02b: Prostate

Question 1

Majority of blood to prostate comes from (X) artery off of (Y) artery.

Answer 1

X = inferior vesical
Y = internal pudendal

Question 2

Most common malignancy in males 15-35 years old:

Answer 2

Testicular cancer

Question 3

T/F: No major genetic factors for testicular cancer.

Answer 3

True

Question 4

Which aspect of history would put patient at risk for testicular cancer?

Answer 4

Undescended testis

Question 5

Diagnosis of testicular cancer via:

Answer 5

Hx, PE, and scrotal ultrasound

Question 6

Rx for testicular cancer:

Answer 6

1. Surg excision of testicle (inguinal approach)

2. Chemo (super effective, even with metastasis)

Question 7

Which tumor markers can be followed to assess efficacy of Rx for testicular cancer?

Answer 7

1. AFP
2. bHCG
3. LDH

Question 8

BPH treatment regimen:

Answer 8

1. Alpha blockers (terazosin, doxazosin, tamsulosin, Alfuzosin)
2. 5a-reductase inhibitors (Finasteride, Dutasteride)

Question 9

Function of alpha blocker Rx in BPH:

Answer 9

Relax smooth muscle at bladder neck

Question 10

Pt being treated for BPH: PSA will decrease by as much as (X)% due to (Y) meds.

Answer 10

X = 50
Y = 5a-reductase inhibitors

Question 11

T/F: BPH Rx regimen will not affect sexual function.

Answer 11

False - 5a-reductase inhibitors have potential sexual side effects (can be irreversible!)

Question 12

T/F: No major genetic factors for prostate cancer.

Answer 12

False - positive FHx and HPC1 gene are risk factors

Question 13

(High/low) (X) diet is risk factor for prostate cancer:

Answer 13

High

X = fat

Question 14

Why is PSA high in prostate cancer?

Answer 14

Cancer cells have destabilized basement membrane, so more leaks out

Question 15

“Med castration” for prostate cancer can include which hormonal treatments?

Answer 15

1. GnRH agonist (Lupron)
2. Estrogen
3. Antiandrogens

Question 16

What’s the next step in Rx for patients with metastatic prostate cancer who have failed hormonal therapy?

Answer 16

Chemo (with goals to contain cancer and alleviate pain)

Question 17

Standard chemo Rx for prostate cancer includes (X). What’s the mechanism of action?

Answer 17

X = Abiraterone (in combo with prednisone)

Inhibits 17a hydroxylase (thus inhibiting androgen synthesis)

Question 18

Predominant blood supply to penis:

Answer 18

Internal pudendal a

Question 19

Which a predominantly responsible for blood supply to erectile tissue of penis?

Answer 19

Cavernosal a (runs through corpus cavernosa)

Question 20

T/F: Urethra runs through corpus cavernosa.

Answer 20

False - corpus spongiosum

Question 21

55 yo M smoker presents with complaints of erectile dysfunction. What do you suspect is the cause? What would you test for?

Answer 21

Arteriogenic (atherosclerotic);

DM, CAD, cholesterol, etc.
Check for distal pulses

Question 22

What are some endocrine diseases that cause erectile dysfunction?

Answer 22

1. DM
2. Thyroid disease
3. Testosterone deficiency

Question 23

Basic workup for erectile dysfunction includes which labs?

Answer 23

1. T, LH
2. TSH
3. Lipid/cholesterol panel
4. HbA1c
5. Prolactin

Question 24

Which PDE5 inhibitor would you recommend for patient with ED that is already paying for multiple meds?

Answer 24

Tadalafil (longest half-life, fewer doses; insurance won’t cover)

Question 25

Common side effects of viagra:

Answer 25

HA, flushing, dyspepsia; maybe transient/mild visual effects

Question 26

List the injectable meds for ED:

Answer 26

3 Ps: 1. Papavarine (PDE inhibitor) 2. Prostaglandin E1 (vasodilator) 3. Phenoxybenzamine/phentolamine (alpha-R blockade)

Question 27

T/F: Penile prostheses are last-resort for erectile dysfunction.

Answer 27

True

Question 28

Priapism: (painless/painful) prolonged erection indicates arterial problem. Is this an emergency?

Answer 28

Painless | No; uncontrolled arterial flow

Question 29

Priapism: (painless/painful) prolonged erection indicates venous problem. Is this an emergency?

Answer 29

Painful | Yes, low-flow priapism (blood trapped in erection chambers); penis can become ischemic

Question 30

Rx options for priapism:

Answer 30

Oral meds (sympathomimetics), irrigation, shunts (extreme case)

Question 31

Condyloma on penis caused by:

Answer 31

HPV

Question 32

T/F: Circumcision essentially eliminates risk of penile cancer.

Answer 32

True

Question 33

RFs for penile cancer:

Answer 33

1. Smoking 2. Poor hygiene 3. HPV infection/sex partners

Question 34

Sequence of spermatogenesis:

Answer 34

Spermatogonium, spermatocyte, spermatid, spermatozoan

Question 35

T/F: Exogenous testosterone decreases sperm production.

Answer 35

True

Question 36

Histo: endometrium in (X) phase has multiple simple, tubular glands in stroma with abundant mitotic activity.

Answer 36

X = proliferative

Question 37

Endometrium has (X) epithelium.

Answer 37

X = pseudostratified

Question 38

Day (X) of menstrual cycle begins change from proliferative to secretory endometrium.

Answer 38

X = 16

Question 39

Histo: endometrium in (X) phase has glands with prominent subnuclear vacuoles. There is (high/low) mitotic activity.

Answer 39

X = early secretory No mitoses

Question 40

Day (X) of menstrual cycle: sub- and supra-nuclear vacuoles are seen with apical discharge.

Answer 40

X = 18

Question 41

Histo: endometrium in (X) phase has "saw-toothed" glands and (Y) in gland lumen.

Answer 41

``` X = late secretory Y = secretions ```

Question 42

Max stromal edema in endometrium is seen on day (X) of menstrual cycle.

Answer 42

X = 22

Question 43

Predecidual changes in endometrium include:

Answer 43

Indistinct perviascular aggregates of cells with eosinophilic cytoplasm

Question 44

Stromal granulocytes in endometrium is classic for day (X) of menstrual cycle and represents preparation for:

Answer 44

X = 26 Menstruation (predecidual change; inflammatory cells enter stroma, ready to mop up debris from menstruation)

Question 45

Most common cause of dysfunctional uterine bleeding is:

Answer 45

Anovulatory breakdown (endometrium right around menopause loses ability to respond properly to hormones)

Question 46

Anovulation: excess (progesterone/estrogen) leading to disordered (X)

Answer 46

Estrogen, relative to progesterone X = gland proliferation (super large grands with relative scarcity of stroma)

Question 47

Endometrial hyperplasia is related to abnormally high, prolonged level of (X). Which diseases/situations might cause this?

Answer 47

X = estrogen 1. Menopause/persistent anovulation 2. PCOD 3. Granulosa cell tumors 4. Estrogen replacement Rx 5. Obesity

Question 48

Key histo characteristic that distinguishes high grade from low grade endometrial hyperplasia:

Answer 48

Presence of atypia

Question 49

20% of endometrial cancer is (X) type with (Y) cells. This type is (less/more) aggressive and (dependent/non-dependent) on estrogen.

Answer 49

X = non-endometrioid Y = serous, clear More Non-dependent

Question 50

Endometrioid Adenocarcinoma grade depends on % of:

Answer 50

Solid growth pattern (non-squamous/non-morular); | G1 is up to 5%, G2 is 6-50%, G3 is over 50%

Question 51

Presence of plasma cell in endometrial stroma is pathognomonic for:

Answer 51

Chronic endometritis

Question 52

List some etiologies for chronic endometritis:

Answer 52

1. Chronic PID 2. Postpartm (retained gestational tissue) 3. IUD 4. TB or other infections (chlamydia)

Question 53

A(n) (X) cyst is also called a "chocolate cyst".

Answer 53

X = endometriotic (filled with degenerated blood products)

Question 54

A mass of benign endometrial glands/stroma projecting into endometrial cavity.

Answer 54

Endometrial polyp

Question 55

Hydatidiform moles tend to occur in (older/younger) women.

Answer 55

Two ends of spectrum (below 20 and over 45)

Question 56

Which classic symptom would a woman with hydatidiform mole present with?

Answer 56

Bleeding in either late 1st T or early 2nd T

Question 57

T/F: Hx of hydatidiform mole puts woman at higher risk of having future incidence of moles.

Answer 57

True

Question 58

p57 staining will be positive in (complete/partial) hydatidiform mole.

Answer 58

Partial (imprinted gene is maternally expressed)

Question 59

T/F: Choriocarcinomas are highly malignant but also highly responsive to chemo.

Answer 59

True