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Clinical Medicine II > Renal: Men's Health > Flashcards

Renal: Men's Health Flashcards

1
Q

Rank the decades of life by prevalence of BPH

A

60-70 (70%) > 51-60% > 41-50 (20%)

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2
Q

A patient presents with the following, concerning for…

  • 4 months of bothersome urinary sxs
  • hx of UTI
  • gross hematuria
A

BPH

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3
Q

What diagnostics can be used for BPH?

A

DRE
UA (r/o infx, hematuria)
PSA
BUN/Cr

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4
Q

Behavior modifications that can be helpful in BPH include…

A

avoid caffeine, etoh, exacerbating meds

fluid restriction b4 bed/activity

double voiding

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5
Q

What are 1st line meds for BPH?

A

alpha blockers (-osin)

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6
Q

What are 2nd line meds for BPH

A

5 alpha reductase inhibitors (-asteride)

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7
Q

The following are surgeries that can treat…

TURP
TUNA
TUMT
Stent
Suprapubic prostatectomy
A

BPH

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8
Q

the following epidemiology describes…

  • young to middle aged men via urethra
  • PEK pathogens
  • increased risk with catheterization, bx, instramentation
A

acute bacterial prostatitis

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9
Q

Patient presents with:

  • acute onset of frequency, urgency, dysuria
  • obstructive voiding sxs
  • perineal pain
  • fever/chills, myalgia, malaise
A

acute bacterial protstatitis

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10
Q

What diagnostics can be helpful in acute bacterial prostatitis?

A

DRE (tender, edematous)

urine stain and cx

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11
Q

What labs can help diagnose acute bacterial prostatitis?

A

leukocytosis
pyuria
elevated PSR and ESR

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12
Q

What differentiates acute bacterial prostatitis from UTI?

A

tender edematous prostate on DRE

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13
Q

If patient is stable and reliable, what outpatient treatment can be done started?

A

fluoroquinolone or TMP-SMZ x 6 weeks

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14
Q

Repeat urine cx in acute bacterial prostatitis when?

A

7 days after abx

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15
Q

If repeat cx is positive after 7 days of abx, what should you do?

A

alternate regimen

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16
Q

When should you consider hospitalization and what tx for acute bacterial prostatitis?

A

toxic sxs

IV abx

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17
Q

A patient presents with the following, which is concerning for what condition?

  • Chronic GU sxs w/ evidence of bacterial prostate infx
  • subtle sxs
  • recurrent UTI

+/- pain, bladder outlet obstruction, hematuria

+/- prostate tenderness/hypertrophy

A

Chronic bacterial prostatitis

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18
Q

Gold standard diagnostic for chronic bacterial prostatitis…

A

prostatic fluid analysis (but most often presumptive dx)

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19
Q

Tx for chronic bacterial prostatitis

A

1st line: fluoroquinolon x 6 weeks

2nd: TMP-SMZ x 6 weeks

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20
Q

the following epidemiology describes what condition?

  • pelvic pain for at least 3 of preceding 6 month
  • large majority of prostatitis cases
  • prevalence peak in 5th decade
A

Chronic prostatitis/chronic pelvic pain syndrome

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21
Q

What labs/diagnostics can be helpful in chronic prostatitis/chronic pelvic pain syndrome?

A

genital rectal exam

UA and Cx

Imaging PRN

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22
Q

How is CP/CPPS diagnosed?

A

exclusion

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23
Q

Patient presents with:

  • chronic pain x 3 mo
  • pain in lower abdomen, testes, on ejaculation
  • voiding difficulty
  • blood in semen
  • relapsing/remitting pattern
A

CP/CPPS

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24
Q

What three medications in combo may be helpful for CP/CPPS?

A

alpha blockers, abx, 5-a-reductase inhibitors

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25
Q

Three methods of screening for prostate CA?

A

DRE
PSA
PCA-3

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26
Q

Who should prostate CA screening be tailored to?

A

> 10 years of life expectancy
FHx
Black men

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27
Q

A patient 60+ yo has the following presentation, which is concerning for…

  • frequency, urgency, nocturia, hesitancy
  • bone pain, fatigue, wait loss
  • nodular/asymmetric DRE
A

prostate CA

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28
Q

Bone pain, fatigue, weight loss in prostate CA indicate what stage of disease?

A

advanced

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29
Q

frequency, urgency, nocturia and hesitancy in prostate CA are often due to…

A

concomitant BPH

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30
Q

abnormal prostate exam or abnormal PSA indicate…

A

prostate biopsy

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31
Q

How is prostate CA scaled?

A

TMN/gleason score

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32
Q

4 options for prostate CA dependent on age, staging, lifestyle, comorbidities…

A

observation
radical prostatectomy
radiation
androgen deprivation

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33
Q

Describe the surveillance after tx for prostate CA…

A

PSA 6-12 mo x 5 years then annually

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34
Q

What causes of ED have the following finding?

rapid onset

A

psychogenic

GU trauma

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35
Q

What causes of ED have the following finding?

nonsustained erection

A

anxiety

venous leak

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36
Q

What causes of ED have the following finding?

depression
certain drugs

A

depression or drug induced

37
Q

What causes of ED have the following finding?

loss of nocturnal erections

A

vascular or neuro dz

38
Q

What labs should be ordered to assess ED?

A 
A1c/FPG
CBC/CMP
TSH
Lipids
serum T
39
Q

The physical exam for ED should include…

A

DRE, 2ndry sex characteristics, femoral/peripheral pulses, breast exam, testicular volume

40
Q

Nocturnal tumescence test can distinguish what two causes?

A

psychogenic or organic cause

41
Q

Duplex doppler is useful in ED to identify…

A

arterial obstruction or venous leak

42
Q

2nd line for ED?

A

vacuum
injectables
suppository

43
Q

The following presentation is concerning for…

  • sexually active male
  • dysuria, urethral d/c
  • inflamed meatus
A

urethritis

44
Q

What two labs can help dx urethritis?

A

gram stain

first void urine NAAT

45
Q

Tx for gonococcal urethritis?

A

ceftriaxone 250 mg IM + azithro 1g x 1 dose

46
Q

Tx for gonococcal urethritis if PCN allergy?

A

gentamycin 240 mg IM + azithro 2g x 1 dose

47
Q

What is the tx for non-gonococcal urethritis?

A

azithro 1g PO

doxy 100mg PO BID x 7 days

48
Q

Is retest needed if urethritis is treated with 1st line?

49
Q

The following presentation is concerning for…

  • acute/unilateral scrotal pain
  • radiation to ipsilateral flank
  • hemi-scrotal swelling, tenderness
  • fluctuant mass

(+) Prehn sign

A

epididymitis

50
Q

What are 4 components to epididymitis dx?

A

PE, UA, swab, US

51
Q

Tx for epididymitis if STI suspected…

A

ceftriaxone 250mg IM x 1 and doxy 100mg BID x 10 days

52
Q

Tx for epididymitis if enteric organism…

A

levofloxacin 500mg qd x 10 days

ofloxacin 300mg BID x 10 days

53
Q

Bacterial epididymorchitis can be treated how?

A

same as epididymitis

54
Q

What are three components for epididymorchitis dx?

A

PE, UA, US

55
Q

Right sided varicocele is less common, and suspicious for what condition?

A

pelvic/abd malignancy

56
Q

The following presentation is concerning for…

dull, achy testicular pain relieved with support or supine (prehns sign)

mass that increases in size with valsalva

decreased size when supine or elevated

A

varicocele

57
Q

How is varicocele treated?

A

ligation of spermatic vein if sxs, infertility concerns, testicular atrophy

58
Q

what imaging can be used for routine varicocele?

A

doppler US

59
Q

If no decompression of varicocele occurs in recumbent position, what test is indicated?

A

CT for outlet obstruction

60
Q

The following presentation is concerning for…

  • unilateral, hemi scrotal swelling
  • neg. prehn
  • bell-clapper deformity
  • absent cremasteric reflex
A

testicular torsion

61
Q

The following presentation can indicate what?

  • painless, solid testicular swelling/nodule
  • dull ache/heavy sensation in lower abdomen, scrotum
  • inguinal, para-aortic LAD

+/- supraclavicular LAD

A

Testicular CA

62
Q

What is important when examining testicles for testicular CA?

A

examine unaffected first

63
Q

Any firm, hard, fixed area should be considered…

A

cancer until proven otherwise

64
Q

What imaging can be helpful for testicular CA?

A

scrotal US

CT abd./pelvis

65
Q

What labs can help ID and monitor testicular CA?

A

Beta HCG
LDH
AFP

66
Q

What are the two primary testicular tumors?

A

nonseminoma (65%)

seminoma (35%)

67
Q

How is testicular CA treated?

A

radical inguinal orchiectomy

radiation/chemo

68
Q

When should post-tx surveillance for testicular CA happen?

A

q 3 mo for 2 yrs

6 mo, yearly after year 5

69
Q

Direct hernia protrudes through…

A

hesselbach’s triangle

70
Q

is direct or indirect hernia more common?

71
Q

Patient presents with:

  • heaviness/discomfort with straining
  • painless bulge
A

inguinal hernia

72
Q

The below are signs of what hernia complication?

NV
abd. distension
pain
redness
fever
A

incarceration

73
Q

2nd MC urologic malignancy associated w/ TOBB, chemical dyes

A

bladder CA

74
Q

PE for bladder cancer is usually…

A

unremarkable

75
Q

What are 90% of bladder cancers?

A

transitional cell carcinoma

76
Q

The following clinical features paint a picture for…

-painless hematuria

+/- obstructive/irritating urinary sxs

para-aortic LAD

A

bladder CA

77
Q

Hepatomegaly, supraclavicular LAD, periumbilical nodules represent what in reference to bladder CA?

78
Q

Gold standard for bladder CA dx?

A

cystourethroscopy

79
Q

Tx for bladder CA?

A

transurethral resection

80
Q

This defines…

leakage with exertion/valsalva due to urinary sphincter dysfunction

A

stress incontinence

81
Q

MC cause of stress incontinence

A

prostate surgery

82
Q

typical presentation for incontinence?

A

nocturnal enuresis

83
Q

4 components to physical exam for incontinence?

A

abd, neuro, genital, rectal exam

84
Q

labs for incontinence?

A

UA and cx

BUN/Cr

85
Q

Tx for urgency incontinence…

A

antimuscarinics (-terodines)

alpha blockers w/ BPH (-oszin)

86
Q

stress incontinence is treated with…

A

condom catheter

penile clamp

surgery

87
Q

overflow incontinence is tx with…

A

alpha blockers

88
Q

The following indicate “complicated incontinence” and require referral to …

severe sxs
pelvic pain
hematuria
PSA
recurrent UTI
previous rads/surgery
neurologic dz

Clinical Medicine II (31 decks)

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