Andropause

Question 1

andropause is a.k.a

Answer 1

Late Onset Hypogonadism or partial androgen deficiency of the aging male

Question 2

Andropause is menopause in men T/F

Answer 2

F

Question 3

When will testosterone start to decline?

Answer 3

40 y.o

Question 4

T/F Osteoporosis, muscle loss and cognitive change is common to andropause and menopause

Answer 4

T

Question 5

What enzyme converts Testosterone to DHT?

Answer 5

5-a-reductase

Question 6

When does testosterone peak?

Answer 6

8-11AM

Question 7

When is testosterone lowest?

Answer 7

before waking up

Question 8

Side effects of anabolic steroids

Answer 8

aggression, testicular atrophy

Question 9

What modulates testosterone synthesis?

Answer 9

LH

Question 10

What secretes testosterone?

Answer 10

Leydig Cells

Question 11

T/F there is decreased Leydig cells in older men, thus decline in testosterone production

Answer 11

T

Question 12

How much of testosterone is bound to SHBG?

Answer 12

98%; biologically inactive

Question 13

[Increase/Decrease]

SHBG in obese

Answer 13

increase

Question 14

When does prostate start to enlarge?

Answer 14

age 50

Question 15

T/F In patients with prostatic cancer, administration of
exogenous testosterone can cause cancer to
metastasize

Answer 15

T

Question 16

The following are true about PADAM except
a. decreased visceral fat
b. ical Manifestations
c. Changes in mood and sleep pattern, decreased
intellectual activity, irritability
d. Decreased lean body mass, muscle volume, and
strength
e. Decreased body hair and skin alterations

Answer 16

A

Question 17

The following are true about PADAM except
a. Development of gynecomastia
b. Decreased bone mineral density  osteoporosis
c. ncreased visceral fat
d. Decreased sexual desire, erectile quality, orgasms,
and ejaculation
e. Lower levels of testosterone always mean PADAM

Answer 17

E

Question 18

When is it best to do testosterone testing?

Answer 18

8-11AM

Question 19

You are hypogonadal when your testosterone levels are

Answer 19

<200ng/L

Question 20

What is best assay for testosterone testing?

Answer 20

Equilibrium analysis

Question 21

How to rule out carcinoma?

Answer 21

PSA and DRE

Question 22

Complex associated abnormalities due to metabolic syndrome (androgen and glucose)

Answer 22

Increased risk for CV and DM

Question 23

3 criminals of andropause

Answer 23

Metabolic Syndrome, late onset hypogonadism, erectile dysfunction

Question 24

Testosterone deficiency leads to

Answer 24

reduced lipolysis, reduced metabolic rate, visceral fat deposition, and insulin resistance

Question 25

Central obesity: waist circumference: Caucasians, Asians

Answer 25

>=94cm, >=90cm

Question 26

``` Metabolic Syndrome Values Increased triglycerides Decreased HDL Systolic: Diastolic:: Increased fasting plasma glucose: ```

Answer 26

>1.7 mmol/L (≥150 | mg/dL);<40 mg/dL); ≥130 mmHg; ≥85 mmHg;≥5.6 mmol/L (100 mg/dL) or Type II DM;

Question 27

How to treat Hypogonadism?

Answer 27

``` Hormone supplementation: IM 200mg monthly; Oral prep Testosterone undecanoate (andriol 40 mg); Mesterolone (proviron 25 mg) Transdermal testosterone injectable: Nebido® 5α-reductase inhibitors ```

Question 28

alkylated forms of oral hormone supplementation may cause ________;Large doses can lead to ____________________

Answer 28

Liver disease;;hepatitis, cholestatic jaundice possibly hepatoma

Question 29

Effect testosterone on nitrogen retention and protein synthesis

Answer 29

increase; thus increase in skeletal muscle mass and strength.

Question 30

Effect of Testosterone Replacement

Answer 30

- Slow bone degradation and increase bone mineral density - increase in total and LDL cholesterol - Improvement in mood and reverse depression - More concentration and more positive approach to life

Question 31

You may absolutely not undergo testosterone replacement if you have the ff except a. Prostate Specific Antigen (PSA) > 4 ng/ml b. Abnormal DRE findings c. Polycythemia d. Snoring e. Severe cardiac insufficiency

Answer 31

D

Question 32

You may absolutely not undergo testosterone replacement if you have Snoring a. Lower Urinary Tract Syndrome (LUTS) b. increased red blood cells, hemoglobin (>60) c. Hyperlipidemia d. Respiratory difficulties

Answer 32

B

Question 33

T/F testosterone supplementation may increase cerebrovascular accident due to thickness of blood

Answer 33

T

Question 34

If symptoms persist even after testosterone replacement, what will you do?

Answer 34

Stop treatment

Question 35

Which division of the nervous system is responsible for erection?

Answer 35

parasympathetic nervous system

Question 36

Erectile dysfunction is related to

Answer 36

endothelial dysfunction

Question 37

``` True about erection a. Erectile dysfunction is a CV problem b. ED may be a sign of atherosclerosis c. Erection is a neurovascular event D. AOTA ```

Answer 37

D

Question 38

T/F Erections need testosterone

Answer 38

F

Question 39

Most important risk factors for ED

Answer 39

``` o Age o Cardiovascular disease o Hyperlipidemia o Diabetes mellitus o Drug side-effects o Smoking ```

Question 40

What is most notorious risk for erectile dysfunction

Answer 40

Diabetes

Question 41

T/F desire is associated with erection

Answer 41

F; it is associated with testosterone

Question 42

True about Sexual Function in the Elderly Except a. Actual latent period between sexual stimulation and erection increases b. no change in erectile turgidity c. Ejaculation is not as explosive d. Volume of ejaculate is less e. Refractory period is longer.

Answer 42

B

Question 43

What are aphrodisiacs for?

Answer 43

increase appetite for sexual activity, but does not enhance erection

Question 44

Enumerate aphrodisiacs

Answer 44

Malunggay, ginseng, ginger, celery, onions, okra, | jackfruit, coconut, milk, durian, avocado

Question 45

Give the reason for gynecomastia

Answer 45

decreased testosterone and increase in estradiol and estrone

Question 46

indole alkaloid causing blood vessel dilation and increase | blood flow; α-2 receptor blocker

Answer 46

Yohimbine

Question 47

side effects of yohimbine

Answer 47

palpitations, tremor, hypertension, anxiety and nausea

Question 48

with antiplatelet property that improves vascular endothelial abnormalities and release of nitric oxide, increases interest in sex, increases performance

Answer 48

Ginseng

Question 49

mainly for dementia, no difference between placebo, improves memory

Answer 49

Gingkgo biloba

Question 50

precursor of nitric oxide, no addition benefit noted vs. placebo, need high dose (5 g) to show difference

Answer 50

L-Arginine

Question 51

effect of zinc on erections

Answer 51

none

Question 52

Enumerate Phosphodiesterase-5 Inhibitors

Answer 52

Sildenafil (Viagra) Vardenafil Tadalafil (Cialis) Udenafi

Question 53

Mode of action of phosphodiesterase-5-inhibitors

Answer 53

blockage of PDE-5 increases cGMP levels, leading to persistent, continued erection; PDE-5 inhibitor does not increase production of cGMP per se, but only slows down its break down

Question 54

Contraindications of Phosphodiesterase-5 Inhibitors

Answer 54

patients taking nitrates, patients with congestive heart failure or previous heart attack, In patients taking alpha-blockers (for BPH), antihypertensive drugs

Question 55

Enumerate treatment options for erectile dysfunction

Answer 55

``` VCD’s (vacuum constriction devices) Intraurethral injection (MUSE) inject vasodilators (Prostaglandin E1, papaverine) into penis, Penile prosthesis Intracavernosal injection, Oral therapy ```