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X Clin Med II Exam 3 > Men's Health > Flashcards

Men's Health Flashcards

(96 cards)

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1
Q

What causes BPH?

A

Androgens cause proliferation of fibrosomal tissue in the transitional zone that can lead to compression of the prostatic urethra

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2
Q

Most common benign tumor in mens ages 40-80

A

BPH

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3
Q

4 zones of prostate

A

Transitional (where BPH occurs most)
Central
Peripheral
Fibromuscular

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4
Q

History to consider with BPH

A

Type 2 DM (causes nocturia and risk factor for it)
Sxs of neurologic disease (neurogenic bladder)
Sexual dysfunction
Gross hematuria/pain suggesting bladder tumor/calculi
Trauma, urethritis or instruments
Family history
Meds that impair bladder function or increase outflow resistance

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5
Q

How long must sxs persist to be considered BPH?

A

3 mos (bothersome urinary sxs)

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6
Q

Who has BPH most often?

A

Blacks

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7
Q

Diagnostic labs for BPH

A

DRE (symmetry, firmness, nodules)
UA to r/o blood and infection
Prostate specific antigen
BUN/creatinine

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8
Q

When do you need to avoid taking a prostate specific antigen?

A

After ejaculation, trauma or urethral catheterization

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9
Q

Options for tx of BPH

A

Behavior modification
Alpha blockers (first line)
5-alpha reductase inhibitors
(can also do surgeries)

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10
Q

Behavior modification for BPH

A

Avoiding caffeine, alcohol or meds that exacerbate
Fluid restriction before bed or going out
Double voiding to promote complete emptying

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11
Q

What do alpha blockers do in BPH?

A

Zosins
Relax smooth muscle in urinary tract and prostate
Side effects: orthostatic hypotension, dizziness, ejaculatory dysfunction

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12
Q

What do 5-alpha reductase inhibitors do in BPH?

A

Finasteride or dutasteride
Decreases prostate size via antiandrogen effects
Side effects: decreased libido, sexual dysfunction

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13
Q

Who gets acute bacterial prostatitis?

A

Young and middle aged men

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14
Q

What causes acute bacterial prostatitis?

A

Typical ones like e coli or proteus

Can be sexually transmitted like gonorrhea or chlamydia

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15
Q

When do you have an increased risk for acute bacterial prostatitis?

A

Urogenital instrumentation, catheterization, prostate biopsy

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16
Q

Features of acute bacterial prostatitis

A

Acute onset of urinary frequency, urgency and dysuria with obstructive voiding sxs
Perineal/pelvic pain
Fever/chills, myalgia, malaise

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17
Q

How to diagnose acute bacterial prostatitis?

A

DRE (gently) reveals tender and edematous prostate
Use this to differentiate from UTI
(can also urine gram stain/culture)
-may also see leukocytosis, pyuria, elevated PSA and ESR

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18
Q

Tx for acute bacterial prostatitis

A

(Debate in or out patient)
Fluoroquinolone or Bactrim for 6 weeks (can gram stain or culture to help guide abx)
Repeat urine culture after 7 days of abx (want to consider an infection in the prostate)

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19
Q

How to tell when there is chronic bacterial prostatitis?

A

Chronic or recurrent urogenital sxs with evidence of bacterial infection of prostate

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20
Q

Feature of chronic bacterial prostatitis

A

Sxs can be subtle or recurrent UTI
May have pelvic pain, bladder outlet obstruction or hematuria
Usually normal prostate exam (may have tenderness)
Labs probably normal but may be elevated for inflammation

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21
Q

How to diagnose chronic bacterial prostatitis?

A

Prostatic fluid analysis (gold standard)

But most often presumptive

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22
Q

Tx for chronic bacterial prostatitis

A 
Fluoroquinolone for minimum 6 wks (first line)
Bactrim alternate (recurrent episodes are same way)
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23
Q

How to define chronic prostatitis/chronic pelvic pain syndrome?

A

Chronic pelvic pain for at least 3 of the preceding 6 mos in the absence of other identifiable causes

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24
Q

What constitutes the majority of prostatitis diagnoses?

A

Chronic prostatitis/pelvic pain syndrome

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25
Features of chronic prostatitis
Pain (perineum, lower abdomen, testicles, penis etc) Voiding difficulty Blood in semen Relapsing-remitting pattern over many mos
26
How to diagnose chronic prostatitis
Diagnosis of exclusion (consider bacterial prostatitis, urethritis, urogenital cancer, strictures, neurologic disease)
27
Most effective meds chronic prostatitis
Alpha blockers, abx and 5 alpha reductase inhibitors (combos)
28
Most common cancer in men age 60-79
Prostate cancer
29
When does prostate cancer usually get diagnosed?
Mostly after elevated PSA and the rest can be an abnormal DRE
30
Who do you target screening of prostate cancer to?
Greater than 10 yrs life expectancy, fmaily hx of prostate cancer and black men
31
Ways to screen for prostate cancer
DRE PSA PCA3 (prostate cancer antigen 3 gene-urine test)
32
Features of prostate cancer
Urinary frequency, urgency, nocturia and hesitancy are common (concomitant BPH)
33
What might you see in advanced prostate cancer
Bone pain, fatigue, weight loss
34
What might be seen on the DRE in prostate cancer?
Nodular or asymmetric prostate
35
Where does a DRE detect tumors in the prostate?
Posterior and lateral aspects of the gland
36
What do you do with an abnormal prostate exam and abnormal PSA?
Prostate biopsy (transrectal u/s guided)
37
What is the Gleason score?
Determine treatment and prognosis of prostate cancer (staging etc)
38
Options for tx of prostate cancer
Observation Radical prostatectomy Radiation therapy Androgen deprivation therapy
39
When do you refer with prostate cancer?
Check with total PSA every 6-12 mos for 5 years and then annually and if it rises then refer
40
Risk factors of ED
``` Male DM Obesity HTN Hyperlipidemia CVD Smoking Meds Age ```
41
How to distinguish psychogenic vs organic cause in ED
Nocturnal tumescence test
42
How to identify arterial obstruction or venous leak in ED
Duplex doppler
43
First line medication for ED
PDE5 inhibitors (sildenafil, vardenafil, tadalafil, avanafil)
44
Second line tx for ED
Vacuum erection device Penile self injectables Intrauretrhal suppository (MUSE) (third line is penile prosthesis or surgery)
45
When is urethritis most common?
Young sexually active males
46
2 types of urethritis
Gonococcal (from Neisseria) | Non-gonococcal (chlamydia, mycoplasma genitalium, trichomonas vaginalis etc)
47
Presentation of urethritis
May be asymptomatic Onset of dysuria and urethral discharge Maybe an inflamed meatus
48
What will a gram stain show in gonococcal urethritis?
Polymorphonuclear cells and gram negative diplococci in the urethral exudate
49
Other diagnostic studies for urethritis
Purulent discharge | First void urine for NAAT
50
Tx for gonococcal urethritis
Ceftriaxone 250 mg IM + Azithro 1000mg x 1 dose PCN allergy: GEntamycin 240mg IM + Azithro 2 g x 1 dose *no retest needed if treat with first (sometimes partner too)
51
Tx for non-gonococcal urethritis
Azithro 1 g orally OR Doxy 100 mg PO BID x 7 days (hold the sex)
52
Association with epididymitis for different ages
Young: STDs Old: urinary pathogens
53
Presentation of epididymitis
Acute and unilateral, dull to severe scrotal pain radiating ipsilateral flank Hemi-scrotal swelling and tenderness which may become an erythematous fluctuant mass (postero-lateral teticle) Prehn's sign (elevate scrotum for relief)
54
What can happen if epididymitis is not treated?
Can cause orchitis, abscess or infertility
55
How to diagnose epididymitis
PE Urinalysis or urethral swab Scrotal US (torsion or abscess)
56
Tx of epididymitis when suspicious for Chlamydia or gonorrhea
Ceftriaxone 250 mg IM x 1 and Doxy 100 mg BID x 10 days | NSAIDs for pain relief
57
Tx of epididymitis for an enteric organism
Levofloxacin 500 mg QD x 10 days or Ofloxacin 300 mg BID for 10 days (NSAIDs for pain relief)
58
How does epididymoorchitis happen?
Involvement of testicle by retrograde infection | May have seen mumps/parotitis first
59
Features of epididymoorchitis
Acute, ipsilateral testicular swelling with tenderss | Maybe fever or bothersome urinary sxs
60
Tx for epididymoorchitis
If mumps then supportive | If bacterial then treat similar to epididymitis
61
Where does a varicocele happen?
Typically left due to longer left spermatic vein (can be bilaterally) -Venous varicosity in the pampiniform plexus (spermatic vein)
62
What do you suspect with a right sided only varicocele?
Pelvic/abdominal malignancy (especially if rapid onset)
63
Who do you suspect a varicocele in ?
Post pubertal male with a reported history of scrotal swelling
64
Classic presentation of a varicocele
"Bag of worms" (increases in size with valsalva and decreases in size when supine or if scrotum elevated) Dull, achy testicular pain relieved with support or supine
65
What can a varicocele cause?
Testicular atrophy and infertility
66
How to diagnose a varicocle
PE (if no decompression in recumbet position then CT scan for outlet obstruction) Doppler scrotal US
67
Tx of varicocele
Ligate spermatic vein if symptomatic, infertility concers or testicular atrophy Supportive care if mild
68
When is testicular torsion more common?
Neonates and post-pubertal boys
69
Presentation of testicular torsion
Acute onset of scrotal pain, unilateral with hemi scrotal swelling Pain on palpation with no relief with elevation Bell-clapper deformity Absent cremasteric reflex
70
How to diagnose testicular torsion
Scrotal "US and see limited or loss of flow to spermatic cord or testis
71
Tx of testicular torsion
Manual detorsion | Emergency and need surgical detorsion and orchiopexy
72
When is testicular cancer more common?
Males 15-35
73
Risk factors for testicular cancer
History of it Cryptorchidism Klinefelter Family Hx
74
Presentation of testicular cancer
Painless solid testicular swelling or nodule Dull ache of heavy sensation in lower abdomen, perianal area of scrotum Inguinal or para-aortic LAD May see other sxs based on mets
75
PE for testicular cancer
Examine the unaffected one first Firm, hard, fixed area is suspicious until prove not Check for supraclavicular LAD Abd exam for nodules
76
Tumor markers in testicular cancer
Beta-human chorionic gonadotropin, lactate dehydrogenase, alpha fetoprotein
77
Tx of testicular cancer
Radial inguinal orchietomy Radiation and chemo based on staging (seminatous tumors less common but radiosensitive and nonseminatous are radioresistant) Nerve sparing retroperitoneal lymph node dissection for nonseminatous
78
Surveillance for testicular cancer
Office visits every 3 mos for 2 years and then 6 mos and then yearly after 5 yrs Always do CXR, tumor markers and CT AB/pelvis *self exams!!
79
Why does an direct inguinal hernia occur?
Weakness in floor of inguinal canal
80
Why does an indirect inguinal hernia occur?
Most congenital but not til later in life (most common an d seen more on the right)
81
Fermoral hernias
Least common but seen mostly in women (most likely to become incarcerated/strangulated)
82
Presentation of an inguinal hernia
Heaviness or discomfort with straining Painless bulge N/v, abd distention and pain, redness
83
Presentation of incarcerated/strangulated hernia
Fever | May see bowel obstruction, peritonitis or toxic appearing
84
Definitive tx for all hernias
Surgery (repair must happen when strangulated) | Watchful waiting if inguinal hernai with minimal or no sxs
85
What is bladder cancer associated with?
Tobacco use or chemical dyes (mostly transitional cell carcinoma)
86
Presentation of bladder cancer
Painless gross hematuria or microscopic hematuria is most common May see obstructive or irritative urinary sxs Pain consistent with areas of invasion or metastasis
87
Gold standard diagnosis of bladder cancer
Cystourethroscopy (also for staging) | Can also use UA, urine cytology, tumor markers, CT with urography (evaluate upper tracts)
88
Tx of bladder cancer
Transurethral resection of bladder tumor Intra-vesical chemo for high grade tumors Muscle invasive tumors need systemic chemo before the cystectomy
89
What is urge incontinence?
Uncontrolled loss of urine that is proceeded by a strong unexpected urge to void Involves uninhibited bladder contractions
90
What is stress incontinence?
Leakage with exertion or valsalva (when pressure on bladder) Due to urinary sphincter dysfunction Most common cause of prostate surgery
91
What is mixed incontinence?
Feelings of urgency and exertional leakage
92
Typical presentation of incomplete emptying incontinence (overflow)
``` Nocturnal enuresis (impaired detrusor contractility or bladder outlet obstruction) Less common ```
93
Tx for urgency incontinence
Antimuscarinic (tolterodine, fesoterodine, oxybutynin) | Alpha blockers if BPH
94
Tx for stress incontinence
``` Condom catheters, penile clamp Surgical options (transurethral bulking agents, perineal sling, artificial urinary sphincter) ```
95
Tx for overflow incontinence
Alpha blockers
96
When to refer to urologist with complicated incontinence
``` Severe sxs Pelvic pain Hematuria Elevated PSA/abnormal prostate exam Recurrent urologic infections Previous pelvic radiation or surgery Neurologic disease ```

X Clin Med II Exam 3 (6 decks)

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