Prostate Screening Guidelines Overview

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Questions and Answers

What is the recommended follow-up for patients under active surveillance for prostate issues?

  • Consultation with a urologist every year.
  • Repeat prostate biopsies every year for the first 5 years.
  • Urinary tract and sexual dysfunction screening only.
  • Repeat prostate biopsies 1 year after diagnosis, then every 2 to 4 years. (correct)

Which type of testicular cancer accounts for the majority of cases?

  • Germ cell tumors. (correct)
  • Gonadoblastoma tumors.
  • Nongerm cell tumors.
  • Seminoma tumors.

Which of the following is NOT a risk factor for testicular cancer?

  • Chronic kidney disease. (correct)
  • Family history of testicular cancer.
  • History of cryptorchidism.
  • Previous history of testicular cancer.

What symptom is commonly associated with testicular cancer?

<p>Painless testicular mass. (C)</p> Signup and view all the answers

What is the typical first-line treatment for stage 1 testicular cancer?

<p>Radical orchiectomy followed by radiation. (C)</p> Signup and view all the answers

The majority of testicular cancer cases are classified under which sub-type?

<p>Germ cell tumors. (A)</p> Signup and view all the answers

What is an important consideration prior to initiating chemotherapy for testicular cancer?

<p>Cryopreservation of sperm. (D)</p> Signup and view all the answers

Which symptom can occur in 5% of patients with germ cell tumors?

<p>Gynecomastia. (B)</p> Signup and view all the answers

What distinguishes an incarcerated hernia from a strangulated hernia?

<p>Incarcerated hernia content cannot be replaced into the abdomen. (D)</p> Signup and view all the answers

Which factor is NOT considered a risk factor for developing a hernia?

<p>Age less than 30 years. (C)</p> Signup and view all the answers

What is a surgical procedure recommended for patients with refractory erectile dysfunction?

<p>Penile prosthesis (B)</p> Signup and view all the answers

Which of the following is a potential side effect of sildenafil (Viagra)?

<p>Headaches (B)</p> Signup and view all the answers

What symptom might suggest a strangulated hernia?

<p>Colicky abdominal pain and nausea. (C)</p> Signup and view all the answers

What is the recommended initial treatment for a minimally symptomatic hernia?

<p>Watchful waiting with regular follow-up. (C)</p> Signup and view all the answers

What underlying condition can lead to the need for psychological support in managing erectile dysfunction?

<p>Stress and depression (B)</p> Signup and view all the answers

Which of the following medications is contraindicated in patients with heart failure?

<p>Sildenafil (Viagra) (D)</p> Signup and view all the answers

Which of the following terms describes a hernia that can be replaced into the abdomen with gentle pressure?

<p>Reducible hernia. (A)</p> Signup and view all the answers

What post-operative instruction should be followed after hernia repair?

<p>Do not lift more than 5 pounds until cleared by a surgeon. (A)</p> Signup and view all the answers

What is the initial recommended dose of Tadalafil for on-demand use?

<p>10 mg (A)</p> Signup and view all the answers

Which finding is characteristic of testicular torsion?

<p>Sudden and severe unilateral scrotal pain. (A)</p> Signup and view all the answers

Which factor requires caution when prescribing phosphodiesterase inhibitors?

<p>Diminished renal function (C)</p> Signup and view all the answers

Which symptom would typically worsen as the day progresses in individuals with hernias?

<p>Intermittent bulge that is painful. (B)</p> Signup and view all the answers

What bacteria is responsible for Gonorrhea?

<p>Neisseria Gonorrhoeae (D)</p> Signup and view all the answers

What type of therapy is primarily used as a second-line treatment for erectile dysfunction?

<p>Intracavernous injection therapy (C)</p> Signup and view all the answers

What is the recommended caloric intake per kilogram per day for individuals with a body mass index (BMI) greater than 120% of normal?

<p>24 kcal per kilogram per day (A)</p> Signup and view all the answers

What is the standard pharmacological therapy for managing gestational diabetes?

<p>Insulin therapy (C)</p> Signup and view all the answers

During the puerperium, which physiological changes occur as the body adjusts back to its non-pregnant state?

<p>Uterine involution (D)</p> Signup and view all the answers

Which screening protocol is typically used for assessing gestational diabetes?

<p>Glucose tolerance test (B)</p> Signup and view all the answers

What does the cremastic reflex indicate when absent in a patient?

<p>Testicular torsion (D)</p> Signup and view all the answers

What is the typical duration of the luteal phase in the menstrual cycle?

<p>14 days (A)</p> Signup and view all the answers

Which hormone triggers ovulation?

<p>Luteinizing hormone (LH) (A)</p> Signup and view all the answers

What must be present for the diagnosis of PCOS in adult women?

<p>Hyperandrogenism (D)</p> Signup and view all the answers

What is NOT a treatment option for managing PCOS?

<p>Surgical intervention (A)</p> Signup and view all the answers

What are the early signs of preeclampsia typically monitored for?

<p>High blood pressure and proteinuria (C)</p> Signup and view all the answers

Which symptom is characteristic of mastitis?

<p>Breast pain, redness, and fever (C)</p> Signup and view all the answers

What is recommended for breast cancer screening for women aged 40 and over?

<p>Mammograms every two years (C)</p> Signup and view all the answers

Which aspect is crucial during labor assessment?

<p>Recognizing signs of labor onset (D)</p> Signup and view all the answers

What is the primary purpose of administering RhoGAM to Rh-negative mothers?

<p>To prevent alloimmunization (B)</p> Signup and view all the answers

Which of the following are common symptoms of a urinary tract infection (UTI)?

<p>Dysuria, frequency, and urgency (D)</p> Signup and view all the answers

At what gestational weeks is screening for gestational diabetes typically performed?

<p>24-28 weeks (C)</p> Signup and view all the answers

What is advised after a spontaneous abortion (SAB) until the beta HCG levels return to 0?

<p>Do not try to conceive (B)</p> Signup and view all the answers

In which situation should a patient experiencing bleeding during pregnancy be evaluated immediately?

<p>More than 2 pads per hour for more than 2 hours (B)</p> Signup and view all the answers

What is a common treatment for gestational trophoblastic disease (GTD)?

<p>Dilation and curettage (D&amp;C) (C)</p> Signup and view all the answers

What is one of the leading causes of neonatal mortality linked to pregnancy?

<p>Preterm labor and birth (B)</p> Signup and view all the answers

What is the significance of repeating beta HCG levels every 2-3 days in early pregnancy?

<p>To monitor for viable pregnancy (B)</p> Signup and view all the answers

Flashcards

Active Surveillance for Prostate Cancer

A strategy for monitoring prostate cancer patients with no immediate treatment. Repeat biopsies are scheduled yearly, then every 2-4 years, to track cancer progression.

Antiandrogen Deprivation Therapy (ADT)

Treatment for prostate cancer that reduces male hormone levels. Requires patient evaluation for cardiovascular risks.

Testicular Cancer Types

Consist of germ cell (most common) and non-germ cell tumors.

Testicular Cancer Risk Factors

Cryptorchidism (undescended testicle), family history, past testicular cancer history, or white ethnicity.

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Testicular Cancer Symptoms

Often painless, involving a hard, unilateral (one-sided) testicular mass. Swelling, discomfort or pain are possible.

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Testicular Cancer Treatment

Typically involves surgical removal (orchiectomy), followed by chemotherapy/or radiation if the cancer has spread.

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Stage 1 Testicular Cancer Treatment

Surgery (radical orchiectomy) and radiation therapy are common initial treatment.

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Cryopreservation of Sperm

The storage of sperm for later use, important for men undergoing specific cancer treatments.

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Femoral hernia

A hernia located below the inguinal ligament, where the femoral ring is weak.

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Incarcerated hernia

A hernia where the protruding organs cannot be pushed back into the abdomen.

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Strangulated hernia

A hernia that cuts off the blood supply to the trapped organs, a surgical emergency.

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Reducible hernia

A hernia that can be easily pushed back into the abdomen.

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Testicular Torsion

A sudden, severe pain in one testicle.

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Scrotal Pain

Pain in the scrotum.

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Surgical Repair

The usual treatment for hernias, especially if the hernia is painful, enlarging, or causing complications.

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Watchful Waiting

A possible treatment for hernias with minimal symptoms and low strangulation risk; monitoring patients every 6 months.

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Radical Prostatectomy

A surgical procedure to remove the prostate gland.

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Erectile Dysfunction Treatment

Variety of therapies to restore erectile function, including lifestyle changes, medication like sildenafil (Viagra) or tadalafil (Cialis), injections (alprostadil), vacuum constriction devices or surgery.

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Sildenafil (Viagra)

Medication used to treat erectile dysfunction, by relaxing smooth muscles in the penis to allow blood flow.

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Tadalafil (Cialis)

Medication used to treat erectile dysfunction, by relaxing smooth muscles in the penis to allow blood flow, longer duration of action than sildenafil.

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Gonorrhea

A sexually transmitted infection causing inflammation of mucous membranes.

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Intracavernosal Injection

A second-line erectile dysfunction treatment, involving injection of vasodilators into the penis.

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Alprostadil

A vasodilator medication used for intracavernosal injection or as a suppository to treat erectile dysfunction.

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Underlying Causes of ED

Conditions like atherosclerosis, smoking, high blood pressure, diabetes, stress, depression, and hormonal imbalances that can contribute to erectile dysfunction.

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Follicular Phase

The part of the menstrual cycle where the egg matures.

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Luteal Phase

The second part of the menstrual cycle, preparing the uterine lining for pregnancy.

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Ovulation

The release of the egg from the ovary.

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Luteinizing Hormone (LH)

Hormone that triggers ovulation.

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PCOS Diagnosis

Diagnosis requires 2 of 3: Hyperandrogenism, Oligoovulation or Anovulation and Polycystic ovaries on ultrasound.

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Mastitis

Breast infection, characterized by pain, redness, and fever.

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Preeclampsia

Condition during pregnancy characterized by high blood pressure and protein in urine.

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Labor Stages

Physiological changes and stages of the birthing process.

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RhoGAM

An injection given to Rh-negative mothers to prevent their immune system from attacking future Rh-positive babies.

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UTI Symptoms

Common symptoms of a urinary tract infection include pain or burning when urinating (dysuria), frequent urination, and a strong urge to urinate.

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Gestational Diabetes Screening

Pregnant women are screened for gestational diabetes between 24 and 28 weeks of pregnancy.

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Early Pregnancy Loss

Pregnancy loss within the first 13 weeks is often referred to as a miscarriage.

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Beta HCG Levels

Beta HCG is a hormone that rises during pregnancy, and its levels can be monitored to evaluate the progression of the pregnancy.

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Placenta Previa

A condition where the placenta covers the opening of the cervix, often causing vaginal bleeding.

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Preterm Labor

Labor that occurs before 37 weeks of pregnancy.

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Preterm Labor Risk Factors

Factors that increase the risk of preterm labor include poor nutrition, substance use, and inadequate spacing between pregnancies.

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Gestational Diabetes Management

Managing gestational diabetes involves dietary changes, exercise, glucose monitoring, and sometimes insulin therapy. Screening is typically done at 24-28 weeks with a glucose tolerance test.

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Puerperium

The postpartum period, where the body gradually returns to its non-pregnant state. This includes uterine involution (shrinking) and muscle tone recovery.

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Indirect Inguinal Hernia

A type of hernia where a portion of the intestine or other abdominal contents protrudes through the inguinal canal, typically seen in men.

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Epididymitis vs Testicular Torsion

Epididymitis is inflammation of the epididymis, usually causing pain that worsens when lifting the testicle. Testicular torsion is a twisting of the spermatic cord, causing severe pain that usually doesn't improve with lifting.

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Cremasteric Reflex

A reflex where stroking the inner thigh causes the testicle to contract upwards. It's absent in testicular torsion.

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Study Notes

Prostate Screening Guidelines

  • USPSTF recommends against routine screening.
  • ACS and AUA guidelines advocate individualized approaches with shared decision-making to determine if PSA and DRE screening is in the patient's best interest.
  • For most men, annual screening begins at age 50 with PSA and DRE.
  • Consider screening at age 45 for high-risk individuals (first-degree relative with prostate cancer before age 65 or Black ethnicity).
  • Men with more than one first-degree relative with a history of prostate cancer should begin screening at age 40.
  • Asymptomatic men with a 10-year life expectancy should not be offered PSA testing.
  • Routine screening includes PSA testing and DRE.
  • PSA levels above 4 ng/mL often warrant further investigation (biopsy, imaging).
  • Screening frequency depends on risk factors like age, family history, and ethnicity.

Risk Factors

  • Age: Risk increases after 50.
  • Family history of prostate cancer.
  • African American ethnicity.
  • Diet high in red meat and low in fruits/vegetables.

Diagnostics

  • DRE: Palpable abnormalities suggest malignancy.
  • PSA: Elevated levels require follow-up; typically <4 ng/mL. Velocity of change in PSA and DRE should be considered. A PSA of >10 ng/mL usually warrants biopsy; 20% of those with PSA 4-9.9 ng/mL have prostate cancer.
  • Adjunctive tests include prostate cancer antigen 3, TMPRSS2-ERG gene fusion, and prostate health index.
  • Elevated alkaline phosphatase indicates metastasis.
  • Testosterone and liver function tests for androgen deprivation suspicion.
  • TRUS with transrectal biopsy for prostate biopsy.
  • CT scans primarily assess prostate size and pelvic lymph node involvement; used for pre-operative staging/metastasis evaluation.

Testicular Cancer

  • Malignant testicle tumor.
  • Two main types:
    • Germ cell (seminoma, teratoma, teratocarcinoma, embryonal carcinoma; 90-95% of cases)
    • Nongerm cell (Leydig cell, gonadoblastoma, adenocarcinoma; 5-10% of cases).
  • Screening: Early detection improves prognosis.
  • Risk factors: Cryptorchidism, family history, white race.
  • Assessment findings: Painless testicular mass, swelling, discomfort; testicle may feel harder.
  • Treatment: Usually involves surgical removal (orchiectomy), followed by chemotherapy/radiation if cancer has spread.

Inguinal Hernia

  • Tissue protrusion through the inguinal or femoral canal.
  • Types: Indirect, direct, femoral.
  • 40% are incarcerated (cannot be returned) or strangulated (blood supply compromised).
  • Reducible hernias return spontaneously.
  • Risk factors: Prematurity, age >60, smoking, family history, connective tissue disorders.
  • Assessment: Painful or painless swelling or lump in the groin/scrotum; symptoms worsen with straining.
  • Treatment: Usually surgical repair.

Testicular Torsion

  • Sudden, severe, unilateral scrotal pain; commonly seen in young males.
  • Findings: Scrotal edema, erythema, firm tender mass, possibly retracted upward, no relief with testicular or scrotal elevation, reactive hydrocele, high-riding testicle ("bell-clapper" deformity), nausea and vomiting, absent cremasteric reflex (negative Prehn's sign).
  • Twist score >4 is a medical emergency.
  • Treatment: Immediate surgical intervention (within 6 hours), manual detorsion if surgery unavailable), bilateral orchiopexy, surgical exploration and orchiopexy/orchiecomy for non-viable testicle.

Erectile Dysfunction

  • Inability to achieve or maintain a rigid erection.
  • Causes can be vascular (cardiovascular disease, hypertension, diabetes, smoking, pelvic radiation), neurological (COPD, sleep apnea, stroke, spinal cord injuries), psychological (performance anxiety, relationship issues), or hormonal/drug induced.
  • Risk factors: vascular, respiratory (COPD), neurological, penile conditions, hormonal, drug-induced (antihypertensives, antidepressants, antipsychotics, antiandrogens).

Sexually Transmitted Infections (STIs)

  • Gonorrhea (Neisseria gonorrhoeae): asymptomatic frequently in women; diagnosed by Nucleic Acid Amplification Test (NAT) of secretions. Treatment: Ceftriaxone 250mg IM + Azithromycin 1g PO.
  • Chlamydia (Chlamydia trachomatis) Symptoms: Asymptomatic; diagnosed with NAAT or culture. Treatment: Azithromycin 1g PO OR Doxycycline, 100 mg BID x 7 days.

Other conditions addressed

  • Various other conditions were addressed: Bacterial vaginosis, Trichomoniasis, Herpes, HPV, Yeast infections.
  • Testing and treatment specifics were included, often differentiating between genders and risk factors for individual conditions.

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