CMN 577 UNIT 1 EXAM WITH CORRECT
ANSWERS
Why is massaging the prostate in suspected acute prostatitis contraindicated? -
Answer-The expression of prostate secretions is contraindicated in acutely inflamed
prostatitis due to the risk of septicemia. These pts often already have a toxic
appearance- high fever, warm, exquisitely tender prostate upon exam, + perineal or
suprapubic pain, & + Urine CX "which will demonstrate the offending pathogen".
McPhee
Why is it OK to massage the prostate in suspected chronic prostatitis? - Answer-
Although it may have evolved from an acute infection, most cases have no HX of acute
infections- thus these pts are often asymptomatic except for some dull, possibly
localized aches and irritative voiding issues & their PE is often unremarkable (but pt
may possibly have a normal, boggy, or indurated prostate). In these non-toxic appearing
pts, the UA is usually normal, thus a culture of the expressed prostatic secretions is
needed to make the DX.
McPhee
Essentials of dx: Acute bacterial prostatitis - Answer-+ Exquisitely tender rectal exam
+ Fever
+ Positive urine culture (usu e coli or psuedomonas)
McPhee
Treatment of acute bacterial prostatitis - Answer-Usually quinolone tx x 4 - 6 days.
If culture indicates another pathogen, it might be ampicillin or something else.
NOTE: RE-CULTURE AFTER TREATMENT! Because the pathogen could concentrate
in the prostate
Men's Health Video
Types of patients that suffer from prostatodynia - Answer-Young, middle aged men.
Mens Health video.
Sx of acute epididymitis - Answer-+ "hurts when i pee"
,+ Inflamed, enlarged epididymis
+ Pain radiates from scrotum to flank (opposite direction of pain in nephrolithiasis)
Men's Health Video
Presentation of pain in men with urinary stone dz - Answer-+ Severe flank pain that is
CONSTANTLY MOVING (unlike acute abdomen, which is usually stationary)
+ Severe n/v
+ Pain can radiate to testicles as stone progresses down ureter.
+ Most common place to get lodged is the uretero-vesicular junction. (Flomax can
provide some relief in this case.)
Men's Health Video
Treatment of urinary stones - Answer-NOTE: > 7 mm = REFER TO UROLOGY
(because those stones are not going anywhere!)
+ Alpha blockers, NSAIDS, corticosteroids, pain meds. (Toradol works wonders!)
Men's Health video
Sexual dysfunction that occurs frequently in male sickle cell patients? - Answer-
Priapism
Men's Health Video
Labs for pts with erectile dysfunction - Answer-Lipids, glucose, testosterone, prolactin
Men's Health Video
S/S of acute intermittent porphyria - Answer-+ Abdominal pain of varying severity
+ Absence of fever or leukocytosis
+ Peripheral neuropathy (symmetric OR asymmetric)
+ CNS sx (seizures, altered consciousness, psuychosis, abnormalities of basal ganglia)
+ Hyponatremia
McPhee p 1690
Labs for acute intermittent porphyria - Answer-+ Hyponatremia
+ Urine which turns dark when exposed to light or air (r/t porphobilonogen excretion)
McPhee p 1690
Prevention of attacks in pts with acute intermittent porphyria - Answer-+ Sulfanoamides
and barbituates
+ Starvation or prolonged fasting
, + Hormone changes during pregnancy
McPhee p 1690
Typical patient with AIP - Answer-Young female
McPhee p 1690
Treatment for acute intermittent porphyria (AIP) - Answer-+ High carb diet
+ Analgesics and IV glucose in saline and hematin
McPhee p 1691
Cause of acute intermittent porphyria (AIP) - Answer-Genetic condition, inherited as an
autosomal dominant condition.
Pts have mutation in HMBS
McPHee p 1690
At what point in pregnancy can Down Syndrome be detected, and what tests are used?
- Answer-+ Down syndrome can be detected in the 1st or early 2nd trimester
+ Screen maternal serum for alpha-fetoprotein (should be LOW) and other biomarkers
(multiple marker screening)
+ Detecting nuchal thickness and underdevelopment of nasal bone on ultrasonography.
McPhee p 1692
s/s of Down Syndrome - Answer-+ Typical craniofacial features (flat occiput, epicanthal
folds, large tongue)
+ Hypotonia
+ Single palmar crease
+ Congenital heart defects (50% of pts)
McPhee p 1692
Hematuria --What do proteinuria and casts in urinalysis suggest? - Answer-Renal origin
McPhee p 962
What do irritative voiding sx, bacteruria and a positive urine culture suggest in the
female patient? - Answer-Urinary tract infection
McPhee p 962
T/F - Urine cytology is recommended in the evaluation of asymptomatic microscopic
hematuria. - Answer-FALSE
ANSWERS
Why is massaging the prostate in suspected acute prostatitis contraindicated? -
Answer-The expression of prostate secretions is contraindicated in acutely inflamed
prostatitis due to the risk of septicemia. These pts often already have a toxic
appearance- high fever, warm, exquisitely tender prostate upon exam, + perineal or
suprapubic pain, & + Urine CX "which will demonstrate the offending pathogen".
McPhee
Why is it OK to massage the prostate in suspected chronic prostatitis? - Answer-
Although it may have evolved from an acute infection, most cases have no HX of acute
infections- thus these pts are often asymptomatic except for some dull, possibly
localized aches and irritative voiding issues & their PE is often unremarkable (but pt
may possibly have a normal, boggy, or indurated prostate). In these non-toxic appearing
pts, the UA is usually normal, thus a culture of the expressed prostatic secretions is
needed to make the DX.
McPhee
Essentials of dx: Acute bacterial prostatitis - Answer-+ Exquisitely tender rectal exam
+ Fever
+ Positive urine culture (usu e coli or psuedomonas)
McPhee
Treatment of acute bacterial prostatitis - Answer-Usually quinolone tx x 4 - 6 days.
If culture indicates another pathogen, it might be ampicillin or something else.
NOTE: RE-CULTURE AFTER TREATMENT! Because the pathogen could concentrate
in the prostate
Men's Health Video
Types of patients that suffer from prostatodynia - Answer-Young, middle aged men.
Mens Health video.
Sx of acute epididymitis - Answer-+ "hurts when i pee"
,+ Inflamed, enlarged epididymis
+ Pain radiates from scrotum to flank (opposite direction of pain in nephrolithiasis)
Men's Health Video
Presentation of pain in men with urinary stone dz - Answer-+ Severe flank pain that is
CONSTANTLY MOVING (unlike acute abdomen, which is usually stationary)
+ Severe n/v
+ Pain can radiate to testicles as stone progresses down ureter.
+ Most common place to get lodged is the uretero-vesicular junction. (Flomax can
provide some relief in this case.)
Men's Health Video
Treatment of urinary stones - Answer-NOTE: > 7 mm = REFER TO UROLOGY
(because those stones are not going anywhere!)
+ Alpha blockers, NSAIDS, corticosteroids, pain meds. (Toradol works wonders!)
Men's Health video
Sexual dysfunction that occurs frequently in male sickle cell patients? - Answer-
Priapism
Men's Health Video
Labs for pts with erectile dysfunction - Answer-Lipids, glucose, testosterone, prolactin
Men's Health Video
S/S of acute intermittent porphyria - Answer-+ Abdominal pain of varying severity
+ Absence of fever or leukocytosis
+ Peripheral neuropathy (symmetric OR asymmetric)
+ CNS sx (seizures, altered consciousness, psuychosis, abnormalities of basal ganglia)
+ Hyponatremia
McPhee p 1690
Labs for acute intermittent porphyria - Answer-+ Hyponatremia
+ Urine which turns dark when exposed to light or air (r/t porphobilonogen excretion)
McPhee p 1690
Prevention of attacks in pts with acute intermittent porphyria - Answer-+ Sulfanoamides
and barbituates
+ Starvation or prolonged fasting
, + Hormone changes during pregnancy
McPhee p 1690
Typical patient with AIP - Answer-Young female
McPhee p 1690
Treatment for acute intermittent porphyria (AIP) - Answer-+ High carb diet
+ Analgesics and IV glucose in saline and hematin
McPhee p 1691
Cause of acute intermittent porphyria (AIP) - Answer-Genetic condition, inherited as an
autosomal dominant condition.
Pts have mutation in HMBS
McPHee p 1690
At what point in pregnancy can Down Syndrome be detected, and what tests are used?
- Answer-+ Down syndrome can be detected in the 1st or early 2nd trimester
+ Screen maternal serum for alpha-fetoprotein (should be LOW) and other biomarkers
(multiple marker screening)
+ Detecting nuchal thickness and underdevelopment of nasal bone on ultrasonography.
McPhee p 1692
s/s of Down Syndrome - Answer-+ Typical craniofacial features (flat occiput, epicanthal
folds, large tongue)
+ Hypotonia
+ Single palmar crease
+ Congenital heart defects (50% of pts)
McPhee p 1692
Hematuria --What do proteinuria and casts in urinalysis suggest? - Answer-Renal origin
McPhee p 962
What do irritative voiding sx, bacteruria and a positive urine culture suggest in the
female patient? - Answer-Urinary tract infection
McPhee p 962
T/F - Urine cytology is recommended in the evaluation of asymptomatic microscopic
hematuria. - Answer-FALSE
