Urology/Gynecology: Male Genitalia and Reproductive Tract Flashcards
What are the common signs and symptoms of prostate cancer?
1) May be asymptomatic early in disease
2) Urinary sx: urgency, frequency, nocturia, hesitancy “dribbling”
3) Hematuria and hematospermia
4) Bone pain: indicates metastases
What does the prostate feel like or DRE in prostate cancer, BPH and prostatitis?
Prostate Cancer: Hard irregular nodule or diffuse dense induration involving one or both lobes, asymmetrical (painless)
BPH: Enlarged, smooth, and rubbery; loss of median sulcus , symmetric
Prostatitis: DRE contraindicated; tender (painful), enlarged, “boggy”
What are the common signs and symptoms of Late-Onset Hypogonadism (also: Testosterone Deficiency Syndrome)?
Fatigue
Decreased libido
Depressed mood
Decreased muscle mass
Decreased body hair
What are the diagnostic criteria of erectile dysfunction?
1) Persistent inability to attain or maintain an adequate erection
2) Disturbance causes marked distress or interpersonal difficulty
3) Not accounted for by another disorder other than sexual dysfunction
4) Is not due to physiological effects of drugs of abuse or general medication condition such as diabetes
What are some underlying causes of erectile dysfunction?
Vascular: Hypertension
Neurologic: Spinal cord injury, MS, Parkinson;s
Endocrine: Hypogonadism, DM
Pharmacologic: Medication side effect
Psychogenic: anxiety, partner dissatisfaction, hx of abuse
Surgery injury: prostatectomy
What medication is used to treat erectile dysfunction?
Sildenafil (phosphodiesterase inhibitor)
What is balanitis?
Inflammation of the glans penis
What are the causes of balanitis and balanoposthitis?
DM
Poor hygiene; uncircumcised
STI
Candidal Infection
HPV
Reactive Arthritis
Psoriasis; Lichen Sclerosis; Contact Dermatitis
What are the common signs and symptoms epididymitis?
Scrotal pain, swelling and redness
Painful ejaculation
Penile discharge
Dysuria
Enlarged inquinal lymph nodes
Blood found in semen
Which organisms are often implicated in acute epididymitis?
N.gonorrhoeare
C. Trachomatis
What is the inflammation of the testis called?
Orchitis
What infection is associated with orchitis?
Mumps or other virsuses (Echovirus, coxsackie or parvovirus) or bacteria (brucellosis)
A man comes to your clinic with obvious inflammation of the foreskin so that it cannot be retracted off the glans of the penis. What is your dx?
Phimosis
How does paraphimosis differ from phimosis?
Paraphimosis: When the cannot be moved out of retraction “Stuck in retraction)
Phimosis: When the foreskin cannot be retracted
What are some of the potential complications associated with paraphomisis?
Gangrene; constriction and possible necrosis of the glans penis
What is a good way of differentiating testicular torsion from epididymitis?
Prehn’s Sign: Pain may be relieved with elevation of testicles in epididymitis, but not in testicular torsion. (poor sensitivity in children)
How can varicocele lead to male infertility?
Common cause of low sperm production and decreased sperm quality
What’s a good diagnostic procedure to test for varicocele?
Varicocele= bag of worms
Inspection scrotum both standing and lying down. Have patient bear down whole standing to feel for enlarged veins. Varicocele will likely decrease while lying down
What are some causes of painLESS scrotal masses?
Tumor, Hydrocele, Spermatocele, Varicocele, Scrotal hernia
What are the causes of painFUL scrotal masses?
Epididymitis, Testicular torsion, Orchitis, testicular trauma, Hematocele
How does hydrocele respond to transillumination?
It transilluminates
How does spermatocele respond to transillumination?
It transilluminate
What are the obstructive signs of BPH?
Decreased force of urinary stream
Dribbling
Urine retention
What are the irritative signs of BPH?
Frequency, urgency, and nocturia
Would you use a sedating antihistamine with a patient with BPH?
They are contraindicated due to worsening of urinary tract obstruction with symptomatic aggravation
What drug is used for male pattern baldness, BPH, and hirsutism in women?
Finasteride
What accessory nutrients are indicated for BPH?
Omega 3 FAs, Vitamin C, Vitamin D, Zinc
What herbs are indicated for BPH?
Cucurbita pepo
Prunus Africanum
Serenoa repens
Urtica dioica root
What herbs are indicated for acute prostatitis?
Treat like severe infectious cystitis
Urinary antiseptic herbs (Juniperus ssp., Arctostaphylos uva-ursi)
Diuretics (Taraxacum or Urtica Leaf, Juniperus
Inflammation Modulators (solidago canadensis, juniperus)
Analgesics (Salix or Betula)
What physical therapy treatment is indicated for chronic prostatitis?
Diathermy
What are the contraindications for performing a digital prostate exam?
In (bacterial ) prostatitis or (acute proctitis: inflammation of rectum) , no prostate message or catheterization as it increase risk sepsis
How do you evaluate your patient is suspected prostatitis?
Urine Culture
Three glass urinalysis (urine from one continuous micturition) with culture and Gram-stain if needed
Serum PSA often elevated
What organism causes chancroid?
Haemophilus ducreyi
How would you described a chancroid ulcer?
Painful, superficial (usually LAO in position),
Red papule that progresses to pustule that can ulcerate
Can a routine culture be used to dx chlamydia?
No, use Nucleic Acid Amplification Tests (NAATs)- are sensitive and be used non-invasively
How is Chlamydia transmitted?
Direct sexual contact
What antibiotics are indicated for Chlamydia?
Azithromycin
Doxycycline
How do you diagnose a Chlamydia infection?
DNA probe of urine or discharge
What are the common signs and symptoms of Lymphogranuloma venereum?
1) Associated with chlamydia trachomatis infections
2) Begins with small, painless, papule that heals within 1-2 weeks
3) 2-6 weeks later develop painful inguinal and femoral lymph nodes
4) Can coalesce to form buboes (lymph node comes together to form one mass) which may rupture then heal slowly
5) Last stage is proctocolitis with fever, blood purulent discharge, rectal pain and tenesmus
What’s the quality of the discharge in Gonococcal (GC) urethritis?
Purulent
Can a routine culture be used to dx Gonorrhea?
No
How do you diagnose a GC infection?
(NAATs) DNA probe or urine or discharge
What antibiotics are indicated for GC?
Ceftriaxone 250 mg intramusucular (IM) single dose or Cefixime 400 mg oral (PO) single dose
If these are not available then a single dose of an injectable cephalosporin PLUS
Azithromycin 1 g PO single dose or Doxycycline 100 mg PO twice a day for 7 days
What are some of the homeopathic remedies to consider for GC?
Medorrhinum
A patient comes to you concerned because they had unprotected intercourse last night. Today they want to be tested for STI’s. What do you tell them?
Must wait at least 3 weeks before any testing can be done
What’s in the DDx for recurrent UTIs in men?
Bladder carcinoma
Bladder stones
Prostatic Obstruction
DM
How do you describe the ulcers in herpes simplex virus?
Painful, vesicular (red mucosal) lesions that last 7-10 days. Typically rupture after 2 days and ooze fluid (this fluid contains virus)
What are the common conventional treatments for HSV?
Acyclovir
Valacyclovir
Describe the lesion of primary syphilis?
Chancre: painless ulcers; highly infectious
What is the lesion of secondary syphilis called?
Condyloma lata/latum with generalized rash this is also on palms and soles
Difference from condyloma acuminata “genital warts, HPV)
What happens when tertiary syphilis is untreated?
Neurosyphilis
If a patient with primary or secondary syphilis does not receive treatment, do their symptoms resolve?
Yes, but then they progress to the next stage
What presents on a pelvic exam of a person infected with Trichomoniasis?
Red “strawberry” spots
What is the treatment for Trichomoniasis? Do you treat, if asymptomatic?
Metronidazole; Yes
