSS - prostate BPH symptoms assessment tool.

Question 29

When should you NOT do a DRE for prostate assessment?

Answer 29

Suspicion of prostatitis, HIV,

Question 30

PVR > _______ usually indicative of pathology.

Answer 30

100-200ml