Hypospadias is opening of the __ on the __ surface of the penis. It is due to the failure of ___.
urethra; inferior surface; urethral folds to close
Epispadias is opening of the __ on the __ surface of the penis. Due to abnormal ___. Associated with ___.
urethra; superior; positioning of the genital tubercle; bladder exstrophy (complete exposure of bladder wall) Rarer than hypospadias
Condyloma acuminatum are benign/malignant __ growth on __ skin. Due to __. Characterized by __.
benign; warty; genital; HPV type 6 or 11; koilocytic change
Lymphogranuloma venerum is ___ inflammation of the __ and __. It is a sexually transmitted disease caused by ___ (serotypes __). Eventually heals with __. Perianal involvement may result in ___.
necrotizing granulomatous; inguinal lymphatics; lymph nodes; Chlamydia trachomatis; L1-L3; fibrosis; rectal stricture
Squamous cell carcinoma of the penis is a benign/malignant proliferation of __ cells of __ skin. Risk factors include ___ (2/3 of cases) and __ (__ acts as a nidus for inflammation and irritation if not properly maintained)
malignant; squamous; penile; high risk HPV (16, 18, 31, 33); lack of circumcision; foreskin
Name the 3 precursor in situ lesions of squamous cell carcinoma of the penis
1) Bowen disease; 2) Erythroplasia of Queyrat; 3) Bowenoid papulosis
Bowen disease is ___ of the penile __ or __ that presents as ___. It is a precursor of squamous cell carcinoma of the penis.
in situ carcinoma; shaft; scrotum; leukoplakia
Erythroplasia of Queyrat is ___ on the __ that presents as ___. It is a precursor of squamous cell carcinoma of the penis.
in situ carcinoma; glans; erythroplakia
Bowenoid papulosis is __ that presents as multiple __. Seen in older/younger pts relative to Bowen disease and erythroplasia of Queyrat. Does/does not progress to invasive carcinoma.
in situ carcinoma; reddish papules; younger (40s); does not
Of the 3 precursor in situ carcinomas of squamous cell carcinoma of the penis, which one presents as leukoplakia? multiple reddish papules? erythroplakia? seen in younger pts? presents on the glans? on the scrotum? does not progress to invasive carcinoma?
Bowen disease; Bowenoid papulosis; erythroplasia of Queyrat; BP; EoQ; scrotum = BD; BP
Cryptorchidism is the failure of ___. Testicles normally develop in the __ and then __ into the __ as the fetus grows. Seen in __% of male infants. Most cases resolve spontaneously, otherwise, __ is performed before __ yrs of age.
testicle to descend into scrotal sac; abdomen; descends; scrotal sac; 1; orchiopexy; 2
Complications of cryptocorchidism include __ and __.
testicular atrophy with infertility; increased risk for seminoma
What is the most common congenital male reproductive abnormality?
Orchitis is __ of the __. Name 4 causes.
inflammation; testicle; 1) Chlamydia/Gonorrhoeae; 2) E coli/pseudomonas; 3) mumps virus; 4) autoimmune orchitis
Chlamydia trachomatis (serotypes ___) or Neisseria gonorrhoaea causes orchitis in ___. Increased risk of __, but __ is not affected because __ are spared.
D-K; young adults; sterility; libido; Leydig cells
E coli and pseudomonas causes orchitis seen in __. __ pathogens spread into the ___. Autoimmune orchitis is characterized by __ involving the ___.
older adults; urinary tract infection; reproductive tract; granulomas; seminiferous tubules
Mumps virus causes orchitis seen in __. It increases risk for __. Testicular inflammation is usually not seen in ___. Mumps virus can cause inflammation of these 4 areas.
teenage males; infertility; children less than 10; parotid gland, meninges, pancreatitis, and orchitis
Testicular torsion is twisting of the __. Thin walled __ become obstructed leading to __ and __. Usually due to congenital failure of ___ to attach to the inner lining of the __ (via the __). Presents in __ with sudden __ and absent __.
spermatic cord; veins; congestion; hemorrhagic infarction; testes; scortum; processus vaginalis; adolescents; testicular pain; cremasteric reflex
Varicocele is dilation of the __ due to __. Presents as __ with a '___' appearance. Usually right/left sided, because the __ testicular vein drains in to the __ renal vein, while the __ testicular vein drains in to the IVC. Associated with __, since it usually invades the renal vein. Varicocele is seen in a large percentage of ___.
spermatic vein; impaired drainage; scrotal swelling; bag of worms; left; left; left; right; left-sided RCC; infertile males (extra blood near testicle might increase temp leading to infertility)
Hydrocele is a __ collection within the ___, which is a serous membrane that covers the __ as well as the inner surface of the __.
fluid; tunica vaginalis; testicle; scrotum
Hydrocele is associated with incomplete closure of the __ leading to communication with the __ (infants) or blockage of ___ (adults). It presents as __ that can be __.
processus vaginalis; peritoneal cavity; lymphatic drainage; scrotal swelling; transilluminated (pass strong light through in order to detect disease or abnormality)
Testicular tumors arise from __ or __. They present as a firm, painful/painless testicular mass that can/cannot be transilluminated. Usually not __ due to risk of seeding the ___. Removed via ___. Most are ___.
germ cells; sex cord-stroma; painless; cannot (different from hydrocele); biopsied; scrotum; radical orchiectomy; malignant germ cell tumors
What is the most common type of testicular tumor? What is the most common testicular tumor? Most common in children? Most common cause of a testicular mass in males greater than 60?
germ cell (greater than 95% of cases); seminoma; yolk sac tumor; lymphoma
Germ cell tumors usually occur btwn __ yrs of age. Risk factors include __ and __. They are divided into __ and __.
15-40; cryptorchidism; Klinefelter syndrome; seminoma; non-seminoma
Seminomas (55% of cases) and non-seminomas (45%) are germ cell tumors. Which is highly responsive to radiotherapy? which shows variable response? Which metastasizes late? Which early? Which has excellent prognosis?
seminoma; nonseminoma; S; NS; S
Seminoma is a benign/malignant tumor comprised of __ with __ cytoplasm and central/peripheral nuclei (resemble spermatogonia). They form a __ mass with/without hemorrhage or necrosis.
malignant; large cells; clear; central; homogenous; without
Testicular seminoma resembles an ovarian ___. In rare cases, it may produce ___. Has a good/poor prognosis and responds/is refractory to radiotherapy
dysgerminoma; B-hCG; good; responds
Name 5 non-seminoma testicular tumors
1) embryonal carcinoma; 2) yolk sac tumor; 3) choriocarcinoma; 4) teratoma; 5) mixed germ cell tumors
Embryonal carcinoma is a benign/malignant tumor comprised of __ that may produce ___. Forms a __ mass with ___. It is aggressive with early ___. __ may result in differentiation into another type of germ cell tumor (e.g. teratoma). Increased __ or __ may be present.
malignant; immature, primitive cells; glands; hemorrhagic; necrosis; hematogenous spread (embryo like, so its made to be aggressive); chemotherapy; AFP (usually think yolk sac tumor); B-hCG (usually think choriocarcinoma)
Yolk sac (___) tumor is a benign/malignant tumor that resembles yolk sac elements. Most common testicular tumor in ___. ___ (glomerulus like structures) are seen on histology. __ is characteristically elevated.
endodermal sinus; malignant; children; Schiller-Duval bodies; AFP
Choriocarcinoma is a benign/malignant tumor of __ and __ (__-like tissue, but __ are absent). Spreads early/late via __. __ is characteristically elevated, and may lead to __ or __, since the __ subunit of it is similar to that of these 3 hormones).
malignant; syncytiotrophoblasts; cytotrophoblasts; placenta; villi; early; blood (trophoblasts are programmed to find bv's); B-hCG; hyperthyroidism; gynecomastia; alpha; FSH, LH, and TSH
Teratoma is a tumor composed of ___ derived from ___. It is benign/malignant in males (as opposed to females). __ or __ may be increased.
mature fetal tissue; 2 or 3 embryonic layers; malignant; AFP; B-hCG
Mixed germ cell tumors: germ cell tumors are usually ___. Prognosis is based on the ___ component.
Sex cord-stromal tumors are tumors that resemble sex cord-stromal tissues of the testicle. Usually benign/malignant. Name two types of tumors.
benign; Leydig cell tumor; Sertoli cell tumor
Leydig cell tumor usually produces ___, causing ___ in children or __ in adults. Characteristic __ may be seen on histology. Sertoli cell tumor is comprised of __ and is usually ___.
androgen; precocious puberty; gynecomastia; Reinke crystals; tubules; clinically silent
Lymphoma is the most common cause of a testicular mass in males ___ years old. Often unilateral/bilateral. Usually of ___ type.
greater than 60; bilateral; diffuse large B-cell type
Prostate is a small round organ that lies at the base of the __ encircling the __. It sits anterior to the __. The posterior aspect of prostate is palpable by __. Prostate consists of __ and __.
bladder; urethra; rectum; digital rectal exam (DRE); glands and stroma
The glands of the prostate are composed of an inner layer of __ and an outer layer of __. They secrete acidic/alkaline __ that is added to sperm and __ fluid to make __. Glands and stroma are maintained by __.
luminal cells; basal cells; alkaline; milky; seminal vesicle; semen; androgens
Acute prostatitis is acute __ of the prostate, usually due to ___. ___ are the most common causes in young adults, and __ are the most common causes in older adults.
inflammation; bacteria; Chlamydia trachomatis and Neisseria gonorrhoeae; Escherichia coli and Pseudomonas
Acute prostatitis presents as __ with __ and __. Prostate is __ and __ on digital rectal exam. Prostatic secretions show __. Culture reveals __.
dysuria; fever; chills; tender; boggy; WBCs; bacteria
Chronic prostatitis is chronic __ of the prostate. Presents as __ with __ or __. Prostatic secretions show ___. Culture reveals __.
inflammation; dysuria; pelvic or low back pain; WBCs; negative
Benign prostatic hyperplasia (BPH) is hyperplasia of prostatic __ and __. It is a __-related change, with increased/no increased risk for cancer. It occurs in the __ zone of the prostate.
stroma and glands; age (present in most men by age 60); no increased; central periurethral
BPH is related to ___. Testosterone is converted to __ by __ in __ cells. __ acts on the androgen receptor of __ and __ cells resulting in __ nodules.
dihydrotestosterone (DHT); DHT; 5-alpha reductase; stromal; DHT; stromal and epithelial; hyperplastic
Name 6 clinical features of BPH
1) problems startng/stopping urine stream; 2) impaired bladder emptying w/inc risk for infxn and hydronephrosis; 3) dribbling; 4) hypertrophy of bladder wall smooth muscle (inc risk for bladder diverticula); 5) microscopic hematuria; 6) PSA slightly elevated
Impaired bladder emptying can occur due to BPH and can increase risk for __ and __. Hypertrophy of bladder wall smooth muscle can occur due to BPH and can increase risk for __.
infection; hydronephrosis; bladder diverticula
PSA is often slightly elevated in BPH (usually less than __ng/ml) due to increased __. PSA is made by __ and liquefies semen.
10; number of glands; prostatic glands
BPH can be treated with __ or __. __ is used to relax smooth muscle, and also relaxes vascular smooth muscle lowering ___. Selective __ (e.g. __) are used in normotensive individuals to avoid __ effects on bv's.
alpha 1 antagonists or 5-alpha reductase inhibitors; alpha 1 antagonists (terazosin); blood pressure; alpha 1A antagonists (tamulosin); alpha1B
5-alpha reductase inhibitors block conversion of __ to __, and is used in the treatment of BPH. Takes days/weeks/months to produce results. Also useful for ___. Side effects are __ and __.
testosterone; DHT; months; male pattern baldness; gynecomastia; sexual dysfunction
What is the most common cancer in men?
Prostate adenocarcinoma is a benign/malignant proliferation of ___. It is the 1st/2nd/3rd most common cause of cancer-related deaths. Risk factors include these 3.
malignant; prostatic glands; 2nd (lung is first); 1) age; 2) race (african americans > caucasians > asians); 3) diet high in saturated fats
Prostate carcinoma is most often clinically __. Usually arises in the __ region of the prostate and, hence, does not produce __ symptoms early on. Screening for prostate cancer begins at age __ with __ and __.
silent; peripheral, posterior; urinary; 50; PSA; DRE (digital rectal exam)
Normal serum PSA increases with age due to __ (__ for ages 40-49 vs __ for ages 70-79). A PSA greater than __ is highly worrisome at any age. Increased/decreased % free-PSA is suggestive of cancer (cancer makes bound/free PSA).
BPH; 2.5 ng/mL; 7.5; 10; decreased; bound
Prostatic __ is required to confirm the presence of carcinoma. It shows large/small, invasive __ with prominent __. Gleason grading system is based on __ alone (and not on __). Multiple regions are assessed. A score of (__) is assigned for 2 distinct areas and then added to produce a final score (__). Higher score suggests better/worse prognosis).
biopsy; small; glands; nucleoli; architecture; nuclear atypia; 1-5; 2-10; worse
Prostate cancer spread to the __ or __ is common. It results in osteoblastic/osteolytic metastases that present as __ and increased serum __, __ and __.
lumbar spine; pelvis; osteoblastic; low back pain; alkaline phosphate (sign of osteoblastic activity - laying down bone); PSA; prostatic acid phosphatase (PAP) (the last two are serum tumor markers)
In prostate cancer, __ is performed for localized disease. Advanced disease is treated with __ to reduce __ and __. Continuous/pulsatile __ analogs (e.g. __) shut down the anterior pituitary gonadotrophs (LH and FSH are reduced). __ acts as a competitive androgen receptor inhibitor.
prostatectomy; hormone suppression; testosterone; DHT; continuous; GnRH; leuprolide; flutamide (Leu's Flute)