L66 Flashcards Preview

P&T Block 5 Renal > L66 > Flashcards

Flashcards in L66 Deck (22)
Loading flashcards...
1
Q

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

A

Irritative > obstructive symptoms

  • Urgency
  • Freq
  • Nocturia
  • Incontinence
2
Q

2 risk factors for BPH

A

Nocturnal emission pre-20 yo

Long sex

3
Q

2 medicines to treat BPH

A

Alpha blockers = terazosin, tamsulosin

5 alpha reductase inhibitors

4
Q

Mechanism of the alpha blockers

A

Relax smooth muscle

5
Q

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

A

DHT = dihydro-testosterone

6
Q

Mechanism of 5 alpha reductase I

A

Testosterone + 5 alpha R = DHT

No androgens to maintain prostate

7
Q

Name the two 5 alpha reductase I

A

Dutasteride

Finasteride

8
Q

SE 5 alpha R-Is

A

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

9
Q

4 surgical options for BPH

A
  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
Q

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

A

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

11
Q

What does PSA tell you about cancer?

A

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

12
Q

Causes of ↑PSA

A

Cancer 10x BPH
Prostatitis
Infarct, retention

13
Q

When do you do a PSA?

A

1/yr AA > 40, men 55-70

Do as pt of dx eval when pt presenting with urinary symptoms/abnormalities

14
Q

5 treatment options for prostate cancer

A
  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
Q

What is ED? Possible cause?

A

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

16
Q

How do testosterone levels effect sexual activity?

A

Low testosterone doesn’t change your ability to get a boner

Changes how often you get one and what you do with it

17
Q

What pt penis gets hard?

A

Corpus cavernosum
+ Arterial blood
↓Venous outflow

18
Q

ED medication + mechanism

A

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
Q

Which pts are CI for PDE 5 I?

A

Cardiac pts on NITRATES

Net vasodilation - pool blood - ↓return to heart - ↓CO

20
Q

4 treatments for impotence

A
  1. PDE-5 I
    • Prostaglandin intra-urethral
  2. Injection
  3. Suction
  4. Implant
21
Q

DDX for swelling + pain of scrotum

A

Torsion - acute

Epididymus - few days

22
Q

Presentation of testicular cancer

A

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