# 11: Mens Health

Question 1

testis twists on spermatic cord

Answer 1

Testicular torsion

Question 2

Common Hx w/ Testicular Torsion (2 things)

Answer 2

Common Hx w/ Testicular Torsion

1. trauma
2. Cryptorchidism

Question 3

Pt presents w/ sudden onset of severe unilateral testicular pain and swelling, N/V. Testis ttp, and high riding with absent cremesteric reflex

what is the best test for Dx it
most likely Dx

Answer 3

Test = URGENT US (see if flow present)

dx = Tesituclar torsion

Question 4

Tx of Testicular torsion

1. non-surgical
2. surgical

Answer 4

Tx of Testicular torsion

1. non-surgical = manual detorsion (open book)
2. surgical detorsion and orchiplexy

Question 5

erection > 4 hrs

Answer 5

Priaprism

Question 6

Priaprism

1. two main causes
2. 2 types - which is MC and more emergent

Answer 6

Priaprism

1. causes = SCD, meds
2. types
   - ischemic = MC and more emergent
   - non-ischemic

Question 7

Priaprism Med Causes

• what 3 meds typically cause it

Answer 7

Priaprism Med causes (think ED drugs)

1. NO
2. PDE 5 Inhib
3. Trazadone

Question 8

Ischemic vs Non ishchemic Priaprism

1. which a/w impaired relaxation of cavernosal smooth muscle
2. which is a/w fistula formation, more gradual, trauma related
3. which usu resolves on it own

Answer 8

Ischemic vs Non ishchemic Priaprism

1. ischemic = a/w impaired relaxation of cavernosal smooth muscle
2. non-ischemic = a/w fistula formation, more gradual, trauma related
3. non-ischemic usu resolves on its own

Question 9

Tx of ischemic priaprism

• what is med given
• what can also be done in addition to med

Answer 9

Tx of ischemic priaprism

• med = phenylephrine (intracavernosal sympathomimetic)
  and/or aspiration

Question 10

cant retract foreskin
vs
entrapment of foreskin behind glans (cant replace foreskin)

Answer 10

phimosis = cant retract foreskin

paraphimosis = entrapment of foreskin behind glans (cant replace foreskin)

Question 11

Phimosis vs Paraphimosis

1. which is a/w purulent d/c
2. which is a/w eyrthema of glans
3. which is emergency

Answer 11

Phimosis vs Paraphimosis

1. Phimosis = a/w purulent d/c
2. Paraphimosis = a/w eyrthema of glans
3. PARAphimosis = EMERGENCY

Question 12

Tx of phimosis

1. main tx
2. rare procedure
3. infection –>

Answer 12

Tx of phimosis

1. main tx = steroid creams
2. rare procedure = circumcision
3. infection –> antigfungals/ABXs

Question 13

Tx of paraphimosis (emergent)

1. 2 options
2. what to consider after initial tx

Answer 13

Tx of paraphimosis (emergent)

1. 2 options= manual or surgical reduction
2. consider circumcision after initial tx

Question 14

24 y/o pt presents w/ heaviness, L sided dull ache in scrotum, fever, chills, pain radiating up L flank. On exam you note a swollen/enlarged epididymis. UA shows pyuria, bacteria and cultures are +

Dx and 2 ABXs for Tx?

Answer 14

Dx = epididymitis

Tx = Ceftriaxone + Doxycyline

Question 15

What is Tx for pts w/epididymitis who are older than 35

Answer 15

Tx for pts w/epididymitis > 35 y/o = Cipro

Question 16

Orchitis

1. what viral infxn is it a/w and what is tx
2. if bacterial cause what do you treat it like
3. presentation (3 things)
4. how to Dx bacterial

Answer 16

Orchitis

1. a/w MUMPS –> symptomatic Tx (ice, analgesia)
2. if bacterial cause –> treat it like epididymitis
3. unilateral testicular swelling/tenderness, fever, tachycardia
4. Dx = UA (signs of bacteria infxn)

Question 17

fluid fluid remains of tunica vaginalis

Answer 17

hydrocele

Question 18

Pt presents w/soft NT fullness of hemiscrotum and pt says size waxes and wanes. On PE the mass transilluminates

Dx?
Tx - needed?

Answer 18

Dx = Hydrocele

tx - usu not needed (go away in 1 yr)
- can do elective surg

Question 19

Pt presents w/ venous varicosity w/in pampiniform plexus on L. On exam the mass is NT, does not illuminate and looks like a bag of worms

dx?
when is Tx needed? and what is it

Answer 19

Dx = variocele

Tx needed if causing infertility or Sxs (surg)

Question 20

1. Nephrolithiasis
2. cystitis + pyelonephritis
3. Acute/CKD
4. vigorous exercise/trauma (rhabdo)
5. CA (bladder, prostate, kidney)

Are causes of _______

Answer 20

causes of hematuria

1. Nephrolithiasis
2. cystitis + pyelonephritis
3. Acute/CKD
4. vigorous exercise/trauma (rhabdo)
5. CA (bladder, prostate, kidney)

Question 21

Things that look like hematuria but arent (3)

Answer 21

Things that look like hematuria but arent

1. beets
2. food dye
3. Phenazopyridine

Question 22

Hematuria and Bladder CA

1. what is MC sx
2. best test to Dx it

Answer 22

Hematuria and Bladder CA

1. what is MC sx = PAINLESS Hematuria
2. best test to Dx it = Cystoscopy

Question 23

Pt presents w/ hematuria, flank pain, abd mass and wt loss. pt also has paraneoplastic syndromes

1) Dx
2) what tests best to Dx? stage?

Answer 23

dx = Renal Cell Carcinoma

Test to Dx = MRI/CT
stage = bone scan

Question 24

Pt presents w/ dysuria, pruritus, burning,and discharge at urethral meatus. You see PMNs on gram stain and leuk esterases on first void urine.

1. What test is best to confirm Dx
2. Dx?
3. what is most likely cause

Answer 24

Test to confirm Dx = NAAT testing

Dx = Urethritis

most likely cause = G/C (STI)

Question 25

Urethritis 1. tx for G/C 2. Tx if not G/C

Answer 25

Urethritis 1. tx for G/C = Ceftriaxone + Azithromycin 2. Tx if not G/C = Azithro or Doxy

Question 26

Pt presents w/ urinary freq, urgency, dsuria, fever, rigors low back/perineal pain, and pain/bleeding w/ejaculation. Dx?

Answer 26

dx = prostatitis

Question 27

Prostatitis 1. findings on prostate exam 2. finding on UA 3. Tx

Answer 27

Prostatitis 1. findings on prostate exam = swollen, tender + boggy prostate 2. finding on UA = pyuria 3. Tx = Fluoroquinolone or Bactrim

Question 28

Nephro/urolithiasis 1. what type is MC 2. when is it considered an emergency (2 situations) b/c it can lead to __________ 3. BEST imaging study

Answer 28

Nephro/urolithiasis 1. MC = calcium (opaque) 2. emergency if infected or complete obstruction --> hydronephrosis 3. BEST imaging study = NON contrast abd + pelvic CT

Question 29

Pt presents w/ severe sudden onset of unilateral, stabbing flank pain. Vitals: RR 22, HR 110 and BP 110/78, PE findings are CVAT and restlessness b/c pt cant get comfortable. UA shows hematuria. dx?

Answer 29

Kidney stone

Question 30

Sxs of kidney stones by location 1. flank pain, N/V 2. abd pain w/ classic renal colic 3. urinary freq, dysuria, pain radiate to groin

Answer 30

Sxs of kidney stones by location 1. flank pain, N/V = prox ureter/ renal pelvis 2. abd pain w/ classic renal colic = mid ureter 3. urinary freq, dysuria, pain radiate to groin = distal ureter

Question 31

1. trauma 2. infxn 3. torsion 4. hernia 5. testicular CA are causes of

Answer 31

causes of scrotal pain 1. trauma 2. infxn 3. torsion 4. hernia 5. testicular CA

Question 32

Most serious cause of scrotal pain (emergent)

Answer 32

Fournier's gangrene

Question 33

Necrotizing fasciitis of perineum, often involves scrotum

Answer 33

Fournier's gangrene

Question 34

Pt presents w/ fever, tachycardia, HoTN, Blisters/bullae of perineum, crepitus and subQ emphysema dx? tx? (2 things)

Answer 34

Dx = Fournier's gangrene Tx = surgical debridement and ABXs - DONT DELAY Tx FOR IMAGING