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Reproductive Medicine Exam 2 > Male Urology > Flashcards

Flashcards in Male Urology Deck (155)
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1
Q

What type of tissue comprises 30% of the prostate?

What comprises the other 70%?

A

30%: Glandular tissue

70%: Stroma

2
Q

What is the smallest structural component of glandular prostate?

A

Acini

3
Q

T/F: Proliferation of the acini results in BPH

A

True

4
Q

Proliferation of the ________ (Acini/Basement Membrane) of the prostate leads to prostate cancer

A

Basement Membrane

5
Q

What are the three zones of the prostate?

A

Central Zone
Transitional Zone
Peripheral Zone

6
Q

Which zone of the prostate contains mucosal and submucosal glands?

Changes in this zone often lead to urethral pressure.

A

Periurethral Zone

7
Q

Which zone of the prostate contains the majority of prostatic glandular tissue and is the origin site for most adenocarcinomas of the prostate?

A

Peripheral Zone

8
Q

Which zone of the prostate is often described of as the “cone shaped” portion of the prostate?

A

Central Zone

9
Q

T/F: The transitional zone of the prostate does NOT surround the urethra

A

False

It does surround the urethra

10
Q

What percentage of men have BPH by the age of 60?

80?

A

60: 50%
80: 90%

11
Q

What is the mechanism for BPH development?

A

Testosterone is broken down by 5alpha-reductase to form DHT

DHT then binds to nuclear receptors in the prostate leading to BPH

12
Q

What receptors in the prostate (near the bladder neck) result in smooth muscle contraction leading to LUTS associated with BPH?

A

A1-Adrenergic Receptors

13
Q

What are examples of obstructive LUTS?

A

Weal Stream
Hesitancy
Incomplete Emptying
Double voiding

14
Q

What are examples of irritative LUTS?

A

Urgency
Frequency
Nocturia

15
Q

What are FOUR key components to a BPH work-up?

A

DRE
UA
BMP
Baseline PSA

16
Q

What ‘imaging’ study can be obtained to see if a patient is retaining urine?

A

PVR (Post-Void Residual)

17
Q

What is the name of the ‘imaging study’ used to measure how strong a patient’s urine stream is?

A

Uroflow

18
Q

What is the name of the procedure used to visual the inside of the bladder?

A

Cystoscopy

19
Q

What may the appearance of the bladder be described as if it has been squeezing hard against the prostate?

A

Trabeculated

20
Q

What medications used in BPH management “open up” the prostate through smooth muscle relaxation?

A

Alpha Blockers…..

Non-Selective: Terazosin (Hytrin), Doxazosin

Selective: Tamsulosin (Flomax), Silodosin (Rapaflo)

21
Q

What medications used in BPH management “shrink” the prostatic glands?

A

%-alpha reductase inhibitors…..

Finasteride
Dutasteride

22
Q

What is an antimuscarinic used in BPH management?

A

Oxybutynin

23
Q

What are examples of surgical procedures used to manage BPH?

A

TURP
TUNA
TUMT
PVP

24
Q

T/F: Recurrent UTIs attributable to BPH is NOT an indication for surgical management

A

False

It is an indication

25
Q

T/F: Prostate CA is the 2nd leading cause of cancer death in US men

A

True

26
Q

What are two crucial screening tools for prostate cancer?

A

PSA

DRE

27
Q

What is the normal PSA range?

A

0.0 - 4.0

28
Q

What are three examples of things that lead to a benign elevation in PSA?

A

Trauma
Instrumentation
Ejaculation

29
Q

T/F: You should always trend PSA values prior to jumping to conclusions or management decisions (ie: Biopsy)

A

True

30
Q

A 75 y.o. male presents for annual screening. He denied any urinary symptoms but has been noticing himself get sweaty at night. His exam is unremarkable other than an enlarged nodular prostate on DRE. Upon review of his annual labs you notice that his PSA is trending up and most recently is at 8.9.

What is your most concerning diagnosis and how is this diagnosed?

A

Prostate Cancer

Diagnosed through a prostate biopsy with transrectal US guidance

31
Q

How many samples of prostate tissue are taken during a prostate biopsy?

A

12

32
Q

What is the name of the ‘grading score’ used in staging prostate cancer?

A

Gleason Score

33
Q

Where are the first two places prostate cancer is likely to metastasize?

A

Lymph Nodes

Bones

34
Q

What is the name of the surgical procedure used in prostate cancer treatment?

What is the most common and concerning ‘side effect’ of this procedure?

A

Radical Prostatectomy

Most Common Complication is ED and Impotence

35
Q

_________ is the name of the prostate cancer therapy in which radioactive seeds are implanted in the prostate….this works best for localized contained prostate cancers.

A

Brachytherapy

36
Q

_________ is pain or burning with urination

A

Dysuria

37
Q

What is hematuria?

A

Blood in the urine

38
Q

________ is the a sudden, strong urge to pass urine

A

Urgency

39
Q

What is urinary frequency?

A

Voiding too often

40
Q

A ______ UTI occurs frequently with different or similar organisms for each infection

A

Recurrent UTI

41
Q

How is a persistent UTI described?

A

Same organism never clears often with the same susceptibility profile

42
Q

A _______ UTI results from inadequate treatment

A

Unresolved

43
Q

A _________ UTI may occur in the presence of features that may result in therapy failure

A

Complicated UTI

44
Q

What is Asymptomatic bacteriuria?

A

Bacteria present in the urine without host response of symptoms

45
Q

What is the most common pathogen associated with an acute UTI?

A

E coli (80%)

*Staph, Klebsiella, Proteus are also common

46
Q

A 39 y.o male presents with complaints of burning with urination, feeling like he has to pee all the time, and a cloudy appearance to his urine over the last two days. He denied any fever or fatigue. This has happened to him as a child she remembers and he was diagnosed with a bladder infection.

What is you most likely diagnosis at this time?

A

Acute UTI

47
Q

A 39 y.o male presents with complaints of burning with urination, feeling like he has to pee all the time, and a cloudy appearance to his urine over the last two days. He is febrile and appears very fatigued in the examination room. He also describes a vague back pain over the last 24 hours, but is unable to localize it.

What would be the most concerning at this time?

What physical examination finding may support this diagnosis?

A

Pyelonephritis

+ CVA Tenderness

48
Q

How should a urine sample be collected when working up a UTI?

A

It need to be a “Clean Catch”

49
Q

Positive nitrites in a urine sample would indicate what?

A

Infection

50
Q

WBC Casts on a microscopic urinalysis would indicate what?

A

Pyleonephritis

Glomerulonephritis

51
Q

T/F: Urine samples don’t need to be cultured

A

False

They do!

52
Q

T/F: All urine samples from men dont need cultured

A

False

All urine samples from men should be cultured!

53
Q

What is the cheapest and most effective ABx in UTI management?

A

TMP/SMX (Bactrim)

54
Q

Why arent fluoroquinoones used as much in UTI management?

A

Resistance
Renal Dosing
Avoid with Warfarin

55
Q

What is a drawback to using nitrofurantonin (Macrobid) in UTI treatment?

A
Longer Course (~7 days) 
GI Upset
56
Q

How long do patients take ABx if they’re on them for UTI prophylaxis?

A

6 Months!

Examples:
TMP/SMX 100 mg
TMP 100 mg
NItrofurantonin 100 mg

57
Q

What is an example of a common hospital procedure/treatment that is associated with a high UTI rate?

A

Urinary Catheters

58
Q

Catheterization longer than __ days greatly increases a patients risk for catheter associated UTIs

A

6 Days

59
Q

What is the most common pathogen associated with pyelonephritis?

A

E Coli

*Proteus, Pseudomonas, and Klebsiella are also common

60
Q

T/F: A patient with a renal calculi is at a higher risk of developing pyelonephritis

A

True

61
Q

A patient with suspected pyelonephritis and a history of renal stones should get what imaging study and why?

A

Renal US

To exclude obstructing stone and hydronephrosis

62
Q

How is pyelonephritis managed?

A

IV Abx
IVF
Glucose control

63
Q

What procedure can be to relieve pressure on the kidneys if the urinary outflow tract is obstructed?

A

Percutaneous Nephrostomy Tube Placement

64
Q

What are the most common types of urinary lithiasis?

A

Ca-Containing Stones (Calcium-Oxalate, Calcium-Phosphate)

65
Q

What is another name for a struvite stone?

A

Infectious Stone

66
Q

A 25 y.o. male presents to the ED with right flank pain. He notes that yesterday he had this waxing and waning pain in his lower back, but this morning it became a harp stabbing pain. He is visibly uncomfortable in the exam room and moves around throughout. He denied any fever or chills, but he has noticed some difficulty and discomfort with urination. He denied any gross hematuria.

What is the most likely Dx at this time?

A

Urinary Lithiasis

67
Q

A 25 y.o. male presents to the ED with right flank pain. He notes that yesterday he had this waxing and waning pain in his lower back, but this morning it became a harp stabbing pain. He is visibly uncomfortable in the exam room and moves around throughout. He denied any fever or chills, but he has noticed some difficulty and discomfort with urination. He denied any gross hematuria

You decide to start his work up with a CBC with is unremarkable, CMP that shows slightly elevated BUN and sCr from the patients normal, and a UA that has microscopic hematuria.

Does this support the diagnosis of Urinary lithaisis? What diagnosis might these labs rule out?

A

The labs support the diagnosis of urinary lithiasis and make pyelonephritis less likely at this time.

68
Q

A 25 y.o. male presents to the ED with right flank pain. He notes that yesterday he had this waxing and waning pain in his lower back, but this morning it became a harp stabbing pain. He is visibly uncomfortable in the exam room and moves around throughout. He denied any fever or chills, but he has noticed some difficulty and discomfort with urination. He denied any gross hematuria

What imaging study is 100% sensitive in diagnosing your most likely diagnosis?

A

CT Abdomen/Pelvis w/o contrast

69
Q

Where are the THREE most common places for stones to “get stuck” or become symptomatic?

A

UPJ
Illiac Vessels/Pelvic Brim
UVj

70
Q

____% of stones in the distal ureter that are less than 4 mm will pass spontaneously

A

90%

71
Q

What alpha-blocker is often given to stone patients to help stones pass easier?

A

Tamsulosin (Flomax)

72
Q

What are examples of surgical procedures used in urinary lithiasis management?

A

Shock-Wave Lithotripsy (ESWL)
Ureteroscopy + Laser Lithrotripsy
Percutaneous Nephrolithotripsy

73
Q

What work up do patients with recurrent stones need?

A

Meatbolic Work-Up to include……

Serum Uric Acid, Calcium, Magnesium, Phosphate, PTH, and 24-Hour urine collection

74
Q

What medication is indicated in a recurrent stone patient with hypercalciuria?

A

HCTZ

75
Q

What medication can be given to a recurrent stone patient with uric acid stones?

A

Allopurinol

76
Q

____________ is described as inflammation of the glans penis or foreskin.

Symptoms include….

Glossy flat lesions on the penis or foreskin with blotchy erythema, smega, and possibly phimosis

A

Balantitis (Glans)

Posthitis (Foreskin)

77
Q

What medication is used to treat balantitis/posthitis?

A

Clotrimazole (Lotrimin)

78
Q

What is phimosis?

A

The inability to retract the foreskin

79
Q

T/F: Yeast are a common cause of phimosis or posthitis in patients especially with poorly controlled DM

A

True

80
Q

How can phimosis be managed pharmacologically?

A

Nystatin +/- Topical Steroid

81
Q

If phimosis is refractory to pharmacological or conservative management…..

What would be recommended?

A

Circumcision

82
Q

__________ is described as the foreskin being stuck in a retracted position and cannot be reduced

A

Paraphimosis

83
Q

What are two ways paraphimosis is managed?

A

Manual Compression/Reduction

Dorsal Silt

84
Q

_____ is described as inflammation of the urethra commonly associated with STIs.

Sx include…..

Diffuse purulent discharge with dysuria

A

Urethritis

85
Q

How is Urethritis treated?

remember it is usually due to a STI

A

Ceftriaxone + Azithromycin

86
Q

________ ________ is the inability to obtain or maintain an erection

A

Erectile Dysfunction

87
Q

What are two classes of medications that are associated with erectile dysfunction?

A

Pyschotropics

Anti-Hypertensives

88
Q

What are co-morbid conditions associated with ED?

A
DM
HTN
CAD
HLD
Smoking
89
Q

T/F: A radical prostatectomy is associated with ED

A

True

90
Q

Up to ___% of patients with undiagnosed vascular disease will present with ED

A

20%

91
Q

What labs should be obtained when working up erectile dysfunction?

A

Total and free testosterone

Lipid Panel

92
Q

What medication class is indicated for ED treatment?

A

PDE-5 Inhibitors

Sildenafil - Viagra

93
Q

What are penile condylomas?

A

Genital Warts

94
Q

What pathogen is typically the cause of genital warts?

A

HPV

95
Q

If there are warts on the penis where else should be inspected for warts?

A

The Anus

96
Q

T/F: Penile Condylomas are a clinical diagnosis

A

True

97
Q

Is there a cure for penile condylomas?

A

No, this is a chronic disease

98
Q

What ‘strains’ of HPV are associated with penile cancer?

A

16
18
31
33

99
Q

How is penile cancer managed?

A

Surgery

100
Q

What is a good preventative measure to take for penile cancer prevention?

A

HPV Vaccine

101
Q

What medication classes are associated with priapism?

A

Psychotropics (Trazadone)

PDE5-Inhibitors

102
Q

What systemic diseases are associated with priapism?

A

Sickle Cell

Disseminated CA

103
Q

_________ _______ results in plaque deposits in the tunica albugenia eventually resulting in penile fibrosis

A

Peyronies Disease

104
Q

Are there proven therapies for peyronies disease?

A

No, there has not been proven therapies for this disease. There are surgical options but not proven effective long term.

105
Q

___________ is low testosterone levels that presents with symptoms of fatigue, ED, decrease ejaculatory force, and decreased libido.

A

Hypogonadism

106
Q

A primary cause of hypogonadism is testicular failure…..

What is a common cause of this?

A

Mumps Orchitis

107
Q

How is hypogonadism treated?

A

Androgen (Testosterone) Supplementation

108
Q

After initiating androgen supplementation for hypogonadism…..

What should you monitor and for how long?

A

Monitor PSA, H&H, Testosterone, DRE

Evaluate at 3, 6, and 12 months and then annually

109
Q

What is the name of the questionnaire used to assess men for hypogonadism?

A

ADAM Questionnaire

110
Q

What is cryptorchidism?

A

Failure of the testis to descend into the scrotum

111
Q

How is is cryptorchidism treated?

A

Hormonal Manipulation (GnRH Injections)

Orchidopexy

112
Q

If cryptorchidism is present……

Most testis descend by what age?

A

3 months

If they are still undescended by 6 months old then descent is unlikely

113
Q

T/F: Being a twin increases the risk for cryptorchidism

A

True

114
Q

What are three common sequelea/consequences of cryptorchidism?

A
  1. Increased CA Risk
  2. Decreased Fertility
  3. Torsion
115
Q

A ________ is a benign accumulation of serous fluid between layers of tunica vaginalis

A

Hydrocele

116
Q

What is the most common cause of a hydrocele in infants?

A

Patent process vaginalis

117
Q

What are common causes of a hydrocele in adults?

A

Idiopathic
Post-Traumatic
Post-Infectious

118
Q

If conservative management of a hydrocele (ie; aspiration) fails what can be done?

A

Scrotal excision (Hydrocelectomy)

119
Q

A ________ results from congestion in the veins around the testis due to a valvular anomaly

Does this condition typically occur in patient older than 40 y.o.?

A

Varicocele

No, these occurtypically in patients 15 - 30 years old

120
Q

Is a varicocele more common in the right of left testis?

A

Left

121
Q

What physical examination finding would help clinically diagnose a varicocele?

A

“Bag of worms” presentation to the veins in the pampiniform plexus

122
Q

T/F: Imaging is required to work up a varicocele

A

False

123
Q

How are varicoceles managed?

A

Varicocelectomy

Embolization

124
Q

T/F: Infertility is associated with varicoceles

A

True

This typically improves with surgical treatment

125
Q

A 21 y.o. male presents to the ED with complaints of sudden right testicular pain that began about 1 hour ago. He denied any traumatic injury prior to the onset of the pain.

What is the most concerning diagnosis?

What physical examination findings are consistent with this diagnosis?

A

Testicular Torsion

Physical Examination….

Negative ipsilateral cremasteric reflex
Scrotal Edema
Negative Phren;s Sign

126
Q

A 21 y.o. male presents to the ED with complaints of sudden right testicular pain that began about 1 hour ago. He denied any traumatic injury prior to the onset of the pain. On examination, he is afebrile, there is no cremasteric reflex on the right, and his pain is not relieved with scrotal elevation.

What is the most diagnostic imaging study?

How should this condition be managed?

A

Scrotal US

Surgery ASAP!

127
Q

What ‘deformity’ is commonly associated with an increased risk of testicular torsion?

A

Bell-Clapper Deformity

128
Q

_______ is the inflammation or infection of the epididymis

A

Epididymitis

129
Q

What are the common pathogens in epipidymitis in patients…..

<35 y.o.?

> 35 y.o.?

A

<35: C. Trachomatis, N. gonorrhoeae

> 35: E Coli

130
Q

If a patient has scrotal pain relieved with elevation, what diagnosis would this be consistent with?

What is the name of the physical examination sign described above?

A

Epididymitis

Phrens Sign

131
Q

How is epididymitis treated?

A

ABx (Doxycycline or Ciprofloxacin)

132
Q

___________ is an acute inflammatory reaction of the testis secondary to an infection

A

Orchitis

133
Q

What is the most common etiology of orchitis?

A

Mumps Orchitis

134
Q

T/F: Bacterial Orchitis is most common associated with epididymitis in sexually active males and men >50 with BPH

A

True

135
Q

Is testicular cancer highly curable?

A

Yes

136
Q

What is the most common type of testicular cancer?

A

95% are Germ Cell

Seminoma, Non-seminoma, Mixed

137
Q

How would testicular CA present?

A

Painless Testicular Mass Incidentally Found

138
Q

What tumor markers are typically present in testicular cancer?

A

AFP
Beta-HCG
LDH

139
Q

in a Bell’Clapper’s Deformity there is an absence or weakness in the ______ ligament, which is a remnant of the gubernaculum

A

Scrotal ligament

140
Q

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

A

Chromosome 12

141
Q

T/F: Most testicular cancers are triploid or tetraploid

A

True

142
Q

Why are varicoceles more common on the left rather than on the right?

A

The left drains to the renal vein instead of the IVC

143
Q

Patients with a patent funicular process may increase the risk for what?

A

Indirect Hernia

144
Q

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

A

Intraperitoneal Bleeding
Ascites
Abdominal CA

145
Q

A __________ (Non-Communicating/Communicating) hydrocele occurs when the process vaginalis has closed.

What are two ways this can occur?

A

Non-communicating

  1. Fluid accumulates in the tunica vaginalis before birth, and just doesn’t get reabsorbed.
  2. A process inside the scrotum (infection, cancer, or fluid production by the tunica itself) causes fluid to build up there.
146
Q

What is the name of the plexus that supplies the prostate and bladder?

A

Pelvic (Hypogastric) Plexus

147
Q

T/F: DHT can activate proto-oncogenes in the prostate

A

True

148
Q

Which zone is the most common site of prostate cancer?

A. Transitional Zone
B. Peripheral Zone
C. Central Zone

A

B. Peripheral Zone

149
Q

T/F: Many prostate cancers are known to increase production of transcription factors that eliminate apoptosis

A

True

150
Q

Prostate cancer is also associated with androgens that _______ (increase/decrease) cell turnover

A

Increase

151
Q

Physiologic phimosis typically resolves by what age?

A

7 y.o.

152
Q

What are THREE risk factors that increase the risk of developing Peyronie’s Disease?

A

Diabetes
Tobacco Use
Pelvic Trauma

153
Q

Erections are mediated by NO and ___________ (paracrine/endocrine) signaling

A

Paracrine

154
Q

What are the TWO types of priapism?

A

High-Flow (non-ischemic): Abundance of arterial flow

Low-Flow (ischemic): Decreased venous drainage, vaso-occlusion

155
Q

The average temperature of the penis is __ degrees lower than the body

A

4 degrees