Summary AANP Exam 3 Study Guide 2023 Complete Men’s Health Priapism - Correct Answer painful erection for 204 hours, ischemi form is medical/surgical emergency Testicular cancer - Correct Answer hard fixed, nodule, heaviness or aching, one testicle larger than other, hydrocele from tumor, painless asymptomatic until Metz, DX gold standard testicular biopsy, US of testes, refer to urology, for surgical removal (orchiectomy) Prostate Cancer - Correct Answer most common cancer in men, new onset of low back pain, rectal perianal area, obstructive voiding symptoms, weak stream, nocturia, risk factor obese and family history, >50 years old, DX routine screening not recommended Torsion of the appendix testes - Correct Answer blue dot sign, blue colored round mass located on testicular surface, polyp like structure attached to testicular surface, infarction and necrosis of the appendix due to torsion, refer to ER Testicular torsion - Correct Answer abrupt onset extremely painful and swollen red scrotum, n/v, affected testes higher and closer to body, the cremasteric reflex is missing, > not corrected in <6 hours permanent damage, if not corrected in 24 hours becomes gangrene, common in males with bell clapper deformity, TX call 911, US doppler preferred test, manual reduction or surgery, elevated PSA, biopsy of prostate tissue, PSA level with DRE TX refer to urologist, individualize screen per risk factors Varicocele - Correct Answer enlargement of the veins within the scrotum, bag of worms, testicular tumor can cause infertility, DX US of scotum, TX surgical removal or varicosities Hydrocele - Correct Answer fluid filed sac around testicle, swelling of scrotum, asymptomatic, DX will glow with transillumination, US of scrotum, TX refer to urologist Direct inguinal hernias - Correct Answer are found in the Hesselbachs triangle indirect inguinal hernia - Correct Answer are common on the right side internal ring Cryptorchidism - Correct Answer a testicle that has not moved into the bag of skin below the penis before birth, maybe one or two, increases risk of testicular cancer BPH - Correct Answer gradual development of urinary obstruction, weak urinary stream, postvoid dribbling, occasional urinary retention, DX PSA is elevated, prostate enlarged, TX alpha adrenergic antagonist-terazosin/Hytrin-first for patients with HTN, Flomax, or Proscar shrinks prostate by 50% 1 / 2
Chronic bacterial prostatis - Correct Answer >6 weeks infection, gradual onset, asymptomatic or UTI,caused by E.coli, suprapubic or perineal pain, irritative voiding, dysuria, nocturia, frequency, DX boggy prostate, urine and prostatic fluid cultures, three tubes, PSA elevated, TX Bactrim, fluoroquinolone Acute prostatis - Correct Answer infections ascends to urinary tract, E.coli, sudden onset of high fever, chills, suprapubic pain perineal discomfort, radiates to back to rectum, UTI, symptoms, DX DRE reveals tender prostate warm and boggy, CBC shows leukocytosis, pyuria, urine culture, TX Ceftriaxone tetracycline, macrolide, fluoroquinolone, refer if septic shock Acute bacterial epididymitis - Correct Answer bacteria ascend the urethra, urethritis, reaching epididymitis, rule out testicular torsion, E coli, swollen red scrotum, unilateral testicular tenderness with urethral discharge, hydrocele with symptoms of UTI, fever, green colored purulent or serous clear discharge, Prehn's sign positive with relief of srotal elevation, DX leukocytosis pyuria, hematuria, Urine culture, test for gonorrhea/chlamydia TX ceftriaxone, doxycycline, or fluoroquinolone Erectile dysfunction - Correct Answer d/t vascular insufficiency, neuropathy, medications, smok,ing alcohol, TX first line TX [hosphodiesterase type 5 inhibitor, Viagra Levitra Peyronie's disease - Correct Answer inflammatory disorder of the penis with firbrotic plaques on the tunica albuginea, penile pain during erection, palpable nodules cause deformity penile erections, may resolve or require surgery, TX refer to urologist Balanitis - Correct Answer candidal infection of the glans penis, diabetic or immunocompromised men, TX topical azole cream, treat partner too Phimosis - Correct Answer foreskin cannot be pushed back d/t edema, seen in neonates Womens health Dominant breast/breast cancer - Correct Answer mass one side feels hard, irregular, immobile, located tail of spence, skin color peau d orange (resembles orange peel), dimpling retraction, painless, bloody nipple discharge, DX order mammogram, refer to breast surgeon Paget's disease of breast - Correct Answer chronic red scaly rash resembling eczema starts on nipple and spreads to areola, itching, pain, burning sensation, skin lesion enlarges incl crusting, ulceration and bleeding at the nipple Inflammatory breast cancer - Correct Answer recent or acute onset red swollen warm area in breast of younger woman, mimics mastitis, no lump, may pit, turn orange, appear bruised, rare but aggressive breast cancer
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