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CPD Spring Term > Quiz 1 - Male GU > Flashcards

Quiz 1 - Male GU Flashcards

1
Q

What questions should be asked in regard to male sexual function?

A

change in libido?
quality of erections
timing/situational problems

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2
Q

what are obstructive urinary symptoms?

A

hesitancy
forked stream
dribbling
straining

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3
Q

what are we inspecting for with an external genitalia exam?

A

lower abdomen (hair pattern), inguinal hernias
scrotum, prepuse (ask pt to retract foreskin for exam)
glans penis, meatus
shaft (lesions, d/c, induration)

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4
Q

what special test is used to evaluate a scrotal mass?

A

transillumination!!!!

it can help differentiate fluid vs solid structures

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5
Q

what is a normal prostate size?

A

4 cm

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6
Q

what will be palpated during a prostate exam if, prostatitis?

A

it will feel boggy and tender to palpation.

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7
Q

what will be palpated during a prostate exam if, benign prostatic hyperplasia?

A

enlargement, rubbery, nontender

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8
Q

what will be palpated during a prostate exam if, carcinoma?

A

hard nodules or areas

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9
Q

what does a scrotal ultrasound assess?

A

masses

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10
Q

when would you order a uroflowmetry?

A

when you are concerned the patient has an obstruction.

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11
Q

how do you assess night time erectile function?

A

Rigiscan for night time tumescence (erectile function)

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12
Q

what is TRUS? when is it used?

A

transrectal ultrasound - used for visualizing the size of the prostate and to see how efficient a patient is at voiding urine from the bladder

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13
Q

what is a red flag symptom of erectile dysfunction?

A

prolonged erection > 4 hrs/

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14
Q

what are red flag symptoms of hematospermia?

A

symptoms lasting > 1 mo
palpable mass
hematuria
obstructive sxs

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15
Q

what are red flags of urethral d/c?

A

pelvic pain
fever
chills
urinary retention

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16
Q

what are red flag symptoms of scrotal pain? what is important to rule out?

A

ACUTE ONSET
N/V
Abdominal pain

IMPORTANT ** r/o testicular torsion **

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17
Q

which penile condition affects the dorsal side of the penis and which affects the ventral side of the penis?

A

epispadias - congenital malformation of the urethral meatus on the UPPER DORSAL side of the penis

hypospadias - congenital malformation of the urethral meatus on the LOWER VENTRAL side of the penis

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18
Q

what is balanitis

A

inflammation of the glans penis

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19
Q

what is posthitis

A

inflammation of the foreskin

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20
Q

what is balanoposthitis

A

inflammation of both the glans penis and foreskin

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21
Q

what is balanitis xerotica obliterans (BXO)?

A

lichen sclerosis of penis
indurated
what area on glans penis

  • generally due to chronic inflammation
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22
Q

what is the difference between phimosis and paraphimosis? What are key factors we should know regarding each of these?

A

phimosis: foreskin cannot be retracted
DO NOT FORCE RETRACTION

paraphimosis: foreskin stuck in retracted position
CAN LEAD TO GANGRENE or NECROSIS

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23
Q

list the causes of penile lesions?

A 
genital herpes 
genital warts 
syphilitic chancre 
chancroid
carcinoma in situ
squamous cell carcinoma of the penis
pearly penile papules
contact dermatitis
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24
Q

What causes genital herpes? What do they look like?

How do you DX?

A

HSV 1 & 2
lesion appearance - clusters of vesicles that erupt and form superficial ulcers with erythematous base

primary - outbreak is generally most painful eruption
recurrent - not as painful as first outbreak.

Diagnosed by clinical evaluation, TZANCK TEST, viral culture

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25
Q

what causes genital warts? what do they look like? what potential, though low, do they carry? what risk factors are associated with genital warts?

A

HPV (6 & 11 account for 90% of infections)

PAINLESS - can be bothersome due to location, soft, irregular surface ** may be dormant OR undetectable!!

*cancer causing potential

risk factors - associated with use of birth control due to increased sexual contact w/o the use of barriers, multiple sex partners and early sexual activity

26
Q

what causes syphilitic cancres? how do they appear? what testing is done?

A

treponema pallidum

solitary PAINLESS lesion
NON-EXUDATIVE, INDURATED EDGE, NON-TENDER (key words!)

serological testing is done as well as lymph exam - region LA will be present, nontender

27
Q

painless lesion of the penis is ____ until proven otherwise

A

Syphilis

28
Q

what causes chancroid? how do they appear? what testing is done?

A

haemophilus ducreyi

PAINFUL, non-indurated ulcers, irregular edges, red borders. GRAY/YELLOW exudate.

PCR testing is done, as well as lymph exam - regional TENDER LA will be present

29
Q

men who are uncircumcised are at greater risk for developing what conditions?

A

carcinoma in situ

squamous cell carcinoma

30
Q

what virus plays a role in the development of SCC of the penis? how does the lesion appear? How would you DX?

A

HPV 16 & 18 (common for women’s cervical cancer*)

non-painful, generally described as a
“sore that does not heal”

biopsy that shit.

31
Q

what condition shows up as hair-like projections on the glans penis?

A

pearly penile papules

32
Q

rut roh! this man had a rash develop after using a latex condom! What could it be?

A

contact dermatitis

33
Q

what are some risk factors associated with Erectile Dysfunction (inability to attain or sustain an erection satisfactory to perform sexual activity and ejaculation)

A 
drugs (SSRI, NSAID)
neurogenic disorders (AD, Parkinsons, MS)
surgery
aging
kidney failure
smoking
DM
alcohol
riding a gahdamn bike! Shit squishes the balls.. NO OXYGEN! HELP!!!
34
Q

what are pertinent questions to ask for ED and what work-up would you perform?

A

what is the pattern? time of day? are you stressed, big guy? partner issues? ASK THEM, WHAT THEY THINK IS CAUSING IT..

Workup involves:
UA, CMP, hormones

35
Q

a young guy thought it would be super funny to take a viagra and have sex all day with his lady friend.. come to find out, he developed this condition.. what is it? What are the risk factors and how is it classified? how do you dx this?

A

PRIAPISM!
- prolonged painful erection lasting longer than 4 hours

EMERGENCY - causes ischemia or even necrosis

classified as:
LOW FLOW (Most Common) - painful, tender, leads to local hypoxia, metabolically related
HIGH FLOW - non-tender penis

dx’d via color doppler US

36
Q

what are painless causes for mass/swelling of the scrotum?

A 
tumors
hematocele
hydrocele
vericocele
INDIRECT inguinal hernia
spermatocele
edema
cysts
abscess (can be tender too)
37
Q

what is a hematocele, what is a hydrocele? how can you differentiate the two?

A

hematocele - blood filled swelling, may be tender initially, DOES NOT transilluminate - generally post trauma

hydrocele - serous fluid filled mass - common in kiddos - TRANSILLUMINATES and you can confirm by scrotal US

38
Q

which condition presents as a “bag of worms” appearance? what side is most common? and what are the r/o associated with the R and the L testicle or older men. How is it dx’d?

A

varicocele

80% occur in the L

in an older man
L - tumor or mass that could occlude L renal or testicular vein
R - occlusion of the vena cava is possible! RULE THIS OUT!

dx via angiography

39
Q

what condition has a risk of bowel strangulation?

A

indirect inguinal hernia

  • large, compressible scrotal mass that may auscultate bowel sounds

**can’t palpate above the region of swelling

40
Q

If a patient between the ages of 10-25 presents to your office with SUDDEn, ACUTE ONSET, UNILATERAL lower abdominal pain.. which condition is this and what are the KEY factors you need to assess?

A

Testicular Torsion!
EMERGENCY! this needs to be de-torsed in s sign (meaning, you lift the testicle and the pain is not relieved!)

Send him off! Most individual who develop this condition never had the testicle attach as it should, to the posterior scrobal sac

41
Q

which rare cause of testicular pain presents with “blue dot discoloration”?

A

torsion of testicular appendix

good ddx for testicular torsion, along with trauma and epididymitis

42
Q

male pt. with painful swelling around his testicle, he complains of radiating pain along the spermatic cord to the lower abdomen.. which condition is this? what types are there? PE? what may be visualized on the overlying skin?

A

ACUTE EPIDIDYMITIS!!!

Infectious vs Non-infectious
Infectious - teen to 35 think GC/CT; 35+ think UTI from coliform bacilli
non-infectious - heavy lifting, local trauma

PE - Positive Prehn’s sign (elevate testes, pain is relieved)
swollen epididymis upon palpation

overlying skin may look like peau d’ orange, it’s moveable (fixed suggests abscess)

43
Q

what male genitalia issue may be caused by TB?

A

chronic epididymitis
- inflamed with no signs of infxn. non-tender.
TB can cause by often associated with recurrent acute epididymitis

44
Q

when the testes fail to descend during infancy, what is this condition called and what are the variations? Patients with this are at a high risk of..

A

cryptorchidism

True - testes remain in abdomen due to mech. obstruction or hormone abn

incomplete - testis in inguinal canal

ectopic testis - lies outside the usual descent path

hypermobile/retractile - sometimes in scrotum (hot bath) sometimes retracted up into the inguinal canal

HIGH RISK OF DEVELOPING TESTICULAR CANCER!!! (2.5-20X more likely)

45
Q

what is the most common solid cancer in males 15-34? what are the ssx of this condition? how do you work it up?

A

Testicular Cancer

painless, testicular nodule, smooth enlargement, firm, nontender
*sensation of heaviness

scrotal US, pelvic CT
increased: alpha-fetoprotein, HCG, LDH (esp. LDH1)

46
Q

if a male presents and can’t seem to void or empty his bladder.. what should this trigger in your mind to start thinking about?

A

PROSTATE!

any condition that narrows the prostatic urethra will lead to voiding symptoms.

47
Q

what is the average size of the prostate?

A

4 cm in length and width

48
Q

what can consistency of the prostate tell you about a potential condition?

A

normal - like tip of the nose

BPH - feels rubbery
Congested - boggy (like your cheek)
Indurated - nodules (infxn)
hard! - consider tumor, esp. if distinct edge.

49
Q

PSA - what in the hell is this?

A

prostate specific antigen

protein produced only by the prostate. levels increase from:
cancer
bacterial infxn
damage due to infarct

normally a little PSA is found in the blood, if the prostate is enlarged, this leakage appears exaggerated.

50
Q

Two types of PSA measures that are used:

A

PSA velocity (how quickly it elevates)

Free/Bound PSA ratio (less free seen with cancers)

51
Q

this condition is commonly seen in men over the age of 50, it presents with urinary urgency and frequency due to incomplete emptying and rapid refill of the bladder. the force of the stream is decreased and they will generally complain of “dribbling” whether initially or after relieving themselves, nocturia may also be present - what condition is this? what is seen on PE and what needs to be r/o?

A

benign prostatic hyperplasia (BPH)

DRE - enlarged, rubbery prostate is palpated, with the loss of it’s central sulcus due to hyperplasia. Non-tender

cancer needs to be ruled out, this can be done with TRUS, or biopsy.

52
Q

BPH though benign, may coexist with what condition?

A

prostate cancer!!

53
Q

young man ptc with sudden onset of spiking fever, chills, lower back pain and the inability to void - what condition should be considered and what should be avoiding pertaining to this condition?? and what work up would you perform?

A

Acute bacterial prostatitis

DO NOT PERFORM PROSTATIC MASSAGE - MAY LEAD TO SEPTICEMIA!!!!!!

PE - Gentle DRE reveals exquisitely tender prostate, swollen, warm.
may see d/c after DRE, culture that for urinary pathogens (cause of acute bacterial prostatitis)

UA - WBCs

54
Q

male ptc with recurrent UTIs, he’s fatigued, he has chronic lower abdominal or perianal pain, but lately - he’s been experiencing sexual dysfunction, pain with ejaculation and a milky d/c.. what condition is this? what is seen on PE? what labs will you run?

A

chronic bacterial prostatitis

upon PE - DRE, moderately tender, boggy, enlarged, soft

labs - after PERFORMING A PROSTATE MASSAGE (yes, it’s ok for chronic, NOT acute) - urine C&S, EPS culture, semen culture

55
Q

what’s the deal with chronic prostatitis/chronic pelvic pain syndrome (CPPS)?

A

who the hell knows - many different ideas, but nothing set in stone - a lot of times, however, it’s becoming increasingly more common that it’s a natural process to empty the prostate (this happens during ejaculation), men may have encountered an emotional breakup and stopped sexual intercourse - and with implementation of ejaculate frequency, the prostate’s inflammation will decrease - What guy doesn’t want to hear that?!

56
Q

what are the signs and symptoms of CP/CPPS?

A 
pelvic pain for > 3 mo
** disability out of proportion to PE/lab findings **
dysuria, sexual dysfunction
post ejaculation pain******
decreased libido
57
Q

prostate cancer kills many men (true or false)

A

FALSE!

More men die WITH prostate cancer.. They generally don’t die FROM prostate cancer.

it’s the most common cancer in men over the age of 50, african american males are at higher risk.

58
Q

what are some risk factors for prostate cancer?

A 
family history
hormones
diet
obesity
smoking
medications
vasectomy (controversy)
59
Q

what is found on PE for prostate cancer? what labs should be ordered?

A

DRE - asymm, NT prostate, firm, stony hard, irregular nodules pathognomonic

PSA velocity
increase of >0.75 ng/ml/year or higher (based on 3 PSA measurements over 18-24 months)
when PSA is 4-10 ng/ml, CaP should be a suspicion

60
Q

How is prostate cancer diagnosed?

A

TRUS w. biopsy

Axial CT or MRI (for staging)

CPD Spring Term (6 decks)

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