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Clinical Medicine II > Renal: Men's Health > Flashcards

Renal: Men's Health Flashcards

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1
Q

Rank the decades of life by prevalence of BPH

A

60-70 (70%) > 51-60% > 41-50 (20%)

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2
Q

A patient presents with the following, concerning for…

  • 4 months of bothersome urinary sxs
  • hx of UTI
  • gross hematuria
A

BPH

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3
Q

What diagnostics can be used for BPH?

A

DRE
UA (r/o infx, hematuria)
PSA
BUN/Cr

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4
Q

Behavior modifications that can be helpful in BPH include…

A

avoid caffeine, etoh, exacerbating meds

fluid restriction b4 bed/activity

double voiding

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5
Q

What are 1st line meds for BPH?

A

alpha blockers (-osin)

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6
Q

What are 2nd line meds for BPH

A

5 alpha reductase inhibitors (-asteride)

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7
Q

The following are surgeries that can treat…

TURP
TUNA
TUMT
Stent
Suprapubic prostatectomy
A

BPH

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8
Q

the following epidemiology describes…

  • young to middle aged men via urethra
  • PEK pathogens
  • increased risk with catheterization, bx, instramentation
A

acute bacterial prostatitis

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9
Q

Patient presents with:

  • acute onset of frequency, urgency, dysuria
  • obstructive voiding sxs
  • perineal pain
  • fever/chills, myalgia, malaise
A

acute bacterial protstatitis

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10
Q

What diagnostics can be helpful in acute bacterial prostatitis?

A

DRE (tender, edematous)

urine stain and cx

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11
Q

What labs can help diagnose acute bacterial prostatitis?

A

leukocytosis
pyuria
elevated PSR and ESR

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12
Q

What differentiates acute bacterial prostatitis from UTI?

A

tender edematous prostate on DRE

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13
Q

If patient is stable and reliable, what outpatient treatment can be done started?

A

fluoroquinolone or TMP-SMZ x 6 weeks

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14
Q

Repeat urine cx in acute bacterial prostatitis when?

A

7 days after abx

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15
Q

If repeat cx is positive after 7 days of abx, what should you do?

A

alternate regimen

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16
Q

When should you consider hospitalization and what tx for acute bacterial prostatitis?

A

toxic sxs

IV abx

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17
Q

A patient presents with the following, which is concerning for what condition?

  • Chronic GU sxs w/ evidence of bacterial prostate infx
  • subtle sxs
  • recurrent UTI

+/- pain, bladder outlet obstruction, hematuria

+/- prostate tenderness/hypertrophy

A

Chronic bacterial prostatitis

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18
Q

Gold standard diagnostic for chronic bacterial prostatitis…

A

prostatic fluid analysis (but most often presumptive dx)

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19
Q

Tx for chronic bacterial prostatitis

A

1st line: fluoroquinolon x 6 weeks

2nd: TMP-SMZ x 6 weeks

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20
Q

the following epidemiology describes what condition?

  • pelvic pain for at least 3 of preceding 6 month
  • large majority of prostatitis cases
  • prevalence peak in 5th decade
A

Chronic prostatitis/chronic pelvic pain syndrome

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21
Q

What labs/diagnostics can be helpful in chronic prostatitis/chronic pelvic pain syndrome?

A

genital rectal exam

UA and Cx

Imaging PRN

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22
Q

How is CP/CPPS diagnosed?

A

exclusion

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23
Q

Patient presents with:

  • chronic pain x 3 mo
  • pain in lower abdomen, testes, on ejaculation
  • voiding difficulty
  • blood in semen
  • relapsing/remitting pattern
A

CP/CPPS

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24
Q

What three medications in combo may be helpful for CP/CPPS?

A

alpha blockers, abx, 5-a-reductase inhibitors

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25
Three methods of screening for prostate CA?
DRE PSA PCA-3
26
Who should prostate CA screening be tailored to?
> 10 years of life expectancy FHx Black men
27
A patient 60+ yo has the following presentation, which is concerning for... - frequency, urgency, nocturia, hesitancy - bone pain, fatigue, wait loss - nodular/asymmetric DRE
prostate CA
28
Bone pain, fatigue, weight loss in prostate CA indicate what stage of disease?
advanced
29
frequency, urgency, nocturia and hesitancy in prostate CA are often due to...
concomitant BPH
30
abnormal prostate exam or abnormal PSA indicate...
prostate biopsy
31
How is prostate CA scaled?
TMN/gleason score
32
4 options for prostate CA dependent on age, staging, lifestyle, comorbidities...
observation radical prostatectomy radiation androgen deprivation
33
Describe the surveillance after tx for prostate CA...
PSA 6-12 mo x 5 years then annually
34
What causes of ED have the following finding? rapid onset
psychogenic | GU trauma
35
What causes of ED have the following finding? nonsustained erection
anxiety | venous leak
36
What causes of ED have the following finding? depression certain drugs
depression or drug induced
37
What causes of ED have the following finding? loss of nocturnal erections
vascular or neuro dz
38
What labs should be ordered to assess ED?
``` A1c/FPG CBC/CMP TSH Lipids serum T ```
39
The physical exam for ED should include...
DRE, 2ndry sex characteristics, femoral/peripheral pulses, breast exam, testicular volume
40
Nocturnal tumescence test can distinguish what two causes?
psychogenic or organic cause
41
Duplex doppler is useful in ED to identify...
arterial obstruction or venous leak
42
2nd line for ED?
vacuum injectables suppository
43
The following presentation is concerning for... - sexually active male - dysuria, urethral d/c - inflamed meatus
urethritis
44
What two labs can help dx urethritis?
gram stain | first void urine NAAT
45
Tx for gonococcal urethritis?
ceftriaxone 250 mg IM + azithro 1g x 1 dose
46
Tx for gonococcal urethritis if PCN allergy?
gentamycin 240 mg IM + azithro 2g x 1 dose
47
What is the tx for non-gonococcal urethritis?
azithro 1g PO doxy 100mg PO BID x 7 days
48
Is retest needed if urethritis is treated with 1st line?
no
49
The following presentation is concerning for... - acute/unilateral scrotal pain - radiation to ipsilateral flank - hemi-scrotal swelling, tenderness - fluctuant mass (+) Prehn sign
epididymitis
50
What are 4 components to epididymitis dx?
PE, UA, swab, US
51
Tx for epididymitis if STI suspected...
ceftriaxone 250mg IM x 1 and doxy 100mg BID x 10 days
52
Tx for epididymitis if enteric organism...
levofloxacin 500mg qd x 10 days ofloxacin 300mg BID x 10 days
53
Bacterial epididymorchitis can be treated how?
same as epididymitis
54
What are three components for epididymorchitis dx?
PE, UA, US
55
Right sided varicocele is less common, and suspicious for what condition?
pelvic/abd malignancy
56
The following presentation is concerning for... dull, achy testicular pain relieved with support or supine (prehns sign) mass that increases in size with valsalva decreased size when supine or elevated
varicocele
57
How is varicocele treated?
ligation of spermatic vein if sxs, infertility concerns, testicular atrophy
58
what imaging can be used for routine varicocele?
doppler US
59
If no decompression of varicocele occurs in recumbent position, what test is indicated?
CT for outlet obstruction
60
The following presentation is concerning for... - unilateral, hemi scrotal swelling - neg. prehn - bell-clapper deformity - absent cremasteric reflex
testicular torsion
61
The following presentation can indicate what? - painless, solid testicular swelling/nodule - dull ache/heavy sensation in lower abdomen, scrotum - inguinal, para-aortic LAD +/- supraclavicular LAD
Testicular CA
62
What is important when examining testicles for testicular CA?
examine unaffected first
63
Any firm, hard, fixed area should be considered...
cancer until proven otherwise
64
What imaging can be helpful for testicular CA?
scrotal US | CT abd./pelvis
65
What labs can help ID and monitor testicular CA?
Beta HCG LDH AFP
66
What are the two primary testicular tumors?
nonseminoma (65%) | seminoma (35%)
67
How is testicular CA treated?
radical inguinal orchiectomy radiation/chemo
68
When should post-tx surveillance for testicular CA happen?
q 3 mo for 2 yrs 6 mo, yearly after year 5
69
Direct hernia protrudes through...
hesselbach's triangle
70
is direct or indirect hernia more common?
indirect
71
Patient presents with: - heaviness/discomfort with straining - painless bulge
inguinal hernia
72
The below are signs of what hernia complication? ``` NV abd. distension pain redness fever ```
incarceration
73
2nd MC urologic malignancy associated w/ TOBB, chemical dyes
bladder CA
74
PE for bladder cancer is usually...
unremarkable
75
What are 90% of bladder cancers?
transitional cell carcinoma
76
The following clinical features paint a picture for... -painless hematuria +/- obstructive/irritating urinary sxs para-aortic LAD
bladder CA
77
Hepatomegaly, supraclavicular LAD, periumbilical nodules represent what in reference to bladder CA?
mets
78
Gold standard for bladder CA dx?
cystourethroscopy
79
Tx for bladder CA?
transurethral resection
80
This defines... leakage with exertion/valsalva due to urinary sphincter dysfunction
stress incontinence
81
MC cause of stress incontinence
prostate surgery
82
typical presentation for incontinence?
nocturnal enuresis
83
4 components to physical exam for incontinence?
abd, neuro, genital, rectal exam
84
labs for incontinence?
UA and cx BUN/Cr
85
Tx for urgency incontinence...
antimuscarinics (-terodines) alpha blockers w/ BPH (-oszin)
86
stress incontinence is treated with...
condom catheter penile clamp surgery
87
overflow incontinence is tx with...
alpha blockers
88
The following indicate "complicated incontinence" and require referral to ... ``` severe sxs pelvic pain hematuria PSA recurrent UTI previous rads/surgery neurologic dz ```
urology

Clinical Medicine II (31 decks)

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