Male Reproductive

Question 1

Dick Necrotizing Fasciitis

Dx/Tx =

Answer 1

Fournier’s

Debridement in OR

Question 2

Testicular Torsion tx:

Answer 2

Bilateral Orchiopexy

Question 3

Risk factors for Priapism include:
excess Testosterone
Trazodone
(3)

Answer 3

Cocaine
Etoh
Sickle Cell Anemia

Question 4

2 treatments for Priapism:

Answer 4

1. Aspirate blood from Corpus Cavernous

2. Intracavernous Phenyleprine injection
alpha 1 agonist

Question 5

BPH can increase risk of what infection?

Answer 5

UTI

Question 6

BPH most likely to arise in what 2 zones?

Answer 6

Central and Transition

Question 7

Prostate cancer most likely to arise in what zone?

Answer 7

Peripheral

Question 8

PSA levels in BPH versus Prostate Cancer:

Answer 8

BPH: wnl/elev PSA

Prostate cancer: elevated PSA

Question 9

Nodular and firm prostate concerning for:

Answer 9

Prostate cancer

Question 10

Risk factors for Prostate cancer:

Answer 10

Age > African American > FMH

Question 11

Recurrent UTIs with intermittent relief and
painful ejaculation is consistent with ____.

Treatment:

Answer 11

Chronic Bacteria Prostatitis

Fluoroquinolone (Ciprofloxacin)

Question 12

Painful prostate on palpation consistent with

Answer 12

Acute Bacterial Prostatitis

Question 13

Painful, unilateral testicular mass
(↑ AFP/hCG/LDH)

what do next? what is likely dx & tx?

Answer 13

Scrotal u/s
Testicular Cancer
Orchiectomy

Question 14

Ropey bag of worms
worse with standing
better with laying
NO translumination

Answer 14

Varicocele

dilation of pampiniform plexus → retrograde flow

Question 15

Treatment of varicocele in young/fertile patients

Answer 15

Gonadal vein ligation to prevent infertility

*old men get NSAIDs & scrotal sac surgery

Question 16

Finasteride is a _____ used for treatment of ____

Answer 16

5 alpha inhibitor

BPH

Question 17

Leuprolide is a _____ which can be used as an adjuvant for treatment of ____

Answer 17

GnRH agonist

BPH s/p TURP

Question 18

What is a surgery that can be used to treat BPH?

Answer 18

Transurethral Resection of Prostate (TURP)

can recur so give finasteride + leuprolide

Question 19

In a penile fracture you repair the ___

Answer 19

Tunica alba

Question 20

s/p penile fracture patient has urinary retention, dysuria, or blood at the urethral meatus.
What do next?

Answer 20

Urethrogram

Question 21

Unilateral varicocele that does not improve when supine what is the likely diagnosis and what is the next best step in management?

Answer 21

Tumor blocking L Renal vein or IVC

Get a CT scan

Question 22

A painless enlargement may be present
Dull, aching pain of the hemiscrotum (typically left-sided)
Soft bands/strands are palpable in the upper pole of the affected scrotum (“bag of worms”)
Symptoms worsen when standing or when performing the Valsalva maneuver.
Negative transillumination

Answer 22

Varicocele
(abnormal dilation/tortuosity of the pampiniform plexus s/t proximal obstruction of the spermatic vein)

MCC of scrotal enlargement

Question 23

Initial imaging and follow up imaging for varicocele :

Answer 23

Ultrasound
Dilated (> 2 mm) hypoechoic pampiniform vessels

Doppler ultrasonography

*Grade based on the extent of vein dilation/reflux during Valsalva

Question 24

A unilateral right-sided varicocele is uncommon and should raise suspicion of a mass in the ____ blocking the spermatic vein.

Answer 24

Retroperitoneal space

lymphoma, RCC, Ormond disease

Question 25

Fluctuant, painless swelling of affected scrotum | Positive transillumination

Answer 25

Hydrocele | fluid in tunica vaginalis

Question 26

A hydrocele must be differentiated from an

Answer 26

inguinal hernia

Question 27

Congenital hydrocele usually resolves spontaneously within ____ of birth.

Answer 27

6 months

Question 28

Indications for hydrocele surgery: If spontaneous resolution does not occur by __ of age If ____ is a concern

Answer 28

1 year | infertility

Question 29

Cryptorchidism typically resolves without treatment via spontaneous descent of testicles by ____ of age.

Answer 29

6 months | if not do surgery ASAP

Question 30

Cryptorchidism complications include: Infertility Inguinal hernia _____ _____

Answer 30

Testicular cancer (germ cell tumors) Testicular torsion

Question 31

Pt presents with unilateral scrotal pain and swelling which radiates to the flank. Pain is alleviated when the scrotum is elevated or sitting On physical exam There is tenderness along the posterior testis. Scrotal skin overlying the epididymis appears red, shiny, and edematous Pt has Low-grade fever and urinary sxs. Diagnosis?

Answer 31

Acute epididymitis

Question 32

Acute epididymitis treatment if: suspected UTI source: ___ suspected STI source (chlamydia/gonorrhea): ___

Answer 32

UTI → levofloxacin STI → ceftriaxone + doxycycline

Question 33

Pt presents with painless or dull, achy L scrotum. Aching worsen when standing or when performing the Valsalva maneuver. Physical exam reveals soft bands/strands palpable in the upper pole of the affected scrotum (“bag of worms”) Negative transillumination. Diagnosis?

Answer 33

Varicocele

Question 34

Most common cause of scrotal enlargement in men

Answer 34

Varicocele

Question 35

Abnormal enlargement and tortuosity of the pampiniform plexus in the scrotum due to proximal obstruction of the spermatic vein.

Answer 35

Varicocele

Question 36

Suspected varicocele on physical exam. | Next best step in management?

Answer 36

U/S (dilated, hypoechoic pampiniform) *Doppler U/S (assess grade and reflux during Valsalva)

Question 37

Invasive treatment for Varicocele indications: - Pain - Infertility Laparoscopic ______

Answer 37

Varicocelectomy affected dilated pampiniform veins are ligated by percutaneous embolization.

Question 38

Cryptorchidism complications include: Testicular cancer (germ cell tumors) Testicular torsion _____ _____

Answer 38

Infertility | Inguinal hernia

Question 39

The testicle is located between the external and internal inguinal ring, preventing adequate mobilization: ___ testis

Answer 39

Inguinal

Question 40

``` What testicular tumors present with elevated Tumor markers: alpha fetoprotein (AFP) human chorionic gonadotropin (HCG) ```

Answer 40

Germ cell tumors | seminoma, dysgerminoma, teratoma, & yolk sac

Question 41

1st diagnostic step for suspected testicular tumor?

Answer 41

Testicular ultrasound | Then tumor markers & biopsy

Question 42

If a testicular tumor is suspected, the testis should be ____ and sent to pathology . ____ is contraindicated because of the risk of tumor seeding!

Answer 42

excised transscrotal biopsy

Question 43

Presents with Palpable painless lump or ulcerative lesion of the penis. Swollen inguinal lymph nodes. Diagnosis?

Answer 43

Carcinoma of the penis | tx: surgery

Question 44

What is the diagnostic (gold standard) for carcinoma of the penis?

Answer 44

Excision biopsy