male repro path

Question 1

external oblique essentially “continues” into the scrotum as what?

Answer 1

cremaster muscle

Question 2

acts as a guide or “line” for drawing testis into the scrotum.

Answer 2

The gubernaculum

Question 3

Twisting of the _______ causing compression of its blood supply

Answer 3

spermatic cord

Question 4

Most common cause for ball torsion

Answer 4

“bellclapper’s deformity”–

Question 5

What would the symptoms of a torsion be

Answer 5

Cremasteric reflex is typically absent

Pain is significant and acute (my nuts!!!!)

Testis is swollen, tender, and high in the scrotum, with an abnormal transverse lie

Question 6

2 possible paths for ball inflammation infection

Answer 6

from the blood stream

retrograde (vas deferens to epididymis to testis)

Question 7

Usually caused by infection

Often in combination with epididymal inflammation

Answer 7

Testicular Inflammation(Orchitis) (Orchitis-Epididymitis)
(you done messed up)

Question 8

Bacterial Testicular Inflammation and non-sexually transmitted testicular inflammation agents:

Answer 8

Staph, Strep, E. Coli (increased risk with surgical manipulation or frequent catheterization)

Question 9

Testicular Inflammation Sexually transmitted agents:

Answer 9

Gonorrhea (GC), Chlamydia (Cz), Syphilis

Question 10

Testicular Inflammation Viral agents:

Answer 10

usually mumps, sometimes coxsackie or parvovirus

Question 11

Orchitis Symptoms

Answer 11

rapid onset of pain in one or both testicles that usually begins locally but over several days may spread to the groin.

testicles may appear tender, swollen, red or purple.

Patient may have a “heavy feeling” in the swollen testicle.

Blood may appear in ejaculate; urethral discharge may occur (but not always!) (such a pretty color)

pain/burning with urination, or pain with increased abdominal pressure (e.g. with bowel movement), groin pain, pain with intercourse.

Systemic symptoms: high fever,nausea,vomiting, malaise

Question 12

Treatment of testicular inflammation :

Answer 12

Antibiotics– p.o. x 10 days specific to the infecting agent
Sometimes IV abx needed

STD counseling (wrap that shit up idiot)

Fertility counseling (no babies bro, fucking please no babies)

Question 13

how does Orchitis- Epididymitis effect fertility

Answer 13

If both testes are affected, fertility can be affected
Damage to Leydig cells– testosterone
Damage to seminiferous tubules
Especially concerning with mumps orchitis
Should ask about hx of orchitis during any infertility visit, or with finding of hypogonadism or low testesterone.

Question 14

Testicular Tumors can arise from two cell types

Answer 14

germ cells (Seminoma or embryonal)

non germ cells (Sertoli or Leydig cells)

Question 15

Most common ball cancer=

Answer 15

seminoma

Question 16

Half of all cases diagnosed between 20 and 34 years of age

Answer 16

Testicular Cancer

Question 17

cure rate testi cancer

Answer 17

High* – 90% survival at 5 years

Question 18

80% of people with testicular cancer have an extra copy of a portion of what chromosome

Answer 18

chromosome 12

Question 19

Most cancer cells are triploid or tetraploid– so the genetic defect seems to affect what? (what a dumb question! do better Caleb!)

Answer 19

proofreading of chromosomes at the pre-mitotic checkpoint.

Question 20

If the cancer arises from germ cells, testicular cancers can secrete what?

Answer 20

embryonic proteins, like β-HCG, AFP, or LDH.

dylan loves ball protein

Question 21

Dilation of veins in the pampinoform plexus

Answer 21

Varicocele

Question 22

Varicocele Most common cause

Answer 22

is poor blood return from pampinoform plexus to testicular vein to central circulation.

Question 23

Which side gets more varicoceles

Answer 23

left

Question 24

One way to treat a varicocele

Answer 24

Embolize the veins (what the hell does that mean!)

Question 25

A fluid collection within the scrotum. Can occur in adults or infants. Can be communicating or non-communicating

Answer 25

Hydrocele

Question 26

Occurs when there is a patent funicular process (processus vaginalis from embryology) allowing fluid to descend from the peritoneal cavity into the scrotal sac. (stomach fluid goes into YOUR ballsack)

Answer 26

Communicating Hydrocele

Question 27

All hydroceles are caused by fluid accumulation where? (be more specific than the nut sack)

Answer 27

tunica vaginalis (the peritoneum-like remnant of the processus vaginalis).

Question 28

t/f Patent funicular process may increase risk of indirect hernia in men.

Answer 28

t

Question 29

what intra-abdominal disease processes could cause this person to have scrotal swelling?

Answer 29

Intraperitoneal bleeding Ascites Abdominal cancer

Question 30

Hydrocele that occurs even when the processus vaginalis has closed, and is now a tunica vaginalis.

Answer 30

non communicating hydrocele

Question 31

Two ways non communicating hydrocele happen

Answer 31

Fluid accumulates in the tunica vaginalis before birth, and just doesn’t get reabsorbed. A process inside the scrotum (infection, cancer, or fluid production by the tunica itself) causes fluid to build up there.

Question 32

If you can see through the sack hydrocele or cancer.

Answer 32

hydrocele (or magic!!!!!!!)

Question 33

If you’re examining a child with a full testi, what could it be

Answer 33

a loop of bowel in the scrotum from an inguinal hernia!!

Question 34

what increases with BPH | sorry not penis size that never changes

Answer 34

increased number of cells, not just larger cells. | Gland (secretory) and muscle cells are both increased in number.

Question 35

The capsule seems to contain the prostate laterally, transmitting pressure of the increased growth which way

Answer 35

medially

Question 36

what nerves cause urinary symptoms in BPH

Answer 36

Prostate enlargement can compress the plexus branches to the bladder, or cause retrograde dysfunction of those nerves. pelvic plexus (hypogastric plexus)– a matrix of sympathetic and parasympathetic nerves that supply the pelvic organs, including bladder and prostate.

Question 37

How does testosterone affect the prostate

Answer 37

Testosterone is at a high concentration in the blood vessels traveling near the prostate. Both testosterone and its metabolite, DHT, can increase cell division in the prostate As men age, their serum testosterone goes down– but their DHT levels in the region of the prostate stay higher, causing a a paracrine effect. So as men age, DHT is the main hormonal actor in BPH. (fuck you DHT, leave my prostate alone)

Question 38

activates proto-oncogenes in the prostate.

Answer 38

DHT (i hate DHT!)

Question 39

t/f prostate cancer is A glandular cancer

Answer 39

true

Question 40

t/f BPH is a risk factor for prostate cancer

Answer 40

f it is not!

Question 41

risk factors for prostate cancer.

Answer 41

History of multiple sexual partners, history of HSV or HPV, and positive serology for HPV 16 and 18

Question 42

Many prostate cancers are known to increase production of what

Answer 42

transcription factors that eliminate apoptosis (increasing odds of cellular immortality).

Question 43

Prostate cancer is also associated with androgens that do what

Answer 43

that increase cell turnover (increasing mitotic events).

Question 44

what does prostate cancer look like

Answer 44

Increased metastases Less organization Obliterated secretory spaces

Question 45

Inability to completely retract foreskin that covers the head of the penis.

Answer 45

Phimosis

Question 46

what is Physiologic Phimosis

Answer 46

Children are born with tight foreskin at birth, and separation occurs naturally over time.

Question 47

what age does physiologic phimosis resolve

Answer 47

Typically resolved by age 7 At birth, the glans is exposable in less than 4% of boys At three years of age, 10% of boys still don’t have a retractable foreskin.

Question 48

Foreskin is partially retracted but “stuck” at that position

Answer 48

Paraphimosis

Question 49

treatment for paraphimosis

Answer 49

Good hygeine (also prevention) Gentle manipulation of the foreskin from the glans Never traumatize a child with overzealous manipulation If needed emergently: circumcision

Question 50

these describe what ``` In situ Invasive Ulcerative HPV Regional lymph nodes. Metatasizes widely. ```

Answer 50

Squamous Carcinoma of the penis

Question 51

what hpv viruses cause Squamous Carcinoma of the penis

Answer 51

HPV 16 and 18

Question 52

Pathologic Phimosis

Answer 52

Glans either cannot be exposed at all or can only be exposed partially Adhesions and scar tissue prevent full exposure Usually caused by recurrent balanitis (infection below the foreskin) or improper hygeine

Question 53

dick look like an elbow macaroni

Answer 53

Peyronie’s Disease

Question 54

Principal manifestation of Peyronie's disease

Answer 54

the formation of a plaque (a segment of flat scar tissue) within the connective tissue of the penis.

Question 55

can cause your dick to shrink

Answer 55

peyronie's disease (ahhhh leave my dick alone!!!!)

Question 56

Peyronie’s Disease causative agents

Answer 56

Probably secondary to mild penile trauma Most experts believe that Peyronie's disease is likely the consequence of a minor penile trauma

Question 57

Increases risk for peyronie's disease

Answer 57

with diabetes, tobacco use, or a history of pelvic trauma

Question 58

Painful Erection lasting >4 hours Uncommon, usually not due to sexual stimulation Has to do with increased flow into penis vs. decreased flow out

Answer 58

Priapism

Question 59

Normal function of erectile tissue

Answer 59

Filling of cavernous sinuses | Relaxation of penile smooth muscle

Question 60

mechanisms are important in erection.

Answer 60

Nitric Oxide and paracrine signaling

Question 61

2 types of priapism

Answer 61

High-flow (non-ischemic) Result of overabundance of arterial flow ``` Low Flow (ischemic) Result of decreased venous drainage, usually due to vaso-occlusion ```

Question 62

Metabolic demands within penile tissue

Answer 62

Average temperature 4 degrees lower than the body Probably why erection can be tolerated for up to 4 hours In low-flow priapism, however, metabolic needs cannot be met Elevated pCO2, low pO2 Acidic pH

Question 63

Who is at risk for priapism

Answer 63

People with viscous or occlusive blood disorders Sickle cell Leukemia Polycythemia Those on certain Rx meds Viagra, cialis Zyprexa, wellbutrin, coumadin Penile/ genital injury Spinal cord injury, blood clots, spider venoms

Question 64

Treatments for priapism

Answer 64

Inhibitors of parasympathetic muscle relaxation Intracavernous injections of vasoconstrictors Shunting of venous blood