Station 10

Question 1

55m Presenting with ED
Assess

Answer 1

I would see the man in a dedicated andrology clinic with partner present

History
ED. - Unable to achieve? Maintain? Penetrate? Masturbate
When - ?Did it start, ?Gradual/Rapid, ? Progressing
All the time ? Sometimes
Morning Erections
What have they tried
Relationship
Libido

**Assess severity with IIEF-5 validated questionnaire. Sever 1-7, Mod 8 -11, Mild 12-16, V Mild 17-21 **
**Framingahm Score for 10 year CVS disease risk **

RFs
Cardiac, HTN, Smoker, Diabetes, Cholesterol
Trauma, Surgery (pelvic), Radiotherapy, Neurologial Disorders

FH
Cardiac disease, T2DM

DH
Allergies, Nitrates, Anti-HTN

SH
Fitness, Smoker

Question 2

55m Presenting with ED
Examine

Answer 2

General - BMI/Fitness
Cardio Exam/ Neurological Exam
Hypogonadism - Loss of hair, Muscle bulk, testicular atrophy
Penis - Peyronie’s Disease, Phimosis
Testicular - Size, Consistency, Vas palpable
DRE (>50 yo) - Sphincter tone, prostate

Question 3

55m Presenting with ED
Ix

Answer 3

Urinalysis
Bloods: Fasted Glucose, Fasted Lipids, Hba1c, Early morning testosterone
If test low Prolactin, LH, TFTs
PSA if >50 / if abnormal DRE

Doppler US with caverject - atypical story, young with CV risk factors, Trauma