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Men's Health Leik & Barkley reviews
Terms in this set (27)
Typically masturbation in boys begins in which Tanner Stage?
Stage 3 - The penis elongates
Male c/o prolonged and painful erection for several hours (2-4).
Priapism: High risk in sickle cell, other factors include - ED drugs, cocaine, quadriplegia.
Teenage to young adult male c/o nodule, sensation of heaviness or aching, one larger testicle, and/or tenderness in one testicle.
Testicular cancer: more common in white males ages 15-30, can initially present as a hydrocele due to tumor pressure on vessels.
Older to elderly male c/o new onset low back pain, rectal area/perineal pain, or discomfort accompanied by obstructive voiding symptoms such as weaker stream and nocturia.
Prostate cancer: may be asymptomatic. More common in older males >50y, obese males, men with family hx and black males.
School-age boy c/o abrupt onset of a blue-colored round mass located on the testicular surface. The mass resembles a blue dot.
Torsion of the Appendix Testis (Blue dot sign). The appendix testis is a round, small pedunculated polyp like structure that is attached to the testicular surface on the anteriaor superior area. The blue dot is caused by infarction and necrosis of the appendix testis due to torsion.
A male (usually adolescent) reports waking up at midnight or in the morning with abrupt onset of an extremely painful and swollen red scrotum. Frequently accompanied by n/v. Affected testicle/scrotum is located higher and closer to the body than the unaffected testicle. Negative cremasteric reflex.
Sx of testicular cancer and subsequent work up.
Affected testicle feels heavier and more solid, may palpate a hard fixed nodule. 20% have a concomitant hydrocele.
U/S of the testicle
Gold standard of Dx: testicular bx.
Refer to urologist
PE findings of prostate cancer
Prostate palpates harder than normal with obscure boundaries and nodules may be present.
Prostate cancer work-up
PSA followed by DRE.
Refer if PSA >4
U/S to identify solid nodules
Needle bx of prostate
Older male c/o gradual development (years) of urinary obstructive symptoms such as weak urinary stream, postvoid dribbling, feelings of incomplete emptying, and occasional urinary retention. Nocturia very common.
PE findings of BPH
May have bladder distention, prostate is non-tender with either asymmetrical or symmetrical enlargement. Smooth rubbery consistency with possible nodules.
UA (r/o UTI)
Abdominal U/S (r/o upper tract path)
Serum creatinine/ BUN
Screening begins at what ages for PSA & DRE
50 & 40
Which racial group has the highest incidence of prostate cancer?
Terazosin 5mg or tamsulosin both alpha-adrenergic antagonists
Finasteride an 5-Alpha-reductase inhibitor
saw palmetto works in some patients at improving sx.
Inflammatory infection of the prostate
Acute bacterial prostatitis
Causative organism in bacterial prostatitis
Usually E. coli or in young men chlamydia
Male c/o fever, chills, low back pain, dysuria, urgency, frequency, nocturia, painful DRE
Acute bacterial prostatitis
PE findings in acute bacterial prostatitis
Edematous prostate, may be warm and tender, boggy to palpation, painful.
Lab work-up of acute bacterial prostatitis
Urine culture for causative agent.
CBC: leukocytosis with left shift (presence of band cells)
UA: large amts of white blood cells, hematuria
Treatment for acute bacterial prostatitis
Age <35 treat with ceftriaxone 250mg IM and doxy 100mg BIDx10days
Age>35: or unlikely sexual transmission, Cipro or ofloxacin PO BID or levofloxacin PO daily for 4-6 weeks
Male presents with c/o pain, dysuria, urgency, frequency, low back pain, perineal pain, fever, chills, malaise scrotal edema (grapefruit-sized)
Acute bacterial epididymitis
PE findings for acute bacterial epididymitis
*Enlarged tender epididymis
*urethral discharge may be evident (green purulent or serous clear.
*Positive Prehn's sign (relief of pain when scrotum elevated to the pubis.
Work-up of acute bacterial epididymitis
Management of acute bacterial epididymitis
age <35y: Ceftriaxone 250mg IM and doxy 100mg BID
or Azithromycin 1gm orally once
age >35y: TMP/SMZ DS 1 tab BID x 10d
cipro 250mg BID x 10d
*analgesics, nsaids, ice/heat, bed rest.
Possible etiologies of ED
*psychosocial issues (stress) (if achieves morning erection or is able to be erect to masturbate)
*medications (diuretics, htn, H2 blockers, antihistamines, snaids, muscle relaxants, antidepressants, parkinson's disease meds, antiepileptics, anti-anxiety meds
Treatment of ED
Explore underlying issues
Check testosterone level
Phosphodiesterase type 5 inhibitors (viagra, levitra, cialis)
AVOID CONCOMITANT NITRATES
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