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CPD III > Quiz 1- Male GU > Flashcards

Quiz 1- Male GU Flashcards

1
Q

Epispadias

A

congenital malformation of urethral meatus: on the upper (dorsal) side of the penis

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2
Q

Hypospadias

A

congenital malformation of urethral meatus on the lower (ventral) side of the penis

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3
Q

Balanitis

A

inflammation of glans penis

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4
Q

inflammation of the foreskin

A

Posthitis

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5
Q

inflammation of the foreskin and the glans penis

A

Balanoposthitis

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6
Q

Causes of: Balanitis, Posthitis and Balanoposthitis

A

Infectious (candida, GC, Chlamydia, scabies, etc)
Non-infectious (contact dermatitis, psoriasis, etc)
More commonly with poor hygiene, diabetics
May predispose to meatal stricture, phimosis, paraphimosis, cancer

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7
Q

lichen sclerosis of penis

indurated, white area on glans penis, from chronic inflammation

A

Balanitis xerotica obliterans (BXO)

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8
Q

Foreskin cannot be retracted back away from the glans penis

A

Phimosis

a. Physiologic:  In boys, 50% of normal retractability by age 10, (but up to 15)  Do not force retraction!  Often cited as reason for circumcision
b. Pathologic: Pain, constriction, meatus blockage due to adhesion
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9
Q

what are the red flags for erectile dysfunction?

A

erection lasting longer than 4 hrs

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10
Q

what are the red flags for hematospermia?

A

sx lasting longer than 1 mo, palpable mass, hematuria, obstructive sx

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11
Q

what are the red flags for urethral d/c?

A

pelvic pain, fever, chills, urinary retention

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12
Q

what are the red flags for scrotal pain?

A

acute onset, N&V, abdominal pain

r/o testicular torsion

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13
Q

Foreskin stuck in retracted position

A

Paraphimosis

becomes inflamed->reduced blood flow to the glans->may cause gangrene or necrosis

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14
Q

Scarring of the tunica albuginea in the corpora cavernosa

A

Peyronie’s disease
can cause painful erection and dorsal curvature
PE: palpable plaque on the dorsal surface of penis

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15
Q

Genital herpes usually caused by what?

A

HSV-2 (10-30% caused by HSV-1)

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16
Q

Genital herpes lesion appearance:

A

clusters of vesicles erupt and form superficial ulcers, erythematous base
concomitant sx: urinary hesitancy, dysuria, constipation, sacral neuralgia, flu-like sx, fever
dx: clinical eval of lesions, Tzanck test, viral culture

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17
Q

Genital warts usually caused by what?

A

HPV
90% are caused by HPV 6 & 11 (low risk)
cancer-causing type of HPV are 16 & 18

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18
Q

Genital warts lesion appearance:

A

Soft consistency, raised, irregular surface

painless but may cause discomfort due to location or itching

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19
Q

Syphilitic chancre caused by what?

A

Treponema pallidum

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20
Q

appearance of syphilitic chancre?

A

solitary, painless ulcer, non-exudative, indurated edge

test: serologic testing

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21
Q

Chancroid is caused by what?

A

Haemophilus ducreyi

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22
Q

appearance of chancroid?

A

painful, shallow non-indurated ulcers, irregular edges and red borders , gray or yellow purulent exudate
test: PCR testing

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23
Q

premalignant lesion: intraepithelial neoplasia
well circumscribed area of reddish, velvety pigmentation usually. on the glans or at the corona, most often in intact (uncircumcised) males

A

Carcinoma in situ/ Erythroplasia of Queyrat

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24
Q

More common in uncircumcised males with poor local hygiene habits
HPV types 16 and 18 play a role
Non-painful “sore that does not heal”

A

Squamous Cell Carcinoma of the Penis

dx: biopsy

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25
Q

soft papular angiofibromas around the corona—hair-like projections

A

Pearly Penile Papules

benign

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26
Q

What are some of the questions you’d want to ask a patient with an erectile dysfunction?

A

are you taking drugs such as anti-depressants, NSAIDs, substance abuse?
any history of neurogenic disorders like spinal cord or brain injuries? nerve disorders such as Parkinson’s, Alzheimer’s, MS?
any history of psychogenic causes such as performance anxiety? stress? mental health disorders?
history of DM?
history of surgery?

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27
Q

What PE would you include for an erectile disorder?

A

cardiovascular, neurological, and mental status exam

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28
Q

what’s the condition called when a male has a prolonged, painful erection longer than 4 hrs?

A

Priapism
considered an emergency because can result in ischemia/necrosis
Causes:
Idiopathic: usually from prolonged sexual excitement
Secondary: assoc with sickle cell dz, DM, CML, penile trauma, drugs, alcohol, cocaine, black widow spider bite

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29
Q

what should you consider scrotal masses until proven otherwise?

A

consider any hard swelling testicular cancer until proven otherwise

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30
Q

Painless scrotal masses/Swellings

A

tumors, abscess, hematocele (blood filled, does not transilluminate), hydrocele (serous fluid filled, transilluminates), varicocele, sebaceous cysts, scrotal edema, indirect inguinal hernia, spermatocele

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31
Q

condition that has a “bag of worms” appearance, located along spermatic cord (80% on left)
worsens with valsalva maneuver and with standing

A

Varicocele
Non-tender, may have “dragging” sensation
Development of a new varicocele or worsening of an old one in an older man:
a. On L: may be a tumor or other mass occluding the L renal or testicular vs.
b. On R: occlusion of the vena cava possible.
Possible sequellae: infertility from dec spermatogenesis (inc scrotal temp)
Diagnosis – angiography

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32
Q

Painful scrotal masses/swellings

A

epididymitis, testicular torsion, testicular trauma, mumps orchitis

33
Q

testicular torsion

A

Emergency–assume until proven otherwise! Needs to be de-torsed <6hrs!
Severe scrotal pain after an episode of trauma or during intensive exercise; or spontaneous in sleep. Common age range 10-25 yo

34
Q

ssx for testicular torsion

A

Sudden, acute onset unilateral, constant pain, poss N&V
Swollen, tender, erythematous scrotum: difficult to discern structures
Affected testicle higher, epididymis may be anterior; reactive hydrocele possible
Pain may radiate to the abdomen “acute abdomen”
Elevation of the scrotum does not relieve pain (negative Prehn’s sign)
Cremasteric reflex absent
Dx: doppler US

35
Q

spermatocele

A

small, painless cyst on the superior posterior pole of the testicle
benign

36
Q

cause of acute epididymitis

A

Infectious: result of an ascending LUT infection (from UTI or STI)
Non-infectious: urine reflux/chemical irritation into ejaculatory ducts from heavy lifting or local trauma

37
Q

acute epididymitis
SSX
PE
DX

A

SSX:
Painful, swollen epididymis; pain may radiate along spermatic cord to abdomen
Hydrocele may develop
Overlying skin may look like peau d’orange; skin is movable (fixed suggests abscess)
May be febrile.
Discharge (if ascending infection), urinary frequency, dysuria may be present
Toxic appearance if sepsis from widespread bacterial infection (rare)
Sequelae: chronic epididymitis
PE:
exquisitely tender, swollen epididymis
Scrotum often indurated, erythematous
elevating the testicle eases pain (positive Prehn’s sign)
no change in cremaster reflex
DX:
UA reveals pyuria
Urine culture, NAAT (Nucleic Acid Amplification Test) testing for GC/chlamydia
Scrotal ultrasound to rule out torsion in those <30

38
Q

cause of chronic epididymitis

A

inflammation with no infection present

39
Q

with chronic epididymitis PE reveals

A

enlarged, thickened, non-tender epididymis

40
Q

what is the name of the condition where the testes fail to descend into the scrotum during infancy?

A

cryptorchidism
there are several types:
a. true cryptorchidism - testis remains in abd. cavity from mechanical obstruction or hormonal abnormality
b. incomplete – testis in inguinal canal, obstructed by mechanical means
c. ectopic testis - lies outside the usual course of descent
d. hypermobile or retractile testis - may lie in the scrotum at times (e.g. hot bath) and then retract up into the inguinal canal
PE: palpate the testicles, if unpalpable, have pt squat or valsalva and repeat palpation

41
Q

with cryptorchidism there is a risk of developing which two conditions later in life?

A

infertility

testicular cancer

42
Q

what is the most common solid cancer in males 15-34 yo?

A

testicular cancer

43
Q

what are the two types of testicular cancer and from where do they originate?

A

Seminomas (40%) - arising in seminiferous tubules)

Non-seminoma germ cell tumor - Embryonal (24%), Teratoma (5%), mixed (26%)

44
Q

What are the SSX of testicular cancer?

A

painless testicular nodule, usually smooth enlargement, firm and non-tender, increases in size over time, may get dull ache, sensation of heaviness/weight, mass does not transilluminate (bc solid tumor)

45
Q

What is the appropriate work-up for testicular cancer?

A

Scrotal US, Pelvic CT (esp if have concerns its METS)

5 yr survival of seminoma is > 80% with tx

46
Q

what portion of the prostate is palpable? what is the normal size and consistency of the prostate?

A

portion of the prostate that is palpable is the peripheral zone, the transition zone is not palpable
normal size of the prostate is 4 cm in length and width
normal consistency is tip of nose

47
Q

what are abnormal consistencies for the prostate and what are their corresponding conditions?

A

rubbery- BPH
boggy - congested
indurated - nodules
hard - consider tumor in absence of WBCs & infxn

48
Q

labs to consider for prostate problems?

A

serum prostate-specific antigen (PSA)
serum PSA levels increase if the barrier between the epithelium and the bloodstream is damaged (barrier damaged due to cancer, bacterial infxn, and infarction)

Draw serum PSA before doing a DRE and obviously before prostate bx

Using PSA as a reliable screen for prostate cancer is currently under great scrutiny.
Other measures:
a) PSA velocity (how quickly it is elevating)
b) Free/bound PSA ratio (less amts of free with cancer)

49
Q

can you think of any reasons for the rise in PSA levels?

A 
DRE (do blood draw before!)
Ejaculation, recent sexual activity
BPH
Prostate cancer 
Cystitis
Acute & Chronic prostatitis 
Prostate bx
exercise involving perineal pressure (biking)
50
Q

can you think of any reasons for the fall in PSA levels?

A 
Finasteride
Saw palmetto
Radical prostatectomy
Withdrawal from anti-androgen drugs
Regular prostatic massage
Green tea
51
Q

What is occurring physiologically with benign prostatic hyperplasia (BPH)?

A

hyperplasia of cells within the transition zone, resulting in formation of large, fairly discrete nodules in the periurethral region. The lumen of prostatic urethra narrows leading to urine outflow obstruction.

52
Q

what is the incidence of BPH?

A

Increases with age, at age 40 there is a 8% chance and by age 80 there is an 80% likelihood of developing it

53
Q

what are the SSX of BPH?

A

progressive urinary frequency, urgency, nocturia due to incomplete emptying and rapid filling of bladder, hesitancy, intermittency of urinatioin, decreased force of stream (forked stream)

54
Q

What are the possible complications of BPH?

A

UTI from urine stasis
Urolithiasis from urine stasis
Straining to urinate may cause rupture of veins, hemorrhoids and hernias to name a few

55
Q

What PE should be completed for BPH? What are the anticipated findings?

A

DRE: enlarged rubbery consistency

Abdominal exam: possible distended bladder

56
Q

Which labs should be ordered for suspected BPH?

A

BUN (incrs)
UA and urine culture (to r/o causative or concomitant infxn)
PSA (mod. incrs)

57
Q

Procedures for BPH?

A

Uroflowmetry (to check urine flow rate and post-void residual volume)
TRUS or prostate bx (to r/o cancer)

58
Q

What condition can coexist with BPH?

A

Prostate cancer

59
Q

Prostatitis

A

Inflammation of the prostate

may be infectious or noninfectious

60
Q

what buggers cause Acute Bacterial Prostatitis?

A

Urinary pathogens: E. Coli, Klebsiella, Proteus, Pseudamonos, Enterobacter, Chlamydia

61
Q

SSX of Acute Bacterial Prostatitis?

A

Sudden onset of spiking fever, chills, malaise, arthralgia, myalgia
LUTS: dysuria, nocturia, urgency and frequency (can have concomitant cystitis)
May see acute urinary retention (inability to void, abdominal fullness)
Low back/perineal/rectal pain

62
Q

PE for Acute Bacterial Prostatitis?

A

GENTLE DRE: exquisitely tender prostate, swollen, firm and warm
Contraindication- do not perform prostatic massage with acutely inflamed gland! May lead to bacteremia, septicemia

63
Q

Labs for Acute Bacterial Prostatitis?

A

CBC shows leukocytosis with left shift
UA shows many WBC’s (cloudy), bacteria, possible hematuria
Culture of prostatic secretions (semen culture may be more accurate!) reveals
increased bacteria

64
Q

sequelae to Acute Bacterial Prostatitis?

A

chronic bacterial prostatitis

only 5-10% of cases are found to have bacteria (possible sequestered infection)

65
Q

SSX of Chronic Bacterial Prostatitis?

A 
Recurrent UTIs (intermittent/relapsing)
Fatigue
Chronic pain (perineal, lower abdominal, testicular, penile)
Sexual dysfunction, ejaculatory pain
Milky urethral d/c
66
Q

PE for Chronic Bacterial Prostatitis?

A

DRE: moderate tenderness, boggy, soft, enlarged

67
Q

Labs for Chronic Bacterial Prostatitis?

A

Post-massage urine culture and sensitivity, EPS culture, semen culture

68
Q

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (“Prostadynia”)

A

Poorly understood condition. Somatic syndrome with biopsychosocial effects

69
Q

Criteria for diagnosing Chronic Prostatitis/Chronic Pelvic Pain Syndrome

A

1) no objective cause is found to explain symptoms 2) symptoms relate to anatomical area around prostate, 3) refractory to treatment

70
Q

SSX for Chronic Prostatitis

A

Pain in pelvic region >3mos
disability out of proportion to PE/lab findings!
Dysuria, urgency
Low back/perineal pain referred to tip of penis
Sense of rectal fullness after unsuccessful defecation
Sexual dysfunction, post-ejaculation pain, decreased libido
Possible hemospermia
Fatigue, stress
May also have concurrent IBS or Chronic Fatigue Syndrome

71
Q

PE for Chronic Prostatitis

A

DRE: mildly tender (variable), boggy, enlarged (rarely)
Assess tenderness of pelvic floor and sidewalls
Also examine for hernia, testicular masses and hemorrhoids

72
Q

Lab for Chronic Prostatitis

A

UA, Urine C&S, EPS cell count and culture, CBC
May need to rule out Chlamydia trachomatis and Neisseria gonorrhea if neg
Urine cytology indicated if hematuria

73
Q

Assymptomatic Inflammatory Prostatitis

A

Found incidentally

No subjective symptoms but, WBCs are found in prostate secretions or in prostate bx

74
Q

Prostate Cancer (CaP)

A

Most commonly adenocarcinoma
most common male cancer in men >50yrs
Lifetime risk 1 in 6 white men; 1 in 5 black men
More men die WITH prostate cancer that FROM it!!

75
Q

What are the risk factors for prostate cancer?

A

Increasing age
Ethnicity- African- American 35% higher incidence
Family hx- primary relatives
Hormones- increased androgen exposure
Diet- high fat, low fiber, alcohol, coffee
Obesity
Vasectomy- perhaps a potential risk factor- controversial
Occupational exposures- increased in farmers, mechanics, plumbers, welding, rubber
Manufacturers, battery manufacturers (Cd)
Smoking- perhaps increased risk
Meds—statins, NSAIDs

76
Q

SSX of prostate cancer?

A

EARLY: often none, slowly progressive depending on where tumor is growing, sexual dysfunction, incontinence, irritative or obstructive sx
LATE: bladder outlet obstruction, ureteral obstruction, hematuria, pyuria, metastasis to pelvis, ribs, vert. may create bone pain
tumor enlargement may lead to cord compression and neuropathy
unintended weight loss

77
Q

PE of prostate cancer?

A

feeling a hard edge
DRE–variable size, asymmetrical, non-tender prostate
firm, stony hard, irregular nodule(s) is pathognomonic

78
Q

Labs for prostate cancer?

A

Total PSA: 4-10 ng/ml likelihood of CaP is 25%; >10 ng/ml likelihood of CaP is >50%
PSA Velocity: inc of >0.75 ng/ml/year or higher (based on 3 PSA measurements over 18-24 mos) when the PSA is 4-10 ng/ml is suspicious for CaP
Free to total PSA ratio: <25% (reduced) in CaP

79
Q

Dx for prostate cancer?

A

TRUS w/ bx (for GRADING)

Axial CT or MRI (for STAGING)

CPD III (7 decks)

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