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ClinMed Flashcards

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1
Q

are testicular self exams recommended?

A

no

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2
Q

what are the CDC recommendations re: the HPV vaccine for males

A

males through 21 years

males 22-26 yo is individual basis

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3
Q

what is the recommendation for HPV vaccine for men with HIV or other immunocompromised condition?

A

through 26 years, 3 doses

same for men who have sex with men

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4
Q

what positions should the patient be in for hernia examination

A

standing then supine

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5
Q

what position should the patient be in for inguinal lymphatics

A

standing

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6
Q

cremasteric reflex evaluates what nerve

A

genitofemoral nerve (L1-L2)

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7
Q

normal cremasteric reflex will be

A

elevation of scrotum and testes

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8
Q

what position should the patient be in for rectum and prostrate exams?

A

left lateral decubitus or upright forward flexion

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9
Q

are screening DREs recommended?

A

nope

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10
Q

what are two congenital penile abnormalities?

A

hypospadias

cryptorchidism

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11
Q

risk of cryptorchidism puts the patient at increased risk for what two conditions?

A

testicular cancer

infertility

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12
Q

when is surgical intervention recommended for cryptorchidism?

A

as soon as possible after 6 months and definitely before 2 years old

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13
Q

what is hypospadias?

when is surgery recommended?

A

abnormal placement of the urethra.

surgery before 18 months

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14
Q

the most common cause of painless scrotal swelling

A

hydrocele

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15
Q

what will occur on PEx in a patient with hydrocele?

A

transillumination

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16
Q

where is the fluid in a hydrocele?

A

within the parietal and visceral layers of the tunica vaginalis

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17
Q

which type of hydrocele is more common in pediatrics?

A

communication (patent processus vaginalis)

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18
Q

bag of worms refers to

A

variocele

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19
Q

what is a variocele?

A

abnormal dilation of the veins of the pampiniform plexus

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20
Q

the most common cause of primary infertility in men

A

varicocele

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21
Q

what should always be on your differential for someone presenting with testicular pain?

A

testicular torsion

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22
Q

what side is the most common side for varicocele?

A

left side

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23
Q

a painless, cystic mass in the head of the epididymus that’s separate from the testicle and may contain sperm is often

A

spermatocele

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24
Q

most sensitive PEx finding for testicular torsion

A

absent cremasteric reflex

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25
how quickly does detorsion of testicular torsion need to occur
6-8 hours
26
most common age group for testicular torsion?
10-20
27
clinical manifestation for testicular torsion
abrupt onset of scrotal, inguinal, lower abdominal pain and N/V often after trauma or workout
28
what is the best initial test for diagnosis of testicular torsion?
doppler US
29
what is the treatment for testicular torsion?
bilateral orchiopexy
30
pain that improves with scrotal elevation, think
epididymitis
31
milking urethra is often seen in what STI
chlamydia
32
if a patient has non-specific urethritis, what STI is assumed?
chlamydia
33
what are the two options for testing for GC and chlamydia
urethra swab procedure and urine
34
a single, painless chancre or papule is associated with what STI?
syphilis
35
secondary syphilis sxs include
skin (rash), mucous membranes, and lymph node involvement
36
tertiary syphillis sxs include
gummas, cardiac, ophthalamologic and auditory
37
what has a classic presentation of multiple, shallow, tender erythematous ulcers that may be vesicular? +/- dysuria
HSV
38
bubo formation (enlarged lymph nodes) is associated with what?
chancroid
39
lymphogranuloma venereum is different from other infections caused by c trachomatis because it affects?
lymphatic, not mucosal, tissue
40
what is characterized by a small papule that quickly ulcerates to beefy-red? is it painless ?
granuloma inguinale, painless
41
CDC recommendation for HIV screening
all adults and adolescents from 13--64 should be tested at least once
42
orchitis is caused by
mumps
43
who typically gets orchitis?
children > adults
44
two most common SIS of orchitis
parotid tenderness and facial edema
45
how long after onset parotitis does orchitis usually develop?
7-10 days develops in 25-40%
46
tx for orchitis?
symptomatic, scrotal elevation, cool compresses, analgesics
47
what type of HIV prevention should be considered for high risk populations
PrEP
48
4 risk factors for prostate cancer
age ethnicity (AA) high fat diet family hx
49
where does prostate cancer tend to metastasize?
bones | sxs: neuro (spinal cord compression) and back pain or pathological fractures
50
DRE detection rate for prostate cx
1.5-7%
51
is serum PSA diagnostic of cancer
nope
52
what else can cause an increase in serum PSA besides cx?
inflammation or BPH
53
when is transrectal US used in the world of prostate cancer
for staging and guidance for bx (NOT screening)
54
what is the recommendation from USPSTF for PSA-based screening?
Recommends against routine PSA-based screening for prostate cancer for average risk regardless of age (Grade D)
55
what is the bottom line for screening with PSA?
discuss pt re: risks and benefits age 50 for average risk age 40-45 for high risk 10+ year life expectancy
56
your pt decides to be screened for prostate cx. he has a normal DRE and a PSA <1 ng/mL. when should you repeat the screening?
repeat 2-4 yrs
57
your pt decides to be screened for prostate cx. he has a normal DRE and a PSA 1-3 ng/mL. when should you repeat the screening?
1-2 years
58
when should you consider bx or close follow up (6 mon) or additional biomarkers after PS cx screening
PSA > 3 or abnl DRE
59
on TRUS, PS cancer will have what type of appearance?
hypoechoic appearance
60
how many cores are taken in bx for PS cancer?
8-12
61
describe the roles of MRI, CT and bone scan in diagnosis of ps cx?
MRI: limited role (can detect lymphadenopathy) CT: no role in initial staging, but can identify mets bone scan: detects bone mets
62
when should you consider a bone scan during the dx portion of ps cx?
consider if PSA >20, high grade histology, bone pain
63
what is the staging system for prostate cx?
gleason system
64
what is the tx for localized prostate cx and less than 10 yr life expectancy
active surveillance
65
what is the mainstay tx for advanced and metastatic ps cx?
androgen deprivation therapy (LHRH or anti-androgens) via surgical (bilateral orchiectomy) or medical castration
66
what does prostate cancer that becomes refractory to hormone therapy indicate?
poor prognosis
67
3 risk factors for penile cancer
lack of neonatal circumcision HPV 16 & 18 infection tobacco use
68
MC histology of penile cancer
squamous
69
MC solid tumor in men age 15-34 is
testicular cancer
70
MC histology of testicular cancer
germ cell tumors
71
cryptorchidism is a risk factor in what type of cancer? which side is MC
testicular | right side
72
a firm, painless unilateral mass in testis, think
testicular cancer
73
dx of testicular cancer is made with what 2 modalities
scrotal US! | confirmed by bx w inguinal orchiectomy (don't do FNA, worry about seeding)
74
what tumor markers are used for testicular cancer?
hCG, AFP, LDH
75
staging for testicular cancer?
TNMS s for serum tumor markers
76
official dx of androgen deficiency includes low serum testosterone and how many symptoms?
3
77
what do you need to check prior to starting testosterone therapy?
CBC and PSA
78
testosterone can worsen what two other comorbid disorders?
OSA, CHF
79
men with ED have a greater risk for what?
cardiovascular events
80
mainstay tx for ED
PDE-5 inhibitor
81
CI for PDE-5 inhibitors
nitrates, severe CV disease
82
transition vs peripheral zone. | where does BPH occur most often?
transition zone | prostate cx in peripheral zone
83
symptoms of bph fall into what two main categories
obstructive or irritative
84
what two tests should you order when you are working up BPH?
UA and PSA
85
two pharm bph tx
1. 5 alpha reductase inhibitors | 2. selective alpha-1 blockers
86
AUA scoring
1-7: mild 8-19: moderate 20-35: severe
87
you are evaluating back pain in a patient. what dx should be on your differential?
acute prostatitis
88
MC organism in prostatitis
e.coli
89
which two organisms are MC in sexually active young men?
n. gonorrhea and c. trachomatis
90
exquisitely tender, normal or hot, boggy prostatitis
acute prostatitis
91
first line tx acute prostatitis? how long?
FQs or TMP/SMZ for 4-6 weeks

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