Men's Health

A 17 year old female is HIV positive. What is the recommendation for cervical screening for her?

Screen now, if negative, screen again in 6 month and annually

Which treatment for vulvovaginal candidiasis relieves symptoms most rapidly? 1.Topical azole antifungal 2.Fluconazole 150 mg tablet 3.Boric acid suppository 4.Ingestion of yogurt

1.Topical azole antifungal

A patient has been diagnosed with vulvovaginal candidiasis. Which choices listed below are predisposing factors? Select all that apply? Not number 4. mmunocompetence

1. Recent antibiotic use 2. Diabetes 3. Increased estrogen levels

A 60 year old female has begun to have a small amount of blood escaping from the vagina. What is the most common cause of malignancy, when one is found?

1.Cervical cancer 2.Endometrial cancer 3.Vaginal cancer 4.Urethral, bladder or rectal carcinoma Answer is 2. Endometrial cancer

Why should "gentle" prostate exam be performed in the setting of likely bacterial prostatitis? Select all that apply 1.It is uncomfortable. 2.Increases risk of bacteremia. 3.Increases risk of UTI. 4.Increases the PSA

1.It is uncomfortable 2.Increases risk of bacteremia

A 22 year old male patient presents wit h complaint of scrotal pain after a minor car accident. What must be part of the differential diagnosis? 1. Epididymitis 2.Testicular torsion 3.Scrotal contusion 4.Hernia

2.Testicular torsion

Which factor listed below is NOT a risk factor for erectile dysfunction1. 1. Advanced age 2.Bloodglucose elevation 3Infection with gonorrhea 4.Hypertension, DM

3. infection with gonorrhea

At what age is the finding of benign prostatic hyperplasia most likely? 1.20 year old 2.40 year old 3.60 year old 4.80 year old

80 years old

15) When ordering laboratory tests to confirm chancroid the NP considers that: A: concomitant infection with herpes simplex is often found. B: a disease specific serum test is available C: a wbc with differential Is indicated D: dark field examination is needed.

A

3. When assessing a 78-year-old man with suspected BPH, the NP considers that: A. prostate size does not correlate well with severity of symptoms. B. BPH affects less than 50% of men of this age. C. he is at increased risk for prostate cancer. D. limiting fluids is a helpful method of relieving severe symptom

A Expalaination: DRE of prostate size is often misleading, however; a prostate that is apparently small on digital rectal examination can cause significant symptoms.American Urological Association Symptom Score for Benign Prostatic Hyperplasia (available at http://www.auanet.org/ common/pdf/education/clinical-guidance/Benign-ProstaticHyperplasia.pdf [see Appendix 6 of document]) increases the likelihood of an accurate diagnosis.

4. Which of the following medications can contribute to the development of acute urinary retention in an older man with BPH? A. amitriptyline B. loratadine C. enalapril D. lorazepam

A. Explanation: Drugs with anticholinergic effect, such as tricyclic antidepressants and first-generation antihistamines (e.g., diphenhydramine [Benadryl], chlorpheniramine [Chlor-Trimeton]), can cause acute urinary retention in men with BPH; opioid use and inactivity also increase the risk of urinary retention. In addition, urinary frequency occasionally becomes worse with ingestion of certain bladder irritants, such as caffeine, alcohol, and artificial sweeteners.

Oral Bisphosphonates Considered first line for most patients with osteoperosis

Alendronate (Fosamax ®) weekly oRisedronate (Actonel®) weekly oIbandronate (Boniva®) monthl

Management for acute prostatitis

Antibiotic: TMPS, ciprofloxacin for 6 weeks or other if STD is present •Analgesics (NSAIDs) and antipyretics •Stool softeners and adequate fluids •Should see improvement in symptoms in 2 -6 days, if not, refer to urologis

Age of Initial Cervical Screening

Starting Age: 21 years •EXCEPTION: Screening at time of initial intercourse if < 21 years and HIV positive, chronic immunosuppressive therapy, SLE, post organ transplantation

Etiology

Unknown usually •Gram negative organisms: E. coli, Proteus sp. are most common •Sexual transmitted : C. trachomatis, Ureaplasma, Trichomonas vaginalis

Patient symptoms: Normal (clear, white, odorless), PH: 4.0 to 4.5, Whiff: Negative, KOH: Negative

VV: itching, burning, dysuria, dyspareunia.PH: 4.0-4.5, whiff test: negative, KOH: often pseudohyphae. BV: Malodorous discharge, PH: >4.5, whiff test: positive 70 to 80% of the time. KOH: negative Trich: malodorous discharge, dysuria, dyspareunia, PH: 5.0 to 6.0, whiff test: could be Positive, KOH: negative.

how often we screen for PAP?

ages 21-29 every 3 years with cytology only. women >30 every 5 yrsw/ cytology plus HPV.Exceptions: HIV infection, SLE, immunosuppression, initially screen every 6 months x2,then annually

when do we stop PAP?

at age 65, Ade quate = 3 consecutive negative cytology tests 2 consecutive negative HPV/Pap co - tests in the 10 years prior to stopping; with the most recent test within 5 years

Which T-score reflects a patient with osteopenia

between -1.0 and -2.5 Osteoperosis: -2.5 or less

What are the major causes of an el evated serum PSA? Select all that apply

BPH2. Prostate cancer 3.Prostate infection

Assessment Findings for Bacterial prostatitis

Bacterial prostatitis usually has acute presentation:•Spiking fever, chills, malaise •Enlarged, boggy, and tender prostate •Cloudy urine •Frequency, urgency •Dysuria, nocturia •Pain with defecation •Hematuria •PSA: elevated

VULVOVAGINITIS

Bacterial vaginosis (BV) is likely the most common •Candidal vulvovaginitis (80 -92% due to Candida albicans) •Trichomoniasis

significant of T zone is where you find squamous cell dysplasia

Brush is used to collect cells from the endocervix. rotate 180degrees. desired results: Interpretation Desired: "Negative for intraepithelial lesion or malignancy

12. All of the following are typical findings for a patient with chancroid except: A. Multiple lesions B. Spontaneous rupture of affected nodes C. blood tinged penile discharge D. dense, matted lymphadenopathy on the ipsilateral side of the lesion.

C

8. Tamsulosin (Flomax) is helpful in the treatment of BPH because of its effect on: A. bladder contractility. B. prostate size. C. activity at select bladder receptor sites. D. bladder pressure.

C Explanation: The prostate and bladder base contain numerous alpha 1 receptor sites. When these receptor sites are stimulated, the prostate contracts, increasing outflow tract obstruction. As a result, treatment with alpha 1 receptor antagonists (alpha blockers) including tamsulosin (Flomax) can be helpful in improving the symptoms of BPH.

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) Nodular B) Asymmetrical C) Boggy D) Indurated

C) Boggy Explanation: 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.

PSA

DRE is

Which choices below are causes of secondary dysmenorrhea? Select all that apply.

Endometriosis 2.Fibroids 3.Adhesions 4.Pelvic inflammatory disease

Truck driver

Epidydmitis

Documentation should include the following for BPH:

Firm, smooth, symmetrically enlarged prostate

Management for Yeast or Candidias

Fluconazole (Diflucan®) orally (remains therapeutic in vaginal secretions for 72 hours)

Epididymitis

Infectious (very uncommon unless STD) •75% of time: C. trachomatis or N. gonorrhoeae •C. trachomatis most common

EPIDIDYMITIS

Inflammation of the epididymis usually occurring from ascent of pathogens or urine from urethra or prostate

Colposcopy Indicated

LSIL(HPV, mild dysplasia, or cervical intraepithelial neoplasia -CIN): Colposcopy and endocervical sampling recommended •HSIL [mod or severe dysplasia, CIN 2 or 3, and carcinoma in situ (CIS)] •Atypical glandular cells (AGC): favor neoplasia

Screening for breast ca

Mammogram: annually at age 40 years (ACS, Am. College of Radiology, AMA, ACOG, NCI) •Mammogram: Mammogram starting at age 50 years) (USPSTF, ACP, AAFP) •Clinical Breast Exam: age 20 -39 years every 3 years; then annually •Monthly self -breast exam (SBE) (Efficacy is unproven)

Topical agent

Miconazole nitrate (Monistat®) vaginal suppository or cream OR •Clotrimazole (Gyne -Lotrimin 3, 7) cream OR •Terconazole (Terazol®) suppository or cream •May delay sexual intercourse until symptoms resolved but no contraindication

Cervical Cancer

Most women with HPV will clear spontaneously within 8 -24 months (especially adolescents and young women

BENIGN PROSTATIC HYPERPLASIA

Noncancerous enlargement of the prostate gland

Etiology of Epidymitis

Noninfectious -MOST COMMON •Reflux of urine through the ejaculatory ducts and vas into epididymis •Prolonged sitting (car or plane trip, desk job, heavy lifting, upper body work outs, long distance runners) •Underlying congenital defect

PSA Velocity = Rate of PSA change over time •May be a good marker of detecting aggressive prostate cancers that are likely to be life threatening

PSA velocity compare if PSA that double that means there is possible predictablility of PSA CA

ACUTEPROSTATITIS(Think Bacterial, consider STI)

Pain in the perineum, lower abdomen, testicles,or penis; pain with ejaculation; voiding difficult

Atrophic vaginitis

Postmenopausal women •Nonspecific sign/symptoms: Watery, yellow or white, malodorous vaginal discharge

CHRONIC PROSTAT ITIS

Presentation can be subtle •Symptoms or recurrent UTI are common •Pain in perineum, lower abdomen or back, testicles, with ejaculation •Prostate exam is usually normal •Diagnosis may be presumptive when persistent or recurrent bacteriuria •Tx: Antibiotics as for acute prostatitis (TMPS or quinolone for 6 weeks

CHRONIC PROSTATITIS

Presentation can be subtle •Symptoms or recurrent UTI are common •Pain in perineum, lower abdomen or back, testicles, with ejaculation •Prostate exam is usually normal •Diagnosis may be presumptive when persistent or recurrent bacteriuria •Tx: Antibioticsas for acute prostatitis (TMPS or quinolone for 6 weeks)

Evaluation for acute prostatitis

Rectal exam: prostate gland usually very tender •UA: rule out UTI, look for hematuria •Get culturebut treat empirically

Diagnostic Studies:Candiadias

Screen for diabetes if suspected •Pregnancy test •HIV if suspect immunocompromised state

13. the causative organism of chancroid is: A) Ureaplasma species B) Chlamydia trachomatis C) Mycoplasma hominis D) Hemophilus Ducreyi

D Explanation: .

Why should "gentle" prostate exam be performed in the setting of likely bacterial prostatitis? Select all that apply 1.It is uncomfortable. 2.Increase risk of bacteremia. 3.Increasesrisk of UTI. 4.Increasesthe PSA

1.It is uncomfortable. 2.Increase risk of bacteremia

What class of medications can be used to treat benign prostatic hyperplasia and provide immediate relief? A) Alpha-1 blockers B) 5-alpha reductase inhibitors C) Diuretics D) Analgesics

A) Alpha-1 blockers Explanation: 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 results in a clinically insignificant increase in the prostate specific antigen (PSA)? A) Digital rectal exam B) Ejaculation C) Prostatitis D) Prostate biopsy

A) Digital rectal exam Explanation: 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.

Question: 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? A) The change is insignificant. B) A decrease in the PSA will occur. C) An increase in the PSA will occur. D) There will be a change, but it is not predictable.

A) The change is insignificant. Explanation: 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.

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: A) acute bacterial prostatitis. B) chronic bacterial prostatitis. C) urinary tract infection. D) nonbacterial prostatitis.

A) acute bacterial prostatitis. Explanation: 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.

Hematuria is not a common clinical manifestation in: A) early prostate cancer. B) benign prostatic hyperplasia. C) bladder cancer. D) renal cancer

A) early prostate cancer. Explaination: There are no symtoms associated with early bladder cancer, therefore it is important to screen patients. Hamaturia is usually seen in renal ca, BPH and bladder ca ut not in early prostate CA..

A common presentation of an inguinal hernia is: A) groin or abdominal pain with a scrotal mass. B) an abdominal mass without pain. C) scrotal and abdominal masses. D) abdominal pain and scrotal erythema.

A) groin or abdominal pain with a scrotal mass. Explanation: 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.

Hesselbach's triangle forms the landmark for: A) inguinal hernia. B) femoral hernia. C) abdominal hernia. D) umbilical hernia

A) inguinal hernia.

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: A) screening starting at 50 years of age. B) prostate specific antigen (PSA) now. C) PSA and digital rectal exam now. D) digital rectal exam only

A) screening starting at 50 years of age. Explanation: 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.

Management on bacterial prostatitis

Antibiotic: TMPS, ciprofloxacin for 6 weeks or other if STD is present •Analgesics (NSAIDs) and antipyretics •Stool softeners and adequate fluids •Should see improvement in symptoms in 2-6 days, if not, refer to urologist.

According to ACS, Men should not be screened unless they have received this information. The discussion about screening should take place at: 1) Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. 2) Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65). 3) Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Assuming no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test: 1) Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years. 2) Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher

Assessment Findings

Asymptomatic •Asymmetry, induration, nodularity suspicious of prostate cancer even if normal PSA • Localized prostate CAs are rarely associated with bothersome SE • Prostate feels hard and/or nodular upon digital exam • New onset ED

American Cancer Society

Average risk: PSA with or without DRE for average risk men starting at age 50 years •High risk: Screening di scussions at age 40 to 45 (AA, FDR with prostate CA before age 65 years) •If initial PSA < 2.5 ng/mL; test every 2 years •If initial PSA ≥ 2.5 ng/mL; annual testing •If PSA > 4.0 ng/mL; refer for evaluation

11. You examine a 32-year-old man with chancroid and anticipate finding: A. a verruciform lesion. B. a painful ulcer. C. a painless, crater-like lesion. D. a plaquelike lesion.

B

9. Concerning BPH, which of the following statements is true? A. Digital rectal examination is accurate in diagnosing the condition. B. The use of a validated patient symptom tool is an important part of diagnosing the condition. C. Prostate size directly correlates with symptoms and bladder emptying. D. Bladder distention is usually present in early disease.

B

7. Finasteride (Proscar, Propecia) and dutasteride (Avodart) are helpful in the treatment of BPH because of their effect on: A. bladder contractility. B. prostate size. C. activity at select bladder receptor sites. D. bladder pressure.

B Explanation: The use of finasteride (Proscar) and dutasteride (Avodart), 5-alpha-reductase inhibitors that block the conversion of testosterone to dihydrotestosterone, helps to reduce the size of the prostate and ameliorate symptoms. Tadalafil (Cialis), a phosphodiesterase inhibitor, is also approved for the treatment of BPH. However, this agent cannot be used in combination with alpha blockers or with patients taking nitrates.

2. When prescribing antihypertensive therapy for a man with BPH and hypertension, the NP considers that: A. loop diuretics are the treatment of choice. B. an alpha 1 antagonist should not be used as a solo or first-line therapeutic agent. C. angiotensin receptor antagonist use is contraindicated. D. beta-adrenergic antagonist use often enhances urinary flow.

B Explanation: The use of alpha blockers as a solo or first-line antihypertensive agent has been associated with higher than expected rates of stroke and heartfailure. Alpha blockers should be considered as a desirable agent in treating a man with hypertension and BPH but only as medication added on to existing therapy; an alpha blocker that is specifically indicated for BPH therapy only, such as tamsulosin, has minimal effect on blood pressure.

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? A) His age B) Infection with Chlamydia C) Underlying hydrocele D) Urinary tract infection

B) Infection with Chlamydia Explanation: 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.

An elderly male patient is taking finasteride, a 5-alpha-reductase inhibitor. What affect might this have on his PSA level? A) It will increase. B) It will decrease. C) There is no predictable change. D) There will be no change.

B) It will decrease. Explanation: 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

A 70 year-old male presents to your clinic with a lump in his breast. How should this be evaluated? A) Palpation and ultrasound B) Mammogram and ultrasound C) Ultrasound only D) Mammogram only

B) Mammogram and ultrasound Explanation: 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.

What symptom listed below might be seen in a male patient with benign prostatic hyperplasia? A) Dysuria B) Nocturia C) Low back pain D) Pain with bearing down

B) Nocturia Explanation: 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.

5-alpha-reductase inhibitors work by producing: A) dilation of the detrusor vessels. B) a decrease in the size of the prostate. C) increase blood flow to the prostate. D) inhibition in the prostate tissue synthesis.

B) a decrease in the size of the prostate. Explanation: 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.

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: A) prostate cancer. B) benign prostatic hypertrophy (BPH). C) prostate infection. D) a perfectly normal prostate gland.

B) benign prostatic hypertrophy (BPH). Explanation: 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 patient with testicular torsion will have a: A) positive cremasteric reflex on the affected side. B) negative cremasteric reflex on the affected side. C) cremasteric reflex bilaterally. D) negative cremasteric reflex bilaterally.

B) negative cremasteric reflex on the affected side. Explanation: 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.

Noninfectious epididymitis is common in: .A) soccer players. B) truck drivers C) marathon runners. D) men who wear "boxers".

B) truck drivers Explanation: 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 crunche

What is the recommendation of American Cancer Society for initial screening of an African-American male for prostate cancer? A) Digital rectal exam starting at age 40 years B) PSA starting at age 45 years C) Discussions starting at age 40-45 years D) He should be screened starting at age 50 years.

C) Discussions starting at age 40-45 years Explanation: 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.

What is American Cancer Society's recommendation for prostate screening in a 70 year-old male? A) He should be screened annually with PSA only. B) He should be screened annually with PSA and DRE. C) He should be screened until he has a life expectancy of less than 10 years. D) Screening can stop at age 75 years.

C) He should be screened until he has a life expectancy of less than 10 years. Explanation: 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.

Which of the following medications should be avoided in a 65 year-old male with benign prostatic hyperplasia (BPH)? A) Dxazosin B) Ciprofloxacin C) Pseudoephedrine C) Propanolol

C) Pseudoephedrine Explanation: 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 antihistamin

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? A) Sports hernia B) Epididymitis C) Testicular torsion D)Prostatitis

C) Testicular torsion Explanation: 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.

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 A) They are all within normal range. B) None are within normal range. C) There is a steady increase that is worrisome. D) There is a steady increase but not worrisome.

C) There is a steady increase that is worrisome. Explanation: 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 male patient has epididymitis. His most likely complaint will be: A) burning with urination. B) testicular pain. C) scrotal pain. D) penile discharge.

C) scrotal pain. Explanation: 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.

OSTEOPOROSIS

Caucasian, Asian •Advanced age , previous fracture •Long -term glucocorticoid therapy •Low body weight (< 127 lbs) •Cigarette Smoking •Excess alcohol intake

Initially: Exam, EMB, US???

Cervical cancer screening •Endometrial biopsy (High sensitivity, low cost) •Transvaginal US (evaluation of adnexa, myometrium): hope to find thin (< 4 mm), homogenous endometrium; if abnormal, EMB

Atrophic vaginitis

Clues: Atrophic Vaginitis •Vaginal irritation or burning •Dyspareunia •Urinary tract symptoms •Exam: Thinn ing of vaginal epithelium, loss of elasticity, loss of rugae •Vaginal pH ≥5 • Symptomatic response to topical estrogen

1. Which of the following is inconsistent with the description of benign prostatic hyperplasia (BPH)? A. obliterated median sulcus B. size larger than 2.5 cm × 3 cm C. sensation of incomplete emptying D. boggy gland

D

10. Concerning herbal and nutritional therapies for BPH treatment, which of the following statements is false? A. The mechanism of action of the most effective and best studied products is similar to prescription medications for this condition. B. These therapies are currently considered emerging therapy by the American Urological Association. C. Major areas of concern with use of these therapies include issues of product purity and quality control. D. These therapies are safest and most effective when used with prescription medications.

D

14) Treatment option for Chancroid includes includes all of the following except: A) Azithromycin B) Cipro C) Ceftrioxone D) Amoxicillin

D

5. A 78-year-old man presents with a 3-day history of new-onset fatigue and difficulty with bladder emptying. Examination reveals a distended bladder but is otherwise unremarkable. Blood urea nitrogen level is 88 mg/dL (31.4 mmol/L); creatinine level is 2.8 mg/dL (247.5 μmol/L). T he most likely diagnosis is: A. prerenal azotemia. B. acute glomerulonephritis. C. tubular necrosis. D. postrenal azotemia.

D Explanation: Prolonged obstruction can lead to hydronephrosis and compromised renal function; this is the etiology of postrenal azotemia, a potentially life-threatening condition.ostrenal azotemia accounts for about 5% of all renal failure. It is characterized by urea nitrogen and creatinine elevation and evidence of urinary retention and outflow tract obstruction; other reasons for renal failure have been ruled out. Intervention in postrenal azotemia is focused on relieving the urinary outflow tract obstruction. When postrenal azotemia is promptly detected, renal function returns to baseline after treatment

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? A) 2-3 days B) 1 week C) 2 weeks D) 4weeks

D) 4weeks Explanation: 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.

What is the recommendation of American Cancer Society for screening an average risk 40 year-old Caucasian male for prostate cancer? A) Digital rectal exam B) Serum prostate specific antigen (PSA) C) Digital rectal exam and PSA D) He should be screened starting at age 50 years.

D) He should be screened starting at age 50 years. Explanation: 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 localized tumor in the prostate gland associated with early stage prostate cancer is likely to produce: A) urinary hesitancy. B) low back pain. C) urinary frequency. I D) an absence of symptoms

D) an absence of symptoms Explanation: 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.

6. Surgical intervention in BPH should be considered with all of the following except: A. recurrent urinary tract infection. B. bladder stones. C. persistent obstruction despite medical therapy. D. acute tubular necrosis

D.

Osteoporosis Screening

dexascan Screening not recommended pre -menopause unless patient risk factors are present

Screening for prostate cancer is most beneficial in men who not have a life expectancy of < 10 years.

family history of prostate cancer in FDR prior to age 65 years. 3.have an older brother diagnosed with prostate cancer. 4.desire screening.

Discontinue pap

hysterectomy with benign pathology hysterectomy if due to non benign pathology then 3 annual negative tests, then discontinue (ACS); ongoing screening for 20 years (ACOG) even if older than 65 years

Most men who are diagnosed with prostate cancer present with:

they are asymptomatic, abnormal PSA.

Breast Masses

us for <30 and a pregnant woman. Mammography will not identify mass in women <30. Mammography (for any female/male> 30 years) with breast complaint •US (for any female/male < 30 years) with focal mass/symptom US to assess mass identified on mammography •US: First line in pregnancy, ages < 30 •Value of Breast Ultrasound : differentiates fluid -filled cyst from solid mass