Male Clinical Cases - Jacobsohn Flashcards Preview

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Flashcards in Male Clinical Cases - Jacobsohn Deck (20):
1

In the context of BPH, what does PVR refer to?

What is a normal value for this?

Post-void residual urine.

Should be <50 in normal people (almost never 0); in BPH it is often elevated.

2

What are some conditions on the differential for BPH?

Urethral stricture (often resulting from prior STIs)

Bladder atony

Prostatitis

Prostate cancer

3

BPH can be treated medically, surgically, or simply monitored.

What are some indications for surgical treatment?

Excessive urinary retention

Recurrent urinary tract infections

Recurrent/persistent gross hematuria

Bladder stones

Renal insufficiency

4

BPH can be treated medically, surgically, or simply monitored.

What medical treatments are used?

Alpha-blockers (eg Prazosin, Terazosin) to relax urinary sphincter.

5a-reductase inhibiters (eg Finasteride) to reduce DHT.

5

Distinguish between some symptoms of obstructive vs irritative lower urinary tract disorders.

Obstructive: Decreased force of stream, hesitancy, incomplete emptying, nocturia, straining.

Irritative: Urgency, frequency, dysuria.

6

Summarize the pathogenesis of BPH.

What regions are most affected?

Describe the histology.

DHT causes stromal and glandular proliferation (nodular).

Usually affects periurethral (transitional) zone.

Hyperplasia with preservation of inner/outer layer architecture.

7

A patient presents with difficulty urinating and a sense of fullness. He has three male family members with prostate cancer, as well as an elevated PSA (~20).

What is causing his symptoms?

BPH! Cancer rarely causes obstructive symptoms.

But yeah, he very well may have prostate cancer. Derp.

8

What is the function of PSA?

What lab measurements are generally made of it?

Which is especially useful for cancer screening?

A serine protease which degrades seminal coagulant.

Measure PSA density (PSA / prostate volume), and percent free PSA.

Cancer tends to produce "bound" PSA, so % free PSA is especially useful.

9

What more invasive tests are used for conclusive diagnosis of prostatic cancer?

Transrectal ultrasound with core biopsies (as many as 12 to sample a broad area).

 

10

Describe the spread of prostatic cancer by stage.

Stages I & II are confined to the prostate.

Stage III has local spread.

Stage IV has metastases to distant sites.

11

Recall the differential diagnosis for scrotal swelling.

Orchitis & Epididymo-orchitis

Hydrocele, Spermatocele, Varicocele

Torsion

Hematoma

Inguinal hernia

Tumor

12

What age group does testicular cancer usually affect?

What is their outlook?

Ages 20-39 (average is 34)

Quite good, 96% 5-year survival.

13

How does testicular cancer tend to present?

How is staging done?

Often painlessly, but 30-50% have pain. 10% have symptoms of metastases.

Staging is based on imaging and tumor markers.

14

How should elevated tumor markers post-orchiectomy be handled?

Adjuvant chemotherapy; the cancer is probably still present elsewhere.

15

Distinguish between the tumor markers AFP and hCG.

Name another highly nonspecific marker.

AFP: 5-7 day half-life. Not present in pure seminomas or choriocarcinomas.

b-hCG: 24-36 hour half-life. Present in choriocarcinomas, embryonal carcinomas, some seminomas.

LDH is non-specific.

16

Describe the approach taken in orchiectomy.

A slit is made inguinally, and the spermatic cord drawn out. Since cancer spreads up the cord, this decreases the likelihood of missed spread.

17

Name 4 risk factors for testicular cancers.

Cryptorchidism

History of testicular atrophy

DES (diethylstilbestrol) exposure

HIV/AIDS (increases risk of seminoma)

18

What benefit is conferred by testicular self-examination.

Nothing, according to the lack of data to support it.

(this may be true of breast self-exam too)

19

Describe the treatments for Stages 1-3 NSGCT.

1: Observation or Chemotherapy (2x Bleomycin+Etoposide+Cisplatin) with retroperitoneal lymph node dissection (RPLND)

2a: RPLND & chemo. 2b, 2c: Chemo.

3 (mets, high markers): Chemo.

20

Describe the treatments for Stages 1-2 Seminoma.

1: Observation preferred. Alternatively, radiation to retroperitoneum.

2: Radiation for 2a, chemo for 2b (or worse)

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