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 ma
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 prosta
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 n
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, prost
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.
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 wil
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.
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 inf
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
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 dimin
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) Urinar
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-p
Hesselbach's triangle forms the landmark for:
A) inguinal hernia.
B) femoral hernia.
C) abdominal hernia.
D) umbilical hernia
A) inguinal hernia.
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) Epi
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 afte
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
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.
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 P
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 infecti
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 bac
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
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 associat
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 s
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
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.
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 wi
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..
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
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 s
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 specifi
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 d
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 pos
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 urinatio
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 prostati
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 sta
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,
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)
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
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
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 r
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 hyperte
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
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
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 a
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
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 charac
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.
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),
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 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
B
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 t
D
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
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
13. the causative organism of chancroid is:
A) Ureaplasma species
B) Chlamydia trachomatis
C) Mycoplasma hominis
D) Hemophilus Ducreyi
D
Explanation: .
14) Treatment option for Chancroid includes includes all of the following except: A) Azithromycin
B) Cipro
C) Ceftrioxone
D) Amoxicillin
D
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
A
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
Cervical Cancer
Most women with HPV will clear spontaneously within 8
-24 months
(especially adolescents and young women
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
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
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
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
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
VULVOVAGINITIS
Bacterial vaginosis (BV) is likely the most common
�Candidal vulvovaginitis (80
-92% due to Candida albicans)
�Trichomoniasis
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
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
Diagnostic Studies:Candiadias
Screen for diabetes if suspected
�Pregnancy test
�HIV if suspect immunocompromised state
Management for Yeast or Candidias
Fluconazole (Diflucan�) orally (remains therapeutic in vaginal secretions for
72 hours)
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
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
Atrophic vaginitis
Postmenopausal women
�Nonspecific sign/symptoms: Watery, yellow or white, malodorous vaginal
discharge
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
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
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
OSTEOPOROSIS
Caucasian, Asian
�Advanced age
, previous fracture
�Long
-term glucocorticoid therapy
�Low body weight (< 127 lbs)
�Cigarette Smoking
�Excess alcohol intake
Which T-score reflects a patient with osteopenia
between -1.0 and -2.5
Osteoperosis: -2.5 or less
Osteoporosis Screening
dexascan
Screening not recommended pre
-menopause unless patient risk factors are
present
Oral Bisphosphonates Considered first line for most patients with osteoperosis
Alendronate (Fosamax �) weekly
oRisedronate (Actonel�) weekly
oIbandronate (Boniva�) monthl
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
�U
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) (
Which choices below are causes of secondary dysmenorrhea?
Select all that
apply.
Endometriosis
2.Fibroids
3.Adhesions
4.Pelvic inflammatory disease
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
Truck driver
Epidydmitis
BENIGN PROSTATIC HYPERPLASIA
Noncancerous enlargement of the prostate gland
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
Documentation should include the following for BPH:
Firm, smooth, symmetrically enlarged prostate
PSA
DRE is
What are the major causes of an el
evated serum PSA?
Select all that apply
BPH2.
Prostate cancer
3.Prostate infection
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
Management
First line of treatment is Alpha blocker (Flomax) (Cardura)
5-alpha-reductase inhibitors
(reduce the size of the prostate-treatment needed 6-12 months to see benefit)Dutasteride (Avodart
...
ACUTEPROSTATITIS(Think Bacterial, consider STI)
Pain in the perineum, lower abdomen, testicles,or penis; pain with ejaculation; voiding difficult
Etiology
Unknown usually
�Gram negative organisms:
E. coli, Proteus
sp. are most common
�Sexual transmitted
: C. trachomatis, Ureaplasma, Trichomonas vaginalis
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
Evaluation for acute prostatitis
Rectal exam: prostate gland usually
very tender
�UA: rule out UTI, look for hematuria
�Get culturebut treat empirically
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
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.
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: Antibiotics
Most men who are diagnosed with prostate cancer present with:
they are asymptomatic, abnormal PSA.
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
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.
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/
EPIDIDYMITIS
Inflammation of the epididymis usually occurring from ascent of pathogens
or urine from urethra or prostate
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
Epididymitis
Infectious (very uncommon unless STD)
�75% of time:
C. trachomatis or N. gonorrhoeae
�C. trachomatis most common
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
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
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
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