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repo med tes 2 > the BALLS!!!!!! > Flashcards

the BALLS!!!!!! Flashcards

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1
Q

low testosterone

< 150-200 ng/dL

A

Hypogonadism

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2
Q

Hypogonadism etiology

A

Primary: testicular failure
Mumps orchitis
Secondary: hypogonadotropic hypogonadism
Age-related (ADAM), chronic opiates

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3
Q

Hypogonadism epidemiology

A

increasingly diagnosed

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4
Q

Hypogonadism presentation

A

decreased energy/fatigue, ED, decreased force of ejaculation, decreased libido

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5
Q

Hypogonadism work - up

A

Free and total testosterone
Exam
If low – DEXA scan (< 100 ng/dL)

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6
Q

Hypogonadism tx

A

Androgen (testosterone) supplementation

Gels, injections, pellets

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7
Q

Hypogonadism follow up monitoring

A

PSA, hemogram (H&H), testosterone, review of urinary symptoms, DRE
3, 6 and 12 months after initiating, then annual
Counsel prostate Ca monitoring; CV risks, infertility.

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8
Q

basic questionnaire can be very useful for men to describe the kind
and severity of their low testosterone symptoms.

A

ADAM Questionnaire

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9
Q

testis (testes) not in scrotum

Possibly absent; possibly non-palpable (20%); if palpable, won’t come down

A

Cryptorchidism

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10
Q

Cryptorchidism etiology

A

not well understood

Normal descent is androgen-independent, mediated by “descendin;” passage through inguinal canal begins 28 weeks

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11
Q

Cryptorchidism epidemiology

A

rare

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12
Q

Cryptorchidism work up

A

good physical exam (don’t forget penis), possible scrotal U/S, urologist may pursue further studies (MRI, diagnostic laparoscopy)

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13
Q

Cryptorchidism tx

A

hormonal manipulation (GnRH injection); orchidopexy

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14
Q

testi at Inguinal canal -

A

between internal and external rings

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15
Q

testi Intra-abdominal (10%) -

A

proximal to inguinal ring

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16
Q

Absent testis (20%)-

A

truly absent, probable vascular event

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17
Q

Ectopic testis -

A

below the internal ring but out of normal path

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18
Q

Retractile testis -

A

reflects exuberant cremasteric reflex

Follow patient until puberty

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19
Q

Most descend spontaneously in first __ months

A

3

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20
Q

If undescended at __months, descent is unlikely

A

6

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21
Q

what percent of term infants have cryptorchidism

A

3

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22
Q

what percent of premes have cryptorchidism

A

30

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23
Q

what percent of Cryptorchidism is bilateral

A

10

3 percent have one or both missing

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24
Q

Cryptorchidism risk factors

A

Twins, low birth weight, pre-term delivery, family history, Prune Belly syndrome

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25
Cryptorchidism cancer risk
Increased risk of testicular cancer (1/2500 versus 1/100,000) Cancer risk may be reduced by orchidopexy, certainly facilitates examination Contralateral testis at increased risk also, even if descended (10-25% of cancers on this side)
26
Cryptorchidism fertility effect
decreased
27
t/f torsion risk is 10 x higher
t
28
benign accumulation of serous fluid between layers of tunica vaginalis
Hydrocele
29
infant Hydrocele presentation
infant/toddler with hemiscrotal enlargement; volume/size waxes and wanes during day
30
infant Hydrocele etiology
patent processus vaginalis (communicating hydrocele)
31
infant Hydrocele work up
clinical diagnosis; scrotal sonogram may be helpful
32
infant Hydrocele tx
if persistent after one year, repair via inguinal incision
33
Adult Hydrocele presentation
scrotal discomfort; scrotal enlargement; possible h/o trauma or infection
34
Adult Hydrocele etiology
idiopathic; post-traumatic; post-infectious
35
Adult Hydrocele work-up
careful physical examination; transillumination; possible scrotal sonogram
36
Adult Hydrocele tx
Expectant management if asymptomatic Aspiration/sclerosis associated with recurrence Scrotal excision (hydrocelectomy)
37
congestion of veins around the testis
Varicocele
38
Varicocele etiology
reflects valvular anomaly exacerbated (or caused?) by gonadal venous anatomy; rare malignant etiology (consider if right-sided, or in man > 40 years)
39
Varicocele presentation
asymptomatic; dull ache; infertility; scrotal enlargement; majority on left
40
Varicocele work up
Clinical diagnosis; “bag of worms” due to dilatation of veins in pampiniform plexus; examine both standing and supine; generally no need for imaging; ?SA
41
Varicocele tx
varicocelectomy; embolization; 2/3 surgically treated have fertility improvement
42
Varicocele epidemiology
age 15-30 years; rarely over 40 years
43
careful dissection of spermatic cord, with ligation of veins (preserve the artery, lymphatics, vas deferens)
Varicocelectomy
44
twisting of spermatic cord causing ischemia of testis
Testicular Torsion
45
Testicular Torsion epidemiology
bimodal distribution | Neonatal (extravaginal) v. pubertal (intravaginal)
46
Testicular Torsion etiology
anatomic predisposition (Bell-clapper deformity; cryptorchidism); trauma; sex
47
Testicular Torsion presentation
Sudden severe onset unilateral scrotal pain; nausea/emesis; abdominal pain; symptoms may be intermittent (intermittent torsion)
48
Testicular Torsion work up
Difficult exam; high-riding testis; ?negative cremasteric reflex on affected side; scrotal edema and tenderness; pain unrelieved by scrotal elevation Sonogram often equivocal or may be misleading, could delay treatment High index of suspicion
49
Testicular Torsion tx
Scrotal exploration, with untwisting of cord and orchidopexy; ?contralateral orchidopexy High salvage rate if treated within 6 hours
50
Inflammation/infection ball mow hawk
Epididymitis
51
Epididymitis etiology
Ascending infection from urethra, prostate, bladder <35 years - C. trachomatis, N. gonorrhoeae >35years - E.coli Surgery (vasectomy) Other trauma
52
Epididymitis
Scrotal pain, scrotal enlargement, fever
53
Epididymitis
Good history and exam; UA C&S; ?penile swab/probe for STI, ?scrotal sonogram
54
Epididymitis
Antibiotics (empiric by age, i.e. doxycycline or ciprofloxacin) Palliatives (scrotal support, NSAIDs, ice, narcotics)
55
- acute inflammatory reaction of testis secondary to infection
Orchitis
56
Orchitis etiology
Most common – viral mumps infection in children Bacterial orchitis - most commonly associated with epididymitis in sexually active males and men >50 with BPH C. trachomatis, N. gonorrhoeae, E. coli
57
Orchitis presentation
Scrotal pain (mild-severe) and swelling Exam can reveal impressive induration and edema Overlying skin frequently thickened Testicle won’t move freely in the scrotum, seems “stuck”
58
Orchitis work up
Good history and exam; UA C&S; ?penile swab/probe for STI, ?scrotal sonogram
59
Orchitis tx
Viral (mumps orchitis) - no medications; may lead to infertility Bacterial - treat suspected organism, exclude/address abscess
60
Highly curable cancer in young to middle-aged men
Testis Cancer
61
Testis Cancer histology
``` Germ cell (95%) Seminoma Non-seminoma (NSGCT) Mixed (managed as NSGCT) Non germ cell (5%) Rare secondary tumors (lymphoma, leukemia) ```
62
Testis Cancer epidemiology
8,500 new cases/year; 350 deaths/year | Trimodal: Up to 10 years (yolk sac); 20-40 years (seminoma); > 60 years (spermatocytic seminoma)
63
Testis Cancer presentation
painless testicular mass Usually incidental by partner or after trauma Cough or dyspnea secondary to lung metastases GI symptoms secondary to retroperitoneal metastases Gynecomastia
64
Testis Cancer work up
Scrotal sonogram Tumor markers (AFP, beta-hCG, LDH); CT to assess the lymph nodes of retroperitoneum Radical inguinal orchiectomy
65
Testis Cancer tx
guided by histology (seminoma v. NSGCT) and staging (markers + imaging) Surveillance Adjuvant chemotherapy Adjuvant radiotherapy Retroperitoneal lymph node dissection (RPLND)
66
Testis Cancer prognosis
Cure rate 90% for seminoma (all stages combined) | Cure rate approaches 100% for low-grade NSGCT

repo med tes 2 (3 decks)

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