Chapter 14 ( Male Genital System ) Flashcards Preview

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Flashcards in Chapter 14 ( Male Genital System ) Deck (33)
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1
Q

Mechanism of hypospadias ?

A

Failure of the urethral folds to close

2
Q

Epispadias mechanism ? Associated with ?

A

Due to abnormal positioning of the genital tubercle

Associated with bladder exstrophy

3
Q

Lymphogranuloma Venereum mechanism ? Cause ? Fate ?

A

Necrotizing granulomatous inflammation of the inguinal lymphatics and LNs

Sexually transmitted disease caused by : Chlamydia trachomatis ( serotypes L1-L3 )

Eventually heals by fibrosis
Perianal involvement may result in rectal stricture

4
Q

Penile squamous cell carcinoma risk factors ? Precursor in situ lesions ?

A

Risk factors :
High risk HPV
Lack of circumcision

Precursor in situ lesions :
1- Bowen disease : in situ carcinoma of the penile shaft or scrotum that presents as Leukoplakia
2- Erythroplasia of Queyrat : in situ carcinoma of the glans that presents as Erythroplakia
3- Bowenoid papulosis : in situ carcinoma that presents as multiple reddish papules , seen in younger patients ( 40y ) and does not progress to invasive carcinoma

5
Q

Most common congenital male reproductive anomaly ?

A

Cryptorchidism

6
Q

Complications of cryptorchidism ?

A

Testicular atrophy with infertility

Increased risk for seminoma

7
Q

Causes of Orchitis ?

A

1- Chlamydia trachomatis ( D-K ) or Neisseria gonorrhea : seen in young adults with increased risk for sterility but libido is not affected because Leydig cells are spared
2- E coli and Pseudomonas : seen in older adults , UTI spreads into the reproductive tract
3- Mumps virus : in teenagers , increased risk for infertility
4- Autoimmune orchitis : characterized by granulomas involving the seminiferous tubules

8
Q

Cause of testicular torsion ?

A

Due to congenital failure of testes to attach to the inner lining of the scrotum ( via the processus vaginalis )

9
Q

Most common type of testicular tumors ?

A

Germ cell tumors

10
Q

Germ cell tumors of testicles occur in age ?

A

Between 15-40 years

11
Q

Risk factors for germ cell tumors ?

A

Cryptorchidism

Klinefelter syndrome

12
Q

Gross appearance of seminoma ?

A

Homogenous mass with no hemorrhage or necrosis

13
Q

Embryonal carcinoma of testicles consequence of chemotherapy ? Labs ?

A

Chemotherapy may result in differentiation into another type of germ cell tumor ( teratoma )

Labs : increased AFP or Beta-hCG may be present

14
Q

Elevated Beta-hCG may lead to ? Why ?

A

Hyperthyroidism or Gynecomastia

Because alpha subunit of hCG is similar to that of FSH , LH and TSH

15
Q

Is teratoma benign or malignant in males ? Labs ?

A

Malignant

AFP and Beta-hCG may be increased

16
Q

Presentation of sertoli cell tumor ?

A

Usually clinically silent

17
Q

Most common cause of testicular mass in males > 60 years old ?

A

Lymphoma usually of diffuse large B-cell type

18
Q

Prostatic glands are composed of ? Secrets ? Maintained by ?

A

Inner layer of luminal cells and outer layer of basal cells

Secrets alkaline milky fluid thats added to sperms and seminal vesicle fluid to make semen

Maintained by androgens

19
Q

Acute prostatitis causes ? Presentation ? On DRE ? Inv ?

A

In young adults : Chlamydia trachomatis and Neisseria gonorrhoeae
In older adults : E coli and Pseudomonas

Presents as dysuria with fever and chills

On DRE : prostate is tender and boggy

Inv : prostatic secretions show WBCs
Culture reveals bacteria

20
Q

Chronic prostatitis presentation ? Inv ?

A

Presents as dysuria with pelvic or low back pain

Inv : prostatic secretions show WBCs
Cultures are negative

21
Q

Mechanism of benign prostatic hyperplasia ?

A

DHT acts on the androgen receptor of stromal and epithelial cells resulting in hyperplastic nodules

22
Q

Site of benign prostatic hyperplasia ?

A

In the central periurethral zone of the prostate

23
Q

PSA source ? Function ?

A

Made by prostatic glands

Liquifies semen

24
Q

Non selective alpha1- antagonist ?

A

Terazosine ( acts on both alpha1a and alpha1b receptors )

25
Q

Selective alpha1a antagonist ?

A

Tamsulosin ( used in normotensive individuals to avoid alpha1b effects on blood vessels )

26
Q

5alpha-reductase inhibitors ?

A

Finasteride

Dutasteride

27
Q

Risk factors for prostatic adenocarcinoma ?

A

Age
Race ( african american > caucasians > asians )
Diet high in saturated fats

28
Q

Most common site of prostate adenocarcinoma ?

A

In the peripheral posterior region of the prostate ( hence does not produce urinary symptoms early on )

29
Q

Prostatic adenocarcinoma effect on free-PSA ?

A

Makes bound-PSA —> ⬇️ free-PSA %

30
Q

Prostatic adenocarcinoma micro picture ?

A

Small invasive glands with prominent nucleoli

31
Q

Grading of prostate adenocarcinoma ? Based on ?

A

Gleason grading system

Based on architecture alone ( not nuclear atypia )

32
Q

Prostate adenocarcinoma is commonly spread to ? Results in ? Presentation ?

A

Lumbar spine or pelvis

Results in osteoplastic metastasis

Presents as :
Low back pain 
⬆️ serum alkaline phosphatase 
⬆️ PSA
⬆️ PAP ( prostatic acid phosphatase )
33
Q

Ttt of advanced prostate adenocarcinoma ?

A

Hormone suppression by :
1- continuous GnRH analogs as Leuprolide ( shuts down anterior pituitary gonadotrophs FSH and LH )
2- Flutamide ( competitive inhibitor at the androgen receptor )