Exam 4 Schwind Material Flashcards

Question

Balanitis

Answer 1

**Acute or chronic inflammation of the glans penis** * More common in uncircumcised men, especially with phimosis * Accumulation of smegma, cellular debris * Commonly caused by chlamydia, mycoplasma * smears /cultures for causative organism

Answer 2

**Neurogenic:** Parkinson’s, stroke, cerebral trauma, peripheral neuropathy (diabetes), spinal cord injury **Hormonal:** Decreased androgen levels, hypoprolactinemia, **Vascular:** HTN, HL, smoking, diabetes, and pelvic radiation can affect vasculature; trauma **Medications:** antidepressants, antipsychotics, antihypertensives; smoking can induce vasoconstriction; ETOH can cause transient ED

Answer 3

**Enhances hardness and duration of erection for men with ED. No effect for men without ED, women** * Side effects: Hypotension, especially if taking alpha blockers; priapism; nonarteritic ischemic optic neuropathy (NAION), sudden hearing loss, HA, flushing * Drug interactions: Nitrates-life threatening hypotension; alpha-blockers-severe hypotension

Answer 4

**Involuntary, prolonged, abnormal, painful erection not associated with sexual excitement** **Causes** **Primary**: Trauma, infections, neoplasms **Secondary:** leukemia, sickle cell disease, stroke, spinal cord injuries; medications such as anticoagulants, antihypertensives, marijuana, drugs for ED

Answer 5

**Undescended testes-one or both testicles fail to move down into the scrotal sac** * May remain in the lower abdomen or at a point of descent in the inguinal canal * Infants who are premature or SGA have highest incidence * Most descend by 6 months of age * Can lead to infertility and malignancy * High rate of testicular cancer-5-40x greater chance

Answer 6

**Excess fluid between the layers of the tunica vaginalis** * 2-layered serous pouch, derived from peritoneum, covers testes and epididymis **Acute or chronic** **Acute:** local injury, epididymitis, orchitis, gonorrhea, lymph obstruction, germ cell testicular tumor, side effect of radiation **Chronic**: more common, gradual. Unknown cause, usually in men over 40 y/o * Relatively benign, no treatment if asymptomatic; if secondary, treat underlying cause

Answer 7

**Accumulation of blood in tunica vaginalis** * Scrotum becomes dark red/purple * May be due to trauma, abdominal surgery, bleeding disorder, testicular tumor * Evacuation of blood often necessary

Answer 8

**Cyst on the epididymis containing sperm** * Usually less than 1cm Freely movable May require excision if painful

Answer 9

**Varicosities of the pampiniform plexus (network of veins supplying testes) due to incompetent valves** * Left side more affected * Similar to varicose veins in legs * Highest incidence 15-35 y/o * May complain of sensation of heaviness in affected testicle, or may be asymptomatic * Palpation- “Bag of Worms” * Treatment- surgical

Answer 10

**Twisting of the spermatic cord** After the neonatal period, most common form is intravaginal * Testis rotates on long axis in tunica vaginalis * Congenital abnormalities in most cases * Testicle high in scrotum * Surgical emergency

Answer 11

**2 types** 1. **Primary nonsexual infection:** voiding of physical strain forces pathogens from urine up prostate into epididymis 2. **STI related:** chlamydia, gonorrhea **Sx:** Unilateral pain, swelling, erythema and edema of overlying scrotal skin; fever and dysuria in 50% of cases

Answer 12

**First sign is slight enlargement of testicle** * Other signs and symptoms include ache in abdomen, sensation of pulling in testicle, flank pain in later stages when tumor is growing rapidly and hemorrhaging occurs * Gynecomastia may occur in hCG-producing tumors * Frequent metastasis, with swelling of LE, back pain, cough, hemoptysis, dizziness

Answer 13

Benign prostatic hyperplasia (BPH) **Age-related, non-malignant enlargement of the prostate gland** * 50% of men by age 60 * 90% of men by age 85 **Risk factors** * age, family history, race (highest in Blacks; lowest in Japanese) Role of DHT (Dihydrotestosterone) * biologically active metabolite of testosterone. Ultimate mediator of hyperplasia * 5α-reductase converts testosterone to DHT

Answer 14

**5α-reductase inhibitor-reduces DHT levels by 70% but does not decrease testosterone level** * Decreases mechanical obstruction * Most effective in men with very large prostates * Benefits develop slowly 6-12 months * Can reduce risk of prostate cancer **SE: Decreases ejaculatory volume and libido in 10%** * Should decrease PSA levels-if levels do not drop, suspect prostate cancer * Propecia-male pattern baldness

Answer 15

* Alpha-1 blocker: relaxes smooth muscle in the bladder neck, decreasing dynamic obstruction * Certain alpha-1 blockers not specific for prostatic alpha-1 receptors, so will also decrease BP-helpful in hypertensive patient, dangerous in one who is not * SE: Tamsulosin is selective and does not cause many SE; nonselective will cause hypotension, dizziness, nasal congestion

Answer 16

**Most common male cancer in the US, second leading cause of cancer death after lung** **Risk factors** * Age: 80% over 65 y/o, risk increases with age * Race: 2x higher risk in Blacks than Whites * Diet: High in fat * Family history: 1st degree relative doubles risk; breast cancer in relatives increases risk **Screening:** All men over 50 should get yearly PSA and DRE; men with strong family history, Blacks should start at age 45 * Prostate specific antigen (PSA): Glycoprotein secreted by benign and malignant prostate cells, indicates POSSIBLE prostate cancer * 1/3 of those with increased PSA do not have cancer * Digital Rectal Exam (DRE)

Answer 17

**Vaginitis- Inflammation of the vagina, characterized by burning, itching, redness, swelling of vaginal tissue; dyspareunia** **Causes** * Poor hygiene, intestinal parasites, foreign bodies * Chemical irritants * Infectious causes * Trichomonas vaginalis * Bacterial vaginosis * Candida Albicans

Answer 18

Vaginal yeast INFECTION! * Predisposing conditions: antibiotic therapy, suppressed immune system, diabetes, pregnancy, oral contraceptives, use of perfumed vaginal hygiene sprays * Ss: Those of vaginitis, plus vulvitis, urethritis, thick “cottage cheese” discharge **TREATMENT- Antifungals** * Antifungal creams: Inserted into vaginal daily for 3-7 days * Antifungal vaginal tablets: Inserted into the vagina for 1-7 days * Clotrimazole (Lotrimin), miconazole (Monistat) * Oral: Avoided unless severe infection * Fluconazole (Diflucan)

Answer 19

**Risk Factors** * HPV: Especially strains 16, 18 (50-70% of cervical cancers) * Sexual Activity: early age at first intercourse, multiple partners, unprotected intercourse * Smoking: Effects on tumor suppressor genes * HIV/AIDS: Immunosuppression * Diet: Low in fruits and vegetables * Low SES: fewer pap smears **Pap smear guidelines** * Women should have their first screening Pap smear at age 21 unless the woman has had a previous abnormal Pap smear * Women aged 21-65 years should have a Pap smear every 3 years (assuming prior Pap smears have been normal) ; can stop after 65 with adequate screening * Women age 30 and older should have HPV co-test every 5 years * Women who have had a hysterectomy for non-cancerous reasons do not need a Pap smear unless they have a cervix * These guidelines need to be followed whether you have or have not had the HPV vaccine

Answer 20

**Abnormal growth of endometrial tissue outside the endometrial lining** Affects 6-10% of reproductive-age women Seen in 30-50% of women with infertility, pelvic pain, or both * Risk factors * Genetic: Familial predisposition is well documented * Early menarche * Late menopause * Environmental toxins * Frequency and severity of symptoms correlate poorly with extent of disease; may be clinically silent * Pelvic pain is major symptom * Dysmenorrhea * Dyspareunia * Pain with defecation, micturition * Chronic low back pain * Infertility **Treatment** * Oral Contraceptives * Suppressive-prevent menstruation * GnRH agonists to suppress release of estrogen * “Medical menopause” * Side effects: decreased breast size, weight gain, acne, hirsutism, increased risk for osteoporosis, menopausal symptoms

Answer 21

**Occurs primarily in post-menopausal women** **Risk factors** * Obesity: 2-4 fold increased risk * Altered menstruation * Late menopause * Early menarche * Chronic anovulation * Nulliparity * Estrogen replacement therapy: 2-fold increased risk * Tamoxifen use: 2-fold increased risk * Genetics: Family history of breast, ovarian, endometrial ca * Diabetes * Smoking

Answer 22

**Benign neoplasms of smooth muscle origin** **Submucosal:** Bulge outward into endometrial cavity **Intramural:** Within uterine wall **Subserosal:** Bulging outward from serosal surface **Risk factors:** * Race, age, early menarche, obesity, nulliparity, exposure to oral contraceptives before age 17 (however, overall OCs reduce risk), family history, diet (increased with red meat, decreased with vegetables), HTN * Smoking may decrease risk

Answer 23

**ENLARGED ovaries with small cysts on the outer edges.** **One of the most common endocrine disorder affecting women** **Symptoms** * Menstrual abnormalities * Excess androgen * Hirsutism, acne, male-pattern baldness * Polycystic ovaries * Not necessary for diagnosis **Associated conditions** * Infertility * HTN, dyslipidemia * Obesity * Prediabetes or type II * High correlation with insulin resistance * Acanthosis nigricans * Darkened, velvety skin at nape of neck, armpits, inner thighs, vulva, under breasts; sign of insulin resistance **Medications** * Oral contraceptives * Anti-androgens-Spironolactone blocks skin effect * Fertility agents-Clomid-increases egg production * Insulin sensitizer-Metformin

Answer 24

**Risk factors** * Age * Residence in industrialized nations * Disordered ovarian function (infertility, nulliparity, frequent miscarriages, use of ovulation-inducing drugs) * Endometriosis * Family history * BRCA1 and BRCA2 genes * Estrogen therapy after menopause does NOT increase risk

Answer 25

Descent of cervix or entire uterus into vaginal canal **Symptoms** * Feeling as if sitting on small ball, dyspareunia, frequency and urgency, low back pain, vaginal bleeding, multiple UTIs **Treatment- surgical**

Answer 26

**Herniation of the bladder into the vagina** **Symptoms** * Difficulty emptying bladder, stress incontinence, UTIs * Dyspareunia

Answer 27

**Bulging of rectum and posterior vaginal wall into the vaginal canal** **Symptoms** * Difficulty with defecation * Dyspareunia

Answer 28

**Herniation of the rectouterine pouch into the rectovaginal septum** Congenital or acquired through birth trauma Asymptomatic or dull, dragging sensation, low back pain

Answer 29

**Milky discharge from nipple unrelated to pregnancy or breast-feeding** * Not a disease itself but a symptom of underlying problem * Most often in women, can happen in men, infants

Answer 30

**A painful infection of the breast tissue** * Occurs most frequently in breast-feeding women * Usually infection due to staphylococcus or streptococcus that travels from the nipple to the ductile structures * May form abscess; abx needed

Answer 31

**The most common cancer in females** **Risk factors:** * Female * increasing age * obesity * early menarche or late menopause * nulliparity (never gave birth) * taking oral contraceptive for longer than 10 years * estrogen or progesterone replacement * radiation to chest * alcohol use

Answer 32

**Uses: Prevent UTI; decrease odor in those with urinary incontinence** **Effectiveness:** Can prevent recurrent UTIs in women in their teens and 20s, and in older adult women, not effective in other age groups. Will do nothing for established infection **Adverse effects:** Drinking more than 1 L/day can cause GI upset and formation of uric acid kidney stones **Drug interactions:** May increase bleeding risk in patients on warfarin

Answer 33

**Uses** * Oral: Stimulate immune function, suppress inflammation, treat viral infections * Topical: Wounds, burns, eczema, psoriasis, herpes simplex **Effectiveness:** Evidence does not support effectiveness in preventing or treating colds **Adverse effects:** Few. Rare allergy-part of the daisy family, which includes ragweed. * Since it can stimulate the immune system, avoid in autoimmune diseases * Long-term therapy can suppress the immune system

Answer 34

**Uses:** Mild to moderate depression; topical for local inflammation or oral for pain and inflammation **Effectiveness:** Unclear. May be useful for mild to moderate depression, not severe depression **Adverse effects:** Well tolerated. Allergies (daisy family). High doses-phototoxicity

Answer 35

**Uses:** Promote sleep, reduce anxiety **Effectiveness:** Not supported by studies **Adverse effects:** Well tolerated, can reduce alertness

Answer 36

Can cause vaso-occlusive disease and liver damage

Answer 37

used to promote sleep or reduce stress Can cause severe **liver injury**

Answer 38

Uses: weight loss or increasing alertness. Contains ephedrine- can cause **hypertension, stroke, MI, death**

Exam 4 Schwind Material Flashcards

(62 cards)