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Flashcards in male repro path Deck (64)
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1

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

cremaster muscle

2

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

The gubernaculum

3

Twisting of the _______ causing compression of its blood supply

spermatic cord

4

Most common cause for ball torsion

“bellclapper’s deformity”–

5

What would the symptoms of a torsion be

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

6

2 possible paths for ball inflammation infection

from the blood stream

retrograde (vas deferens to epididymis to testis)

7

Usually caused by infection
Often in combination with epididymal inflammation

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

8

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

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

9

Testicular Inflammation Sexually transmitted agents:


Gonorrhea (GC), Chlamydia (Cz), Syphilis

10

Testicular Inflammation Viral agents:

usually mumps, sometimes coxsackie or parvovirus

11

Orchitis Symptoms

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

12

Treatment of testicular inflammation :

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)

13

how does Orchitis- Epididymitis effect fertility

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.

14

Testicular Tumors can arise from two cell types

germ cells (Seminoma or embryonal)

non germ cells (Sertoli or Leydig cells)

15

Most common ball cancer=

seminoma

16

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

Testicular Cancer

17

cure rate testi cancer

High* – 90% survival at 5 years

18

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

chromosome 12

19

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

proofreading of chromosomes at the pre-mitotic checkpoint.

20

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

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

(dylan loves ball protein)

21

Dilation of veins in the pampinoform plexus

Varicocele

22

Varicocele Most common cause

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

23

Which side gets more varicoceles

left

24

One way to treat a varicocele

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

25

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

Hydrocele

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)

Communicating Hydrocele

27

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

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

28

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

t

29

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

Intraperitoneal bleeding
Ascites
Abdominal cancer

30

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

non communicating hydrocele

31

Two ways non communicating hydrocele happen

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.

32

If you can see through the sack hydrocele or cancer.

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

33

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

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

34

what increases with BPH
(sorry not penis size that never changes)

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

35

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

medially

36

what nerves cause urinary symptoms in BPH

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.

37

How does testosterone affect the prostate

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)

38

activates proto-oncogenes in the prostate.

DHT (i hate DHT!)

39

t/f prostate cancer is A glandular cancer

true

40

t/f BPH is a risk factor for prostate cancer

f it is not!

41

risk factors for prostate cancer.

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

42

Many prostate cancers are known to increase production of what

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

43

Prostate cancer is also associated with androgens that do what

that increase cell turnover (increasing mitotic events).

44

what does prostate cancer look like

Increased metastases

Less organization

Obliterated secretory spaces

45

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

Phimosis

46

what is Physiologic Phimosis

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

47

what age does physiologic phimosis resolve

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.

48

Foreskin is partially retracted but “stuck” at that position

Paraphimosis

49

treatment for paraphimosis

Good hygeine (also prevention)

Gentle manipulation of the foreskin from the glans

Never traumatize a child with overzealous manipulation
If needed emergently: circumcision

50

these describe what

In situ
Invasive
Ulcerative
HPV
Regional lymph nodes.
Metatasizes widely.

Squamous Carcinoma of the penis

51

what hpv viruses cause Squamous Carcinoma of the penis

HPV 16 and 18

52

Pathologic Phimosis

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

53

dick look like an elbow macaroni

Peyronie’s Disease

54

Principal manifestation of Peyronie's disease

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

55

can cause your dick to shrink

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

56

Peyronie’s Disease causative agents

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

57

Increases risk for peyronie's disease

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

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

Priapism

59

Normal function of erectile tissue

Filling of cavernous sinuses
Relaxation of penile smooth muscle

60

mechanisms are important in erection.

Nitric Oxide and paracrine signaling

61

2 types of priapism

High-flow (non-ischemic)
Result of overabundance of arterial flow

Low Flow (ischemic)
Result of decreased venous drainage, usually due to vaso-occlusion

62

Metabolic demands within penile tissue

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

63

Who is at risk for priapism

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

64

Treatments for priapism

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