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Terms in this set (26)
A 22 year-old male who is otherwise healthy complains of scrotal pain. His pain has developed over the past 4 days. He is diagnosed with epididymitis. What is the most likely reason?
Infection with Chlamydia
Several factors predispose males to epididymitis. In men under age 35, the most common cause of epididymitis is infection with Chlamydia trachomatis. In older men, urinary tract pathogens are more typical. In pre-pubertal boys, bicycle riding and heavy physical exertion are most common. In pre-pubertal boys, consideration should be given to congenital abnormalities.
A common presentation of an inguinal hernia is:
groin or abdominal pain with a scrotal mass
An inguinal hernia is characterized by herniation of bowel or omentum into the scrotum. It typically presents with scrotal pain and a scrotal mass or scrotal swelling. Abdominal or groin pain with a scrotal mass is a common presentation. Bowel sounds may be audible in the scrotum.
What is the recommendation of American Cancer Society for initial screening of an African-American male for prostate cancer?
Discussions starting at age 40-45 years
American Cancer Society guidelines recommend beginning screening discussion at age 40-45 years for males at high risk for developing prostate cancer (e.g. a first degree relative with prostate cancer before age 65 or African American race). The reason for "screening discussions" is to keep males involved in individual decision making. The PSA threshold is 4.0 ng/mL. Testing is discouraged for males with less than a 10 year expected survival. US Preventive Services Task Force does not recommend screening.
Hematuria is not a common clinical manifestation in:
early prostate cancer
Localized tumors confined to the prostate gland are rarely associated with hematuria. In fact, localized tumors in the prostate gland rarely produce symptoms or any clinical manifestations. This fact strengthens the importance of screening for prostate cancer using digital rectal exam (DRE) and measurement of prostate specific antigen (PSA). Hematuria is commonly seen in benign prostatic hyperplasia, bladder cancer and renal cancer.
What is the effect of digital rectal examination (DRE) on a male's PSA (prostate specific antigen) level if it is measured on the same day as DRE?
The change is insignificant
There is an inconsequential rise in PSA levels within 72 hours after DRE. DRE should not prevent a patient from having a PSA level measured at any time.
The following PSA levels have been observed in a patient. What conclusion can be made following these annual readings? Year 1: 3.2 ng/mL Year 2: 3.8 ng/mL Year 3: 4.2 ng/mL
There is a steady increase that is worrisome
Generally, a PSA measurement less than 4 ng/mL is considered normal. However, the PSA velocity (the rate of PSA change over time), is concerning. A PSA velocity > .35 ng/mL per year is associated with high risk of death from prostate cancer. This patient should have prostate biopsy by a urologist.
A 65 year-old patient has a firm, non-tender, symmetrical enlarged prostate gland on examination. His PSA is 3.9 ng/mL. This probably indicates:
benign prostatic hypertrophy (BPH)
This probably indicates BPH. These findings of the prostate gland do not rule out prostate cancer. A prostate infection usually produces greater elevations in PSA as well as a tender gland. A PSA > 2.5 ng/mL in this instance may reflect PSA changes seen with BPH. An important historical note would be the value of his last PSA for comparison as well as to assess for PSA velocity.
A 50 year-old male comes to the nurse practitioner clinic for evaluation. He complains of fever 101F, chills, pelvic pain, and dysuria. He should be diagnosed with:
acute bacterial prostatitis
Acute bacterial prostatitis should always be considered first in a male patient who presents with these symptoms. He may be expected to have cloudy urine and symptoms of obstruction, like dribbling. Chronic bacterial prostatitis presents with a more subtle presentation such as frequency, urgency, and low-grade fever. Urinary tract infection is far less common in men than women and is usually associated with anal intercourse or being uncircumcised. Nonbacterial prostatitis presents like chronic prostatitis except that urine and prostate secretion cultures are negative.
A patient with testicular torsion will have a:
negative cremasteric reflex on the affected side
A patient with testicular torsion will have a negative cremasteric reflex and a high riding testis. There can also be profound testicular swelling and an acute onset of scrotal pain.
What is the recommendation of American Cancer Society for screening an average risk 40 year-old Caucasian male for prostate cancer?
He should be screened starting at age 50 years
American Cancer Society recommends initial prostate screening of an average risk male at age 50 years with PSA testing with or without digital rectal exam. If the initial PSA is < 2.5 ng/mL, the screen can be repeated in 2 years. If the PSA is > 2.5, annual screening should take place.
A male patient has epididymitis. His most likely complaint will be:
The most common complaint is scrotal pain. It usually develops over a period of days. Occasionally, it develops acutely and will be accompanied by fever, chills, and a very ill-appearing patient. Burning with urination is possible if the underlying cause is a urinary tract infection, but, this is not usual. This presentation is seen more commonly in older males. Testicular pain is not a common complaint with epididymitis. Penile discharge would not indicate an infection in the epididymis since the epididymis is a tightly coiled tubular structure located on the testis.
A 25 year-old male patient is training for a marathon. He reports an acute onset of scrotal pain after a 10 mile run. He has nausea and is found to have an asymmetric, high-riding testis on the right side. What should be suspected?
The most serious cause of acute scrotal pain is testicular torsion. The most common age group for this to occur is adolescents; however, almost 40% of torsion occurs in males greater than age 21. This is more common after minor testicular trauma or after strenuous exercise. This is an urgent urological referral. The other choices listed do not produce acute scrotal pain in conjunction with these physical findings.
Noninfectious epididymitis is common in:
Noninfectious epididymitis occurs when there is reflux of urine into the epididymis from the ejaculatory ducts and vas deferens. This can cause ductal obstruction and acute inflammation without infection. This can occur if males spend a lot of time sitting. Truck drivers are particularly susceptible because they spend many uninterrupted hours sitting when they are driving. Other typical risk factors are vigorous exercise that involve heavy lifting or upper body workouts; especially sit-ups or abdominal crunches.
What is American Cancer Society's recommendation for prostate screening in a 70 year-old male?
He should be screened until he has a life expectancy of less than 10 years
Prostate cancer screening at age 70 years includes both prostate specific antigen measurement (PSA) and digital rectal exam (DRE). Prostate cancer is typically a slow growing tumor, thus if life expectancy is < 10 years, screening is not cost-effective.
What class of medications can be used to treat benign prostatic hyperplasia and provide immediate relief?
Alpha blockers (alpha-adrenergic antagonists) provide immediate relief of symptoms. The alpha-1 receptors are abundant in the prostate gland and base of the bladder. The body of the bladder has very few alpha-1 receptors. Those alpha blockers most commonly used are terazosin, doxazosin, tamsulosin, and alfuzosin. Prazosin is a short-acting and so has less utility than the other agents mentioned.
Which of the following medications should be avoided in a 65 year-old male with benign prostatic hyperplasia (BPH)?
Nasal decongestants like pseudoephedrine should be avoided in men with BPH. These will increase the urge to urinate. Urinary frequency is a bothersome symptom of males with BPH. Medications that are known to impair urination are muscle relaxants, narcotics, tricyclic antidepressants such as amitriptyline, and medications with anticholinergic properties such as antihistamines.
What symptom listed below might be seen in a male patient with benign prostatic hyperplasia?
Men with benign prostatic hypertrophy (BPH) have some classic symptoms that include: hesitancy, urgency, post-void dribbling, and frequency. They will seek help for these symptoms. Although these symptoms are typical of BPH, prostate cancer can also present in the same way.
A localized tumor in the prostate gland associated with early stage prostate cancer is likely to produce:
an absence of symptoms
Localized tumors associated with early stage prostate cancer usually produce no symptoms or clinical manifestations. Occasionally, localized tumors produce UTI symptoms, nocturia, daytime voiding frequency, and diminished force of urinary stream. These symptoms are common with benign prostatic hypertrophy (BPH). An uncommon manifestation of prostate cancer is hematuria.
A 70 year-old male presents to your clinic with a lump in his breast. How should this be evaluated?
Mammogram and ultrasound
This patient has a lump identified in the breast. Since males can develop breast cancer, it must be evaluated in the same means that a female breast lump would be evaluated. He should have a clinical breast exam to identify the position of the lump, and any other abnormal findings such as nodes or other lumps. Then, he should have mammogram and ultrasound to help evaluate the lump. If the findings were suspicious for a malignancy, the patient would be referred to a surgeon.
An elderly male patient is taking finasteride, a 5-alpha-reductase inhibitor. What affect might this have on his PSA level?
It will decrease
The 5-alpha-reductase inhibitors will reduce PSA levels by 50% or greater within the first 3 months and will sustain this reduction as long as the medication is taken. This class of medication interferes with the prostatic intracellular androgen response mechanism.
Which of the following results in a clinically insignificant increase in the prostate specific antigen (PSA)?
Digital rectal exam
Digital rectal exam (DRE) leads to a clinically insignificant increase of 0.26-0.4 ng/ml for about 48-72 hours afterwards. Prostate biopsy increases the PSA about 8 ng/ml for up to 4 weeks following biopsy. Prostate infection and ejaculation both can increase the PSA levels.
A 40 year-old male has been diagnosed with acute bacterial prostatitis. His prostate specific antigen (PSA) is elevated on diagnosis. How soon should his PSA be rechecked?
Prostate infection or inflammation can cause a sharp rise in PSA values. Elective PSA should be deferred for four weeks after an episode of bacterial prostatitis. Checking prior to this time will likely result in an elevated serum PSA level and unnecessary testing and worry for the patient.
5-alpha-reductase inhibitors work by producing:
a decrease in the size of the prostate
The class of drugs known as the 5-alpha-reductase inhibitors reduces the size of the prostate gland but benefits are not usually realized for several months; maybe up to 6-12 months before a symptom decrease is realized. For men who need relief of symptoms related to prostate enlargement, an alpha-blocker will provide significantly faster symptom relief. These two drugs can be used in combination.
Hesselbach's triangle forms the landmark for:
Direct inguinal hernias occur through Hesselbach's triangle. The inguinal ligament, the rectus muscle, and the epigastric vessels form the triangle. When there is a weakness in the floor of the inguinal canal, a hernia can result. Inguinal hernias are the most common groin hernias in men and women. Repair of this is the most common surgical procedure performed in the US.
Digital rectal exam may be performed to assess the prostate gland. Which term does NOT describe a prostate gland that may have a tumor?
A boggy prostate describes a gland that is edematous and tender, such as is seen in a patient with bacterial prostatitis. The other terms indicate an abnormality that could represent a prostate gland tumor.
What is the recommendation from American Cancer Society for assessment of the prostate gland in a man who is 45 years old and of average risk for development of prostate cancer? He should have:
screening starting at 50 years of age.
At age 50 years, males of average prostate cancer risk should have PSA measurement with or without digital rectal exam (DRE). If they are deemed to be of high risk because of a family history (first degree relative with prostate cancer before age 65 years) or race (African American), screening discussions should take place at age 40-45 years. If initial PSA is > 2.5 ng/mL; annual testing should take place. If the initial PSA is < 2.5 ng/mL; test every 2 years.
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