Male Path

Question 1

Old man with signs of bladder outlet obstruction (urinary hesitancy, need to strain, weak flow, incomplete voiding) most likely due to

Answer 1

benign prostatic hyperplasia (BPH)

Question 2

digital rectal examination shows a smooth, homogenously enlarged prostate

Answer 2

benign prostatic hyperplasia (BPH)

Question 3

a sedating antidepressant used off-label most often as a hypnotic to treat insomnia associated with depression or antidepressant treatment.

Answer 3

Trazodone

Trazzz o bone

Question 4

associated with the rare but serious side effect of priapism (ie, persistent erection of the penis for >4 hours that is not associated with sexual excitement).

Answer 4

Trazodone

*contraindicated in Sickle Cell Anemia

Question 5

Medical orchiectomy uses continuous GnRH analogues (____) to reduce LH production, which subsequently reduces androgen production in the testes.

Because there is an initial SURGE in androgens at the start of therapy (due to stimulation of the GnRH receptor),

GnRH therapy is usually treated with a few weeks of androgen-receptor inhibitors (______).

Answer 5

buserelin

bicalutamide

Question 6

Prostate cancer is an _____-dependent tumor, patients with advanced disease are generally treated with surgical or medical orchiectomy.

Answer 6

androgen

Question 7

Patient with acute, severe, progressive scrotal pain with a HIGH-riding scrotal mass is concerning for

Answer 7

testicular torsion

Question 8

Scrotal edema and an absent cremasteric reflex (testicular elevation when stroking the ipsilateral inner thigh) is highly suggestive of

Answer 8

testicular torsion

Question 9

Twisting of spermatic cord

Venous congestion, hemorrhagic infarction & necrosis of testis

Answer 9

testicular torsion

Question 10

↑ Risk of Testicular Torsion with poor fixation of testis to ____

Answer 10

tunica vaginalis

Question 11

scrotal mass that increases in size when standing as compared with supine positioning. This dilation of the pampiniform plexus may cause a dull ache

Answer 11

Varicocele

Question 12

presents with acute scrotal pain that is relieved with manual elevation of the testicle and dysuria

Answer 12

Epididymitis

Neisseria gonorrhoeae

Question 13

Hydrocele is a fluid collection within the ____ that transilluminates on examination and causes scrotal enlargement

Answer 13

tunica vaginalis

Question 14

non-fusion of the urethral folds would most likely result in

Answer 14

Hypospadias

urethra opens on ventral shaft

Question 15

For Heart Failure. It has significant antiandrogenic effects and can cause gynecomastia, decreased libido, and impotence.

Answer 15

Potassium sparing Diuretic

Question 16

Laboratory testing shows elevated serum thyroxine and triiodothyronine levels. Scrotal ultrasonography demonstrates a hypoechoic mass within the right testicle. Hyperthyroid Symptoms

Answer 16

Germ Cell tumor

hCG marker

Question 17

Abrupt onset, clear precipitating event or stressor
Impaired erections with a partner 
Normal nocturnal/Morning erections
Normal masturbation
Impaired or premature orgasm

Answer 17

Sexual Performance Anxiety

Question 18

Serum testosterone is normal or elevated. However, spermatogenesis (sperm count) is decreased.

Answer 18

anabolic steroids

Question 19

excessive doses of _____ include acne, gynecomastia, azoospermia, decreased testicular size, and increased aggression

Answer 19

anabolic steroids

Question 20

Sertoli cells produce ___ in response to FSH from the anterior pituitary.

Answer 20

inhibin

Question 21

Inhibin suppresses ___ production in the pituitary.

Answer 21

FSH

Question 22

____ cells facilitate spermatogenesis within the seminiferous tubules.

Answer 22

Sertoli

Question 23

A communicating hydrocele results when the ____ remains patent and allows peritoneal fluid to accumulate in the tunica vaginalis.

Common in newborns
Presents as a painless scrotal swelling that transilluminates.

Answer 23

processus vaginalis

Question 24

Peyronie disease, excess collagen formation within the ____ can cause significant pain and curvature of the penis.

Answer 24

tunica albuginea

Question 25

The highest ____ grade of 5 is assigned to poorly differentiated tumors; these tumors do not resemble normal prostatic tissue and are generally arranged into sheets of invasive cells with no glandular elements.

Answer 25

Gleason | staging via spreading to LNs

Question 26

Prostatectomy or injury to the prostatic plexus (inferior hypogastric, pelvic, sacral splanchnic nerves) can cause .

Answer 26

erectile dysfunction

Question 27

Patients with congenital bilateral absence of the vas deferens (Cystic Fibrosis) have azoospermia and infertility with ___ levels of FSH, LH, and testosterone.

Answer 27

normal

Question 28

____ is a 5-alpha reductase inhibitor and it inhibits the conversion of testosterone to dihydrotestosterone that acts on epithelium of prostate.

Answer 28

Finasteride

Question 29

alpha-1 blockers act on _____ of prostate and bladder base.

Answer 29

smooth muscles

Question 30

The ___ gonadal vein drains directly into the inferior vena cava.

Answer 30

right

Question 31

The __ gonadal vein drains into the __ renal vein.

Answer 31

left | left

Question 32

Inability to void with a full bladder sensation, a high-riding boggy prostate, and blood at the urethral meatus are suggestive of ____ injury, particularly in the presence of a ____ fracture.

Answer 32

urethral | pelvic

Question 33

If urethral injury is suspected, placement of a _____ is contraindicated.

Answer 33

Foley catheter

Question 34

The ____ urethra is further divided into the prostatic and membranous segments

Answer 34

posterior

Question 35

the _____ urethra is divided into bulbous and penile segments.

Answer 35

anterior

Question 36

Trauma to the pelvis severe enough to cause fracture often results in disruption of the posterior urethra at the ______ junction

Answer 36

bulbomembranous

Question 37

Although the _____ urethral segment is reinforced by the surrounding corpus spongiosum, it is susceptible to crushing injuries when the perineum is struck forcefully (ie, straddle injury).

Answer 37

bulbous

Question 38

Primary hypogonadism can be confirmed with __ serum testosterone associated with ___ LH.  Management of male hypogonadism includes testosterone therapy

Answer 38

low | elevated

Question 39

For the treatment of erectile dysfunction

Answer 39

Phosphodiesterase 5 inhibitors (eg, sildenafil)

Question 40

Prostate cancer causes ___ lesions that result in new bone growth.  Biopsy would show disordered trabeculae and signs of prostate cancer such as irregular glands with enlarged nuclei and prominent nucleoli.

Answer 40

osteoblastic

Question 41

Secondary (hypogonadotropic) hypogonadism ___ testosterone ___ FSH, LH

Answer 41

Low | Low/normal

Question 42

Androgen insensitivity syndrome (AIS) is caused by loss-of-function mutations of the androgen receptor (AR) gene on the __ chromosome

Answer 42

X

Question 43

___ receptor dysfunction leads to decreased facial, axillary, and pubic hair; oligospermia; gynecomastia;

Answer 43

Androgen

Question 44

Following vasectomy, viable sperm remain in the portion of the vas deferens distal to the transection.  Patients can still have viable sperm in the ejaculate for up to __ months and at least 20 ejaculations after the procedure

Answer 44

3

Question 45

This patient's acute testicular pain, posterior testicle tenderness, and pyuria raises suspicion for acute ____.

Answer 45

epididymitis

Question 46

Acute epididymitis Epidemiology Age <35: sexually transmitted (chlamydia, gonorrhea) Age >35: _________

Answer 46

bladder outlet obstruction (coliform bacteria)

Question 47

The finding of impaired sperm motility raises concern for _______.

Answer 47

primary ciliary dyskinesia (PCD)

Question 48

Patients with Klinefelter syndrome (47,XXY) have primary hypogonadism characterized by low testosterone and elevated gonadotropin (FSH, LH) levels.  In addition, ____ estradiol/ estrogen results in the common finding of gynecomastia.

Answer 48

elevated

Question 49

``` Age 15–35 solid, firm, or fixed testicular mass in the tunica albuginea ovoid in shape painless to palpation ``` Dull ache in lower abdomen Does NOT transilluminate

Answer 49

Testicular Cancer

Question 50

95% percent of testicular cancers are

Answer 50

Germ cell tumors: | seminomatous or nonseminomatous (embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed)

Question 51

During embryogenesis it is responsible for development of the internal male genitalia.

Answer 51

Testosterone (Leydig cells)

Question 52

is responsible for regression of the paramesonephric (müllerian) ducts that normally give rise to the internal genitalia in the female fetus.

Answer 52

müllerian inhibiting factor (MIF). 

Question 53

can be used to treat both the BPH symptoms and hypertension.

Answer 53

alpha-1 blocker (doxazosin, prazosin, terazosin)

Question 54

Alpha-1 blockers work by relaxing smooth muscle in the ___ & ____, opening up the bladder outlet and decreasing the resistance to the flow of urine.  They also relax smooth muscle tone in arterial walls, thus decreasing blood pressure.

Answer 54

bladder neck and prostate

Question 55

The _____ lymph nodes drain nearly all cutaneous structures inferior to the umbilicus, including the external genitalia (scrotum) and the anus up to the pectinate line.

Answer 55

superficial inguinal

Question 56

Lymph from the testes drains to the ____ lymph nodes.

Answer 56

para-aortic

Question 57

Lymph from the glans penis drains into the _____ lymph nodes.

Answer 57

deep inguinal

Question 58

___ cells suppress female internal reproductive organ development by producing anti-Müllerian hormone (AMH)

Answer 58

Sertoli

Question 59

Sertoli cells produce ______, which concentrates testosterone in the seminiferous tubules to enable spermatogenesis.

Answer 59

androgen-binding protein

Question 60

___ cells secrete testosterone, which stimulates the Wolffian (mesonephric) ducts to develop into internal male

Answer 60

Leydig

Question 61

The SRY gene on the Y chromosome codes for the ______, which differentiates the primitive gonads into testes.

Answer 61

testes-determining factor

Question 62

Testosterone is ____ converted into dihydrotestosterone, which transforms the genital tubercle, urogenital folds, and labioscrotal swelling into the external male reproductive organs.

Answer 62

peripherally

Question 63

Testicular torsion causes decreased _____ leading to hemorrhagic infarction

Answer 63

Venous drainage

Question 64

↑ risk of cryptoorchidism

Answer 64

Prematurity

Question 65

In BILATERAL cryptoorchidism testosterone levels

Answer 65

decrease

Question 66

In UNILATERAL cryptoorchidism testosterone levels

Answer 66

remain normal

Question 67

In cryptoorchidism _______ is impaired

Answer 67

spermatogenesis

Question 68

In cryptoorchidism ___ Inhibin B ___ FSH/LH

Answer 68

↓ | ↑

Question 69

↑ of GERM cell tumors associated with

Answer 69

cryptoorchidism, Klinefelter syndrome

Question 70

Scrotal enlargement ↑ with Valsalva (squatting) ↓ when Laying down does NOT transilluminate

Answer 70

Varicocele

Question 71

Dilated veins in Pampiform plexus cause

Answer 71

Varicocele | *more common on the LEFT side due to venous drainage to left renal vein

Question 72

Hematocele is a bloody scrotal fluid collection that does NOT

Answer 72

transilluminate | infection, trauma

Question 73

Scrotal Cyst due to dilated EPIDIDYMAL duct or rete testis

Answer 73

Spermatocele | fluctuant nodule

Question 74

Do NOT biopsy a suspected testicular germ cell tumor due to risk of

Answer 74

seeding scrotum

Question 75

Leydig and Sertoli cell tumors are mostly

Answer 75

Benign | Rare (5%)

Question 76

Sertoli cell tumors ____ Estrogen

Answer 76

Increase

Question 77

Leydig cell tumors ____ Estrogen & ___ Testosterone

Answer 77

Increase both

Question 78

Painless testicular mass ***MOST COMMON*** Excellent Prognosis ↑ Placental ALP (PALP)

Answer 78

Seminoma (germ cell) *phenotypic features of spermatogonia

Question 79

Painful testicular mass Bloody, Necrotic mass Gladular/Papillary ↑hCG

Answer 79

Embryonal Carcinoma (germ cell) * if also ↑AFP/ LDH = mixed

Question 80

Yellow Mucinous Look like Glomeruli (Schiller-Duval bodies) ↑AFP/LDH Aggresive AF

Answer 80

Endodermal Yolk Sac tumor | germ cell

Question 81

Hyperthyroidism symptoms (high yield) +/- Gynecomastia Lung/ Brain metastasis ↑↑ hCG

Answer 81

Choriocarcinoma

Question 82

Testicular mass with no elevations in: AFP hCG PALP

Answer 82

Teratoma

Question 83

Localized pain over posterior testis | + Prehn sign (pain relief with scrotal elevation)

Answer 83

Epididymitis * E.coli/Pseudomonas in Older men * Chlamydia/ Gonorrhea in young men * possibly caused by autoimmune (granulomas)

Question 84

Inflammation of testis

Answer 84

Orchitis * E.coli/Pseudomonas in Older men * Chlamydia/ Gonorrhea in young men * possibly caused by autoimmune (granulomas)

Question 85

Dysuria, urgency, lower back pain | Warm, tender, swollen prostate

Answer 85

Prostatitis * E.coli in Older men * Chlamydia/ Gonorrhea in young men

Question 86

Prostatic adenocarcinoma arises most often from ___ lobe

Answer 86

posterior | peripheral zone

Question 87

Prostatic adenocarcinoma __ total PSA __ free PSA

Answer 87

↑ | ↓

Question 88

Prostatic adenocarcinoma metastasize where?

Answer 88

Lower Back vertebrae | Osetoblastic lesion

Question 89

Prostatic adenocarcinoma metastasis to the spine occurs via _____ venous plexus

Answer 89

Batson (vertebral) venous plexus

Question 90

May lead to distention and hypertrophy of bladder, hydronephrosis, & UTIs

Answer 90

BPH

Question 91

Inhibit conversion of testosterone to dihydrotestosterone Reduce prostate gland size Adverse effects: decreased libido, erectile dysfunction

Answer 91

5-alpha-reductase inhibitors (finasteride, dutasteride)

Question 92

Usual first-line therapy for BPH | Adverse effects: orthostatic hypotension, dizziness

Answer 92

Alpha-adrenergic antagonists (terazosin, tamsulosin) Relax smooth muscle in bladder neck, prostate capsule & prostatic urethra

Question 93

``` Decreased lean body weight Increased total weight & subcutaneous fat Decreased body hair Breast enlargement Decreased bone density Decreased prostate volume Decreased libido Erectile dysfunction Decreased sperm count ```

Answer 93

Effects of Androgen deprivation in men or Orchiectomy

Question 94

a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors. 

Answer 94

Flutamide

Question 95

Flutamide is used in combination with ___ for the treatment of prostate cancer.

Answer 95

long-acting gonadotropin-releasing hormone agonists (Leuprolide)

Question 96

Secondary hypogonadism occurs in _____ due to deposition of iron in the pituitary gland.

Answer 96

Hemochromatosis *also at risk for deficiencies in other pituitary hormones (eg, central hypothyroidism).

Question 97

The penile flaccid state is maintained by tonic alpha-adrenergic (norepinephrine) sympathetic activity, causing high vascular and trabecular ____, preventing corporal engorgement with blood. 

Answer 97

smooth muscle tone

Question 98

Priapism can be treated with penile injections of ____, which induce smooth muscle contraction, leading to detumescence.

Answer 98

alpha-adrenergic agonist (phenylephrine)

Question 99

The penile flaccid state is maintained by tonic ___ activity

Answer 99

alpha-adrenergic (norepinephrine) sympathetic

Question 100

Priapism can be treated with penile injections of alpha-adrenergic agonist (phenylephrine), which induce ____, leading to detumescence.

Answer 100

smooth muscle contraction

Question 101

inhibitors block the generation of androgens in the adrenal glands, testes, and tumor cells.  This reduces systemic androgen levels, which limit prostate cancer growth.

Answer 101

17-alpha-hydroxylase | abiraterone