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Inflammation of the prostate, can be acute or chronic

*Bacterial causes include E coli, Gonorrhea and Chlamydia

Sxs= fever, chills, dysuria, frequency, urgency, etc.
Signs= prostate is tender and soft (“boggy”) on exam

Prostatitis

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Prostate enlarges with age leading to compression of the urethra

*symptoms such as incomplete bladder emptying, poor urinary stream strength, urinary frequency, urgency

BPH

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Obstruction in BPH can weaken the bladder over time, leading to retention of urine which can predispose to….

UTIs

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Tx for BPH can be pharmacologic or surgical. What is the surgical procedure?

Transurethral resection of the prostate (TURP)

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Screening via digital rectal exam (DRE) and serum PSA is important for men over 50 to help dx…..

Prostate cancer

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Which location is common for prostate cancer mets?

Spine! often get back pain in late disease

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Orchiectomy (removing the testicles)
Anti-androgen therapy (blocks testosterone)
LH releasing hormone antagonists

All treatments for prostate cancer

hormonal therapy..seeks to remove hormonal, mainly testosterone, stimulation

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Testicular inflammation

MC cause= mumps
*also caused by gonorrhea and chlamydia

Orchitits

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Testicular pain, swelling and constitutional symptoms

if viral, will resolve spontaneously
if bacterial, give abx

tx testicular pain with ice, bed rest and analgesic therapy

Orchitis

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Can be asymptomatic or can present as a testicular mass, infertility, pain and/or sensation of testicular fullness

*more common in young men (under 40)

Testicular cancer

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Cryptorchidism (failure of testicular descent at birth) increases the risk of…..

Testicular cancer

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Can be caused by trauma, exercise or predisposition secondary to undescended tests or a congenital “bell clapper” deformity

most common in men under 30
severe scrotal pain, swelling and erythema of scrotum, abdominal pain and/or N/V

Testicular torsion

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Menstrual cycle is mediated by…. (4 things)

LH
FSH
Estrogen
Progesterone

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Day 1 of the menstrual cycle corresponds to menstruation, at which time a new ovum-containing follicle beings to grow under the influence of….

FSH (follicle stimulating hormone)

..which comes from the pituitary

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FSH stimulates the follicle to secrete _______, which causes the proliferation of the endometrial lining

estrogen!

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Estrogen secretion from the follicle stimulates an increase in LH and FSH section from the pituitary, which leads to an LH surge around what day of the cycle?

(*this is a positive feedback loop!)

day 14

the LH surge on day 14 causes the ovum to be released..ovulation!!

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LH surges on day 14, which causes the ovum to be released (ovulation) and the follicle to become the….

corpus luteum

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What does the corpus luteum secrete?

Estrogen and progesterone, which stimulate development of secretory glands in the endometrium

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Corpus luteum secretes estrogen and progesterone which stimulate development of ______ glands in the endometrium

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secretory

If the ovum is not fertilized, the continued estrogen and progesterone secretion will inhibit….

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FSH and LH

**the fall in FSH and LH will lead to the degeneration of the corpus luteum

Estrogen can function both to increase LH/FSH secretion (leading to ovulation) and to inhibit it, at the end of the _____ phase

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luteal

Combination OCPs serve to suppress….

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LH/FSH, which prevent ovulation

The hypothalamus stimulates the pituitary gland via…

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GnRH

The pituitary gland releases which 2 things, which stimulate the uterus

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FSH/LH

If a woman has primary amenorrhea and her FSH levels are HIGH..this suggests what may be the cause?

Ovarian failure! *if the ovaries fail, the level of estrogen they secrete decreases, reducing the negative feedback on FSH secretion from the pituitary

Discharge= yellow, frothy Wet mount= protozoans KOH/whiff test= negative (no rxn)

Trichomonas *tx= Metronidazole (oral)

Discharge=white, thick, "curds" Wet mount= branching yeast KOH/whiff test= negative (no rxn)

Candida

Discharge= gray, thin Wet mount= clue cells (cells with many small bacteria attached to the surface) KOH/whiff= gives fishy odor

Gardnerella | bacterial vaginosis

Inflammation of the cervix caused by trauma, radiation, malignancy or infection (chlamydia, gonorrhea, HSV, HPV) * generally coexists with vaginitis

Cervicitis

Acute abdominal pain, sometimes N/V * abdominal exam reveals tenderness and can also show signs of peritonitis (rebound, guarding) * vaginal exam: purulent cervical discharge and cervical motion tenderness

PID

Fitz-Hugh-Curtis syndrome (inflammation/fibrosis surrounding the liver from intra-abdominal spread)

complication of PID

Occurs when a sperm fertilizes an "empty" ovum (i.e. an ovum with no maternal chromosomes in it) *this empty ovum can be fertilized by one sperm, which then duplicates and forms a...

COMPLETE MOLE | this is a type of Gestational trophoblastic disease (GTD)

An ovum with one set of maternal chromosomes can be fertilized by 2 sperm causing the formation of a...

partial mole | this is a type of Gestational trophoblastic disease (GTD)

Can present as pregnancy: enlarged uterus, N/V, positive pregnancy test * early bleeding, uterus may be too big/too small for presumed stage of pregnancy * patients may notice vesicle like material in vaginal bleeding

Gestational trophoblastic disease (GTD)

Diagnosis is confirmed by extreme elevation of beta-hCG and a "snow storm" appearance on ultrasound

Molar pregnancy (GTD)

What does it mean if you remove a mole but beta-hCG does not decrease?

Either an incomplete removal of the mole or possible malignant transformation (choriocarcinoma)

If a mole becomes malignant (choriocarcinoma), what is the tx?

Chemo! (usually involving methotrexate)

larger tumor-like growths seen in endometriosis (aka chocolate cysts) because of the appearance of the thick, dark liquid they contain

Endometriomas

How do you confirm a endometriosis dx?

Laparoscopic exam with biopsy

OCPs Danzol (inhibitor or FH/LSH) GnRH agonist

Can be used in tx of endometriosis

Bleeding, pain, urinary symptoms, infertility, palpable mass Diagnosis made with scan and biopsy

Uterine fibroids

Post menopausal bleeding (usually adenocarcinoma, MC) Diagnosis made with sampling/bx

Endometrial cancer

Asymptomatic or abdominal/pelvic/bloating/pain Torsion possible Acute mass, may be palpable Dx made with ultrasound/laparoscopy

Ovarian cyst

Often asymptomatic leading to diagnosis at advanced stage and poor prognosis *when symptoms are present: vague abdominal/pelvic bloating/pain Dx with CA-125, LDH, aFP, b-hCG can be elevated *ultrasound, CT scan

Ovarian cancer

Cyclic diffuse breast pain (usually right before period) | Lumpiness of breasts on exam

Fibrocystic changes

Mass: firm, well circumscribed Painless, moveable very common in younger women

Fibroadenoma

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