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A | 19 |year |old |male |presents |to |the |ED |with |complaints |of |right |testicular |pain |that |started | 3 |days |ago. |Patient |denies |penile |discharge. |What |should |be |included |in |his |differential |diagnosis? |Select |all |that |apply.
- |Acute |epididymitis
- |STI
- |Testicular |torsion
- |Varicocele
- |Hydrocele
- |Spermatocele/Epididymal |cyst
- |Fournier's |gangrene |- |correct |answer |✔All |of |the |above.
- |Acute |epididymitis: |fever, |pos |Cremasteric, |pos |Prehn |sign
- |STI: |discharge
- |Testicular |torsion: |extreme |pain, |N/V, |neg |Cremasteric |reflex
- |Varicocele: |dull |ache, |bag |o' |worms
- |Hydrocele: |painless |swelling |anterior |or |lateral |to |the |testicle |
- |Spermatocele/Epididymal |cyst: |painless |swelling |from |the |head |of |the |testicle
- |Fournier's |gangrene The |AGACNP |is |concerned |with |acute |epididymitis |after |eliciting |a |positive:
- |Prehn's |sign
- |Cremasteric |reflex
- |Tinel |sign
- |Phalen |test |- |correct |answer |✔Prehn |sign
- |Elevation |of |the |scrotal |contents |alleviates |the |pain |associated |with |epididymitis.
- |Cremasteric |reflex: |lifting |of |the |testicle |in |response |to |stroking |of |the |thigh
- |Due |to |STI |in |young |men |and |UTI |in |older |men
- |R/O |amiodarone |as |a |cause A |15yo |male |presents |with |complaints |of |testicular |pain |the |woke |him |up |while |sleeping. |The |AGACNP |has |a |high |suspicion |that:
- |the |patient |needs |to |be |treated |with |antibiotics |and |notify |their |partners |to |be |treated |as |well
- |the |patient |will |need |to |be |evaluated |by |GI |surgery |for |concerns |for |an |inguinal |hernia |incarceration
- |the |patient |needs |to |be |evaluated |by |urology |for |concerns |of |testicular |torsion
- |the |patient |has |a |spermatocele |an |will |need |to |follow |up |with |urology |in |clinic |- |correct |answer |✔The |patient |needs |to |be |evaluated |by |urology |for |concerns |of |testicular |torsion The |most |common |age |range |for |testicular |cancer |is:
- |10-20 |years
- |20-35 |years
- |35-55 |years
A |male |patient |present |to |urgent |care |with |complaints |of |penile |discharge |and |lesions. |What |are |your |differentials?
- |Gonorrhea/chlamydia
- |Acute |bacterial |prostatitis
- |Herpes |simplex
- |Syphilis |- |correct |answer |✔All |of |the |above Discharge: |gonorrhea/chlamydia, |epididymitis Chancre: |syphilis, |treat |with |penicillin |G What |are |the |symptoms |of |primary, |secondary, |tertiary, |and |latent |syphilis? |- |correct |answer |✔1: |Chancre, |local |lymphadenopathy 2: |Flu-like |symptoms, |maculopapular |rash |on |the |palms, |and |systemic |lymphadenopathy 3: |Cardiac |and |gummous |lesions L: |Lacking |clinical |manifestations Neurosyphilis |can |occur |at |any |stage. |Tabes |dorsales |and |general |paresis |are |late |signs. A |19yo |presents |with |complaints |of |dysuria |and |denies |any |other |complaint. |What |diagnostics |will |you |order?
- |Urine
- |Gonorrhea |urine |test
- |Chlamydia |urine |test
- |CBC
- |BMP |- |correct |answer |✔Urine, |gonorrhea, |and |chlamydia What |are |the |potential |complications |of |not |treating |gonorrhea |in |men?
- |Sterility
- |epididymitis
- |spreading |to |blood |and |joints, |increased |chances |of |getting |HIV
- |all |of |the |above |- |correct |answer |✔All |of |the |above Treat |with |Rocephin |(gonorrhea) |and |Doxycycline |or |azithromycin |(chlamydia) Inflammation |of |the |glans |penis |is |known |as |_____. Condition |where |the |foreskin |of |an |uncircumsized |male |patient |cannot |be |retracted |over |the |glans |penis |is |known |as |_____. Condition |of |the |foreskin |of |an |uncircumsized |male |patient |is |trapped |behind |the |glans |penis |and |cannot |be |pulled |to |its |original |state |is |known |as |_____. |- |correct |answer |✔Balanitis |- |better |hygiene |and |treatment |of |candidiasis |with |an |-azole |if |present Phimosis |- |circumcision Paraphimosis |- |consult |urologist A |45yo |male |presents |stating |he |is |unable |to |maintain |an |erection |for |sexual |intercourse. |You |are |aware |that:
- |over |half |of |men |aged |40-70 |years |old |will |have |erectile |dysfunction
T/F: |Males |have |a |higher |risk |for |prostate |cancer |if |they |are |diagnosed |with |benign |prostate |hyperplasia. |What |are |the |risk |factors? |- |correct |answer |✔False Risk |factors |include |African |American, |family |history, |and |a |high |fat |diet A |male |patient |presents |for |an |urgent |care |visit. |What |symptoms |would |cause |concern |for |BPH? |SATA
- |Post-void |dribbling
- |Urinary |frequency
- |Increased |caliber |of |urine |stream
- |Obstructive |hesitancy |
- |Burning |with |urination |- |correct |answer |✔Post-void |dribbling Urinary |frequency/double-voiding/nocturia Obstructive |hesitancy Decreased |force |and |caliber |of |stream Sensation |of |incomplete |bladder |emptying Prostate |is |smooth, |firm, |with |elastic |enlargement What |differentials |would |you |consider |for |a |patient |presenting |with |hesitancy, |decreased |stream, |double |voiding. |post-void |dribble, |and |urinary |frequency |other |than |BPH? |SATA
- |UTI
- |STI
- |Prostate |cancer
- |Bladder |cancer
- |Neurogenic |bladder |- |correct |answer |✔All |of |the |above Also |urethritis, |urethral |trauma, |urethral |stricture, |and |bladder |stones A |male |presents |with |complaints |of |urinary |hesitancy, |post-void |dribbling, |and |urinary |frequency. |What |is |the |first |diagnostic?
- |US |scrotum |with |doppler
- |CT |abdomen |and |pelvis |wo |contrast
- |DRE
- |Check |Prehn's |sign |- |correct |answer |✔DRE: |check |for |smooth, |firm, |elastic |enlargement |of |the |prostate |without |sensitivity Check |UA |and |PSA; |if |abnormal, |cystoscopy, |cystometrogram, |urodynamic |profiles, |flow |rate, |PVR, |and |pressure-flow |studies What |is |the |most |common |bacterial |cause |of |acute |and |chronic |bacterial |prostatitis?
- |Gram |negative |cocci
- |Gram |negative |rods
- |Gram |positive |cocci
- |Gram |positive |rods |- |correct |answer |✔GNR, |especially |E |coli |and |Pseudomonas; |less |commonly |gram-positive |Enterococci
- |Chronic |bacterial |prostatitis?
- |Prostatodynia |- |correct |answer |✔Non-bacterial |prostatitis Afebrile, |- |UA |and |UC, |+ |WBCs |but |- |culture |of |prostatic |secretions What |are |the |potential |treatments |for |prostatodynia? |- |correct |answer |✔Alpha |blocking |agents |-zosins Diazepam |for |pelvic |floor |dysfunction Sitz |bath Biofeedback |therapy Pelvic |floor |physical |therapy Diagnosis |of |non-bacterial |prostatitis |is |usually |from:
- |DRE
- |exclusion
- |biopsy
- |US |w |doppler |- |correct |answer |✔Exclusion Prostate |cancer |is |the |___________ |leading |cause |of |cancer |related |deaths |in |men |in |the |US. |- |correct |answer |✔Second Watch |for |urinary |retention, |discrete |nodules |on |DRE, |and |increased |PSA |> | 4 |(18-30% |likelihood) |and |PSA |> | 10 |(50-80%) Back |pain |may |indicate |metastases.
A |25-year-old-male |presents |to |the |ED |with |complaints |of |acute |onset |unilateral |scrotal |pain |that |started |one |hour |prior. |He |also |reports |nausea |without |vomiting. |Patient |is |afebrile |and |denies |urinary |frequency |or |pain |with |urination. |The |patient |reported |playing |disc |golf |the |night |before |the |pain |started, |but |denies |trauma |to |the |area. |Exam |revealed |enlargement |and |edema |of |the |entire |scrotum, |more |on |the |left |side. |The |left |side |was |extremely |tender, |more |so |than |the |right |side. |No |scrotal |erythema. |Unable |to |elicit |the |cremasteric |reflex. |The |most |likely |diagnosis |is:
- |hydrocele
- |testicular |torsion
- |testicular |tumor
- |epididymitis |- |correct |answer |✔Testicular |torsion A |64-year-old |man |presents |with |a |long |history |of |nocturia. |He |now |has |some |trouble |initiating |a |urinary |stream. |Your |initial |plan |is:
- |order |a |pelvic |ultrasound
- |order |a |PSA
- |order |a |cystoscopy
- |perform |a |DRE |- |correct |answer |✔Perform |a |DRE Cystoscopy |would |evaluate |for |abnormal |urinary |tract |pathology |in |a |patient |with |dysuria, |polyuria, |and |lower |pain |pain |with |hematuria |but |no |indication |of |infection While |examining |the |male |genitalia, |you |are |unable |to |retract |the |foreskin |of |an |uncircumcised |patient. |There |is |erythema |and |swelling |noted |to |the |distal |end |of |the |foreskin. |This |condition |is |know |as:
A |young |male |presents |with |a |complaint |of |a |feeling |of |fullness |in |the |scrotum. |Physical |examination |reveals |a |round, |soft, |nontender, |nonadherent |bluish |discolored |testicular |mass |resembling |a |"bag |of |worms". |There |is |no |variation |in |size |with |respiration |or |the |Valsalva |maneuver. |The |mass |transilluminates |and |is |located |anterior |to |the |testes. |What |is |the |most |likely |diagnosis?
- |Varicocele
- |Tumor
- |Spermatocele
- |Hernia |- |correct |answer |✔Varicocele Consider |this |when |assessing |for |infertility A | 25 |year |old |male |presents |to |the |emergency |department |with |complaints |of |scrotal |pain |and |swelling |for | 3 |days. |Upon |evaluation, |the |NP |notices |that |the |patient |has |white |penile |discharge, |a |positive |Prehn's |sign, |and |his |cremasteric |reflex |is |present |bilaterally. |The |NP |knows |that |his |scrotal |US |will |likely |be |positive |for:
- |testicular |torsion
- |inguinal |hernia
- |Fournier's |gangrene
- |acute |epididymitis |- |correct |answer |✔Acute |epididymitis Advise |partners |to |get |tested |if |symptomatic |within | 60 |days Treat |with |Rocephin |and |doxycycline/azithromycin; |in |MSM |Rocephin |and |a |fluoroquinolone
Most |common |causes: |chlamydia |and |gonorrhea |and |in |MSM, |E |coli A | 37 |year |old |male |presents |to |the |ED |with |complaints |of |dysuria |and |perineal |pain. |His |temperature |is |100.5, |BP |is |131/86, |HR |is |99, |RR |18, |O2 |96% |on |RA |upon |arrival. |Patient |has |moderate |to |severe |tenderness |to |his |prostate |on |rectal |examination |without |any |signs |of |scrotal |or |perineal |cutaneous |infection |or |deterioration. |The |NP |knows |that |they |will |most |likely:
- |Have |urology |immediately |consult |and |prep |the |patient |for |surgery |as |there |are |concerns |for |Fournier's |gangrene.
- |Admit |the |patient |to |the |hospital |for |IV |fluids |and |IV |antibiotics |as |the |patient |meets |sepsis |criteria |and |likely |has |acute |bacterial |prostatitis.
- |Give |the |patient |a |dose |of |IV |antibiotics |in |the |ED |and |discharge |the |patient |to |follow |up |with |urology |within |a |week |for |concerns |of |chronic |bacterial |prostatitis.
- |Discharge |the |patient |with |education |on |biofeedback |techniques |and |prescriptions |for |terazosin |and |diazepam |to |treat |for |prostat |- |correct |answer |✔Admit |the |patient |to |the |hospital |for |IV |fluids |and |IV |antibiotics |as |the |patient |meets |sepsis |criteria |and |likely |has |acute |bacterial |prostatitis. When |should |a |patient |with |hepatitis |be |admitted? |- |correct |answer |✔Encephalopathy Coagulopathy |INR |> |1. Inability |to |maintain |hydration T/F: |A |woman |can |be |considered |menopausal |one |year |after |the |cessation |of |menstruation. |- |correct |answer |✔True Menopausal |transition: |from |cycle |irregularity |to |the |final |menstrual |period
- |prophylactic |UTI |management |with |bactrim
- |androgen |replacement |therapy
- |estrogen |replacement |therapy
- |Mirena
- |tamoxifen
- |SSRIs |- |correct |answer |✔Prophylactic |UTI |management |with |bactrim
- |androgen |replacement |therapy: |treats |low |libido |and |sexual |dysfunction, |but |side |effects |include |hirsutism, |acne, |decreased |triglycerides |and |HDLs, |contraindicated |in |liver |disease
- |estrogen |replacement |therapy: |must |be |low |dose |or |include |intermittent |progesterone |to |prevent |endometrial |hyperplasia |and |bleeding
- |Mirena: |progestin |releasing, |use |with |estrogen |to |reduce |uterine |bleeding |and |carcinoma
- |tamoxifen: |SERMS, |lowers |risk |for |osteoporosis, |breast, |and |endometrial |cancer
- |SSRIs: |treats |vasomotor |symptoms What |are |the |benefits |and |risks |of |estrogen |replacement? |- |correct |answer |✔Benefits: |decreased |CVD, |triglycerides, |osteoporosis, |vasomotor |symptoms, |vaginal |symptoms, |insomnia, |cognitive |dysfunction, |joint/body |pain, |depression Risks: |increased |HDL, |VTE, |endometrial |hyperplasia, |cognitive |decline |due |to |small |strokes, |incontinence, |mastalgia, |seizure, |pituitary |prolactinoma, |GERD, |hepatic |hemangiomas, |gallstones
What |are |the |effects |of |estrogen, |progestin, |and |SERMs |on |cancer |and |CVD |risk? |- |correct |answer |✔E+P |increases |risk |of |breast |cancer, |decreases |risk |of |uterine |cancer E |increases |risk |of |uterine |cancer, |decreases |CVD SERMs |decrease |risk |of |breast |cancer |and |endometrial |cancer All |of |the |following |are |common |fracture |sites |in |those |with |osteoporosis |except:
- |vertebra
- |proximal |femur
- |distal |forearm
- |clavicle |- |correct |answer |✔Clavicle The |others |are |considered |fragility |fractures A |58yo |Caucasian |female |with |PMH |of |gastric |bypass |and |post |menopausal |state |presents |with |acute |hip |pain. |Imaging |reveals |a |femur |fracture |without |sustaining |any |type |of |trauma. |You |are |concerned |for |what |underlying |disease |process |that |needs |further |evaluation? |- |correct |answer |✔Post-menopausal |osteoporosis
- |Gastric |bypass |reduces |calcium |absorption Your |patient |has |a |t-score |of |< |-2.5 |from |a |DEXA |scan. |You |diagnose:
- |osteopenia
- |osteoporosis
Vitamin |betaine T/F: |Those |with |osteoporosis |commonly |have |associated |Vitamin |D |deficiency |- |correct |answer |✔True Vitamin |D |plays |a |role |in |calcium |absorption, |bone |health, |muscle |performance, |balance, |and |risk |for |falling All |of |the |following |are |possible |treatments |for |osteporosis |except:
- |raloxifene
- |zolendronic |acid
- |alendronate
- |venlafaxine
- |teriparatide
- |denosumab
- |estrogen |- |correct |answer |✔Venlafaxine
- |raloxifene, |tamoxifen: |SERMs
- |zolendronic |acid, |alendronate: |bisphosphonate
- |teriparatide: |anabolic |steroid
- |denosumab: |antiresorptive |agent All |of |the |following |are |absolute |contraindications |to |prescribing |oral |contraceptives |to |a |21yo |sexually |active |female |except:
- |uncontrolled |HTN
- |renal |dysfunction
- |surgery |requiring |prolonged |immobilization
- |history |of |clotting |disorder |with |recurrent |DVT
- |migraines |with |an |aura
- |active |hepatitis |- |correct |answer |✔Renal |dysfunction Absolute: |thromboembolic |disorders, |CVA, |IHD, |CAD, |breast |cancer, |pregnancy, |liver |tumor, |abnormal |vaginal |bleeding, |uncontrolled |HTN, |DM |with |vascular |disease, |migraine |with |aura, |older |smokers, |active |hepatitis, |ortho |surgery |with |prolonged |immobilization Strong |relative: |severe |vascular |or |migraine |headaches |without |aura, |HTN |>140/90, |DM, |gallbladder |disease, |mono, |SSD T/F: |Oral |contraceptives |can |only |be |used |for |birth |control |measures. |- |correct |answer |✔False, |it |can |be |used |for |abnormal |menstrual |pain |and |bleeding, |and |acne T/F: |A |thorough |history |and |physical |exam |should |be |the |healthcare |providers |top |concern |when |caring |for |a |patient |who |is |experiencing |intimate |partner |violence. |- |correct |answer |✔False Safety |should |be |the |providers |top |priority T/F: |The |following |is |a |form |of |indirect |questioning |when |asking |about |abuse: |"When |you |and |your |partner |argue, |does |the |situation |ever |turn |physical?" |- |correct |answer |✔True
