Flashcards in Dz Deck (266):
In which zone does BPH occur?
In which zone does prostate cancer occur?
What is the purpose of DRE?
to check for nodules/cancer
Is DRE helpful for detecting BPH?
What are the type of BPH?
obstructive and irritative
What is obstructive BPH? ie?
ie) Bladder outlet obstruction
ie) adrenergic tone - muscle tone is causing obstruction
What is irritative BPH?
detrusor muscle hypertrophy/hyperplasia
the BLADDER is irritated
How may a pt with BPH come in looking like?
When should peds get imaging done on their kidneys/bladders?
What labs should be done for BPH?
Serum creatinine would be elevated or decreased in BPH? What next?
UA in BPH? What next?
refer to urology
What imaging if considering cancer?
BPH mild - tx?
BPH mod- severe - tx?
selective alpha 1a-receptor blocker (not lungs)
nonselective alpha blockers (lungs)
BPH w/ large prostate + hematuria?
5 alpha-reductase inhibitors
6mo until benefit
ADD W/ ALPHA BLOCKER
BPH when to refer?
BPH surgery gold standard?
Transurethral resection of the prostate (TURP)
What does PSA measure?
protein that is measured in the blood --> if elevated may indicate: infxn, cancer, enlarged prostate
--further eval would be needed
failure of the urethral folds to close at the tip of the penis
if infant has a strong pee
Hypospadias - tx?
nothing - unless bothersome
Urethral stricture/meatal stenosis?
narrowing of the urethra
Complication from uncircumcised penis?
pearly penile papules
Decrease urine stream, spraying/double stream, postvoiding dribbling?
urethral stricture/meatal steonsis
chronic infxn from poor hygiene
SQUAMOUS CELL CARCINOMA UNDER FORESKIN
Phimosis - tx?
foreskin gets stuck when retracted behind the glans
Paraphismosis - sx/pe?
edema d/t venous congestion
arterial occlusion and necrosis may occur
Paraphismsis - tx?
firmly squeezing glans for 5min to decrease tissue edema
skin can be drawn forward over glans
Curvature of the penis of the painful erection but NO pain when not erected?
Penis is rigid but NOT painful?
Nonischemic priapism -tx?
What should sickle cell pts be aware of?
What is happening in ischemic priapism?
venous drainage circulation gets cut off --> build up of viscous and poorly oxygenated blood in copora cavernosa
What drug can cause ischemic priapism?
Ischemic priapism - tx?
analgesia + alpha agonist
If pt has sickle cell and ischemic priapism?
treat the underlying sickle cell dz - O2, hydration, transfusion
Where does LH and FSH come from?
leydig --> synthesize testosterone --> secondary characterisitcs
sertoli cell --> spermatogensis
Fails at testes?
primary hypergonadotrophic hypogonadism
Primary hypergonadotrophic hypogonadism- LH and FSH?
NO negative feedback because testes are broken --> continuos LH and FSH is made but NO testosterone
Secondary hypogonadotrophic hypogonadism?
fails at the gonads
Secondary hypogonadtrophic hypogonadism - LH and FSH?
low LH and FSH --> LOW testosterone
Secondary hypogonadtrophic hypogonadism PE-before puberty?
before puberty- nothing
Secondary hypogonadtrophic hypogonadism PE-after puberty?
after puberty - NO secondary characteristics (hair, narrow shoulders, gynocomastia)
Secondary hypogonadtrophic hypogonadism PE-later in life?
later in life - erectile dysfxn, poor libido, mood changes (depression), low energy
Normal range for testosterone?
What do to if lower than 300 testosterone level?
suspect androgen deficiency
What do you a LH and FSH lab test for those w/have small testes?
to distinguish between primary hypergonadtrophic and secondary hypogondatrophic hypogoandism
When do you tx for hypogonadism?
testosterone is <300
AND 3 sx (erectile dysfxn, poor libido, mood changes, fatigue)
How long do you monitor hypogonadisim tx? What else do you monitor?
after 3 mo + q 3 mo
consider prostate screening, hct, lipids
What are contraindications for testosterone replacement?
CHF, MI, unstable angina
hx of prostate cancer, breast cancer
severe lower urinary tract sx
What form does testosterone replacement come in?
What are DIs for testosterone replacement?
What are the benefits of testosterone replacement?
better mood --> depression
better libido --> libido
decrease erectile dysfunction --> erectile dysfunction
more muscle strength and endurance --> fatigue
What are the treatments for hypogonadism?
Premature gonadal failure vs "andropause"?
premature gonadal failure: ABNORMAL decrease of testosterone in YOUNG males
andropause: NATURAL decrease of testosterone w/age
What are the diff types of testicular dysfxn?
What is Klinefleter?
What is cryptorchidism?
incomplete dropping of the testes
correct before 2yo - surgery
Cryptorchidism - complication?
Bilateral > unilateral
increase risk for testicular neoplasm
increase risk for inguinal hernias
What is testicular torsion?
twisting of the testes
Testicular torsion - cx?
HX OF CRYPTOCHIDISM (complication)
Testicular torsion - population?
Testicular torsion - sx/pe?
testes move freely in the tunica vaginls
What is the timeframe for testicular torsion saving?
sx w/ 6+hrs = risk of losing testes
What haps if you lose one testes?
other will kick into gear - not a prob
Testicular torsion - test?
Testicular torsion - tx?
blood flow increases --> presses down on the veins --> blood accumulates --> erection
needs both pudendal nerve and skeletal muscle
1) seminal emission
2) projectile ejaculation
--needs both pudendal nerve and skeletal muscle
How to tx premature ejaculation?
-behavioral therapy: stop stimulation just prior to climax and hold base of penis anterior to posterior to prevent emission (kind of like desensitizing)
-SSRI: d/t increase in serotonin
-reduce penile sensitivity: condomn, topical anesthetizing cream
What can cx delayed oragsm?
What is retrograde ejaculation?
backflow of semen into the bladder
Cx of retrograde ejaculation?
after TURP (d/t BPH)
alphablockers for BPH
Tx for retrograde ejaculation?
What is organic erectile dysfunction?
having the desire but not able to physically get the penis erected
What is pychogenic erectile dysfunction?
not having the desire to get an erection
What must be ruled out before erectile dysfunction?
-peripheral neuropathy (diabetes)
Pt comes in erectile dysfunction - what is important to take note of/review?
-meds: SSRI, opiates, non selective beta blockers, antishitamines, H2 blockers
If pt is taking meds for the heart and is having trouble with erections, what drug can be used? avoided?
-change the beta blocker to alpha agonist
-do NOT use sildenfil in case pt needs to take nitro
What pts should have labs done for erectile dysfunction?
ONLY if they are:
Tx erectile dysfunction?
adjust meds (Beta blockers, SSRI)
drugs: PDE 5Is
transurethral therapy: alprostadil
vacuum pump device
What adjustment to meds for erectile dysfunction?
Beta blockers --> alpha agonist
SSRI --> bupropion/wellbutrin, drug holiday, reduce SSRI
What drugs can be used for erectile dsyfunction?
When are the drugs for erectile dysfunction effective?
IF he is aroused
MOA of sildenafil?
increase cGMP levels --> vasodilation
Who may NOT respond to sildenafil?
Which tx of erectile dysfunction does NOT need sexual arousal?
What are the types of hernias?
groin --> inguinal and femoral
RF for hernias?
abdominal wall injury
HX OF CRYPTORCHIDISM
Hx of cryptorchidism can cx?
Population for hernias?
dull pain when NOT moving
worse w/ moving, heavy lifting, coughing
bulge in groin but NON TENDER
Inguinal hernia: direct vs indirect PE?
Complication of hernia?
incarceration --> strangulation --> bowel obstruction
What is incarceration (hernia)?
the bowel gets stuck outside - pain
What is strangulation (hernia)?
bowel AND ischemia starts - blood flow compromised
What is bowel obstruction (hernia)?
BLOCKING of gas/stool - DIFFUSE abdomen pain
How to diff indirect and direct hernia?
When to use CT for hernia?
When to use MRI for hernia?
to check if strangulated
How to tx hernia uncomplicated w/ little sx?
How to tx hernia uncomplicated w/ sx?
How to tx ACUTE incarcerated hernia w/ no sx of strangulation?
manual reduction - trandelenburg w/ slow pressure
How to tx unreducible incarerated hernia +/-strangulation?
Congenital hernia vs acquired hernia?
congenital: processus vaginalus did NOT oblierate and internal ring did NOT close
acquired: trauma/damage to fibromuscular tissue of abdominal wall (cyclists, straining of the abdomen that increases pressure, etc)
What hernia is ABOVE the inguinal ligament?
indirect and direct inguinal hernia
What hernia is BELOW the inguinal ligament?
What hernia is congenital?
What hernia is acquired?
What hernia can be both congenital and acquired?
Which hernia can be seen in children?
Which hernia can be seen in adults?
Which hernia is the most common? least?
least: femoral but MORE complications
What is hap in indirect hernia?
goes THROUGH the inguinal ring
LATERAL to the inferior epigastric artery
What is hap in direct hernia?
goes THROUGH the Hesselbach's triangle
LATERAL to inferior epigastric vessels
MEDIAL to rectus muscle
What is hap in femoral hernia?
goes THROUGH the empty space MEDIAL to femoral canal
THROUGH the femoral ring
What is follicular/sebaceous cyst?
BLOCKED sebaceous gland/hair follicle
Is follicular/sebaceous cyst - benign/malignant?
"small dome-shaped skin-colored 'pearly' papules on the CORONAL margin"?
pearly penile papules
"benign dome shaped subcutaneous papules on SCROTUM"?
"black/blue/dark red dome shaped papules on scrotum"?
angiokeratomas of fordyce
Which derm are reassurance and tx for cosmetics?
pearly penile papules
angiokeratomas of fordyce
lichen planus unless lesions
Pearly penile papules vs herpes/warts?
pearly penile papules: ON THE CORONAL
What is psoriasis?
non infectious and of the GLANS
"Well demarcated scaly erythematous plaques"?
Pt comes in with dilated thin walled venules and black/blue papules on scrotum - pt most likely has...?
"violet flat topped lesions" on...?
glans and shaft
Pruitic/painful lesions on glans and shaft?
Lichen planus tx?
papular lesions - topical corticosteroids
erosive lesions - intralesional steroid injection
Pt is <5yo, uncircumcised, poor hygiene + early stages of red erosions on glans?
Balanitis - later stages?
Uncircumcised + old skin cells, oils, but NO skin irritation?
Smegma - tx?
What is lichen sclorsis also called?
balanitis xerotica obliterans
What are the stages of lichen sclorsis?
early: atophic puritic white plaques/papules
progressing: dysuria, painful erection
later: phimosis, meatal stenosis
Tx for lichen sclorsis?
early: HD topical steroids
later: intralesional corticosteroids
What are the gonadal deficiency?
HIV, COPD, cancer, liver/kidney dz
What drugs can affect gonadal deficiency?
What is androgen insensitivity?
do not have secondary characteristics
How does an androgen insensitivity person look like?
genitally male (XX) but appearance is female
What is precocious puberty?
puberty comes on TOO fast
What is delayed puberty?
NO secondary characteristics by 14yo
Delayed puberty vs constitutional delay?
What is officially gynecomastia?
bigger than 4cm
GLANDULAR tissue NOT adipose
What is hydrocele?
Cx of hydrocele?
What can hydrocele be associated with?
Why do a US in hydrocele?
distinguish between simple (watch) vs complex (refer)
If young child has hydrocele?
normal d/t testes dropping
PAINLESS cyst that is MOVEABLE
located AWAY from testes
Spermatocele/epididymal cyst -tx?
"dilation of venous plexus and internal spermatic vein" - what would you expect?
bag full of worms
Which side is varoicele commonly found?
Right --> refer
right is DIRECTLY connected to the IVC
Tx of varicocele?
What can cause infertility?
hx of cryptochiasm
Pt notices ONE blue dot that is hard and tender?
torsion of appendix testes
What is high and low risk in HPV?
high: 16, 18
low: 6, 11
How can HPV be transmitted?
skin to skin
HPV incubation period?
genital warts: condylomata acuminata, flat genital, smooth papule
Do you bx HPV?
ONLY if pt is immunosuppressed, bleeding, ulceration
What STD has a vaccine?
What are the vaccines available for HPV?
Quadrivalent and bivalent
Age for vaccine HPV?
between 9-10yo; before 11yo
men who have sex w/men: cut off is 26yo
HPV vaccine dosage?
1st --> 2) 2mo later --> 3) 6mo later
First line tx for HPV? dosage?
podofilox 0.5% GEL NOT solution
3x/daily x 4days for 4 cycles --> no change? suspect cancer
How does HSV1 present?
papules --> vesicles -->pustules --> ulcers --> crust
HSV1 on the nose?
be careful for ocular herpes/herpes keratits--> may cause blindness
test w/ Floursecein --> medical emergency
HSV1 and HSV2 present?
What can trigger HSV2?
burning and tingling
HSV dx? what is no longer used?
viral culture - gold standard
Tzanck is no longer used
HSV tx for fist episdoe?
1) acyclovir 800mg TID
2) valacyclovir 1000mg BID
3) Famciclovir 250mg TID
HSV tx chronic suppressive if..?
HSV tx chornic suppressive?
acyclovir TID x3-5days
famiciclovir 1g BID x1day
Complication for HSV2?
somatitis and pharyngitis
if HSV is on the face?
What is chlamydia assocaiated with?
RF for chlamydia?
oropharynx infxn - NO discharge
When to culture for chlamydia?
if suspicion for child abuse
azithromycin 1g PO x 1 dose
IF pt is allergic to azithormycin-chlamydia?
doxycycline 100mg PO BID x7days
levofloxacin 500mg PO daily x 7days
Pt education for chlamydia?
NO sex for 7 days after tx OR after 7days w/ abx
scant grayish green penile discharge
metronidazole 2g PO x 1dose
What to advise during tx for trichomoniasis?
do NOT drink ETOH
Pubic lice sx/pe?
pruitic reddish/bluish papules/wheals
Pubic lice tx?
permethrin RINSE 1% x10min
permethrin CREAM 5% for 8hrs
Granuloma inguinale cx?
Where is granuloma inguinale found?
Granuloma inguinale sx/pe?
2) painful - foul smelling purulent discharge
lesions WAIST down
Granuloma inguinale dx?
bx--> DONOVAN BODIES
Granuloma inguinale tx?
doxycylcline 100mg PO BID x3-4wks
TMP-SMX DS Q12hrs x3wks
UNTIL ALL LESIONS HEAL
Which STI have bubos?
Lymphgogranuloma venereum cx?
Where is lymphogranuloma found?
Lymphogranuloma venereum sx/pe?
1) painless ulcer/papule
2) painful inguinal LYMPHADENOPATHY
3) BUBOS -purple
check partners w/in 60 days
Lymphogranuloma venereum tx?
doxycycline 100mg PO BID 3-4wks
tx partners like chlyamdia b/c it is subset
What STI are txd with doxycylcine?
chlyamdia if allergic to azithromycin
Chancroid found where?
What is important to keep in mind for chancroid?
CO FACTOR FOR HIV
1) PAINFUL vesticulopustural lesion - red at the base and bleeds easily (friable)
ceftriaxone 250mg IM x1dose
azithromycin 1g PO x1dose
MUST RTC 3-7DAYS
check parter w/in 60 days
What are AA RF?
Chlamydia vs gonorrhea sx/pe?
chlamydia: water discharge, NO discharge from oropharynx
gonorrhea: PURULENT discharge and in oropharynx
What do BOTH chlamydia and gonorrhea have?
How dx chlamydia and gonorrhea?
How to tx gonorrhea?
Ceftriaxone 250mg IM x1dose
AND cover for chlyamdia - azythromycin 1g PO x1dose
What is the diff between dipstick, microscopy, and culture?
UA is a screening tool
microscopy can be used for dx
When to use culture?
when microscopy is positive for bacteria/WBC
When to suspect false positive for dipstick?
if the sticks have been exposed to air for a proglonged period of time
Sx/PE for acute bacterial cystitis?
foul smelling urine
Tx for acute bacteria cystitis?
bactrim or cipro (fluroquinolone) x 7days
What sx/PE acute bacterial cystitis, acute prostitis, and chronic prostitis have in common?
What is the difference between acute prostitis and chronic prostitis?
acute: fast, FEVER, PAINFUL DRE/prostate, can lead to septic
chronic: slow, afebrile, normal DRE
How to tell difference between acute bacterial cystitis vs prostitis?
prostitis has PERINEAL PAIN
Tx of acute prostitis?
bactrim or cipro x 4-6wks
Tx for chronic prostitis?
bactrim or cipro x 6wks-3mo
What are younger men likely to have-acute or chronic prostits? bug?
acute - e.coli
pt has scrotal pain?
What other PE can epididmytis/orchitis have?
positive phren sign
How to tx epididmytis/orchitis?
o Fluroquinolone PO x14days
RF for syphilis?
How can syphilis be spread?
skin to skin
ANYTIME! ANY rash!
What are the sub types of syphilis?
primary and secondary syphilis
latent syphilis: early latent and late latent
Primary syphilis sx/pe?
PAINLESS w/ CLEAN bse
Secondary syphilis sx/pe?
When does chancre heal?
When does secondary syphilis sx/pe occur?
How can primary and secondary syphilis present?
THEY CAN OVERLAP
How does latent syphilis present?
When does latent syphilis occur?
between primary and secondary
AFTER secondary stage
What is the criteria for early latent syphilis?
pos w/in 12mo
4 fold incr from previous titer test
sx w/in 12 mo
contact w/ someone who has syphilis (documented)
possible exposure w/in 12 mo
What is late latent syphilis?
same sx as early but more than 1 yr
PE for tertiary syphilis?
gummatous lesions - destruction of nasal bone/septum
cardiovascular syphilis - aneurysms, aortic regurgitation, CAD
What is early neurosyphilis?
cranial nerve dsyfxn
altered mental status
What is late neurosyphilis?
poor judgement skills
What labs should you run for syphilis? to be aware of?
partners should get VDRL
note: if sx are early in primary syphilis - may be false negative
What is dx if pt has chancre?
darkfield microscopy + VDRL/RPR
What is dx if pt doe snot have chancre?
FTA-ABS + VDRL/RPR
How to tx primary, secondary, and early latent? F/u?
Benzathine penicillin G: 2.4million units IM x1dose
How to tx late latent and tertiary?
Benzathine penicillin G: 2.4million x3 doses (total 7.2)
f/u: 6, 12, 18, 24mo
How to tx neurosyphilis?
aqueous crystalline penicillin G + admit
Complication from tx'ing syphilis?
What is Jarisch-Herxcheimer rxn?
NOT an allergic rxn from the penicillin --> the bug dying int he body
usually occurs w/in 24hrs after therapy
"pearly, skin colored, umbilicated papules"?
Molluscum contagiosum - bug?
How can molluscum contagiosum spread?
When is molluscum contagiosum the most contagious?
thick white paste
How to tx molluscum contagiosum?
imiquimod 5% 3x/wk for 1-3mo
Incubation period for chlaymdia?