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Finals > Urogen > Flashcards

Urogen Flashcards

1
Q

What is the definition of Impotence/erectile dysfunction

A

inability to attain or keep an erection sufficient for satisfactory sexual performance

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2
Q

RFs /causes for ED

A 
Lack of exercise, obesity
smoking, alcoholism
hypercholesterolaemia/hyperlipidaemia
HTN
DM
Hx of penile #, trauma
Surgery/RT to the pelvis or retro peritoneum

Drugs

  • **Anatomical:
  • Peyronie’s disease
  • micropenis

Metabolic disease

  • hypogonadism
  • hyperprolactinaemia
  • thyroid
  • **- cushing’s

Neuro:

  • brain lesion (stoke tumour, trauma, vasc)
  • parkinson’s
  • Spinal cord disease/injury
  • intervertebral disc disease

Psychogenic

  • GAD< depression
  • situational- stress, partner
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3
Q

what drugs may cause impotence

A
  • antiHTN, Betablockers, diuretics
  • antidepressants- tricyclics, SSRIs
  • antipsychotics
  • **- hormones- cyproterone, LH
  • **- phenytoin, carbamazepine
  • *- antihistamines
  • H2 antagonists- cimetidine, ranitidine
  • recreational
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4
Q

What in the hx would suggest a psychogenic cause of ED

A
  • sudden onset
  • *- early collapse of erection
  • self-stimulated or waking erections still present
  • *- premature ejac or inability to
  • problems/changes in relationship
  • major life events
  • psych hx
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5
Q

What in the hx would suggest an organic cause for ED

A
  • gradual onset
  • normal ejaculation
  • normal lipido (except hypogonadal men)
  • RF in med hx- CVD, endocrine, neuro)
  • operations, **RT, trauma to pelvis/scrotum/penis
  • Current drug with SE EG
  • smoker/ex
  • *- high alcohol consumption
  • *- recreational/bodybuilding drugs
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6
Q

What should you exmamine in a man with ED

A

Endocrine

  • testicular size
  • secondary sexual characteristics

Neuro exam

Vascular

  • peripheral pulses
  • BP
  • Full cardiovasc

Rectal- if >50

genitals

  • Peyronie’s disease
  • gonadal abnormalities
  • retractile foreskin
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7
Q

ix for ED

A
  • fatsing glucose/hba1c/pipid profile if nt done in past year
  • testosterone (hypogonadism)
  • FSH, LH
  • *- PSA
  • prolactin if low testosterone
  • vascular, neuro, endocrinology, pscyhological work ups for specialist to do
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8
Q

management of ED

A

Testicular failure- testosterone
Pit/hypothalamic- tx cause
psycholigcal Therapies

1st LINE:

  • Phosphodiesterase type 5 inhibitors- sildenafil, tasalafil
  • Vacuum devices

2nd LINE:

  • Intraurethral/topical/intracavernosal alprostadil (prostaglandin E1)
  • intraurethral pellet about 15min before sex
  • cream with plunger device, 5-10min before sex
  • injection- may cause priapism

3rd LINE:
penile prosthesis- malleable/inflatable device inserted surgically

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9
Q

How do phosphodiesterase type 5 inhibitors work

A

Sildenafil, tadalafil, vardenadil, avanafil

relaxes smooth muscles

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10
Q

contraindication for using phosphdiesterase type 5 inhibitors

A

nitrites- may cause severe hypotension

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11
Q

What types/grading of FGM are there

A

1- Clitoridectomy- partial/total removal of clit

2- Excision- partial/total removal of clit and labia minora +- excision of majora

3- Infibulation - narrowing of vaginal orifice with creation of a covering seal by cutting and appositioning labia +- excision of clit

4- All other harmful prcedures for non-medical purposes to female genitalia, including pricking, piercing, incising, scraping, cuaterisation

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12
Q

What countries/continents does FGM occur

A

Africa

  • East Africa- Somalia, Eritrea, Ethiopia, Egypt
  • West Africa- Mali, Guinea, Sierra Leone

Middle East

  • Turkey
  • Syria
  • Iraq
  • Lebanon
  • Israel
  • Iran
  • Saudi
  • Yemen
  • Afghanistan
  • Pakistan

Asia
Latin America
Australia, NZ, UK

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13
Q

What is the law concerning documentation and reporting of FGM

A
  • you must record FGM in over 18y/os health records

Reporting:

  • must do for all girsl <18
  • must inform police by the close of the next working day
  • includes genital piercings in girls <18
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14
Q

Gynae complicaitons of FGM

A
  • Dyspareunia, Sexual dysfunction, anorgasmia
  • chronic pain
  • Keloid scar
  • Dysmenorrhea (incl. haematocolpos esp in T3- when blood cant exit, vagina fills)
  • urinary flow obstruction, recurrent UTIs, urinary leakage
  • PTSD
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15
Q

Obstetric complications of FGM

A
  • Difficulty conceiving
  • Fear of childbirth
Increased rate of:
- c-section
- PPH
- Episiotomy
Severe vaginal lacerations
- fistulas
- Increased LOS

difficulty with

  • vaginal exmaintions
  • Applying fetal scalp electrodes
  • Fetal blood sampling
  • Catheterisation
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16
Q

tx of FGM

A

Reversal of infibulation

- should be done preconceptually, antenatally or can be done during intra-partum

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17
Q

What are the different kinds of inguinal hernias

A

Indirect- hernia enters canal through deep inguinal ring and exits through superficial ring

Direct- herniation through posterior wall of the canal, due to wall weakness

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18
Q

What type of inguinal hernia is more likley to occur in a child/baby

A

Indirect- due to embryology rather than weakness

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19
Q

describe how an indirect hernia occurs

A

Testicles descend/gubernaculum structure descends though the canal, from next to the renal structures.

As they descend, peritoneum is pulled down which makes the canal

connects testicles to abdo cavity
the tube is called processus vaginolis and is meant to close before birth

if not, bowel herniates through, causing swelling in labia/scrotum

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20
Q

What are your main differentials for testicular/scrotal/inguinal swelling

A 
Idiopathic scrotal oedema 
hydrocele
torsion
lymph nodes
abscess
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21
Q

what are sx of idiopathic scrotal oedema

A

children
redness/rash on one side of scrotum

rash may extend to peritoneum, anal canal, legs
not usually tender

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22
Q

Difference between inguinal hernia and hydrocele, an don O/e

A

hydrocele- fluid in patent processus vaginolus

  • transilluminates
  • narrow neck
  • fluctulant

hernia- bowel structure/ovary/fallopian tubes in through much wider patent vaginolus

  • doesnt transilluminate (unless a neonate)
  • often reducible
  • wide neck
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23
Q

how to tell the difference clinically between hydrocele and hernia

A

can you get behind the swelling?

  • yes- you are feeling between swelling and external inguinal ring- hydrocele
  • no- sweling is coming throgh canal- hernia

Transillumination
- in adults- hydrocele will shine through, bowel will not

  • neck thickness (hernia=thick)
  • reducibility- hernia is (mostly)
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24
Q

tx of inguinal hernias

A
  • surgically repair
  • more urgent in children as more likely to suffer from strangulaiton, irreducibility, incarcerated
  • do within days for neonates, within weeks for infants
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25
Q

What are the clinical features of an epididymal cyst

A

fluid filled

  • feels smooth, spherical, well-defined
  • transillumination
  • extratesticular- cyst is palpable separately form the testicale (unlike a hydrocele)
  • often multiple, BL
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26
Q

ix for ?epididymal cyst

A

If certain- none
if uncertain- scrotal USS
aspiraiton rarley needed

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27
Q

tx of epididymal cyst

A

most not needed

resection if children in pain/cyst is large

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28
Q

What other conditions is epididymal cyst associated with

A

Polycystic kidney disease
CF
von Hippel Lindau (cystic formations in various places, genetic)

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29
Q

complications of epididymal cyst

A

torsion

no risk of infections

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30
Q

What is a hydrocele

A

Fluid accumulation in the tunica vaginalis

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31
Q

causes of hydrocele in older pts

A 
trauma
epididymo-orchitis
**hernia
**testicular torsion
variocele
testicular tumour
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32
Q

management of congential hydrocele

A

leave it unless uncomfrtable/huge- goes withing 1st 2 years of life

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33
Q

sx of hydrocele

A
  • non tender may be uncomfortable if acute
  • enlarged testicles, hangs lower
  • smooth
  • lies anteroinferioly to teh testis
  • transilluminates
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34
Q

When would you investigate a hydrocele

A

tenderness

internal shadows on transillumination

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35
Q

what ix may you do for ?hydrocele

A
  • USS- for spermatoceles
  • Doppler USS
  • Serum alpha fetoprotein nd human chorionic gonadotropin- exclude malignancy
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36
Q

tx of hydrocele

A
  • infant- observe until 2 years old- reassure

- only do surgery if suspicion of inguinal hernia or other testicular pathology /large

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37
Q

What is a variocele

A

abnormal dilatation of testicular veins in pampiniform venous plexus

cuased by venous reflux

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38
Q

is variocele assoc with decreased ferility

A

yes, in 1/3- reduced testicular function

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39
Q

is hydrocele assoc with reduced fertility

A

no- not in itself, unless condition leading to it eg trauma, tumour- does

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40
Q

what side is variocele more common on- why?

A

Left

angle at which L testicular veing enters onto the L renal vein means there’s a lack of effective valves between testicular and renal vein

R attaches to IVC directly

if renal cancer spreads into the L renal vein- it will prevent blood from draining from the L testicular vein into renal vein

R testicular vein drains into the vena cava, rather than the renal vein

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41
Q

clincial features of variocele

A

rarely causes pain- if so, it’s throbbing/dull pain worse on standing
Dragging sensation
disappears when pt lies down

usually asymptomatic
‘bag of worms’

usually found incidentally- infertility screning/routine medical exminations

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42
Q

exmiantion of variocele

A

have pt standing

affeted scrotum hangs lower than other
Valsalva manouvre whilst standing increases dilation further
dilation of veins is increased when staning compared to lying

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43
Q

Ix for variocele

A

sperm counts
doppler studies if physical exmination is inconclusive
- if ?RCC carcinoma– USS/CT/MRI

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44
Q

tx fo variocele

A

observe with annyal examinations
bioflavonoids- slows progression- fruit, veg, nuts, wine ;)
Surgery

Advice:

  • not likely will get LT complications– 2/3 of men who have variocele have no issues conceiving
  • supportiev underwear an simple analgesia can be used for discomfort
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45
Q

when to refer urgently with view of surgery for ?variocele

A

*- pain
- variocele appears suddenly
- doesnt drain when lying down
*- solitary R variocele
adolescents with
*- reduced testicular volumes (testicular growth arrest)
- if concerned about appearance and cannot be reassured in primary car

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46
Q

sx of pelvic inflamm disease

A
  • Pelvic/lower abdo pain (usualy BL)
  • RUQ pain- peri-hepatitis (fitz-hugh-curtis syndrome)
  • deep dyspaerunia
  • Abnormal vaginal bleeding (IMB, PC), Secondary dysmenorrhagia
    Abnormal discharge
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47
Q

What is Fitz-high-curtis syndrome, sx

A

usually due to chlamydia
liver capsule inflammation leading to adhesions

acute onset RUQ pain
Aggravated by breathing, coughing, laughing
may be referred to R shoulder
tenderness on RUQ and percussion of lower ribs
N+V in 50%

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48
Q

signs of PID

A

Biman

  • lower abdo tnderness (BL)
  • adnexal tenderness
  • may be palpable mass
  • cervical motion tenderness
  • uterine tenderness

Spec
- abnormal cervical/vaginal mucopurulent discharge

+-fever

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49
Q

Ix for ?PID

A
  • pregnancy test- excludes ectopic
  • hgih vag swab- for BV/candidiasis
  • chlamydia/gonorrhoea, myciplasma genitalium tetsing
  • HIV, syphillis bloods
  • wet mount vaginal smear- pus cells– if absent, PID unliklet

ESR, CRP, Leukocyte count
USS- could be done, not helpful if uncomplicated PID
Doppler USS- increased BF, not specific (eg endometriosis)
MRI or CT- not routine but could be useful if ?ddx

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50
Q

ddx for ?PID

A

Gynae

  • ectopic
  • *- threatened abortion
  • *- ruptured corpus lutea cyst
  • *- endometriosis
  • ovarian csyt torsion/rupture/haemorrhage
  • Mittelschmerz pain- ovulatory pain

GI

  • IBS
  • *- acute bowel perf
  • *- Diverticular disease
  • Appendicitis

**UTI
Functional- other longstanding general sx

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51
Q

Complications of PID

A
  • infertility (tubal)
  • ectopic
  • chronic pelvis pain
  • tubo-ovarian abscess
  • Fitz-Hugh-Curtis syndrome
  • *- Ovarian Cancer
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52
Q

management of ?PID

A
  • pain- ibuprofen and para
    ABX- all of the below
  • ceftriaxone (gonorrhoea) 1g stat IM
  • oral doxy 100mg (chalmydia) BD for 14 days
  • oral metronidazole (BV, trich) 400mg BD for 14 days

IUD removal if no improvement in 72hours- with emergency contraception if needed

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53
Q

when should you admit urgently a pt with ?PID

A
  • ectopic/appendicitis, tubo-ovarian cyst cannot be ruled out
  • *- pt is pregnant
  • severe N+V
  • Fever >38
  • signs of peritonitis- rebound rigidity, guarding
  • immunocomprimised
  • *- Fitz-hugh- curtis syndrome is suspected
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54
Q

What is phimosis

A
  • inability to retract the foreskin
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55
Q

types of phimosis

A

physiological

  • healthy prepuce
  • inner mucosa everts through opening like a flower
  • rarely causes sx
  • can cause ballooning of foreskin when passing urine

pathological

  • thickening, scarrning of foreskin
  • no inner mucosal eversion
  • can cause multiple sx
  • due to BXO, balanitis
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56
Q

Management of physiological and patholigcal phimosis

A

reassurance- likely to resolve as boy grows older

  • encourage genital hygiene- gently retract foreskin after bathing (skin made soft)
  • dont force the foreskin
  • corticosteroid cream for 4-6w to prevent need for circumscision
  • circumcision if older/pathological
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57
Q

What si Balanitis Xerotica Obliterans

A

Lichen Sclerosis on males

- genetic/autoimmune- not fully understood

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58
Q

sx/signs of balanitis xerotica obliterans

A
  • white patches
    • scarring
  • affecting glans, foreskin, urethra
  • may have blistering/ulcers
    • haemorrhagic vesciles/purpura
    • meatal narrowing/thickneing
  • phimosis
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59
Q

ix for ?BXO

A

clinical dx
biopsy if uncertain or is ?malignancy/no response to tx
***autoantibdy screen for autoimmune disease

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60
Q

tx BXO

A
  • no cure
  • potent topical steroids- clobetasol propionate 0.05% (mild)
    intralesional triamcinolone steorid injections

refer if no repsonse to steroids after 3m/phimosis

procedures

  • meateal /urethral dilatation
  • meatoplasty
  • grafting
  • circumcision (relatively urgently)
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61
Q

sx of balanitis

A 
redness/irritation of glans
may involve ofreskin too
pain
woth or without thick, clumpy discharge from under foreskin
\+-phimosis
dysuria
bleeding
itching
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62
Q

causes of balanitis

A
  • poor hygiene- irritation due to smegma
  • tight foreskin preventing cleaning
  • candida
  • herpes, chlamydia, gonorrhoea
  • condoms, soaps, scrubbing, washing powders
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63
Q

management of balanitis

A 
- hygeine promotion
tx causes
- abx (doxy, ceftriaxone)
- antifungal cream clotrimazole
**- avoid irritant
**- trail steroid cream
- if recurrent- circumcision
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64
Q

what is the definition of a micropenis

A

scretched penile length -2.5SD of the mean in a pt with otherwise normal internal and external genitalia

Adult <3.6inch
prepubescent <1.5inch
neonate <0.75inch

sperm count.ability to become erect is sometimes affected

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65
Q

What syndrome can a micro penis be associated with

A

Kallman’s

  • no sense of smell
  • hypogonadotropic hypogonadism
  • cleft lip/palate
  • short fingers, toes (esp ring finger)
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66
Q

what is peyronies disease

A

connective tissue disorder fo the penis

fibrous scar tissue/palques form in tunica albuginea in the corpus callosum

inflammatory thickening
fibrin deposition
increased collagen production
decreased quantity of elastic fibres

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67
Q

sx of peyronie’s

A
  • bent erect penis
  • hour glass deformity with distal flaccidity
  • painful erections
  • palpable fibrotic plaque at site of angulation
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68
Q

ix of Peyronie’s

A

clinical dx

duplex USS occasionally to detect abnormalities

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69
Q

what conditions are peyronie’s assoc with

A 
dupuytrens
DM
ED
smoking, acloholism
lipid abnormalities, IHD, HTN
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70
Q

management of peyronie’s

A
  • self limiting- 1/2 of patients will get progressive disease, 1/2 will get tsatic disease

drugs

  • para-aminobenzoate, vit E, colchicine, tamoxifen
  • topical verapamil
  • intralesional verapamil, interferon

Conservative

  • external penile traction
  • vacuum devices

surgery- disease must’ve been stable for 3m, risk of penile shortening

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71
Q

What is hypospadias

A
  • congential

- urethral meatus on shaft/mase of penis

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72
Q

what must you check o/e for hypospadias

A

both testes are palpable- excl. congenital adrenal hyperplasia

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73
Q

management of hyospadias

A
  • surgical correction for normal void and sexual function
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74
Q

What is paraphimosis

A

foreskin is stuck in retracted position

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75
Q

Management of paraphimosis

A

Penile nerve block with lidocaine (ischaemia is painful), do before any of the following!

Compression- for 5-10mins
- hand around distal end to squeeze out oedema

2 thumbs on glans, index and ring finger under resticting band, apply pressure with thumbs and pull up with fingers

Osmotic methods

  • gauze soaked in mannitol (hypertonic)
  • do not do ice packs in gloves- cuases vasocontriction and makes it worse

Dundee methods- dorsal slit surgery, then offer circumcision for aesthetic

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76
Q

what tissue has ruptured in penile #

A

tunica albuginea

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77
Q

describe the internal tissue of the penis

A

corpus spongiosum- around urethra, at bottom

  • corpus cavernosa- 2 larger bits above spongiosum, filld with blood when erect (contain carvernosal ateries)
  • Tunica albuginea- fibrous layer that envelopes the corpus cavernosa and spongiosum , ruptues
  • superficial dorsal vein, deep dorsal vein, dorsal arteries and dorsal nerve run superiorly
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78
Q

decsribe the journey of the sperm

A

made in testes

stored in epididymis and brings them to maturity

travel through vas deferans

seminal vesicles (which sit above prostate) inject 70% of the total volume of the semen (alkaline fluid, fructose, prostaglandins, clotting factors)

Prostate- produces and injects seminal fluid (proteins, hormones, vitamins, proteins, mucus)

ejaculated

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79
Q

Complications of penile #

A

deformity (angluation)
ED
**painful erections
**fistula

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80
Q

sx of penile #

A 
snap/popping sounds
immediate loss of erection
blood at meaturs/blood in urine
retention
difficulty urinating (urethral injury)
pain
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81
Q

O/E of penile #

A

aubergine sign- blood contained in Buck’s fascia- superficial layer , penis goes dark purple

  • bruising can spread to peritoneum (butterflu ecchymosis)/lower abdo
  • contralateral bending
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82
Q

tx of penile #

A
  • surgical repair- evac haematoma, close defect, repair urethral injury around a catheter if present

post op counselling

  • abstain from masturbatin/sex
  • F/U if any complications
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83
Q

what is priapism

A

prolonged and peristent erection int eh absence of sexual desire lasting >4 hours

sickle cell children may get this

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84
Q

when is priapsim an emergency

A

ischaemia- PAIN

  • obstruction if venous outflow
    will cause irreversible ED
  • penile compartment syndrom effectively
  • thrombus formaiton and tissue damage
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85
Q

what is stuttering priapism

A

recurrent ischamei priapsim
often in sickle cell pts

will resolve with conservative measures (showers/exercise)

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86
Q

causes of ischaemic priapsim

A 
idiopathic
intracavernosal prostaglanding injections for ED
sickle cell
thalassamia
leukaemia

cauda equina
spinal cord injury

**penile injury/trauma

drugs

  • antids
  • anticoags
  • alpha blockers-doxazosin, tamsulosin
  • antipsychotics , lithium
  • testosterone, GnRH
  • *- methylphenidate and other ADHD meds
  • *- recreational
  • *- alcohol excess
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87
Q

hx of priapism

A

need to diff between isch and non-isch- pain?

  • onset
  • duration
  • ED present before ischaemia (importnat for medico-legal reasons)

PMHx

  • sickle cell
  • penile trauma
  • thalassaemia
  • Leukaemia
  • strokes
  • cauda equina

drugs

  • antids
  • antiphsychotics
  • recreational
  • ED injection
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88
Q

ix for priapism

A

intracavernosal aspiration- diagnotic and therapeutic (send off for testing)

Irrigation- move blots out

blood gas from aspiration

  • low flow - low O2 and acidosis
  • non isch- normal O2 and pH

bloods

  • FBC
  • Hb Electrphoresis (thalassaemia)

USS penis- coloured doppler for aterial flow

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89
Q

management of priapism

A
  • intracavernosal aspiration and irrigation
  • intracavernosal phenylepinephrine- sympathetic selective alpha agonist causes vessel constriction

if no response in an hour
- distal shunt

stuttering- input from haematologys- blood transfusion, home phenylepinephrine, LT management

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90
Q

When should a circumcision be considered? (generally)

A
  • physiological phimosis not resolved at adolescnce
  • painful ejaculation
  • paraphimosis
  • recurrent balanitis
  • recurrent UTI
  • BXO
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91
Q

ddx of acute scortal pain

A 
Testicular torsion
torsion of hydatid
epididymo orchitis
trauma
acute hydrocele
****idiopathic scrotal odema
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92
Q

Sx of testicular torsion

A
  • severe acute onset
  • may feel sick/vomit
  • testicle is teder to touch
  • redness, swelling- LATE SIGNS
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93
Q

signs of tetsicular torsion

A

loss of cremasteric reflex

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94
Q

sx of torsion of appendix/hydatid or morgania

A

same as tetsicular torsion

  • pain may be less severe
  • pain may start in upper pole of the testis
  • 1/3 of cases- blue dot in upper pole
  • cremesteric reflex present!
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95
Q

when are the peaks of testicualr torsion

A

neonatal, adolescent

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96
Q

sx of idiopathic scrotal odema

A
  • UL scrotal erythema and oedema
    raised rash
    in half of cases- extends to perineum, anal canal , legs
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97
Q

ix for ?idiopathic scrotal oedema

A
  • USS_ thickening and oedema of scrotal wall, hypervadcularity, normal testes
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98
Q

tx of idiopathic scrotal oedema

A 
self limiting (3-5d)
NSAIDS and Abx
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99
Q

causes of acute acquired hydrocele

A

trauma
epididymitis
testicular torsion/infarction
testicular neoplasm

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100
Q

sx of acute hydrocele

A

Rapid onset which is therefpre tender

discomfort, heaviness

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101
Q

ix for ?acute hydrocele

A

USS- fluid
transilluminates

cause:

  • urethral swab, urinaylsis/culture
  • alphafetoprotein, hCG
  • USS
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102
Q

Epididymo-orchitis- causes

A
  • UTI- e.coli tracking down vas deferans
  • STI- chlamydia, gonorrhoea
  • Mumps- swelling of parotids, virus accesses testicle via blood streatm in 1 in 5 cases in Males
  • post op infection eg prostatecomy
  • amiodarone
  • idiopathic
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103
Q

sx epididymo orchitis

A 
onset over ~1 day
pain
swelling, enlarged scrotum
erythema
infection- dusyuria, discharge, fever, malaise
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104
Q

ix epididymo orchitis

A
  • urine analysis
    urine culture
    urethral swab
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105
Q

Tx of epididymo orchitis

A

?STI- 1g ceftriaxone IM stat plus doxy BD for 10-14days without waiting for test results

  • ***UTI
  • ofloxacin 200mg BD 14days

advice-

  • bed rest
  • scrotal elevation (supportive underwear)
  • analgesia
  • *- stop amiodarone
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106
Q

What is bacterial vaginosis

A

when vaginal pH is >4.5 detah of normal vaginal microbiome and excess of others

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107
Q

Causative agents of BV

A
  • Gardnerella vaginalis
  • Mycoplasma hominis
  • Lactobacillus rhamnosus
108
Q

RFs for BV

A
  • Sexually active
  • concurrent STIs
  • use of douches, deodorant, vaginal washes
  • Menstruation
  • Presence of semen in the vagina
  • Copper intrauterine device
  • smoking
109
Q

Complications of BV

A

increased risk of acquiring STIs

late miscarriage, preterm labour/birth/RoM, low BW, postpartum enometriosis

110
Q

sx of BV

A

1/2 are asymptomatic
grey/white discharge
thin and watery
strong fishy smell, particularly after sex

+-soreness or itchiness

111
Q

What would you see O/E in someone with BV

A

thin, white, homogenous discharge coating walls of the vagina and vestibule

smell

112
Q

tx of BV

A

non pregnant women with asymptomatic BV dont require tx

oral metronidazole (ok for pregnant women)
can have this intravaginally, or clindamycin cream

Advice to stay away from exposing factors where possible

113
Q

What organism is chlamydia caused by histological appearance

A

Chlamydia trachomatis

obligate intracellular gram NEGATIVE, pink,BACILLI, pus cells

114
Q

How is chlamydia transfered

A

vaginal, anal or oral sex
from infected mother to her baby after childbirth
eye infections may also spread via towels

115
Q

sx of chlamydia

A

most are asymptomatic
sx may occur weeks later

women:

  • vaginal discharge- white/cloudy/milky/wateryyellow/pus-like
  • bleeding (PC, IMB)
  • dysuria
  • vulval soreness

men:

  • white.cloudy/watery discharge
  • dysuria
  • pain/swelling on one.both testicles
116
Q

what would the cervix look like O/E in woman with symptomatic chlamydia

A

inflamed

mucopurulent discharge covering it

117
Q

Ix for ?chlamydia

A
  • endocervical or vulvo/vaginal swab for women
    urethral swabs/first void urine for NAAT (nucleic acid amplificiation)
  • pass med says vulvovagina is more sensitive for C&G over endocervical
118
Q

What si the suggested screening for chlamydia

A

annually for sexually active women and men under the age of 25

1st prenatal visit

119
Q

Complications of chlamydia (in non pregnant people)

A
  • PID
  • Tubal infertility
  • Trachoma- blindness, repeated inf withotu tx
  • Epididymo-orchitis
  • Reiter’s syndrome- cant wee, pee or climb a tree- conjunc, arthritis, urethritis
  • *- SARA- polyarthritis of weight bearing joints with rash
  • perihepatitis (Fitz-Hugh-Curtis)
  • *- Lymphogranuloma venereum- lymphatic system infection
120
Q

Complications of chlamydia in pregnant people

A

Chorioamnionitis- PROM
Neonatal conjunctivitis
Neonatal pneumonia

121
Q

How do you take an endocervical swab

A
  • use spec

- rotate swab 360 degrees inside cervical Os

122
Q

How do you take a vulvovaginal swab

A

insert swab ~5cm into vagina, rotate for 10-30sec

123
Q

Instructions for first catch urine

A

need to have held urine for at least 1 hour

124
Q

how to take urethral swab

A

put swab 2-4cm into urethra and rotate it once

125
Q

What is the difference between a double and triple swab?

A

Double

  • a NAAT swab (endocervical or vulvovaginal depending on local guidelines)
  • a high vaginal charcoal media swab

triple

  • NAAT swab (endocerv/vulvovag)
  • high vaginal charcoal media swab
  • endocervical charcoal media swab
126
Q

What is a charcoal media swab for

A

High vaginal swab- BV, Trich, candida, Group B strep

Endocervical- gonorrhoea

127
Q

What are vulvovaginal and endocervical NAAT swabs for

A

chlamydia, gonorrhoea- pass med says vulvovgainal is more sensitive

should be performed first in double/triple swab kits

128
Q

Tx for chlamydia

A

Doxy 100mg BD for 7 days

in pregnant/breats feeding women
- azithromycin, amox, erythro

contact tracing and tetsing

test of confirmation esp in (3m after tx completion)

  • pregnant women (3w after tx completion)
  • diagnosed rectal infections
  • <25s
  • > 25 at risk of reinfection
129
Q

How long should someone not have sex for after being treated for chlamydia

A

1 week

130
Q

What is the discharge like for BV

A

grey
smell like fish, unpleasant
thin/watery

other sx- +- ithcing, soreness

131
Q

What is the discharge like in Trichomonas vaginalis

A

yellow/green!
thin, FROTHY
may have an odour! (fishy)

other sx- itching, irritation, dyspareunia

132
Q

What is the discharge like in Gonorrhoea

A

green/yellow
blood
thick consistency

other sx

  • painful/burning urination
  • frequency
  • sore throat
  • changes in bleeding (F)
  • dyspareunia
133
Q

What is the discharge like in chlamydia

A

white/cloudy/yellow/watery/milky
bleeding

other sx

  • dysuria
  • dyspareunia
  • unusual bleeding (F)
  • sore throat
134
Q

What is the discharge like in Candida infection

A

white
clumpy
cottage-cheese like

other sx
- itching soreness
inflammation
burning

135
Q

What is the discharge like in perimenopause

A

irregular bleeding

other sx

  • hot flushes, chills
  • mood swings
  • sleepign issues
  • wt gain
  • thinning hair
136
Q

What is the discharge like in cervical Ca

A

brownish/blood tinged

other sx
- PCB/IMB
- frequency
pelvic pain
dysuria
137
Q

What is gonorrhoea caused by?

A

Neisseria gonorrhoeae

Gram NEGATIVE diplococci

138
Q

sx of gonorrhoea

A
  • often symptomatic
  • usually between 2-14 days after exposure
  • pus liek discharge
  • White/yellow/greenish
  • bleeding
  • dysuria

Male

  • swelling/redness at opening of penis (m)
  • swelling of testicles

Female

  • deeps dyspareunia
  • sharp pain in lower abdo
  • IMB, PCB, heavy periods
  • pain in rectum if there
  • sore throat
  • conjunctivitis
139
Q

Ix for gonorrhoea

A

NAAT swab
Endocarvical charcoal swab
of penis, vaginal, rectum, throat

if ?arthritis- aspiration for microscopy
if systemic features- blood microscopy

140
Q

Complications of gonorrhoea

A

Men

    • scarring/stricture of urethra
  • abscess in the interior of the penis
  • reduced fertility or sterility
  • epididymo-orchitis

Women

  • subfertility
  • *- ectopic pregnancy
  • *- gonorrhoea infection to newborn
  • PID
**- reiter's syndrome
if in bloodstream
- septic arthritis
- rash
- heart valve damage
- meningitis
141
Q

tx of gonorrhoea

A

Ceftriaxone- IM 1g single dose
Azithromycin- oral 2g dose

STI and HIV screening

Advice

  • abstain from sex 7 days after tx ahs finished
  • pt lead partner notification
142
Q

f/u of gonorrhoea

A

1w after tx has finished

143
Q

risk to pregnant women having gonorrhoea

A

Spontaneous abortion
premture labour (PRoM)
- perinatal mortality
- gonoccocal conjuncitvities

144
Q

tx of gonorrhoea in pregnanct/breatsfeeding women

A

ceftriaxone
azithromycin 2nd line

NOT fluoroguinolones

145
Q

What is Type one herpes simplex Virus

A

Oral

  • cold sores
  • less severe
  • has ~1 outbreak in 1st year
146
Q

What is type 2 Herpes simplex virus

A

genital
more severe
~3 outbreaks in 1st year

147
Q

sx of HSV

A
  • clusters of yellow vesicles that pop to become ulcers
  • slouging (labia fuse)
  • v painful
  • dysuria
  • sometimes discharhe
  • flu-like illness
  • inguinal lymphadenopathy
  • autonomic neuropathy- can go into retention
148
Q

why does type 2 HSV have recurrent attacks

A

thought to be due to virus lying dormant in sacral ganglia- can be triggered by stress, sex, menstruation

149
Q

ix of HSV

A

viral culture of vesicle fluid

150
Q

tx for HSV

A

no cure

acyclovir to reduce severity of attack

  • apply 5x per day for 5-10 days/oral 200mg 5x a day
  • can be applied every 4 hours
  • can have preventative tx if >=6 a year- 400mg BD for 6-12months

paracetemol, lidocaine
salt baths

151
Q

complications of HSV during pregnancy

A

miscarriage

neonatal herpes

152
Q

complicaiotns of HSV

A 
disseminated herpes (IV acyclovir)
Encephalitis
meningitis
***sacral radiculopathy (retention, constipation)
***Myelitis
153
Q

Tx of herpes outbreak during pregnancy

A

Acyclovir - 400mg TDS for 5 days

LCS if outbreak is from 29w gest. (3rd trimester)

154
Q

What type of cells does hIV destroy

A

CD4 cells

155
Q

What are the stages of HIV disease

A

Seroconversion/primary/acute

asymptomatic

symptomatic

Late stages/AIDs

156
Q

What is the seroconversion stage of HIV

A
  • up to 6w post infection
  • minor sx (sore throat, fever, rash)
  • often goes unnoticed
  • most infectious at this stage
157
Q

What is the asymptomatic stage of HIV

A
  • can last several years

- virus infecting host cells and replicating, damagign the immune system

158
Q

What is the symptomatic stage of HIV

A
  • secondary infections
  • *- weight loss, night sweats,
  • cancers
  • swollen lymph glands
  • long lasting diarrhoea
  • fatigue
  • *- mouth: dry, thrush, gingivitis, ulcers, HSV, canker sores
159
Q

What is the late stage HIV

A

AIDS <200cells/mm3 CD4 count

160
Q

What are the AIDS defining illnesses

A

GI

  • Candidiasis of the esophagus, bronchi, trachea, or lungs
  • Salmonella septicemia, recurrent

Resp

  • TB
  • pneumocystitis jiroveci pneumonia
  • recurrent pneumonia

Eyes
- Cytomegalovirus retinitis (with loss of vision)

Brain

  • Encephalopathy, HIV related
  • *- toxoplasmosis of the brain
  • Progressive multifocal leukoencephalopathy

Cancers

  • Kaposi’s sarcoma
  • invasive cervical cancer
  • *- non-Hodgkin’s lymphoma
  • *- Herpes simplex: chronic ulcer(s) (more than 1 month in duration); or bronchitis, pneumonitis, or esophagitis
  • Histoplasmosis, disseminated or extrapulmonary
  • CMV (other than liver, spleen, or nodes)
  • HIV wasting disease
161
Q

What cancers are more common in people with HIV, but not AIDs defining

A

cervical cancer
Hodgkin’s lymphoma
Liver cancer (may be related to Hep B/C)

162
Q

HIV testing

A

Antibody/third gen test

  • blood, oral fluid or urine
  • only effective AFTER seroconversion stage (3m after exposure)

Combined antigen/antibody test/4th gen

  • antibodies and p24 antigens
  • reliable 1m after exposure
163
Q

What is Kaposi’s sarcoma, sx

A

cancer of the lymph and blood vessels

  • painless purplish, maculopapular on legs, skin, feet, face
  • can alo appear in genital area, mough
164
Q

tx of HIV

A

no cure- stops HIV replication by decreasing viral load to undetectable levels

Combination/highly active antiretroviral therapy (HAART)- should commence asap after diagnosis

durgs included are:

  • nuleoside reverse transcriptase inhibitors eg emtricitabine, tenofovir
  • integrase inhibitors
  • non-nucleoside reverse transcriptase inhibitors

strict coherence is needed over lifetime

  • pre-exposure prophylaxis (emtricitabine with tenofovir)
  • post exposure prophylaxis (above plus raltegravir) for 28 days
165
Q

What type of HPV cause warts

A

6, 11

166
Q

tx of HPV warts

A
  • Salicylic acid
  • formaldehyde
  • glutaraldehyde
  • silver nitrate
  • podophyllin- used for external soft, non keratinised warts
  • imiquimod cream- for both keratinised and non keratinised
  • cyrotherapy
  • surgery
167
Q

What types of HPV cause cervical pre-cancer/cancer

A
  • 16, 18, 31, 33

most are type 16

168
Q

what type of HPV is the gardasil vaccine against

A

6, 11, 16, 17

169
Q

what types of cancers are also caused by high risk HPV types

A

penile
vulval
head
neck

170
Q

What is the cervical screening programme

A

25-49- ever 3 years
50-64- every 5 years
65+- if last one abnormal

171
Q

Indications for colpsoscopy

A
  • genital warts
  • cervictitis
  • PCB
  • smear results abnormal (CIN)/cervix grossly abnormal
  • if had HPV positive on smear with normal cytology, they then get smear every year for 3 years, if all 3 years are abnormal and HPV persists- colposcopy
172
Q

what does papanicolaou class 1 cervix mean

A
  • no dysplasia
  • no intraepithelial lesion/malignancy
  • negative for CIN
  • infection
173
Q

what does CIN stand for

A

cervical intraepithelial neoplasia

174
Q

what does class 2 cervix mean

A
  • sqyamous atypia (dysplasia level)
  • atypical squamous cells of undetermined significance
  • HPV infection
175
Q

what does class III cervix mean

A
  • mild/moderate dysplasia
  • CIN1/2
  • Low grade squamous intraepithelial lesion
  • precancer
176
Q

what does class IV cervix mean

A
  • severe dysplasia, carcinoma in situ
  • CIN 3
  • high grade squamous intraepithelial lesion
  • precancer
177
Q

what does class V cervix mean

A
  • carcinoma
178
Q

Management of pre cervical cancers

A

CIN1- further screenign to make sure HPV regresses and CIN1 resolves

CIN2- cut out the area- cyrotherapy, laser therpay, loop electrosurgical procedure

  • CIN3- remove affected part of cervix- large loop excision of the transformation zone
179
Q

What cell type is cervical cancer

A

Sq (most)

adenocarcinoma

180
Q

FIGO scoring system of cevrical cancer

A

I
A- not grossly visualised, microscopic
B- visualised, only on cervix

II
- invasion of surrounding organs and tissue

III
- distant lymph nodes ot tissue within the pelvis

IV
- distant mets

181
Q

Management of cervical cancer

A

Ia
- take off the cells from cervix (loop electrosurgical excision procedure)

Ib
- radical hysterectomy- cervix, surrounding tissue and 3cm of vagina (fertility lost, nerve damage)

Stages 2+- RT, CT, palliative

182
Q

What is lymphgranuloma venereum

A
  • caused by 3 unique strains of chlamydia trachomatis
  • infeciton of lymphatic system
  • most common in MSM, HIV pts
183
Q

sx of lymphogranuloma venereum

A
  1. small, often asymptomatic genital skin lesion which later ulcerates- painless
  2. followed by regional painfuul lymphadenopathy in groin/pelvis
  3. Severe proctitis if anally acquired –>
    - anal bleeding
    - Anal pain
    - diarrhoea
    - Frequent/continuous need to defecate
    - fullness, tenesmus
184
Q

ix for lymphogranuloma venereum

A

rectal swab

185
Q

tx of lymphogranuloma venereum

A
  • doxy oral 100mg BD for 21 days
  • give contacts the above tx
    warn about photosensitivity , oesophageal ulceration
186
Q

what causes genital pediculosis pubis

A
  • pthirus pubis infestation
187
Q

transmission of pediculosis pubis

A
  • sex, bedding, clothing, towels
188
Q

sx of pediculosis pubis

A 
- intesne itcihng
grey/blue discolouration at feeding sights
eggs/lice visible
excoriation markes
crusting
scarring
secondary bacterial infection

rarely present in

  • hair near anus
  • beard
  • armpit
  • eyebrows
  • eyelashes
189
Q

tx of pediculosis pubis

A
  • premethrin- whole of body for 12hours
  • 2 rounds of tx at least 1 week apart to kill newly hatched

if on eyes
- premetrhin 1% lotion

wash bedding, clothing and towles in >=50 degrees centigrade water

contact tracing and tx

190
Q

What is scabies caused by

A

sarcoptes scabbei mite

191
Q

how are scabies transmitted

A

skin to skin contact, often during sex

192
Q

sx of scabies

A
  • track marks- silver lines with dot/scab at end of the line
  • red rash which tunrs into red vesicles
  • often in webbing of fingers, trunk, limb, genitalia
  • intense pruritis, esp at night
193
Q

tx of scabies

A
  • premethrin 5%- coat skin for 12 hours, repeat in 7 days
  • tx household
  • hot wash bedding/ clothes, towels
194
Q

What is crusted/Norwegian scabies

A

severe ascabies occurring in immunocomprimised people, elderly, or disabled

195
Q

sx of Norwegian scabies

A
  • thick crusting

- intense itching

196
Q

tx of Noerwegian scabies

A
  • topic permethrin

- oral ivermectin

197
Q

What is syphillis caused by

A

Treponema pallidum

gram negative (pink/red) spirochete

198
Q

what is the diseasecourse of syphillis

A

Primary

Secondary

Tertiary

199
Q

What happens in primary phase of syphillis

A
  • chancre- hard, painless
  • at site of infection
  • within 3w
  • inguinal lymph
  • resolves within 6w
  • often not seen in women as lesion may be on cervix
200
Q

What happens in secondary phase of syphillis

A
  • 6-10w weeks after primary
  • septiciaemia
  • classic rash on palms, soles ro trunk- medium sized red/brown spots, flat
  • lymphadenopathy
  • anterior uveitis
  • buccal snail track ulcers
  • painless warty genital lesions (condylomata lata)
201
Q

What happens in tertiary phase of syphillis

A
  • if left untreated
  • in about 40% is 3 years after, can be up to 40 years
  • neurosyphillis- dementia
  • CVD- aneurysm of aortic root (thoracic anuerysm)
  • inflammatory plaques on skin/bones- gomata
  • paralysis
  • Argyll robertson pupil
202
Q

ix of syphillis

A
  • blood test- Rapid plasma reagin (RPR)
  • spirochete in nasal discharge
  • XR- perichondritis
  • CSF- increase monocytes, protein positive
203
Q

tx of syphillis

A

Infection of <2 years
- Benzathine benzylpenicillin stat IM 2.4million units
erythro or doxy if allergic, 14d

if asymptomatic for >2years
- benzathin benzylpenicillin IM 2.4million units, once weekly for 2 weeks
or doxy 28d

Asymptomatic contacys- doxy 14d

204
Q

how to tx syphillis in pregnant woman

A

Benathine benzylenicillin stat IM 2.4million units, repeat after 1 week

205
Q

sx of congential syphillis

A
  • skeletal and teeth malformations (hutchinson (notched))
  • meningitis
  • keratitis, blindness
  • nerve deafness
  • rhinitis, rash
  • hepatosplnomegaly, lymphadenopathy
  • jaundice, anaemia
  • hydrops (fluid in compartments- ascites, pleural eff, pericard eff, oedema)
206
Q

tx of neonatal syphillis

A

baby- 3w benzathine benzylpenicillin IM

207
Q

what is trichomonas vaginalis caused by

A

parasite

motile flagellated protozoon

208
Q

sx of trichomonas vaginalis

A
  • many asymptomatic, men v rarely get sx
  • men, infeciton passes after 7d
  • women it persists for years

if sx appear, they will do so within 1m

  • soreness- low abdo, vulval
  • inflammation
  • vulva ulceration
  • vulval itching
  • thick/thin/forthy yellow/green discharge
  • strong unpleasant smell
  • dyspareunia

Men

  • urethral discharge- thin and white
  • inflammation of foreskin sometimes
  • prostatitis may occur
209
Q

Complciaitons of trichomonas vaginalis

A
  • PID
  • prostitis
  • enhances HIV transmission
  • increased risk of TB if alos have HIV
  • increase risk of HPV

if pregnant

  • preterm
  • LBW
  • vertical transmission
210
Q

ix of trichomonas vaginalis

A
  • wet smear microscopy of vaginal secretions
  • NAAT- better than above, swab taken from posterior vaginal fornix, can be self swab
  • men- first void urine sample NAAT
211
Q

tx of trichomonas vaginalis

A

nitromidazoles
- oral metronidazole 400-500mg BD for 1 week (ok in breastfeeding/pregnant)

or 2g stat dose oral metronidazole

212
Q

sx of urethritis

A

urethral dicharge
dysuria
penile discomfort
mucus in urine (urinary threads)

213
Q

Management of urethritis

A

tx empiriccally as chlamydia
- doxy 100mg BD for 1 week (or azithro)

if gonococcal suspected:
- ceftriaxone IM 1g stat (or azithro)

  • f/u 1-2 w after tx
  • contact tracing
214
Q

classifications to urethritis

A
  • gonococcal
  • non gonococcal- in 1/2 has nto ID cause
  • peristsent/recurrent- occurring >1m after tx, no ID cause usually
215
Q

what two type of renal cancer are there

A

Renal cell carcinoma
- most common kidney cancer- which is most commonly clear cells

Transitional Cell /urothelial carcinoma

  • cell type that makes up the pelvis, ureters, bladder and urethra
  • rarely causes kidney cancer
  • most common cause of bladder cancer
216
Q

sx of prosatitis (acute)

A
  • UTI sx- dysuria, frequency, urgency
  • perineal, penile, rectal pain
  • acute urinary retention- difficulty vioding, hesitancy, straining, weakn stream
  • lower back pain
  • pain on ejaculation
  • rigors, arthralgia, myalgia, fever
217
Q

signs of prostatitis

A

DRE

  • warm, tender, swollen prostate
  • NOTE- do NOT massage the prostate or palpate it too much as you risk causing

+-Sepsis, tachy

218
Q

sx of chronic prostatitis

A

at least 3m of

  • Pelvic, urogenital pain
  • LUTS
  • sexual dysfunction- ED, pain on ejac, haematospermia
  • pain with bowel movmenets
  • +- tender, enlarged prostate O/E (although DRE may be normal)
219
Q

complications of prostatits

A
  • abscess
  • bacteraemia
  • epididymitis
  • pyelonephritis
220
Q

Ix for ?prostatitis

A
  • MSU, urine MC&S to confirm UTI
  • do no collect prostate secretions, as massaging it can increase risk of sepsis
  • blood cultures
  • chlamydia and gonorrhoea NAAT (Endocerv or vulvovag)
  • FBC
  • Abdo exmaination
  • DRE- gently!
221
Q

why does prosatitis occur

A
  • UTI usually (e.coli, enterobacteriae - klebsiella, enterobacter, proteus)
222
Q

management of acute prostatitis

A

Abx

  • cipro
  • amikacin
  • levofloxacin
  • laxatives if pain on bowel movements

Advice
- paracetemol+- weak low dose opioid eg codeine
- NSAIDs
- fluids
- usually lasts several weeks
- seek help if sx worsen or dont improve within 48hours of abx
-

223
Q

when to admit someone with prostatitis

A

Admit if:

  • unable to take oral abx
  • severe sx
  • sepsis/acute retention/prostatic abscess sx
  • no improvement in 48 hours after starting abx

Consider referral if:

  • immunocomprimised
  • DM
  • pre-existing urological conditions- eg BPH, catheter
  • STI is identified
224
Q

management of chronic prostatitis

A
  • alpha blockers- tamsulosin
  • psychological support
  • abx- longer course- trimethoprim/doxy 4-6w
  • laxatives
225
Q

f/u for prostatitis

A
  • 48hours after abx started to check response and review abx after culture results
  • admit if no improvement
  • at 14d also - either stop or continue abx
  • after recovery- refer for ix to r/o structural abnormality of UT
226
Q

BPH cause

A

hyperplasia of stromal and epithelial cells

227
Q

sx BPH

A

LUTS

  • hesitancy
  • urgency
  • frequency
  • weak flow, intermittency
  • straining
  • terminal dribbling
  • incomplete emptying
  • nocturia
228
Q

ix for ?BPH

A

DRE- smooth, symmetrical, slightly soft, with central sulcus, >walnut size

  • abdo- palpate bladder
  • bladder diary
  • urine dipstick
  • PSA- unreliable
229
Q

what is the PSA glycoprotein raised in

A
  • prostate cancer
  • BPH
  • prostatitis
  • UTI
  • vigorous exercise (cycling)
  • recent ejaculation
  • prostate stimulation incl. DRE
230
Q

tx BPH

A
  • alpha adrenoreceptor blcoker- tamsulosin, doxazosin
  • 5 alpha reductase inhibitor- finasteride, dutasteride
  • surgery fro severe sx/unresponsive to meds
231
Q

SE of alpha adrenoceptor blockers

A

ie tamsulosin, doxazosin
- postural hypotension

– check their meds and lying/standing BP

232
Q

SE of finasteride

A

5 alpha reductase inhibitor

- sexual dysfunction

233
Q

BPH surgeries

A
  • transurethral resection of the prostate
  • laser surgeries
  • prostatic urethral lifts- small implants in prostate that lift excess prostate tissue away from urethra
  • open prostaectomy
234
Q

SE of BPH surgeries

A
  • increased frequency/urgency
  • haematuria
  • urine infection
  • weak flow
  • retrograde ejaculation
  • ED
235
Q

cell type of prostate cancers

A

adenocarincoma (usually in peripheral zone of the prostate

236
Q

sx of prostate cancer

A
  • asymptomatic
  • LUTS
  • haematuria
  • haematospermia
  • ED
  • wt loss, bone pain, CES- advanced
237
Q

differentials of haematospermia

A
  • vesiculitis (seminal vesicle inflammation)
  • seminal vesicle cysts
  • prostatitis
  • *- recent urological surgery- biopsy, cystoscopy
  • *- STI
  • *- Severe HTN
  • *- coagulopathy
  • prostate cancer
  • testicular cancer
      • bladder cancer
  • seminal vesicle calculi
238
Q

ix for ?prostate cancer

A

DRE- hard, asymmetrical, craggy, irregular, loss of central sulcus, hard nodule(s)

  • PSA raised (done if DRE abnormal)
  • MRI- do before biopsy
  • USS guided or transperineal biopsy
  • isotope bone scan
239
Q

risks of prostate biopsy

A

bleeding
infection
urinary retention
ED

240
Q

grading system used for prostate cancer

A

Gleason
- histology grade of most prevalent pattern in biopsy + grady of second most prevalent pattern in biopsy

TNM

241
Q

prostate cancer tx

A
  • watch and wait
  • RT- external beam, androgen deprivation therpay
  • Brachytherapy- radioactive seeds in prostate

Hormone therapy
**- androgen receptor blockers- bicalutamide
**- GnRH agonists- goserelin
***^^^co prescribe with Anti-androgen treatment such as cyproterone acetate/flutamide
for 1st 3 w due to the risk of tumour flare.
- BL orchidectomy (rarely done

  • prostatectomy
242
Q

SE of hormonal tx of prostate cancer

A
  • hot flushes
  • sexual dysfunction
  • fatigue
  • OP
243
Q

SE of prostatectomy

A
  • urinary incontinence

- ED

244
Q

where does prostate cancer met to

A

bone- cord compression- urgent MRI spine- dexamethasone BD, PPI, bedrest, RT/neurosurgery
- lymph nodes

245
Q

what is a vasectomy

A
  • vas deferens cut, sperm cannot travel from testes/epididymis to be ejaculated
  • les sinvasive than female sterilisation
  • should be considered permanent, as reversals are not always successful
246
Q

advice post vasectomy

A
  • sue other forms of contraception for 2m post procedure

- testing of semen needed before can be relied upon- 12w post op

247
Q

infertility hx- qs to ask

A

Lifestyle

  • tobacco smoking
  • marijuana
  • alcohol
  • illicit drugs
  • *- obesity
  • stress levels
  • Diet- hgihly processed foods/vit deficiency
  • highly intensive exercise
  • exposure to pesticides, lead, paint, solvent, radiation, heavy metal

**trauma to testicles

pmhx

  • kidney failure
  • mumps in past
  • undescended testicles in past/present
  • *- varioceles
  • ejaculatory issues, ED
  • *- chronic illness
  • surgical- any urological surgeries (retrograde ejaculation sx screen - cloudy urine after sex)
  • RT/CT exposure

Drugs
- anabolic steroid use

Puberty

  • age
  • secondary sexual characteristics
248
Q

ix for male infertility

A

Semen

  • sperm count
  • motility
  • morphology
  • repeat in 3m if abnomral as illness can affect
  • examination- gentitalia, secondary sexual characteristics
  • *- smears, swabs- STI
  • FSH, LSH
  • prolactin
  • *- karyotyping
  • *- CF screen
  • *- testicular biopsy if azoospermia
  • vasogram
  • USS
249
Q

what does high FSH and low testosterone mean

A

testicular failure

250
Q

what does high testosterone and low FSH and LH mean with azoospermia/small testes o/e

A

anabolic steroid use

251
Q

tx male inferility

A
  • mild- IU insemination
  • Mod- IVF
  • Severe- intracytoplasmic sperm injection
  • Azoospermia- surgical sperm recovery/donor insemination
    Surgery
  • correction of epididymal block
  • vasectomy reversal
  • if hypogonadotrophic- hCG with or without rhFSH– injections of hCG three times per week under the skin for at least six months and usually one to two years. monitor BP
  • hyperprolactinaemia- bromocriptine (DA agonist)
  • steroids- wait until effects are reverse
  • smoking/alco cessation
  • *- folic acid, Zn and vit e
  • lose wt
252
Q

tx of unexplained infertility

A
  • dx of exclusion
  • if trying for >2yrs- tx
  • clomifene for female
  • IVF
253
Q

sx ix, tx prostate abscess

A
  • frequent urination
  • pain while urinating
  • difficulty with urination, or retaining urine.

ultrasonography, cystoscopy to confirm the diagnosis.

abx- eg trimeth- and surgical drainage

254
Q

most likely cell type of bladder cancer caused by schistosomiasis infection

A

Sq cell carcinoma

  • transitional/urothelial cell carcinoma is most common cell type of bladder cancer, but schisto increases chance of SCC bladder cancer!
255
Q

haematuria red flag for

A

bladder cancer, esp if painless

ddx

  • prostatic adenocarcinoma
  • UTI, cysitis, prostatitis
  • stones
  • BPH
  • glomerulonephritis- Alport’s, IgA post strep, HSP, goodpasture, SLE, membranoproliferative glomerulonephritis, IE
  • renal tumour
  • sickle cell
  • trauma
256
Q

what vaccine should be offered to all MSM, chronic liver disease pts, IVDU, haemophilia pts and close contacts

A

hep A

257
Q

ddx of painless gential ulcer

A
  • syphillis

- lymphogranuloma venereum

258
Q

ddx of painful genital ulcer

A
  • herpes
  • chancroid- Haemophilus ducreyi. painful necrotizing genital ulcers that may be accompanied by inguinal lymphadenopathy
  • behcet’s- eye sx (red, pain, blurring), swollen/painful/stiff joints
259
Q

what is chancroid

A

Haemophilus ducreyi

  • painful genital ulcer- sharply defined, ragged boarder
  • painful inguinal node enlargement
260
Q

what is curlings ulcer, sx

A
  • stress induced ulcer of the duodenum/stomach
  • GI bleeding- vomit, stool
  • shock- tachy, hypotension
  • burns victims, children, ICU pts
261
Q

what should u co-prescribe with goserelin

A

Anti-androgen treatment such as cyproterone acetate/flutamide, due to the risk of tumour flare.

262
Q

what is post obstructive diuresis

A

> 200ml/hour following catheterisation

- AKI, confusion, hyponatraemia

263
Q

management of post obstructive diuresis

A

Patients producing >200ml/hr urine output should have around 50% of their urine output replaced with intravenous fluids to avoid any worsening AKI.

264
Q

what two conditions are associated with pH >4.5

A

BV
Trich
- both have foul smelling discharge, altho trich is green

265
Q

when should yuo refer men with a UTI to urology

A
  • complicated- ie recurrent

- ongoing sx despite abx

266
Q

when do you tx UTI in catheterised pts

A
  • dont tx if asymptomatic

- 7d course if symptomatic

Finals (15 decks)

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