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GP FELLOWSHIP RNZGP > Men's Health > Flashcards

Men's Health Flashcards

(52 cards)

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1
Q

Epididymoorchitis
Treatment (no STI/not sexually active)

A

Treat like prostatitis

Trimethoprim 300mg nocte 14 days

or cephalexin 500mg Q6H for 14 days

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2
Q

Epididymoorchitis
Treatment (sexually active)

A

Treat like STI

Ceftriaxone 500mg in 2mL 1% lignocaine IM
PLUS
1g Azithromycin oral STAT
PLUS
1g Azithromycin 7 days later

OR Doxy 100mg BD for 7 days instead of azithro

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3
Q

Steps for genital exam (male)

A
  • Vitals
  • Inspection: Size, swelling, skin, colour, discharge)
  • Herniae and groin (LN)
  • Scrotum (varico/hydrocoele)
  • Testes& epi (size, lie, tenderness, lumps) prehns sign
  • DRE
  • CREMASTERIC REFLEX!!
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4
Q

DDX for Epididmyoorchitis or testicular pain

A

Epididymoorchitis

Torsion

Prostatitis

Hernia

Varicocoele, hydrocoele

Mumps orchitis (7-10 days post infection)

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5
Q

Overactive bladder conservative management

A
  • Bladder retraining
  • Pelvic floor physiotherapy
  • Reduce caffeine
  • Reduce risk factors: etOH, obesity, spicy foods, bladder stones
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6
Q

Overactive bladder pharmacological management (specifics) 3 options

A

Oxybutynin 5mg TDS
non selective anticholinergic

Solifenacin 5-10mg daily
Selective anticholinergic

Mirabegnon 25-50mg daily
Beta 3 agonist

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7
Q

Contraindication for Oxybutynin

A

Glaucoma

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8
Q

Minimally invasive options for detrusor overactivity (specialist level)

A

Botox A

Sacral nerve stimulation

Peripheral tibial nerve stimulation

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9
Q

DDX for overactive bladder

A

UTI
Cancer
urolithiasis
Neurogenic cause: MS, Diabetic neuropathy
OSA
outlet obstruction
CCF, DM polyuria

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10
Q

Risk factors for overactive bladder (modifiable and non modifiable)

A

Modifiable
- etOH
- Caffeine
- obesity
- smoking
- spicy food

NON modifiable
- Female
- age
- POP
- BPH-
- Post menopausal

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11
Q

Macroscopic haematuria managment and investigations

A
  1. CT IVP (gold standard) or US KUB in low risk <50
  2. referral for cystoscopy
  3. Cytology x3
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12
Q

Microscopic haematuria with UTI

A

Repeat urine test in 6 weeks

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13
Q

Microscopic haematuria - when to consider for further evaluation

A
  • > 50
  • Smoker
  • occupational exposure: benzene, dyes, amines
  • cyclophosphamide
  • pelvic irradiation
  • irritative LUTS
  • recurrent UTIs

IF these then refer for:
CT IVP
Cystoscopy
Cytology

IF NONE of these then repeat urine in 6 months

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14
Q

Urine cytology collection

A

Morning
3 consecutive days
3 samples

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15
Q

Causes of haematuria

A

TIP think top down

  • IgA nephritis
  • pyelonephritis
  • Renal Stones
  • Renal cell carcinoma
  • Urothelial carcinoma
  • Bladder stones
  • Cystitis
  • BPH
  • Caruncle

Other: exercise, trauma, POP, vaginal atrophy

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16
Q

LUTS causes

A

Cystitis
BPH
Stones
Overactive bladder syndrome
Urothelial carcinoma
Diabetes- polyuria
Stricture
Phimosis
Vaginal atrophy

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17
Q

BPH investigations

A

US KUB (hydronephrosis and size of prostate)

Urine MCS/urinalysis (haematuria

EUCs

Consider PSA
Consider cytology

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18
Q

Non pharmacological management of BPH

A

Reduce Caffeine
Reduce spice
Reduce evening fluids
Reduce constipation
Bladder retraining

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19
Q

BPH pharmacology

A

Tamsulosin 400microg daily
Silodosin
(alpha blocker)

Prazosin 0.5 to 2 mg orally, BD

Dutasteride 500microg daily
Finasteride
(5alpha reductase inhibitor)
GOOD IF >40mL prostate
Can take moths to get max benefit

Sildenafil
(phosphodiasterase 5 inhibitors)
(less common)

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20
Q

Dose of tamsulosin for BPH
Dose of dutaseride for BPH

A

400mcg daily
500mcg daily

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21
Q

Bilateral impalpable undescended testes

Study These Flashcards
A

URGENT REFERRAL to paediatric surgeon

Plus
EUC for hyponatraemia in CAH
Internal genitalia US
Karyotype

22
Q

Unilateral undescended testes

Study These Flashcards
A

Routine referral to paediatric surgeon for elective orchidopexy/repair at 6 months

23
Q

Bilateral undescended BUT palpable testes (with Abnormal genitalia)

Study These Flashcards
A

URGENT referral

24
Q

Bilateral BUT palpable testes (with normal genitalia)

Study These Flashcards
A

Routine referral to paeds surgeon
(no need for US )

25
Acquired or ascending descended testes.. What to do?
Urgent referral to Paeds surgeon
26
Retractile testes what to do
Annual review, if when you manipulate them down they stay then continue annual review OR if they do not stay post exam then REFER
27
Age group for retractile testes
2-6 yrs old usually
28
Age to review undescended testes
3 months (as only 1-2% not descended by then)
29
Testing for male infertility
Semen analysis Morning testosterone FSH US If abnormal then add Free testosterone, LH, prolactin and repeat morning testosterone
30
Counselling for semen analysis
Abstinence 2-3 days Sample to lab within 1 hr Abnormal then repeat 1-3 months grossly abnormal then 2-4 weeks
31
Side effects of Alphablockers (eg tamsulosin)
Nasal congestion Retrograde ejaculation Hypotension Tachycardia
32
Heamatospermia first line investigations
Urine MCS and cytology (plus baseline bloods)
33
Abnormal semen analysis - where to from here?
- Repeat in specialised andrology lab - Mildy deranged in the next 3 months - Very deranged in the next 2-4 weeks
34
Leukocyte count >1x10^6 in semen analysis next step ?
Needs urine MCS
35
Male infertility blood tests
FSH and morning testosterone If abnormal then Repeat morning, LH and prolactin
36
Hypogonatotropic hypogonadism: blood pattern
LH low FSH low Testosterone Low Prolactin normal or high
37
Testicular failure/ hypergonatotrophic hypogonadism: blood pattern
FSH and LH HIGH testosterone LOW Prolactin normal
38
History questions for haematospermia
- Recent urological procedure - Prolonged masterbastion or intercourse - Prolonged abstinence - Pain on ejaculation (prostatits) - TB - anticoagulants
39
Ural cautions
- Reduces efficacy of nitrofurantoin - Crystalluria with quinolones
40
Chronic bacterial prostatitis managment
Ciprofloxacin 500mg BD 4 weeks or trimethorpim 300mg nocte 4 weeks or norflox 400mg BD 4 weeks
41
Klinefelter syndrome hormonal findings
Primary hypogonadism: Low testosterone Raised LH and FSH Karyotype 47XXY
42
Examination findings for erectile dysfunction
- Penile plaques - Small testicular volume - Lack of secondary sexual characteristics (lack of body hair) - Weak peripheral pulses - Lower limb neuro signs (decreased anal tone) - Gynaecomastia
43
Risk factors for erectile dysfunction
- Peyronie's disease (fibrous plaques) - Recreational drug use (etOH) - Age - CVD and risk factors - Endocrine: androgen deficiency - Diabetes - Medications: BB, antidepressants - Prostate cancer therapy
44
First line treatment for erectile dysfunction
Sildenafil 50mg 1hour before sex
45
Paraphimosis management
- Transfer to emergency department with urology cover - Anaesthetise penis with penile nerve block - Apply circumferential pressure to the glans of the penis to disperse oedema (eg gloved hand) - Intermittent ice to head of the penis - Aspiration of blood from the head of the penis with a needle - Apply granulated sugar to the head of the penis
46
Premature ejaculation pharmacology
Dapoxetine 30mg 1-3 hrs prior to intercourse OR Emla cream to glans and shaft 15-30 mins prior
47
Androgenic Alopecia treatment & side effects
Oral finasteride 1mg daily OR Topical minoxidil (can use combo) - Impotence - Loss of libido - Gynaecomastia - Infertility
48
History questions for erectile disfunction
- Rapid onset - Morning or spontaneous erections - Sufficient for penetrative intercourse - Premature ejaculation - Changes to appearance of penis (peyronie's ) - Reduced facial hair/gynaecomastia (Andgrogen insufficency) - Low mood/anhedonia - Inter-partner conflict -
49
Klinefelter hormonal test results:
Low testosterone HIGH FSH LH Karyotype 47XXY
50
Most common adverse outcome of a TURP
Retrograde Ejaculation
51
Vasectomy counselling
- Permanent nature of procedure - Need 3 months to be effective - risk of infection - risk of haematoma - risk of failure - risk of anti-sperm antibody
52
History questions for male infertility causes:
- Chemotherapy or radiotherapy - Previous cryptoorchidism (undescended testicle) - Previous torsion - Delayed puberty - Previous genital surgery/ pelvic surgery - Spinal cord disease - Erectile dysfunction - Family history of infertility - Exogenous testosterone use

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