McIntyre- surgical approach to male repro. disorders

Question 1

______ can inhibit sperm motility

Answer 1

lubricants

Question 2

patient’s progressive motility high or low

Answer 2

very low

Question 3

Answer 3

varicocele

Question 4

dilation of pampiniform plexus

Answer 4

varicocele

Question 5

L or R side more common spot for varicocele

Answer 5

L side

Question 6

exists to regulate temperature and wash down toxin metabolites from kidney and wash away oxidative stress and ROS

Answer 6

scrotum

Question 7

top to bottom

Answer 7

top: skin
dartos
external spermatic fascia
cremaster muscle
internal spermatic fascia
tunica vaginalis

Question 8

Answer 8

hydrocele

Question 9

collection of fluid in tunica vaginalis

Answer 9

hydrocele

Question 10

development the testis start in abdomen and migrate to scrotum (gubernaculum brings them down); if canal stays open, intra-abdominal fluid builds up (patent process vaginalis)

Answer 10

infantile hydrocele

Question 11

why you never want to go below inguinal ligament

Answer 11

femoral a, n, v are there

Question 12

testes drop through what during their descent

Answer 12

inguinal canal

Question 13

a form of surgical sterilization by which the vas deferens is divided or damaged to the point it will no longer transport sperm

Answer 13

vasectomy

Question 14

role of epididymis

Answer 14

sperm maturation and storage

Question 15

Answer 15

vasectomy (isolate vas deferens)

Question 16

Complete absence of sperm or presence of nonmotile sperm in semen after procedure means what

Answer 16

successful vasectomy

Question 17

time of vasectomy to time of reversal; sperm backs up in epididymis

Answer 17

obstructive interval

Question 18

steps of sperm transport

Answer 18

created in seminiferous tubules
stored in epididymis
move from epididymis to vas deferens
mix with fluids from seminal vesicles and prostate
travel through ejaculatory duct, prostate, and urethra and exit

Question 19

diploid cells

Answer 19

spermatogonia and primary spermatocyte

Question 20

haploid cells

Answer 20

secondary spermatocyte, spermatids, and sperm cells

Question 21

____ to ____ after the 1st meiotic division

Answer 21

spermatogonia to primary spermatocyte

Question 22

primary spermatocyte to ______ then to spermatid and sperm cells

Answer 22

secondary spermatocyte

Question 23

____ region of epididymis is where sperm gains ability to fertilize

Answer 23

cauda (tail region)

Question 24

______to inguinal ring obstruction to vas deferens is reversible

Answer 24

external

Question 25

come together to form ejaculatory duct

Answer 25

vas deferense, seminal vesicles, and ampulla

Question 26

useful surgical anatomy to identify what first

Answer 26

vas deferens

Question 27

no sperm seen on semen analysis

Answer 27

Azoospermia

Question 28

vas deferens absent in what main disease

Answer 28

CF

Question 29

The vas is unable to form embryonically due to thickened secretions lack of canalization Seminal vesicles are also atretic

Answer 29

CF

Question 30

semen volume mainly from what

Answer 30

fluid from seminal vesicles

Question 31

primordial bladder

Answer 31

cloaca

Question 32

_____ descends over time

Answer 32

Vas (Wolffian duct)

Question 33

"precum"; neutralizes the urethra; lubrication

Answer 33

bulbourethral glands

Question 34

watery discharge; contributes PSA

Answer 34

prostate

Question 35

(screening tool for prostate cancer) ----break down coagulum that comes out with ejaculate (so it can stick to cervix)

Answer 35

PSA

Question 36

Sperm formation is normal but they are unable to traverse the male genital tract.

Answer 36

Obstructive Azoospermia

Question 37

sperm retrieval in setting of OA

Answer 37

percutaneous approach to the epididymis

Question 38

men of reproductive age should never be above _____ for FSH

Answer 38

7.5

Question 39

LH and FSH abnormally high but testosterone normal; what does this mean

Answer 39

pituitary is abnormal

Question 40

brain is not seeing ______ signal back from testicles for negative feedback loop to work

Answer 40

inhibin

Question 41

example of primary hypogonadism/testicular failure where FSH and LH are elevated

Answer 41

Klinefelter's (XXY)

Question 42

progressive scarring of testicles disproportionate stature infertility hypogonadism

Answer 42

Klinefelter's

Question 43

treatment options for non-obstructive azoospermia

Answer 43

IVF

Question 44

sperm retrieval rates for NOA patient

Answer 44

60%

Question 45

pregnancy rates for NOA patient

Answer 45

45%

Question 46

scrotal ultrasound shows what

Answer 46

a mass

Question 47

labs to order for testicular mass

Answer 47

hCG LDH AFP

Question 48

orchiectomy

Answer 48

remove testicle

Question 49

scrotum drains to what nodes

Answer 49

inguinal

Question 50

if you violate the scrotum while removing a testicle what can happen

Answer 50

expose lymphatics to cancer

Question 51

what else is seen here

Answer 51

hydronephrosis on L side

Question 52

elevated hCG most likely associated with what type of testicular cancer

Answer 52

Nonseminomatous germ cell tumor

Question 53

most common germ cell tumor

Answer 53

seminoma

Question 54

marker for Yolk Sac Tumor

Answer 54

AFP

Question 55

marker for choriocarcinoma

Answer 55

beta hCG

Question 56

treatment for seminoma w/ mets to retroperitoneum

Answer 56

chemo/radiation

Question 57

treatment for non-seminomatous germ cell tumor with mets to retroperitoneum

Answer 57

surgery/chemo

Question 58

Answer 58

R sided modified template

Question 59

Answer 59

L sided modified template

Question 60

why would you need to spare the nerves that innervate male reproductive tract

Answer 60

erection and ejaculation happen from sympathetics and parasympathetics

Question 61

Erection Preganglionic neurons innervate the corpora cavernosa IML at the S2-S4 level. Exit through pelvic nerves Pass through the hypogastric plexus

Answer 61

parasympathetic

Question 62

_____ artery comes off internal iliac artery

Answer 62

internal pudendal that supplies the penis

Question 63

______ artery becomes cavernous arteries

Answer 63

internal pudendal

Question 64

what pinches outflow of blood through veins that keeps blood into cavernous and maintains erection

Answer 64

Buck's fascia

Question 65

what causes NO release in the erection pathway

Answer 65

parasympathetic stimulation

Question 66

NO stimulates ______ that upregulates cGMP

Answer 66

smooth muscle guanylyl cyclase

Question 67

_____ causes penile arteriolar vasodilation and relaxation of penile corporeal smooth muscle

Answer 67

cGMP

Question 68

terminates cGMP function

Answer 68

PDE5

Question 69

erectile dysfunction can be treated by inhibiting what

Answer 69

PDE5

Question 70

_____ inhibitors increase blood flow and muscle relaxation of penis

Answer 70

PDE5 inhibitors

Question 71

main 2 causes of ED

Answer 71

vascular and diabetes

Question 72

____ is a risk factor for cardiovascular disease in the future

Answer 72

ED

Question 73

first used for primary pulmonary HTN treatment and then ED

Answer 73

Viagra (Sildenafil)

Question 74

negative pressure pumped in to help erection

Answer 74

vacuum erection device

Question 75

topical prostaglandin E1 (intraurethral suppositories to do what)

Answer 75

erection

Question 76

inject prostaglandin E1 to vasodilate arteries is _____ mediated

Answer 76

cAMP

Question 77

_____ activates protein kinase G and causes decreased intracellular Ca2+ and decreased smooth muscle tone and vasodilation of penile arteries

Answer 77

cGMP

Question 78

____ activates protein kinase A and causes decrease in intracellular Ca2+ and decreased smooth muscle tone and vasodilation of penile arteries

Answer 78

cAMP

Question 79

another way to achieve erection if all other options dont work

Answer 79

penile implant (pump in scrotum)

Question 80

how long can penile implant last

Answer 80

7-10 years