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CPD 2 > male GU > Flashcards

male GU Flashcards

1
Q

Erectile dysfunction

A

RED FLAG: prolonged erection >4hrs (see priapism below)

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2
Q

Hematospermia:

A

RED FLAGS: symptoms lasting >1mo, palpable mass, hematuria, obstructive sx

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3
Q

Urethral discharge:

A

may be STIGU or NGU treated empirically
RED FLAGS: pelvic pain, fever, chills, urinary retention
culture

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4
Q

Scrotal pain

A

: RED FLAG if acute onset, N&V, abdominal pain (r/o testicular torsion)

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5
Q

Epispadias

A

congenital malformation of urethral meatus: on the upper (dorsal) side of the penis make sure urine flow is adequate - scarring/stricture ! reflux

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6
Q

Hypospadias

A

malformation of urethral meatus on the lower (ventral) side of the penis

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7
Q

Balanitis:

A

inflammation of glans penis

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8
Q

Posthitis:

A

inflammation of the foreskin

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9
Q

Balanoposthitis:

A

inflammation of both. Infectious (candida, GC, Chlamydia, scabies, etc) or
Non-infectious (contact dermatitis, psoriasis, etc)
More commonly with poor hygiene, diabetics
May predispose to meatal stricture, phimosis, paraphimosis, cancer

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10
Q

Balanitis xerotica obliterans (BXO)

A

lichen sclerosis of penis indurated, white area on glans penis, from chronic inflammation

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11
Q

Phimosis:

A

Foreskin cannot be retracted back away from the glans penis.
a. Physiologic: In boys, 50% of normal retractability by age 10, (but up to 15) Do not
force retraction! Often cited as reason for circumcision
b. Pathologic: Pain, constriction, meatus blockage due to adhesion

risk factors:Frequent diaper rash; poor hygiene; use of condom catheter, DM, aging w/ reduced sexual activity

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12
Q

Paraphimosis:

A

Foreskin stuck in retracted position becomes inflamed”reduced blood flow to the glans, may cause gangrene or necrosis.

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13
Q

Peyronie’s Disease

A

Scarring of the tunica albuginea in the corpora cavernosa “formation of plaques that can cause painful erection and dorsal curvature.
A disorder of wound healing leading to over-expression of TGF-β1 (transforming growth factor).
Most common in Caucasians. Up to 10% of men with erectile dysfunction have PD.

PE: palpable plaque on the dorsal surface of penis

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14
Q

Primary Genital Herpes Infection

A

Usually occurs between 4-7 days after exposure to the virus.

Lesion appearance:
Clusters of vesicles erupt and form superficial ulcers, erythematous base (on prepuce, glans, penile shaft, anus, rectum, thighs)
Concomitant sx can include urinary hesitancy, dysuria, constipation, sacral neuralgia, flu-like discomfort, fever
Scarring may follow healing
The virus sheds for about 3 weeks.

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15
Q

Recurrent Genital Herpes Infection

A

80% of HSV-2 and 50% of HSV-1 have recurrent outbreaks, less severe The virus sheds for a much shorter period of time (about 3 days).
On average, ~ four recurrences a year
Men have 20% more recurrences than women

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16
Q

Genital Warts (Condylomata Accuminata)

A

common sexually transmitted disease (HPV) >more than 100 types of HPVs
~90% are caused by two specific types (6 and 11), and these are considered “low risk,”

(HPV types 16 and 18 highly associated with cervical and penile carcinoma)
Most are seen between ages 17–33 yrs
highly contagious - 60% risk of getting the infection with exposure

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17
Q

Syphilitic Chancre:

A

solitary, painless (or slightly tender) ulcer non-exudative, indurated edge
contagious primary infection of Treponema pallidum regional nontender adenopathy
Serologic testing

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18
Q

Chancroid:

A

painful, shallow non-indurated ulcers, irregular edges and red borders gray or yellow purulent exudate
infection of Haemophilus ducreyi
regional tender adenopathy, may abscess (form buboes)
PCR (Polymerase Chain Reaction) testing

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19
Q

Carcinoma in situ/ Erythroplasia of Queyrat

A

premalignant lesion:
intraepithelial neoplasia
well circumscribed area of reddish, velvety pigmentation usually. on the glans or at the
corona, most often in intact (uncircumcised) males

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20
Q

Squamous Cell Carcinoma of the Penis

A

More common in uncircumcised males with poor local hygiene habits
HPV types 16 and 18 play a role
Fungating/exophytic or ulcerative/infiltrative types
Non-painful “sore that does not heal”
bx

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21
Q

Pearly Penile Papules

A

soft papular angiofibromas around the corona—hair-like projections benign

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22
Q

Contact dermatitis

A

eczematous rash (red, pruritic) may develop in response to latex or other agent

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23
Q

Erectile Dysfunction (ED)

A

History: clarify pattern of ED – time of day, circumstance, stress related, particular partner(s)
PE: cardiovascular, neurological, and mental status exams
Work-up: UA, CMP, hormone testing

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24
Q

Priapism

A

Prolonged, painful erection >4hrs duration. Emergency due to ischemia/necrosis
Causes:
Idiopathic: usually from prolonged sexual excitement
Secondary: assoc with sickle cell dz, DM, CML, penile trauma, drugs (PDE5 inhibitors,
anti-hypertensives, antidepressants), alcohol, cocaine, black widow spider bite

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25
Q

Priapism classifications

A

Classifications:
1) low-flow (veno-occlusive): Most common. Painful and tender penis; little intracorporal blood; “compartment syndrome” with metabolic changes and increased pressures leading to local hypoxia and acidosis by corporal blood gases.
2) high flow (inc arterial inflow without inc venous outflow resistance) non-tender penis
Pathophysiology:
Nitrous oxide imbalance leads to penile vasculopathy and anoxia and oxidative stress Diagnosis: Color Doppler US, assessment of corporal blood gases

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26
Q

SCROTAL MASSES/ SWELLINGS

A

consider any hard swelling testicular cancer until proven otherwise (esp young) swelling may be due to trauma, inflammatory conditions, neoplasms, etc

27
Q

Painless Masses/Swellings

A

i. Tumors—e.g. adenocarcinoma
ii. Abscess (may be tender) - tend to drain spontaneously

iii. Hematocele- blood-filled swelling usu. 2° to trauma, may be initially tender.
does not transilluminate

iv Hydrocele- non-tender, serous fluid filled mass. Fluid between tunical layers
acute – most common hydrocele occurs between 2-5 y/o, usu. the result of inflammation of epididymis or testis
chronic – middle age men, from inflammation, injury usually aren’t painful and typically require no treatment.
Transilluminates; scrotal US to confirm

28
Q

Varicocele

A

Due to gravity’s downward pull on venous valves as a result of upright posture, valve incompetence, leads to dilatation of pampiform plexus
“bag or worms” appearance, located along spermatic cord (80% on left) worsens with valsalva maneuver and with standing
Non-tender, may have “dragging” sensation
Development of a new varicocele or worsening of an old one in an older man:
a. On L: may be a tumor or other mass occluding the L renal or testicular vs.
b. On R: occlusion of the vena cava possible.

29
Q

vi. Sebaceous cysts-

A

firm, cutaneous nodules

30
Q

Scrotal edema-

A

from CHF, nephrotic syndrome, ascites, parasites, filariasis,
tumor cells blocking lymphatics etc.

31
Q

Indirect inguinal hernia may extend into scrotum

A

Large scrotal mass, compressible
may hear bowel sounds
cannot palpate above the swelling. Risk of bowel strangulation

32
Q

Testicular torsion-

A

Emergency–assume until proven otherwise! Needs to be de-torsed <6hrs!
Severe scrotal pain after an episode of trauma or during intensive exercise; or spontaneous in sleep. Common age range 10-25 yo
Most boys who develop torsion have the variant “bell clapper” anatomy (testicle freely rotates)

33
Q

Testicular torsion- ssx

A

Sudden, acute onset unilateral, constant pain, poss N&V
Swollen, tender, erythematous scrotum: difficult to discern structures
Affected testicle higher, epididymis may be anterior; reactive hydrocele possible Pain may radiate to the abdomen “acute abdomen”
Elevation of the scrotum does not relieve pain (negative Prehn’s sign) Cremasteric reflex absent

34
Q

torsion ddx

A

iii. Torsion of testicular appendix (vestigial structure upper pole of testis) in boys 7-14 yr
SSX subacute onset of pain in upper pole of testis Cremasteric reflex present
“blue dot” sign—discoloration seen under skin
iv. Testicular tumor: painless unless large or hemorrhage is present
v. Testicular trauma: clear history of event
swelling, hematocele or hydrocele may develop
vi. Mumps orchitis (paramyxovirus)
20% of post puberty boys, onset 1-2 weeks after parotitis
unilateral or bilateral scrotal pain, erythema and swelling
Abdominal pain, N&V
may result in testicular atrophy

35
Q

Spermatocele

A

Small, painless cyst on the superior, posterior pole of the testicle
(on vas deferens), may follow epididymitis.
Benign. Contains dead spermatozoa Diagnosis– ultrasound or aspiration.

36
Q

Acute epididymitis (or epididymo-orchitis if testis involved) -

A

-Infectious: result of an ascending LUT infection
In children and men over 35 – UTI most common cause from coliform bacilli
Teens to age 35 – STIs most common cause (GC or Chlamydia) –NON-INFECTIOUS VERSION: urine reflux/chemical irritation into
ejaculatory ductsfrom heavy lifting or local trauma

37
Q

epididimytis ssx

A

Painful, swollen epididymis; pain may radiate along spermatic cord to abdomen
Hydrocele may develop
Overlying skin may look like peau d’orange; skin is movable (fixed suggests
abscess) May be febrile.
Discharge (if ascending infection), urinary frequency, dysuria may be present
PE: exquisitely tender, swollen epididymis
Scrotum often indurated, erythematous
elevating the testicle eases pain (positive Prehn’s sign)
no change in cremaster reflex Diagnosis: UA reveals pyuria
Urine culture, NAAT (Nucleic Acid Amplification Test) testing for GC/chlamydia Scrotal ultrasound to rule out torsion in those <30

38
Q

Chronic epididymitis

A

inflammation with no infection present Enlarged, thickened, non-tender epididymis occurs after repeated acute epididymitis may find incidentally on exam

39
Q

Cryptorchidism

A

Failure of the testicles to descend into the scrotum during infancy (most by 3-12mos) Categories:
a. true cryptorchidism - testis remains in abd. cavity from mechanical obstruction or hormonal abnormality
b. incomplete – testis in inguinal canal, obstructed by mechanical means
c. ectopic testis - lies outside the usual course of descent
d. hypermobile or retractile testis - may lie in the scrotum at times (e.g. hot bath) and
then retract up into the inguinal canal hormonal function is usually normal

40
Q

cryptorchidism PE

A

High risk of developing infertility or testicular cancer later in life (2.5-20x risk)
PE- (gloved hand and warm room). Palpate for testicles
If unpalpable, have patient squat or valsalva and repeat palpation
This will distinguish retractile teste from undescended testicle Treated with orchiopexy

41
Q

Testicular cancer

A

Most common solid cancer in males 15-34 yo Classification (germ cell tumors)
a) Seminomas - 40% (arising in seminiferous tubules) b) Non-seminoma germ cell tumor (NSGCT):
Embryonal: 24% Teratoma: 5% Mixed: 26% Choriocarcinoma: rare Yolk sac: rare

42
Q

testicular cancer ssx

A

SSX: painless testicular nodule, usually smooth enlargement, firm and nontender Increases in size over time, may get dull ache, sensation of heaviness/weight Mass does not transilluminate
Often found on self exam

43
Q

testicular cancer tx

A

Work-up –Scrotal US, Pelvic CT
increased alpha-fetoprotein, HCG, LDH (esp. LDH1)
5 yr. survival of seminoma is > 80% with treatment

44
Q

voiding symptoms:

A

Any condition that narrows the prostatic urethra

45
Q

bladder and storage symptoms:

A

Chronicity of obstruction will lead to damage to the

46
Q

prostate consistency

A

Normal– like thenar eminence/tip of nose
Rubbery–BPH
Boggy - congested (infrequent ejaculation, chronic infection) Indurated – nodules (infection, with or without stones)
Hard – consider tumor in absence of WBC’s & infection
3. symmetry
4. presenceoftenderness
5. presence of urethral secretions after the exam (EPS)

47
Q

prostate labs

A

Serum prostate-specific antigen (PSA)
PSA: protein manufactured in prostate epithelial cells. . Three typical sources
for damage are: cancer, bacterial infection, and prostate damage by infarction
Normally a little PSA leaks from the prostate into the blood. If the prostate is enlarged thenthe leakage appears exaggerated.

48
Q

Raises PSA levels

A

DRE ( do blood draw before!) Ejaculation, Recent sexual activity BPH
Cystitis
Acute & Chronic prostatitis (falls when treated) Prostate biopsy
Exercise involving perineal pressure

49
Q

lower PSA levels

A 
Finasteride (Proscar)
Saw palmetto
Radical prostatectomy
Withdrawal of anti-androgen drugs Regular prostatic massage
Green tea
50
Q

Benign Prostatic Hyperplasia BPH

A

Hyperplasia of prostatic stromal and epithelial cells in the transitional zone, resulting in the formation of large, fairly discrete nodules in the periurethral region.
Lumen of prostatic urethra narrows leading to urine outflow obstruction
Urine stasis in the bladder from residual urine leads to hypertrophy of detrusor muscle….Higher number of androgen receptors….malfunction of valves, etc

51
Q

BPH sx

A

SSX: progressive urinary frequency, urgency, nocturia due to incomplete emptying and
rapid refilling of bladder

52
Q

BPH complications

A

Complications: UTI from urine stasis (cystitis, pyelonephritis) Urolithiasis from urine stasis
Hydronephrosis and resulting impaired renal function Straining to urinate may cause rupture of veins, hematuria
and vasovagal syncope, hemorrhoids, hernias Sudden urinary retention (catheterization needed!)

53
Q

BPH PE

A

PE- DRE: enlarged, rubbery consistency
Smooth, symmetric enlargement (typically), loss of median furrow (sulcus) Non-tender prostate
Abdominal exam may reveal distended bladder

54
Q

BPH labs

A

increased BUN, serum creatinine if obstruction backs up to kidneys UA and urine culture- to rule out causative or concomitant infection PSA: mod. increased (depending on size and degree of obstruction)..
NOTE: PSA increased with DRE, so draw blood sample prior to PE

55
Q

BPH procedure

A

Procedures:
Uroflowmetry: to check urine flow rate and post-void residual volume May consider transrectal U/S or prostate biopsy to help R/O cancer

56
Q

PROSTATITIS

A

Inflammation of the prostate which may be infectious or non-infectious (often poorly understood). Variable presentations of irritative and/or obstructive urinary sx and perineal pain.

57
Q

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS)/”Prostadynia”

A

Chronic (>3mos) genitourinary pain in the absence of bacteria (no infx) localized to prostate
DRE: moderate tenderness, boggy, enlarged, soft prostate
Lab: Post-massage urine culture and sensitivity, EPS culture, semen culture UA: May be incidental bacteriuria
>10 leukocytes/HPF in EPS
Studies ongoing using RT-PCR for occult infx

58
Q

Inflammatory CPPS

A

Significant WBCs found (>10-20/hpf) in the semen, expressed prostatic secretions (EPS) or voided bladder urine-3 (VB-3)

59
Q

Asymptomatic inflammatory prostatitis (AIP)

A

No specific CP/CPPS symptoms found but WBCs found in EPS or in prostate tissue bx

60
Q

prostatitis labs

A

Lab: CBCshowsleukocytosiswithleftshift
UA shows many WBC’s (cloudy), bacteria, possible hematuria
Culture of prostatic secretions (semen culture may be more accurate!) reveals increased bacteria
Elevated CRP
Transient increase in PSA (back to normal in~ 2 wks)

61
Q

. Prostate Cancer (CaP) (most commonly adenocarcinoma)

A

most common male cancer in men >50yrs
~220,000 new cases diagnosed/yr; 32,000 deaths
Lifetime risk 1 in 6 white men; 1 in 5 black men
>75% of CaP diagnosed in men over 65
More men die WITH prostate cancer that FROM it!! BUT there are aggressive, fast growing forms

62
Q

late prostate cancer ssx

A

Late: bladder outlet obstruction, ureteral obstruction, hematuria, pyuria metastasis to pelvis, ribs, vert. may create bone pain
tumor enlargement may lead to cord compression and neuropathy unintended weight loss

63
Q

prostate cancer labs

A

Lab:
Total PSA: 4-10 ng/ml likelihood of CaP is 25%; >10 ng/ml likelihood of CaP is >50% PSA Velocity: inc of >0.75 ng/ml/year or higher (based on 3 PSA measurements
over 18-24 mos) when the PSA is 4-10 ng/ml is suspicious for CaP
Free to total PSA ratio: <25% (reduced) in CaP Other markers being used: PCA3 mRNA in urine
Advanced cancer– CMP: inc BUN, creatinine (if bilateral utereral obstruction) Inc alk phos from bone mets, inc acid phos
CBC: Anemia from mets

64
Q

prostate cancer dx

A 
Transrectal US (TRUS) with biopsy
Axial CT or MRI (for STAGING)

CPD 2 (2 decks)

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