Male Genitourinary Disorders Flashcards
(121 cards)
1
Q
Cryptorchidism
A
undescended testis
2
Q
Rectractile testis
A
testis out of scrotum but can be brought down into scrotum and they will stay
3
Q
Gliding testis
A
testis is out of the scrotum, when moved into scrotum they return when released
4
Q
Ectopic testis
A
lying outside the normal path of descent
5
Q
Ascended testis
A
has fully descended but has reascended (outside scrotum)
6
Q
Trapped testis
A
dislocated after herniorrhaphy
7
Q
Development of testes
A
occurs during 7th month in upper growing of the abdomen
8
Q
Reasons of failure to descend
A
mechanical
secondary to hormonal, chromosomal and anatomic disorders
9
Q
Most common genitourinary disorder in boys
A
cryptorchidism
10
Q
At risk for cryptorchidism
A
preterm infants low birth weight infants first born toxemia hypospadias subluxation of hip winter conception down's maternal age 35
11
Q
Self correction of cryptochidism
A
majority will descend by 6 months
if >6 months the rate of spont. descend rare
12
Q
Most often affected teste with cryptochidism
A
left (can be bilateral)
13
Q
Most common location of undescended testes
A
- just outside external ring
- inguinal canal
- abdomen
14
Q
Position for exam of testis
A
cross-legged
frog-legged
squat
standing
15
Q
Appearance of scrotal rugae with cryptochidism
A
less full
16
Q
Reason for early dx of cryptochidism
A
preserve fertility and detect malignancy
17
Q
Risk of observation >1 year
A
delays tx
lowers rate of success
affects sperm
18
Q
Possible complications of undescended testicles
A
poor development infertility malignancy (repair does not decrease risk) trauma torsion (50%) inguinal hernia
19
Q
Testicular Torsion
A
pain and swelling
EMERGENCY
20
Q
<6 years old with testicular pain
A
almost always torsion
21
Q
7-12 years old with testicular pain
A
50% torsion
22
Q
19-24 years old with testicular pain
A
80% epididymitis
23
Q
most common cause of testicular loss
A
torsion
24
Q
bell-clapper
A
used to describe torsion
testes swing and can twist at spermatic cords
25
Pain manifestation with torsion
acute onset
26
abnormal and should rule out abruption or torsion
testicular pain lasting >1 hr following trauma
27
General exam with torsion
swelling, red, warm, TENDER
28
transillumination of testes
reveals a solid mass
29
cremasteric reflex
pinch the skin of the upper thigh and watch for testicular reflex.
absent in torsion
30
Prehn Sign
elevate the scrotal contents, if pain relieved most likely epididymitis. If pain persists, torsion.
31
torsion of a testicular appendage
tenderness limed to upper pole
32
Blue dot sign
small bluish discoloration visible through the skin of the testes indicating torsion
33
Torsion signs
```
absence of cremaster reflex
abnormal positioning of testes
absent prehn's sign
absent dysuria
absent erythema
neg UA
```
34
Epididymitis signs
```
positive cremaster reflex
normal position of testes
prehn's sign present
can have dysuria
erythema present
pos UA
```
35
If torsion suspected
refer immediately
36
CBC with torsion
leukocytosis may be present with this and with epididymitis as well
37
doppler ultrasonography
perform if unsure of diagnosis
assesses blood flow of testicular artery
can see torsion and hydrocele
38
Nuclear Scintigraphy
takes 1-2 hours
| can have false negative
39
Orchiopexy
surgical procedure for torsion
| if surgery put up for >12 hours could require removal.
40
Testicular salvage rate with torsion
within 3 hours 100%
6 hours 92%
6-12 hours 62%
12-24 hours 38%
41
Trauma to testes
can lead to torsion, but more commonly scrotal hematoma and ecchymosis
pain caused by compression against pelvic bones
42
hydrocele
common cause of scrotal swelling
43
Cause of hydrocele in infants
caused by peritoneal fluids extending through a patent processus vaginalis
44
Cause of hydrocele in older kids
result from inflammatory processes, torsion, trauma or tumors
45
types of hydroceles
communicating
| noncommunicating
46
communicating hydrocele
failure of the processus vaginalis to close during development and fluid is peritoneal (often hernia)
may increase in size during the day or with valsalva
47
noncommunicating hydrocele
fluid only in scrotum
fluid comes from the mesothelial lining of the tunica vaginalis
is not reducible and does not change size
48
To confirm hydrocele
transillumination
49
Tx of hydrocele
surgery for those persisting beyond one year
50
Scrotal masses in adult been best described
by anatomic origin
51
Mass in tunica vaginalis testis
hydrocele
| hematocele
52
Mass in processus vaginalis testis
inguinal hernia
| hydrocele
53
Mass in pampiniform plexus
varicocele
54
Mass in epididymis
epididymitis
| spermatocele
55
Test of choice for evaluation of mass
color doppler untrasonography
56
Swelling of testis tender
torsion
| orchitis
57
Swelling of testis nontender
hydrocele
| carcinoma
58
Swelling of spermatic cord
hydrocele- smooth, transilluminates
varicocele- bag of worms
inguinal hernia- swelling into ingiunal ring
59
Irregular swelling of skin
rule out carcinoma
60
welling of skin that is smooth, cystic
sebaceous cyst
61
indirect inguinal hernia
follow the path of processus vaginalis thru the internal inguinal ring and into scrotum
62
can hernia's be reduced
yes unless incarcerated
63
swelling in hernia vs hydrocele
will extend up spermatic cord into ring with hernia
| will not extend up spermatic cord
64
a new hydrocele or one that hemorrhages may signal
cancer
65
varicocele
most common scrotal swelling in adult men
dilation of veins of pampiniform plexus
may ache or "drag"
more common on left side
66
Grade 1 varicocele
observed only with valsalva
67
Grade 2 varicocele
palpable but not visible
68
Grade 3 varicocele
visible
69
Refer varicocele if
if there is hypertrophy of testicle
if symptomatic
sudden left-sided in older adult (renal tumor)
sudden right-sided in older adult (vena cava obstruction)
70
Young men with varicocele and normal semen analyses
do analysis every 1-2 years
71
Causes of dysuria
```
infections
malformations
neoplasms
inflammatory conditions
psychogenic
```
72
Infections with dysuria
```
pyelo
cystitis
prostatitis
urethritis
orchitis
```
73
Malformations with dysuria
BPH
| urethral strictures
74
Neoplams with dysuria
renal cell tumor
| bladder or prostate cancers
75
Inflammatory with dysuria
spondyloarthropathies
| drug S/E
76
pain after voiding
infection
77
Physical exam for dysuria
abdominal
costovertebral angle (pyelo)
penile (d/c)
DRE
78
Positive nitrate with UA
suggests UTI
79
Acute epididymitis
lasts <6 weeks
80
Causes of epididymitis
Chlamydia and gonorrhea in those <35
| UTI in over 35
81
Evaluation of epididymitis
Gram stain of urethral secretions (perferred and highly sensitive)
Leukocye esterase
82
Tx of Epididymitis
Ceftriaxone 250 IM once
plus
Doxy 100 BID x 10 days
83
Adjunct therapy with epididymitis
bed rest
scrotal elevation
analgesics
84
Goal of tx with epididymitis
cure
improve symptoms
decrease transmission
decrease long term effects
85
Tx for acute epididymitis most likely caused by enteric organisms
Levofloxacin 500mg PO daily x 10 days
86
Type I prostatitis
acute bacterial prostatitis (UTI with systemic involvment)
| Abx therapy for 2-4 weeks
87
Type II prostatitis
chronic bacteria prostatitis with or without symptoms
perineal, inguinal or suprapubic pain may be present with erectile dysfx
Fluroquinolones
TMP-Sulfa (Bactrum)
88
Type III prostatitis
chronic abacterial prostatitis
(Pelvic pain syndrome either inflammatory or noninflammatory)
pain with ejaculation
hesitancy
tx with muscle relaxants, NSAIDS, fluroquinolones
89
Type IV prostatitis
```
asymptomatic inflammatory prostatitis
postvoid dribbling
lumbar pain, penile and urethral pain
must take biopsy
Abx, NSAIDS
```
90
Chlamydia (c. trachomatis)
most common reportable STD among adolescents
91
Incubation period of chlamydia
7-21 days
92
Clinical manifestations of chlamydia
urethritis
epidymitis
Reiters syndrome
mucopurulent, mucoid or clear d/c
93
Reiters syndrome
post-inflammatory autoimmune disease
94
Dx chlamydia
culture
nucleic acid amplification
serology
95
Tx chlamydia
Azithromycin 1g once
plus
doxy 100mg BID x 7 days
No sex within 7 days
96
Evaluated partners for chlamydia
if sex with someone 60 days prior to onset of symptoms
97
Gonorrhea (Neisseria) risk factors
```
south
black
hispanic
native americans
ages 15-29
multiple sex partners
lower socioeconomic status
```
98
transmission of gonorrhea
male-to-female at 50-70%/intercourse episode
female-to-male at 20%/episode but >4 60-80%
pharyngeal
increased risk for HIV
99
common indicator of gonorrhea in men
urethritis
100
incubation period for gonorrhea
7-14 days
101
inflammation of liver capsule with right upper quadrant pain from gonorrhea
perihepatitis (Fitx-Hugh)
102
Evaluation of gonorrhea
culture
| oxidase pos gram-neg diplococcus
103
Tx for gonorrhea
```
Ceftriaxone 250 IM once
plus
azithromycin 1g once
or
doxy
```
104
Avoid in pregnancy for tx gonorrhea
quinolones
| tetracyclines
105
Syphilis
Treponema Pallidum
106
incubation of syphilis
10-90 days
107
early manifestations of syphilis
involve skin and mucosal
108
late manifestations of syphilis
affect organ system and neurosphilis
109
syphilis most infective
during primary and secondary stages
110
syphilis spread
sexually and vertical (pregnancy)
111
view of syphilis under microscope
cork-screw shaped motile
112
lesions with syphilis
chancre
| secondary and primary syphilis can overlap
113
clinical finding with secondary syphilis
```
rash on palmes and soles
macular
papular
squamous
pustular
```
114
other clinical manifestations in syphilis
```
lymphadenopathy
malaise
mucous patches
condylomata lata
liver and kidney involvment
alopecia
```
115
Tertiary (late) syphilis
within 1-20 years but very rare and typically involves cardiovascular
116
early dx of syphilis
darkfield microscopy
117
other dx of syphilis
nontreponemal (VDRL, RPR, TRUST)
| treponemal (TP-PA) can be pos for life
118
Tx of latent syphilis
PCN G 2.4 IM
| if PCN allergic to doxy or tetracycline 500 QID x14 days
119
Tx of teriary syphilis
PCN G 2.4 IM x 3 doses
120
normal reaction to tx with PCN G
Jarisch-herxheimer reaction
121
F/U syphilis
6 months and 1 year for primary and secondary
| 12 and 24 montsh for latent
