Male GU disorders

Question 1

Cause of ST epididymitis

Answer 1

chlamydia or gonorrhea

Question 2

Cause of non-ST epididymitis

Answer 2

seen in older men, GNR

Question 3

CP of epididymitis

Answer 3

pain in scrotum and may radiate to the flanks and along the spermatic cord
usually fever and swelling
+/- prostate tenderness

Question 4

Labs of epididymitis

Answer 4

CBC: left shift
Gram stain: N gonorrhea or white cells with no organisms (chlamydia)
UA: pyuria, bacteriuria, varying hematuria

Question 5

Imaging of epididymitis

Answer 5

scrotal U/S to confirm diagnosis

Question 6

DDx of epididymitis

Answer 6

tumor (usually painless)
testicular torsion (Prehn's sign-elevation- makes tortion worse and epididymitis better)

Question 7

tx for epidiymitis

Answer 7

bed rest, scrotal elevation

STD suspected: Rocephin (ceftriaxone) and doxycycline (10 days) or zithromax

Question 8

Non-ST tx of epididiymitis

Answer 8

Levofloxacin x 10 days
NSAIDs
treat promptly to avoid orchitis, abscess, infertility

Question 9

Most common cause of STD? age group? Sx?

Answer 9

Gonorrhea, 15-29, yellowish discharge and urethral pain

Question 10

CP of gonorrhea in men? Women?

Answer 10

dysuria and clear to yellow discharge; less severe or asymptomatic but with dysuria, fq, urgency, and vaginal discharge, + chandelier’s sign. Look for eyes, throat, anal, or blood stream infection

Question 11

diagnosis of gonorrhea in men? Women?

Answer 11

gram stain; women purely clinical

Question 12

DDx for gonorrhea

Answer 12

chlamydia, trichomonas, gardnerella, candida

Question 13

Tx of gonorrhea

Answer 13

rocephin IM

cefixime po

Question 14

Chlamydia

Answer 14

usually an insidious infection, may spread to the lymph

Question 15

CP of chlamydia in men? Women?

Answer 15

clear to white d/c, lymphadenopthy, or asymptomatic, possibly epidid or prostatitis;
PID, cervicitis, etc or asymptomatic

Question 16

most reliable dx for chlamydia? Most used?

Answer 16

Culture (takes too long); immunoflourescence assay, enzyme-linked assay, and DNA PROBE (best)

Question 17

What is the DDx for chlamydia

Answer 17

all other STDs

Question 18

tx for chlamydia

Answer 18

zithromax (uncomp) or erythromycin (10 days) or doxycycline 7-10 days plus rocephin IM

Question 19

Prognosis for chlamydia

Answer 19

if left untreated, females have probability of infertility

Question 20

What is the one radiolucent stone? Most common type?

Answer 20

Uric acid; calcium

Question 21

Labs of stones

Answer 21

possible hematuria

Question 22

most common symptom of urinary stones

Answer 22

pain, won’t stop moving (unlike appendicitis)

Question 23

What medications may cause ED?

Answer 23

beta blockers and thiazides

Question 24

diagnostic studies for ED?

Answer 24

CBC, UA, glucose, Lipids, testosterone, Prolactin (endocrine consult indicated)

Question 25

What are the treatments used for ED?

Answer 25

vascular reconstruction, etc MEDICAL: injections.... OR DRUGS Viagra, Cialis, Levitra

Question 26

What drugs should you not use ED meds with?

Answer 26

Nitrates or vasodilators! | FATAL

Question 27

When is infertility work up indicated?

Answer 27

after 6 months of unprotected intercourse

Question 28

What are some common causes of inferility in men?

Answer 28

Testicular trauma, MUMPS, epididymitis, radiation, chemo, use of lubricants

Question 29

What are important causes of mostly reversible infertility?

Answer 29

Meds: Steroids, cimetidine, spiro, phenytoin, sulfa, nitrofurantoin, marijuana, ETOH

Question 30

What may indicate a pituitary tumor?

Answer 30

Loss of libido, HA, bitemporal hemiopsia

Question 31

Labs for infertility

Answer 31

semen analysis after 72 hours of abstinence, analyzed within 1 hour

Question 32

Lab testing for infertility

Answer 32

FSH, LH, testosterone, and serum prolactin

Question 33

Imaging for infertility

Answer 33

scrotal U/S may reveal varicocele

Question 34

Tx for infertility

Answer 34

hypogonadotropic hypogonaism: tx with chorionic gonadotropin IM 3x a week Imipramine TID

Question 35

Most common age of testicular torsion

Answer 35

10-20, usually with physical activity, some during sleep

Question 36

SUDDEN ONSET OF SEVERE TESTICULAR PAIN

Answer 36

Testicular torsion

Question 37

DIAGNOSTIC STUDY FOR TESTICULAR TORSION

Answer 37

DOPPLER U/S

Question 38

If testicular torsion is ruled out, what are other causes of testes pain?

Answer 38

epididymitis, varicocele, hydrocele

Question 39

Treatment for testicular torsion

Answer 39

SURGICAL EMERGENCY, scrotal exploration

Question 40

CP of varicocele

Answer 40

get out of supine position, valsalva or standing: the veins of the plexus become dilated and feel like a "bag of worms" DETERMINE THAT THE VARICOCELE REDUCES WHEN THE PATIENT IS SUPINE

Question 41

Diagnostics for varicocele

Answer 41

None indicated unless there is infertility, then semen analysis (transillumination) If it doesn't reduce: venography

Question 42

Ddx for varicocele

Answer 42

inguinal hernia

Question 43

Treatment for varicocele

Answer 43

watch and wait/surgery

Question 44

Hernia that comes down into the inguinal canal and occurs lateral of inferior epigastric vessels

Answer 44

indirect; do occur in women, often become incarcerated

Question 45

hernia that protrudes through Hesselbach's triangled

Answer 45

direct, rarely incarcerate

Question 46

What is the second leading cause of bowel obstruction?

Answer 46

incarcerated hernias

Question 47

Pt presents with an indirect inguinal hernia and pain. What diagnostics are indicated?

Answer 47

CBC: elevated WBC with a left shift Electrolytes and elevated BUN=dehydration and toxic state acute abdominal series to r/o free air and obstruction, +/- barium enema

Question 48

DDx for inguinal hernia

Answer 48

LYMPH NODE ENLARGEMENT Hydrocele (non-tender, transillumination) Testicular torsion (acute incarcerated hernia) RULE OUT TORSION FIRST

Question 49

Tx for acute incarceration? Chronic?

Answer 49

Acute: attempt reduction Chronic: DON'T ATTEMPT IF THERE IS ANY QUESTION OF DURATION! Do surgery with hydration and antibiotics pre-op