testicular + penile + prostate pathology

Question 1

painful upon palpation of epididymis
+/- testicular swelling
IMPROVES with elevation of testicles

Answer 1

epididymitis

Question 2

treatment for male

Answer 2

STD: gonorrhea/chlamydia
ceftriaxone IM (1 dose), doxycycline x 10 days

Question 3

treatment for male > 35 yo or hx of anal intercourse with epididymitis/prostatitis think of:

Answer 3

UTI:enterobacteriaceae (E. coli, klebsiella, serratia, enterobacter, proteus)
fluoroquinolones x 10-14 days (vs prostatis x 1 mo)

Question 4

acute onset of pain in testes
high-riding teste on affected side
+/- testicular swelling
absent cremasteric reflex (tickle teste and no movement of teste)

Answer 4

testicular torsion: twisting of spermatic cord → ischemia/necrosis of testicle
(medical emergency)

Question 5

diagnosis of testicular torsion requires

Answer 5

US - blood flow in testicle

Question 6

treatment of testicular torsion

Answer 6

surgery within 6 hrs to prevent ischemia to testes: bilateral orchiopexy (suture teste to scrotum to prevent happening again)

Question 7

failure of teste to descend into scrotum is called

Answer 7

cryptochordism

Question 8

complications of cryptochordism

Answer 8

↑ temperature (only sertoli cells affected by temp): → impaired spermatogenesis
↑ risk malignant germ cell tumors
prematurity ↑ risk of cryptochoridism

Question 9

treatment of cryptochordism

Answer 9

infant: early orchiopexy to suture testes down into scrotum (↓ cancer risk since can palpate tumors now)
post pubertal tx: orchiopexy or orchiectomy

Question 10

differential diagnosis for cryptochordism

Answer 10

androgen insensitivity: 46 X,Y with testes but no scrotum (female genitalia - in labia majora), treatment is orchiectomy
bilateral undescended: 46 X,Y without testes
CAH: 46 X,X with male external genitalia

Question 11

testicular mass that doesn’t transluminate think

Answer 11

testicular cancer

Question 12

testicular mass that transluminates think

Answer 12

hydrocele

Question 13

“fried egg” appearance

Answer 13

seminoma

also koilocytes in HPV, oligodendroglioma

Question 14

most common testicular cancer

Answer 14

seminoma

Question 15

PAINLESS testicular mass in 15-35yo

malignant, excellent prognosis (late mets)

Answer 15

seminoma

Question 16

schiller-duval bodies (resemble primitive glomeruli, central capillary)

Answer 16

yolk sac tumor

Question 17

most common testicular cancer

Answer 17

yolk sac tumor

Question 18

yellow, mucinous testicular mass
malignant
↑AFP

Answer 18

yolk sac tumor

Question 19

malignant

↑ HCG due to synctiotrophoblasts present (also has cytotrophoblasts)

Answer 19

choriocarcinoma

Question 20

hemorrhagic stroke can be the presentation for this testicular cancer

Answer 20

choriocarcinoma

hematogenous mets to lungs + brain (bleed into mets in brain)

Question 21

↑HCG and may have ↑AFP
malignant tumor in adult males (not malignant in females)
hair, teeth - multiple tissue types

Answer 21

teratoma

Question 22

PAINFUL testicular mass
malignant
↑ HCG with normal AFP
bad prognosis

Answer 22

embryonal carcinoma

Question 23

glandular/papillary morphology of testicular cancer

Answer 23

embryonal carcinoma

Question 24

reinke crystals (rod-shaped, crystal like)

Answer 24

leydig cell

Question 25

secrete testosterone→ peripheral conversion to estrogen → gynecomastia if adult (esp if obese) or precocious puberty in boy (due to ↑ exposure to T)

Answer 25

leydig cell

Question 26

most common non-germ cell tumor

Answer 26

leydig cell

Question 27

most common type of testicular tumor

Answer 27

germ cell tumor

Question 28

germ cell tumor types (malignant)

Answer 28

``` seminoma yolk sac choriocarcinoma teratoma embryonal carcinoma ```

Question 29

non-germ cell tumor (benign)

Answer 29

leydig cell sertoli cell testicular lymphoma

Question 30

secrete estrogen → gynecomastia | associated with: Peutz-Jeghers syndrome, Carney syndrome

Answer 30

sertoli cell

Question 31

testicular cancer in older man

Answer 31

testicular lymphoma: lymphoma mets to testes aggressive

Question 32

dilated epididymal duct

Answer 32

spermatocele

Question 33

incomplete fusion of processus vaginalis

Answer 33

hydrocele in infant | resolves on own

Question 34

treatment of prostatitis

Answer 34

treat like UTI: give 4 wks fluoroquinolones levofloxacin TMP-SMX

Question 35

what can cause sexual dysfunction

Answer 35

drugs: antihypertensives, neuroleptics, SSRI (↓ libido), ethanol disease: depression, diabetes, small vessel atherosclerosis physiological: performance anxiety hormones: low T, hyperprolactinemia

Question 36

types of erectile dysfunction

Answer 36

can have any combo (no morning erections): failure to initiate (psychogenic, endocrinologic, neuro) failure to fill (atherosclerosis) failure to store adequate blood volume in lacunar network 80% older men with ED have: diabetes (35-75% DM men), atherosclerosis, drug-related

Question 37

types of bowen disease

Answer 37

bowen disease erythroplasia of queyrat bowenoid papulosis

Question 38

gray, solitary,crusty plaque on PENILE SHAFT or SCROTUM (or female genitalia) usually >50 yo

Answer 38

bowen disease

Question 39

red, velvety plaque involving GLANS PENIS usually

Answer 39

erythroplasia of queyrat

Question 40

multiple papular lesions (not invasive) | younger patients

Answer 40

bowenoid papulosis

Question 41

benign genital warts (STD) caused by HPV types 6 + 11

Answer 41

condyloma acuminatum

Question 42

male with dysuria, increase in frequency/urgency, and low back pain think

Answer 42

prostatitis

Question 43

common cause of prostatitis by age

Answer 43

35 yo: UTI (E. coli, klebsiella, serratia, enterobacter, proteus) chronic: can be bacterial or abacterial (chronic is hard to treat)

Question 44

hyperplasia of prostate gland due to DHT smooth, firm nodular enlargement of periurthetral (middle + lateral lobes) which compresses the urethra into a vertical slit ↑PSA (but not premalignant) clinical diagnosis: ↑ frequency (2-3 times), difficulty starting or stropping a stream, dsyuria, sensation of incomplete voiding, weak stream size of lesion does not correlate with degree of obstruction or symptom severity

Answer 44

benign prostatic hyperplasia

Question 45

rectal exam will not highlight this pathology

Answer 45

BPH: occurs in middle + lateral lobes of prostate

Question 46

rectal exam will highlight this pathology

Answer 46

prostatic adenocarcinoma: occurs in posterior lobe

Question 47

treatment for BPH

Answer 47

α1 blocker (doxazosin, prazosin, terazosin) α1ad blocker (tamulosin) 5αreductase (finasteride)

Question 48

inflammation of glans penis 40% due to candida albicans other causes: local trauma, STDs, virus more common in diabetic or non-circumscribed

Answer 48

balanitis

Question 49

associated with HPV and lack of circumcision most common in Asia, Africa, South America bowen disease can be a premalignant lesion of this

Answer 49

penile squamous cell carcinoma

Question 50

painful sustained erection not associated with sexual stimulation or desire associated with sickle cell disease or spinal cord injuries can get ischemia + blood clots in penis

Answer 50

priapism

Question 51

angulation of penis due to inflammatin + fibrous tissue formation in tunica albuginea painful with erection

Answer 51

Peyronie disease

Question 52

``` > 50 yo male same symptoms as BPH screening tool: ↑ PSA (high false positive) diagnosis: needle core bx prostate exam: asymemtric, hard nodule ```

Answer 52

prostatic adenocarcinoma

Question 53

treatment for prostatic adenocarcinoma

Answer 53

flutamide: inhibit testosterone at the receptor level

Question 54

osteoblastic bone lesions low back pain ↑ alk phos

Answer 54

metastatic prostate cancer

Question 55

complications of BPH

Answer 55

UTI | bladder distention