Male Reproductive System Flashcards
(500 cards)
1
Q
Testicular Torsion
A
x
2
Q
epid
A
x
3
Q
who most commonly gets these?
A
most common in adolescents
4
Q
syx
A
x
5
Q
what are the common syx of testicular torsion?
A
n/v, testicular inguinal and abdominal pain
6
Q
PE
A
x
7
Q
what are physical exam findings?
A
horizontal testicular lie with elevated testicle, absent cremasteric reflex, swollen and erythematous scrotum
8
Q
dx
A
x
9
Q
what would imaging show for testicular torsion?
A
U/S with doppler: no blood flow to scrotum
10
Q
management
A
x
11
Q
what is the management plan?
A
surgical detorsion and fixation (orchiopexy) with exploration of the contralateral side
12
Q
how soon should management be implemented?
A
within 24 hours, do an orchiopexy. Torsion within 6 hours typically allows for complete viability
13
Q
if immediate surgery is not available, what do you do?
A
manual detorsion
14
Q
Epididymitis
A
x
15
Q
Syx
A
x
16
Q
what are the syx of epididymitis?
A
Coliform infxn: Dysuria, frequency
Other syx: unilateral scrotal pain, swelling, and tenderness
17
Q
PE
A
x
18
Q
what is the classic physical exam findings?
A
prehn sign (pain relief with scrotal elevation)
19
Q
Dx
A
x
20
Q
what should initial evaluation involve?
A
UA and culture, NAAT for chlamydia and Gonorrhea
21
Q
cause
A
x
22
Q
if <35 y.o, what is the most common cause of epididymitis?
A
N. Gonorrhoeae and Chlamydia trachomatis
23
Q
if >35 y.o, what is the most common cause of epididymitis?
A
bladder outlet obstruction (coliform bacteria-E.Coli)
24
Q
Trx
A
x
25
what are comfort measures that can be taken?
scrotal elevation and NSAIDs (ibuprofen)
26
what is the trx for acute epididymitis if STI-i.e. gonorrhea and chlamydia?
ceftriaxone/doxycycline
27
what is the trx for acute epididymitis if coliform bacteria-i.e. E.Coli (older nonsexually active men)?
Levofloxacin
28
Retrocecal Appendicitis
x
29
PE
x
30
what is the physical exam finding?
psoas sign: pain in the RLQ with passive ipsilateral hip extension
31
Leriche Syndrome
x
32
syx
x
33
what is the triad of leriche syndrome?
LE claudication, absent or diminished femoral pulses, Erectile Dysfunction
34
Erectile Dysfunction (ED)
x
35
causes
x
36
what are causes of ED ?
vascular, neurolgic, psychogenic, endocrine, medications, hypogonadism
37
vascular ED
x
38
syx
x
39
what are syx?
abnormal vascular exam (eg bruits, decreased pulses)
40
risk
x
41
what are risk factors?
cardiovascular (HTN, smoking, DM)
42
dx
x
43
how do you best dx it before initiating trx?
ABI index, cardiac stress testing prior to initiating trx
44
trx
x
45
what is first line trx?
PDE5 inhibitors (sildanefil, vardenafil, tadalafil)
46
neurologic ED
x
47
syx
x
48
what are syx of neurologic ED?
gradual onset, loss of bulbocavernosus reflex
49
risk
x
50
what are risk factors?
Neurologic comorbidity (eg, diabetic neuropathy, multiple sclerosis, spinal injury/surgery)
51
psychogenic ED
x
52
risk
x
53
what are risk factors?
interpersonal conflict, performance anxiety, underlying emotional disorder
54
syx
x
55
what are the symptoms?
sudden onset, Situational (eg, ED with partner, normal erection during masturbation), persistence of nonsexual nocturnal erections
56
PE
x
57
what are the physical exam findings?
normal nonsexual nocturnal erections
58
endocrine ED
x
59
what are additional endocrine syx?
underlying disorder
60
dx
x
61
how do you dx it?
abnormal hormone levels (eg TSH, prolactin)
62
Medication induced ED
x
63
cause
x
64
what are the meds that causes ED?
anti-HTN (i.e. carvedilol), SSRIs, anti-androgenic medications
65
hypogonadism ED
x
66
syx
x
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what are syx of hypogonadism ED?
gradual onset
68
PE
x
69
what are physical exam findings?
decreased libido, gynecomastica, testicular atrophy
70
Dx
x
71
what would lab values show?
low serum testosterone
72
Pearly Penile Papules
x
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PE
x
74
what are the physical exam findings of penile papules?
>=1 rows of small, flesh colored, dome topped or filiform papules positioned circumeferentially around the corona or sulcus of the glans penis
75
management
x
76
what is the management of pearly penile papules?
normal variant, no intervention, just reassurance
77
Condyloma Acuminata
x
78
PE
x
79
what are physical exam findings?
skin colored or pink, smooth flattened papules to verrcous, papilliform growths
80
trx
x
81
what is the treatment?
topical imiquimod, an immunomodulatory drug
82
Acute Urinary Incontinence
x
83
causes
x
84
what are reversible causes of incontinence?
"DIAPPERS"
```
Delirium
Infection (eg, UTI)
Atrophic urethritis/vaginitis
Pharmaceuticals (eg, alpha blockers, diuretics)
Psychological (eg, depression)
Excessive urine output (eg, diabetes mellitus, CHF)
Restricted mobility (eg, postsurgery)
Stool impaction
```
85
what are neurologic causes?
MS, dementia (parkinsons, alzheimer, NPH), spinal cord injury, disc herniation
86
what are genitourinary causes?
- Decreased Detrusor contractility, detrusor overactivity
- Bladder or urethral obstruction (eg, tumor, BPH)
- Urethral sphincter or pelvic floor weakness
- Urogenital fistula
87
dx
x
88
what is the best initial dx test for elderly with urinary incontinence?
UA with culture
89
Chronic Prostatitis
x
90
timing
x
91
how long must you have prostatitis to call it chronic?
>3 months
92
syx
x
93
what are syx of chronic prostatitis?
>3 months of dysuria, pelvic pain, and/or pain during ejaculation
94
dx
x
95
what should you do first to evaluate?
UA and urine culture before and after prostate massage
96
what does chronic prostatitis UA normally show?
>20 leukocytes/hpf after prostate massage
97
urine culture is then used to differentiate what?
chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)-urine culture is aseptic
chronic bacterial prostatitis-urine culture results >10 fold increase after prostate massage
98
PE
x
99
what would physical exam show?
hypertrophy, tenderness, or edema
100
management
x
101
what is the best treatment for chronic prostatitis?
no clear approach- alpha blocker, abx, anti-inflammatories, and/or psychotherapy are all reasonable
102
Acute Prostatitis
x
103
syx
x
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what are syx of acute prostatitis?
high fever, dysuria, pelvic /perineal pain, cloudy urine, generalized body aches
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PE
x
106
what does rectal exam show?
warm, edematous, very tender prostate
107
dx
x
108
what does the UA show?
mod blood, LE positive, nitrites positive, many bacteria, WBC many, RBC some
109
what does urine culture show?
gram negative organism (E Coli or Proteus)
110
complications
x
111
what are complications of acute prostatitis?
bladder outlet obstruction w acute urinary retention
112
trx
x
113
what is the trx for acute prostatitis?
urgent bladder decompression (suprapubic catheter, since uretheral cath increases risk of septic shock) and Abx (TMP-SMx, Ciprofloxacin)
114
Interstitial Cystitis
x
115
syx
x
116
what are syx ?
longstanding dysuria, discomfort worse when bladder is full and improved with voiding
117
dx
x
118
what does UA show?
aseptic dysuria
119
Benign Prostate Hyperplasia (BPH)
x
120
syx
x
121
what are syx of BPH?
urgency, hesitancy, nocturia, weak urinary stream
122
dx
x
123
what does the PSA show?
elevation
124
trx
x
125
what is a typical surgical trx?
TURP
126
what is a common complication of TURP?
retrograde ejaculation (urinary incontinence and ED are uncommon)
127
Elvated PSA's (Prostate Specific Antigen)
x
128
causes
x
129
what are causes of transient elevated PSA?
urine retention, mild acute prostate infections/inflammation, urologic procedure (eg cystoscopy), DRE (minimal elevation), recent ejaculation
130
what are causes of chronic elevated PSA?
BPH, prostate cancer, severe or chronic prostatitis
131
management
x
132
what should you do if you encounter elevated PSA
repeat PSA in 4-6 weeks
133
Constitutional Delay of Growth and Puberty
x
134
syx
x
135
what are syx of consitutional delay?
fam hx of "late bloomers", delayed puberty, short stature, normal growth velocity, delayed bone age
136
management
x
137
what is management for constitutional delay?
reassurance, watchful waiting, +/- hormonal therapy
138
when should you give hormonal therapy (testosterone in boys, estrogen in girls)?
consider in boys >14y.o, or girls >12 y.o.
139
when psychosocial concerns are expressed, what should you do?
confidential interview should be conduccted to screen for depression and anxiety
140
prognosis
x
141
what is the prognosis?
puberty onset correlates with fam members, normal expected adult height
142
Kallman Syndrome
x
143
syx
x
144
what are syx of kallman syndrome?
anosmia, hypogonadism, cryptorchidism, micropenis
145
Cryptorchidism
x
146
define
x
147
what is it ? what age is it concerning?
>=6months infants with undescended testis (normally drop through inguinal canal at 28 wks)
148
risk
x
149
what are the risks of cryptorchidism?
prematurity, small for gestational age, low birth weight (<2.5kg), genetic disorders
150
PE
x
151
what are Physical exam findings of cryptorchidism?
empty, hypoplastic, poorly rugated scrotum or hemiscrotum
+/-inguinal fullness
152
management
x
153
what is the management?
orchiopexy after 6 months and before 1y.o. (it is done during infancy to optimize fertility and testicular growth)
154
how does orchiopexy change risk of testicular malignancy ?
it will decrease after orchipexy but remain higher than in patients without a hx of cryptorchidism
155
complications
x
156
what are complications?
inguinal hernia, testicular torsion, subfertility, testicular cancer
157
Scrotal Trauma
x
158
syx
x
159
what are the symptoms of scrotal trauma?
scrotal pain, swelling, bruising
160
PE
x
161
what is a common physical exam finding?
absent or present cremasteric reflex
162
management
x
163
what is appropriate management for mild scrotal trauma?
mild: analgesics and supportive care
164
what is appropriate management for moderate/severe scrotal trauma?
U/S, plus or minus surgical exploration w/n 3 days
165
dx
x
166
what consitutes moderate/severe scrotal trauma?
moderate bruising, sig swelling, marked pain
167
preventative measures
x
168
what are preventative measures to be used?
protective cup
169
Testicular Cancer
x
170
epid
x
171
what is the epidemiology of testicular cancer?
15-35 y.o.
172
risks
x
173
what are risk factors for testicular cancer?
fam hx, cryptorchidism
174
syx
x
175
what are syx of testicular cancer?
unilateral, painless testicular nodule, dull lower abdominal ache
176
what are mets syx associated with testicular cancer?
dyspnea, neck mass, low back pain
177
PE
x
178
what are physical exam findings ?
firm, ovoid mass
179
dx
x
180
what labs do you order?
UA, tumor markers (AFP, b-hcG)
181
what imaging do you order?
scrotal U/S, then staging imaging (CT scan, CXR)
182
trx
x
183
what is the treament?
radical orchiectomy and chemotherapy,
184
what is the cure rate?
cure rate ~95%
185
Priapism
x
186
risk
x
187
what are common risk factors for ischemia?
PDE5 inhibitors, intracavernosal injections (eg alprostadil), certain meds (eg trazaodone), and sickle cell disease
188
syx
x
189
what are syx?
persistent >4h, painful erection
190
PE
x
191
what are the physical exam findings?
engorged and tender to palpation corpus spongiosum
192
Dx
x
193
what is the best way to diagnose priapism?
blood gas analysis of a corporeal aspirate
194
management
x
195
what is the best management at the onset of syx?
terminated with simple interventions (eg urination, cold compresses)
196
if syx last >4 hours, what do you do?
require invasive treatment
197
what does management involve?
aspiration of corpora cavernosa and intracavernosal injection of alpha agonist (eg phenylephrine)
198
what is the trx of choice for nonischemic (high flow) priapism- due to traumatic fistula from the cavernosal artery?
angiographic embolization
199
complications
x
200
what are complications?
irreversible ischemic injury, tissue acidosis, anoxia
201
Prostate Cancer
x
202
prognosis
x
203
what is the prognosis?
most men who develop prostate cancer die from other causes
204
screening
x
205
who do you screen for prostate cancer?
men: age 55-69yo with PSA. Not recommended for men <55y.o or >=70 yo. or with patients who have a <10 year life expectancy
206
Viral Orchitis
x
207
cause
x
208
what are the causes?
mumps, rubella, parvovirus
209
syx
x
210
what are syx?
scrotal swelling, pain, tenderness, and erythema
211
what are some extrauterinary manifestations?
aseptic meningitis, parotitis
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