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NR511 FINAL EXAM STUDY GUIDE. A+ RATED.

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NR 511 / NR511 FINAL EXAM STUDY GUIDE Week 5 Identify the population most commonly affected by bacterial prostatitis: Acute bacterial prostatitis occurs predominantly in sexually active men between the ages of 30 and 50 years old, whereas chronic bacterial prostatitis is most common in men older ...

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  • February 16, 2022
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  • 2022/2023
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NR 511 / NR511 FINAL EXAM STUDY
GUIDE
Week 5

Identify the population most commonly affected by bacterial prostatitis: Acute bacterial
prostatitis occurs predominantly in sexually active men between the ages of 30 and 50 years old,
whereas chronic bacterial prostatitis is most common in men older than 50.

Prostatitis (Acute, chronic, nonbacterial)

Risk factors

Age> 50 yrs, Hx of prostate calculi, BPH, prev. UTI, recurrent UTIS

acute and chronic-> strep. Faecalis and staph. Aureus are most common

physical exam: abd. Exam to detect distended bladder, costovertebral angle tenderness, genital
exam, digital rectal exam

acute: warm, tense, swollen, boggy and very tender prostate vs chronic: normal or little boggy

diagnostic testing: U/A (PYURIA + for all three), midstream urine cand s, 츛, urethral swab for
GC AND CT, cystoscopy, transrectal ult

Acute-- treatment

14 to 28 day regimen-cipro 500 mg q 12 hr, levofloxacin 500mg daily or doxycycline or TMP-
SMX

STD coverage for ABP; single dose IM ceftriaxone 250 mg + single dose azithromycine or doXy
100 mg BID 7 D

Supportive measure: antipyretics, nsaids, hydration, stool softeners

Chronic-treatment

5 to 12 week antibiotic course with same meds + alpha-blocking agents to relax the smooth
muscles around prostate

Nonbacterial prostatitis- treatment

FEFER TO UROLOGIST

,Discuss the physical exam characteristics of acute bacterial prostatitis: urinary complains
(frequency, urgency, nocturia, dysuria) pain & discomfort (LBP, penile, scrotal pain, fever,
chills, malaise or painful ejaculation, arthralgia, myalgia)

Chronic bacterial s/s: symptoms often absent, perineal pain, LBP, lower abd. Pain, scrotal or
penile pain, pain with ejaculation, dysuria…

Discuss how the Phren sign can differentiate between testicular torsion and epididymitis:
The most common symptom in testicular torsion is sudden, severe pain accompanied by swelling
of the affected testis. The patient may have pain for several days without seeking medical
attention. The most common finding on clinical exam is the absence of the cremasteric reflex and
unlike in epididymitis, elevation of the affected testis does not relieve the pain (negative Phren’s
sign).

Epididymitis

Can affect any age in male, Hx of unprotected intercourse, a new sexual partner, Hx of UTI or
urinary discharge

Symptoms

Unilateral scroll pain which radiates along the spermatic cord or to the flank

HALLMARK SYMPTOM: RELIEF OF DISCOMFORT WITH ELEVATION OF
TESTIS AND EPIDIDYMIS

Tx: same antibiotics ceftriaxone 250mg IM TIMES 1 and azythromycine 1 gm po times 1



BPH

Most common condition in males > 40 yrs

Risk factors: ?

Size does not correlated with severity of symptoms

BPH= smooth and enlarged, if hard, suspect cancer

Treatment

, Avoid caffeine and alcohol

Conservative tx vs surgery

Alpha blockers (relax smooth muscle)Tamsulosine 0.4-0.8mg qd, doxazosin 4-8 mg qd

5-alpha-reductade inhibitors finasteride 5mg qd or dutasteride 0.5 mg qd

Testicular torsion- twisting or rotation of the testes around the spermatic cord, blocking blood
to the testes UROLOGICAL EMERGENCY!! (> 6 hrs, viability 10-15%, >24 hrs, below
10%)

Sx: mostly seen in adolescent and young adults; trauma, exercise, extreme cold,

absence of the cremasteric reflex, unlike in epididymitis, elevation of the affected testis does
NOT relieve pain (Phrens’s sign)



Discuss common symptoms reported from a patient with BPH:

Obstructive symptoms include

 decreased stream
 hesitancy
 postvoid dribbling
 sensation of incomplete bladder emptying
 overflow incontinence
 inability to voluntarily stop the urine stream
 urinary retention
 straining

Irritative symptoms include

 nocturia
 urinary frequency
 urinary urgency
 dysuria
 urge incontinence



Discuss the hallmark characteristic of a varicocele: Sensation that the testes feel like a “bag of
worms

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