Repro Exam 5

Question 1

Which of the following is NOT a history question to ask about a penile and scrotal lesions?
a. pruritis
b. painful or painless
c. recurrence
d. urinary sx

Answer 1

urinary sx

Question 2

Which of the following is NOT part of the PE for penile and scrotal lesions?
a. color
b. configuration
b. size
c. transillumination

Answer 2

transillumination

Question 3

What is NOT part of the work up for penile and scrotal lesion?
a. skin biopsy
b. UA
c. skin scraping
d. STI testing

Answer 3

UA

Question 4

What is the DDX for penile and scrotal lesions?

Answer 4

inflammatory or papulosquamous
infectious
neoplastic

Question 5

Which of the following is NOT a history questions to ask when pt presents penile discharge?
a. systemic sx
b. urinary sx
c. painful or painless
d. sexual hx and practices

Answer 5

painful or painless

Question 6

What is the PE for penile discharge ?
a. palpate inguinal lymph node
b. cremaster reflex
c. discharge
d. a and c

Answer 6

a and c

Question 7

What are the ddx for penile discharge?

Answer 7

Gonococcal urethritis
Non-gonococcal urethritis
Urethral irritation (soaps, detergents, lubricants)
Hematospermia

Question 8

What is the work up of penile discharge?
a. complete UA with culture and sensitivity
b. STI testing
c. semen analysis and discharge analysis
d. all of the above

Answer 8

all

Question 9

What is the PE for diagnosing scrotal masses and swelling?
a. palpate and ascultate
b. transilluminaion
c. cremaster reflex
d. hernia
e. all of the above

Answer 9

all

Question 10

What is the ddx of scrotal masses and swelling?

Answer 10

Hydrocele – will transilluminate
Hematocele – may not transilluminate
Varicocele – feels like “bag of worms” on palpation
Edema – from systemic conditions
Indirect inguinal hernia – bowel sounds, positive hernia exam
Orchitis – very tender to palpation
Testicular cancer – firm to palpation
Testicular torsion – sudden pain
Torsion of appendix testis – blue dot sign (~20% of cases)
Epididymitis – painful, acute or chronic, usually STI in younger men
Spermatocele – painless

Question 11

What is the work up for scrotal masses and swelling?
a. UA
b. STI testing
c. US
d. biopsy
e. all of the above

Answer 11

all

Question 12

Which of the following is not a PE of prostatitis?
a. DRE
b. genital exam
c. abdominal exam
d. skin exam

Answer 12

skin

Question 13

What are the ddx of prostatitis?

Answer 13

Acute bacterial prostatitis
Prostatic abscess
Cystitis
Epididymitis
Proctitis
Diverticulitis
Pelvic floor dysfunction
IBS, colon cancer
Interstitial cystitis, bladder cancer, STI
Chronic prostatitis
BPH
Prostate cancer
Chronic pelvic pain syndrome

Question 14

What is the work up for acute prostatitis?
a. UA
b. STI
c. CBC
d. a and b

Answer 14

a and b

Question 15

What is the work up for chronic prostatitis?
a. PSA
b. UA
c. US
d. all of the above

Answer 15

all

Question 16

What are the PE of erectile dysfunction?
a. genitalia exam
b. abdominal exam
c. cardiovascular exam
d. a and c

Answer 16

a and c

Question 17

What is not part of the erectile dysfunction work up?
a. hormone testing
b. lipid panel and ASCVD
c. DM testing
d. UA

Answer 17

UA

Question 18

What is included in the PE for gynecomastia?
a. breast
b. abdominal
c. genital
d. a and c

Answer 18

a and c

Question 19

What is NOT included in the work up of gynecomastia?
a. hormone testing
b. US
c. mammography
d. MRI

Answer 19

MRI

Question 20

What is the ddx of gynecomastia?

Answer 20

Congenital hypogonadism
Medications
Anabolic steroids
Alcohol, cannabis
Cirrhosis (+estradiol, +SHBG)
Cushing’s disease (low T)
Renal disease (low T)

Question 21

What is bioethics?

Answer 21

advancments in medicine due to new technology

Question 22

What are some ethical issues within the reproductive block?
a. genetic testing for unborn babies
b. advancments in fertility technology
c. contraceptive technology
d. all of the above

Answer 22

all

Question 23

What are the ethical issuse around fertility?
a. ferility drugs
b. surrogacy
c. gamete donors
d. all of the above

Answer 23

all

Question 24

What is the definiton of perimenopause?
a. a period of time before a patient reaches 12 continous months without having a cycle
b. varying cycle length greater than 7 days different from normal
c. the day after 12 months and from then on
d. when a patient has no menstural cycle for 12 months

Answer 24

a period of time before a patient reaches 12 continous months without having a cycle

Question 25

When do hot flashes normally occur? a. early perimenopause b. late perimenopause c. menopause d. post-menopause

Answer 25

late perimenopause

Question 26

What are the ovarian follicle changes in perimenopause?

Answer 26

oocytes undergo atresia each month and eventually deplete the amount of ovarian follicles resulting in hypoestreogenemia and high FSH

Question 27

What are the endocrine changes in menopause?

Answer 27

dec in antral follicle count dec inhibin inc FSH dec estradiol

Question 28

What is the average age of perimenopause? a. 47 b. 50 c. 51 d. 40

Answer 28

47

Question 29

What is the average menopause? a. 47 b. 50 c. 51 d. 40

Answer 29

51

Question 30

What is the MOA of physiologic menstural irregularity?

Answer 30

dec in functional follicles shortened follicular phase causing cycles to shorten in length to 25 days or less,

Question 31

What is the hallmark sxs that indicates perimenopause transition has started?

Answer 31

Hot flashes Insomnia Weight gain and bloating Mood changes Irregular menses (perimenopause) Mastodynia Depression Headache Sexual function changes & vulvovaginal atrophy (VVA) Joint pain

Question 32

When is urogenital atrophy most significant? a. early perimenopause b. late perimenopause c. menopause d. post-menopause

Answer 32

post-menopause

Question 33

STRAW staging system

Question 34

What is the general approach to evaluation of a menopausal patient?

Answer 34

history pelvic exam FSH sometimes

Question 35

What test maybe useful but not necessary for dx with the exception of special circumstances? a. FSH b. inhibin c. AMH d. estradiol

Answer 35

FSH

Question 36

What factors can affect the onset of menopause?

Answer 36

smoking genetics ethnicity partial hysterectomy type 1 DM DES exposure Galactose consumption fragile X carrier exposure to certian chemotherapeutic agents or radiation

Question 37

What are diseases linked to estrogen deficiency?

Answer 37

osteoprosis cardiovascular disease cognitive impairment impaired vison/macular degeneration asthma polymetabolic syndrome

Question 38

How do you test folx with underlying menstural cycle disorders to see if they are in menopause? a. FSH b. inhibin c. AMH d. estradiol

Answer 38

FSH

Question 39

How do you test for menopause in those takinf oral contraceptives? a. FSH b. inhibin c. AMH d. estradiol

Answer 39

FSH

Question 40

How do you test for menopause in posthysterectomy or endometrial ablation? a. FSH b. inhibin c. AMH d. estradiol

Answer 40

FSH

Question 41

What FSH level indicates menopause? a. 4 b. 14 c. >25 d. <25

Answer 41

>25

Question 42

What are the risk factors for developing hot flashes (VMS)?

Answer 42

obesity cigarette smoking reduced physical activity hormone concentration black pt those with tachykinin receptor 3 (TACR3) gene

Question 43

What is the physiology of hot flashes?

Answer 43

the thermoneutral zone is narrowed w/ less estrogen causing the hypothalamus to trigger the feeling of warmth or cold easier, thermoregulatory area are close to GnRH containing neruons so could be crossing over from high FSH

Question 44

What dosen't brings on hot flashes? a. alcohol b. spicy or hot food/drinks c. difficult emotions d. cold drinks/food

Answer 44

cold drinks/food

Question 45

What should be included in the hot flash assessment when taking a hx with a pt?

Answer 45

frequency, duration, severity

Question 46

List some DDX’s for hot flash presentation.

Answer 46

menopause hot drinks alcohol cancer infections hyperthyroidism

Question 47

Discuss treatment options for hot flashes; when is it safe to use MHT and when is it not safe to prescribe it for a pt?

Answer 47

stress managment, mindfulness, yoga, plant-based diet, dec alcohol, acupuncture, sleep hygeine, homeopathy, undas, botanicals,

Question 48

List the non-hormonal pharmaceutical options for hot flashes.

Answer 48

SSRIs SNRIs Paroxetine Citalopram Gabapentin Bazedaxifene

Question 49

What treatment options are available for insomnia?

Answer 49

stress management mindfulness tai chi, Qi Gong alcohol acupuncture pine bark extract 20 mg daily unda 30, 9, 22, 210 melationin 0.5-3 mg botanicals- valerian, passiflora, avena, skullcap, kava, leonorus. magnolia bark

Question 50

For a menopausal pt presenting with vulvovaginal changes what exam must be performed?

Answer 50

pelvic

Question 51

What treatment options are available for vulvovaginal changes?

Answer 51

moisturizers, lubricants, lactobacillus and vitamin E suppositories suppositories hyaluronic acid, vit A, vit d, Vit E nightly topical ginseng, menthol, l-arginine local estrogen options ospemifen black cohosh, dong quai, maca, tribulus, soy holistic pelvic floor

Question 52

What treatment options are available for depression and anxiety?

Answer 52

mind-body medicine (CBT, MBSR, yoga, Tai Chi, Qi Gong) magnolia bark b vitamins Vitamin d 5HTP, GABA hypericum, maca homeopathy undas SSRI MHT

Question 53

Why does CVD increase in menopause, the underlying MOA?

Answer 53

dec estrogen effects endothelila functions and tone, inc risk of HTN, negative change in lipids and glucose, in levels of coagulation markers, inc adipose, inc leptin and PAI-1, dec ghrelin and adiponectin, inc clotting, inflammation, and atherosclerotic plaquing

Question 54

What are the treatment options available for CVD related to menopause?

Answer 54

lifestyle diet stress managment excercise smoking cessation intimacy and quailty social support

Question 55

What is the effect of hormones on the breast tissue?

Answer 55

estrogen and progestin: node + breast cancer and inc mortality, HER2 + estrogen alone: no risk for breast cancer

Question 56

What health maintenance and screening should be included for the menopausal patient?

Answer 56

BMI/waist cicrumferance pap & HPV testing CBE pelvic exam lipids glucose mamogram colon cancer screening DEXA Vit D testing

Question 57

Describe the difference on a physiological level between transdermal and oral estrogen.

Answer 57

transdermal: dec fibrinogen, dec factor VII, promotes postive effect on ednothelial function, dec CRP, amyloid A procoagulant factors, or acute inflammation oral: goes first pass-metabolism, cuases upregulation of plaque inflammatory processes and increase plaque instability, increase acute inflammation, increase CRP, dec ghrelin,

Question 58

What delivery system of progesterone protects the uterus?

Answer 58

OMP

Question 59

When is it not safe to prescribe HMT for a pt?

Answer 59

no risk of hormone senstive cancer, breast cancer, CVD, clotting disease

Question 60

What do you need to do before starting menopause hormone therapy?

Answer 60

lipid panel mammogram Gail model ASCVD rule out contraindications

Question 61

What ethical issues do genetic testing pose? a. none b. sexual selection c. expensive d. explotation

Answer 61

sexual selection

Question 62

What population tends to get physiologic phimosis? a. older b. middle aged c. young d. teenagers

Answer 62

young

Question 63

What indicates pathological phimosis? a. nontender, swelling, and increased blood flow b. redness, swelling, and decreased blood flow c. white and decreased blood flow d. none of the above

Answer 63

redness, swelling, and decreased blood flow

Question 64

Which of the following is a RF for phimosis? a. poor hygeine b. sexual activity c. drug use d. smoking

Answer 64

poor hygeine

Question 65

What are some methods to prevent phimosis? a. frequent hygeine and diaper changes b. hydrotherapy c. healthy diet with fiber d. quit smoking

Answer 65

frequent hygeine and diaper changes

Question 66

What is the difference between phimosis and paraphimosis? a. phimosis is more sevre than paraphimosis b. phimosis is tight forseskin cannot be retracted from the glans penis and paraphimosis is when foreskin is trapped in the retracted positons c. phimosis is due to infection and parahimoiss is not due to infection d. phimosis can cause gangrene/necrosis and parahimosis can not

Answer 66

phimosis is tight forseskin cannot be retracted from the glans penis and paraphimosis is when foreskin is trapped in the retracted positons

Question 67

Which of the following is NOT a RF of phimosis? a. diaper rash and poor hygeine b. condome catheter c. balanitis xerotica obliterans d. penile trauma

Answer 67

penile trauma

Question 68

What are treatment options for phimosis? a. antibiotics b. topical creams either steroids or callendula/centella c. ice d. sitz baths

Answer 68

topical creams either steroids or callendula/centella

Question 69

Which of the following is NOT a cause of paraphimosis? a. patholigcal phimosis b. balanitis c. sexual activity d. heart disease

Answer 69

heart disease

Question 70

Which of the following is a treatment for paraphimosis? a. ice b. topical pain managment c. slowly attempt to reduce the foreskin over the glans d. all of the above

Answer 70

all

Question 71

What is the difference between balanitis and balanopostitis? a. they are the same thing b. balanitis is more sever than balanoposthitis c. balanitis is inflammation of the glans penis and balanoposthitis is inflammation of both the glans penis and the foreskin d. balanitis is due to poor hygiene and balanoposthitis is not

Answer 71

balanitis is inflammation of the glans penis and balanoposthitis is inflammation of both the glans penis and the foreskin

Question 72

What is the most common cause of balanitis and balanoposthitis? a. bowenoid papulosis b. psoriasis c. candidia d. reactive arthritis

Answer 72

candidia

Question 73

What is the difference between the presentation of balanits/balanoposthitis and phimosis? a. phimosis presents as redness, swelling, and blockage of flow but balanits/balanoposthitis is pain during or after urination, discharge from painful inflammed tissue, local erythema and edema b. balanits/balanoposthitis presents as redness, swelling, and blockage of flow but phimosis is pain during or after urination, discharge from painful inflammed tissue, local erythema and edema c. phimosis presents as snapping, sound, sudden pain and balanits/balanoposthitis resents as redness, swelling, and blockage of flow d. none of the above

Answer 73

phimosis presents as redness, swelling, and blockage of flow but balanits/balanoposthitis is pain during or after urination, discharge from painful inflammed tissue, local erythema and edema

Question 74

Which of the following is RF is specific to balanoposthitis but not balanitis? a. poor hygeine b. antibiotic use c. phimosis d. a and c

Answer 74

a and c

Question 75

Which is not a causes of balantits/balanoposthitis? a. infectious b. dermatological c. pre/malignant d. tramua

Answer 75

trauma

Question 76

how dose treatment for balantits/balanoposthitis compare to treatment of paraphimosis? a. balantits/balanoposthitis and paraphimosis have the same treatment b. balantits/balanoposthitis involves topical antifungals, corticosteriods, and antibiotics while parphimosis only involves topical antifungals c. balantits/balanoposthitis involves topical pain managment while parahimosis involves topical centella, Vit E, and callendular d. balantits/balanoposthitis involves topical antifungals, corticosteriods, and antibiotics while paraphimosis involves topical pain managment

Answer 76

balantits/balanoposthitis involves topical antifungals, corticosteriods, and antibiotics while paraphimosis involves topical pain managment

Question 77

What is circinate balanitis associated with? a. chlamydia b. squamous cell carcinoma c. reactive arthritis d. balanitis xerotica obliterans

Answer 77

reactive arthritis

Question 78

what dose balanitis xerotica obliterans look like? a. glans and forseskin atrophies and appears white b. redness and erythema c. muliple little papules d. alll of the above

Answer 78

glans and forseskin atrophies and appears white

Question 79

what dermatological conditons is NOT are associated with balanits? a. psoriasis b. eczema c. lichen planus d. contact dermatitis e. acne

Answer 79

acne

Question 80

which of the following is NOT a benefit of circumcison? a. easier hygeine b. reduction in UTI, HPV, HIV, HSV c. sexual sensation d. reduction in penile inflammation and phimosis

Answer 80

sexual sensation

Question 81

which of the following is a benefit of circumsion? a. procedural complications b. easier hygiene c. sexual dissatisfaction and stress d. potentially unethical

Answer 81

easier hygiene

Question 82

Which of the following is NOT a way to remove pearly penile papules? a. liquid nitrogen b. excison c. laser surgery d. radiosurgery

Answer 82

excison

Question 83

what are RF for tumors of the penis?

Answer 83

poor hygeine, smoking, hx of HPV, UTIs, penile injury, phimosis, HIV infx, HSV, psoriasis, uncircumcised

Question 84

which of the following is not a pre-cancerous lesion of penis cancer? a. leukoplakia b. pearly penile papules c. balanitis xerotica obliterans d. condyloma accuminata

Answer 84

pearly penile papules

Question 85

Which of the following is a carcinoma in situ associated with HPV 8? a. bowen disease b, erythroplasia of queyrat c. bowenoid papulosis d. all of the above

Answer 85

erythroplasia of queyrat

Question 86

What is the most common penile cancer? a. basal cell carcinoma b. kaposi sarcoma c. melanoma d. squamous cell carcinoma

Answer 86

squamous cell carcinoma