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P&T Block 5 Renal > L66 > Flashcards

Flashcards in L66 Deck (22)
1

TESTQ: What kind of symptoms cause men with BPH to seek treatment?

Irritative > obstructive symptoms
- Urgency
- Freq
- Nocturia
- Incontinence

2

2 risk factors for BPH

Nocturnal emission pre-20 yo
Long sex

3

2 medicines to treat BPH

Alpha blockers = terazosin, tamsulosin
5 alpha reductase inhibitors

4

Mechanism of the alpha blockers

Relax smooth muscle

5

TESTQ: what hormone/molecules causes prostate enlargement/growth?

DHT = dihydro-testosterone

6

Mechanism of 5 alpha reductase I

Testosterone + 5 alpha R = DHT
No androgens to maintain prostate

7

Name the two 5 alpha reductase I

Dutasteride
Finasteride

8

SE 5 alpha R-Is

Takes 6-12 mo to work
Sexual dysfxn
Gynecomastia, painful nipples
↑Hair

9

4 surgical options for BPH

1. Laser - burn off superficial layers, less impotence, SE retrograde ejac
2. Thermotherapy - microwave adenoma (central), capsule protected b/c better BF
3. TUNA - needle lesions to push open
4. Urolift = sutures anchored on outside prostate to hold open

10

What is stage 1/2 vs 3 vs 4 for prostate cancer? Prognosis?

1/2 confined
3 local invasion
4 distant mets
3 + 4 = not curable

11

What does PSA tell you about cancer?

Screen for tumors too small to be palpated on PE aka earlier stage
Question is - would this have ever really become your issue

12

Causes of ↑PSA

Cancer 10x BPH
Prostatitis
Infarct, retention

13

When do you do a PSA?

1/yr AA > 40, men 55-70
Do as pt of dx eval when pt presenting with urinary symptoms/abnormalities

14

5 treatment options for prostate cancer

1. Remove entire prostate
2. Brachy = radioactive particles, less invasive + incontinence
3. External beam radiation
4. Cryosurg - if fialed brachy/radio, argon gas
5. Hormonal - block testosterone

15

What is ED? Possible cause?

Consistently can't get a boner
Vs premature ejac - do you ejaculate before you lose your boner?
May be cause by hypo-gonadism

16

How do testosterone levels effect sexual activity?

Low testosterone doesn't change your ability to get a boner
Changes how often you get one and what you do with it

17

What pt penis gets hard?

Corpus cavernosum
+ Arterial blood
↓Venous outflow

18

ED medication + mechanism

PDE-5 inhibitors = sildenafil
PDE 5 breaks down cGMP
cGMP is needed to relax arterial SM
Nerve stim -> arginine -> NO -> GC -> ↑cGMP -> SM relax -> vasodilate -> erection

19

Which pts are CI for PDE 5 I?

Cardiac pts on NITRATES
Net vasodilation - pool blood - ↓return to heart - ↓CO

20

4 treatments for impotence

1. PDE-5 I
2. + Prostaglandin intra-urethral
3. Injection
4. Suction
5. Implant

21

DDX for swelling + pain of scrotum

Torsion - acute
Epididymus - few days

22

Presentation of testicular cancer

Painless testicular mass - 1 ball feels heavier than other
(vs choriocarcinoma = painful)
Young pts - puberty -> 40
Sensitive to treatment