men's health review

Question 1

priapism

Answer 1

prolonged painful erection
> risk is sickle cell
ischemic form is emergency

Question 2

testicular cancer

Answer 2

new onset of hydrocele
painless/asymptomatic until metastasis
common in young white males

Question 3

prostate cancer

Answer 3

NEW onset of LOW back pain/rectal area with 50yo, obese, black, family hx

Question 4

testicular torsion

Answer 4

ABRUPT extremeley painful scrotum, n/v
affected testicle is higher
no cremasteric reflex
age 10-20

Question 5

cremasteric reflex

Answer 5

testicle elevates toward body (dt stroking/pinching of inner thigh).
ABSENT with testicular torsion

Question 6

cryptoorchidism

Answer 6

undescended testes

> risk of testicular cancer

Question 7

spermatogenesis stimulated by what

Answer 7

LH

testosterone

Question 8

prostate gland

Answer 8

produces PSA (prostate specific antigen) and prostatic fluid
helps sperm survive in vagina
50% of 50 yo males have BPH

Question 9

epididymis

Answer 9

coiled tubular organ loacted posterior aspect of the testis. stores immature sperm for 3 months , these are cut during vasectomy

Question 10

transillumination scrotum

Answer 10

beam of life behind the scrotum
Serous fluid- bright red glow (hyrocele)
blood/mass- dull or NO glow (cancerous tumor)

Question 11

testicular cancer common in whom, s/s, labs

Answer 11

most common males 15-30 yo, white
s/s: testicle feels “heavier”
nodule
new hydrocele

labs: ultrasound, biopsy, refer to urologist
removal- orchiectomy

Question 12

testicular torsion

definition and s/s

Answer 12

spermatic cord becomes twisted
blood supply interrupted
if not corrected within 24 hours, 100% of the testicles become gangrenous/surgical removed

classic case: 14 yo with SEVERE testicular pain, extremely red swollen, n/v.

call 911!, doppler sound, tx is manual reduction or surgery

Question 13

prostate cancer

risk factors

Answer 13

risk factors:
>50 yo, AA, obese, family member (1st degree relative doubles the risk)
digital rectal exam (DRE) and PSA routine NOT recommended.
do exam based on pt’s age and risk factor

Question 14

prostate cancer s/s

Answer 14

PAINLESS nodule (hard/indurated)
Elevated PSA >4.0
screen: PSA with DRE, If 4.0 PSA

drug therapy: anti androgens (proscar), hormone blockers (lupron)

Question 15

BPH

Answer 15

seen in 50% of males >50
urinary obstruction s/s
nocturne common

PSA is elevated (norm: 0-4)
enlargd prostate, symmetrical, rubbery

medictions:
Alpha andrenergic antagonist: Terazin (HYTRIN) )/tamsulosin/flomax

***5 alpha reductase inhibitors: Fiasteride (PROSCAR) (blocks testosterone)

avoid cold medications, antihistamine, caffeine
herbal: saw palmetto

Question 16

how to determine effectiveness of proscar

Answer 16

MULTIPLE PSA by 2. value should be below baseline.

Question 17

proscar

Answer 17

category X
teratogenic
should not be touched with bare hands by reproductive aged female

Question 18

chronic bacterial prostatis

Answer 18

>6 wks
E.coli
UTI s/s
boggy prostate
NORMAL UA unless urine mixed with prostatic fluid= E. Coli

labs: urine/prostatic fuid. Use 3 tubes (urethra, bladder, urine)
PSA will elevated

medications: Bactrim (trimethoprim-sulfamethoxale)
Ofolzcin (floxin) or levofloxacin (levaquin)

Question 19

acute prostatis

Answer 19

YOUNG male
enterobacter
 UTI s/s, cloudy urine, fever
prostate WARM and TENDER
DO NOT massage virorously dt risk of infection 

tx >35 yo fluoro

Question 20

bacterial epidiymitis

Answer 20

bacteria ascends up the urethra (urethritis) and reaches epidymis
RULE OUT testiculor torsion
POSITIVE PHRENS SIGN (relief of pain with scrotal elevation)

tx: 35 levo
scrotal elevation, ice packs, bed rest.

Question 21

erectile dysfunction rx

Answer 21

1st line: phosphodiesterase type 5
viagra/levitra on empty stomach 30-60 min before sex
other: intravernous injections (alpostadil or caverject)

contraindicatsion: nitrates, alpha blockers, post MI

Question 22

peyronie’s disease

Answer 22

penile pain during erection/nodles/crooked penile dt fibrotic plaques on the tunica albuginea.

no labs, refer to urologist

Question 23

phimosis

Answer 23

foreskin cannot be pushed back dt edema ( seen in neonates)

Question 24

varicocele

Answer 24

veins “bag of worms” in scrotal sac. new onset can be testiculr tumor

order ultrasound

Question 25

> 35 think E. coli

Answer 25

true