UW and FA Flashcards
1
Q
Leyding cells (endocrine cells) - function
A
secrete testosterone in the presence of LH
2
Q
Leyding cells (endocrine cells) vs temperature
A
testosterone production unaffected by temperature
3
Q
vasectomy?
A
remove of ductures deferens (vas deferens) –> birth control
4
Q
prostate location
types of obstruction in BPH
A
between pubic symphisis + + anal canal
- static obstriction (androgen-mediated)
- dynamic obstriction (α adrenoreceptor mediated)
5
Q
Benign prostatic hyperplasia - treatment (and mechanism)
A
- a1 antagonists (terazosin, tamsulosin) –> relaxation of SMC
- 5α-reductase inhibitors (eg. finasteride
- tadalafil (PDE-5 inhibitor)
6
Q
Prostatitis - divided to/due to
A
- acute: bacterial (eg. E.coli)
2. chronic (bacterial or abacterial)
7
Q
Prostatitis - symptoms / PE
A
- dysuria
- frequency
- urgency
- low back pain
- warm, tender, enlarged prostate
8
Q
PSA - in Prostatic adenocarcinoma
A
increased total with decreased fraction of free
9
Q
PSA - normal range
A
- increases in age by BPH
- under 2.5 ng/ml in 40-49
- under 7.5 ng/ml in 70-79
10
Q
Penile pathology - 4 diseases
A
- Peyronie disease
- iscemic priapism
- SCC
- penile fracture
11
Q
Peyronie disease - definition/mechanism
A
abnormal curvature of penis due to fibrous plaque within tunica albuginea (goes up)
12
Q
Peyronie disease - symptoms / treatment
A
- pain
- anxiety
- erectile dysfunction
- surgical repair once curvature stabilizes
13
Q
Ischemic priapism - definition / etiology
A
painful sustained erection lasting more than 4 hours
etiology: 1 sickle cell anemia (trapped RBCs in vascular channels)
2. drugs (sildenafil, trazodone, prazosin,methylfainidate, cocaine)
3. cauda equina syndrome
14
Q
ischemic priapism - management
A
treat immediately with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia
15
Q
SCC of penis - epidimiology
A
more common in Asian Africa, South America
16
Q
SCC of penis - precursor in situ lesions/and their definition
A
- Bowen disease –> leukoplakia in penile shaft
- erythroplasia Queyrat –> in situ carcinoma of glans, presents as erythroplakia
- Bowenoid papulosis –> carcinoma in situ of unclear malignant protention, presenting as redish papules
17
Q
SCC of penis - risk factors
A
- HPV
2. lack of circumcision
18
Q
Cryptorchidism - sperm vs testosterone - mechanism
A
- impaired spermatogenesis: sperm develops best at less than 37. sertoli are Q sensitive
- normal Testosterone levels (Leyding unaffected to Q)
19
Q
Cryptorchidism - complication / RF
A
high risk of germ cell tumors
RF: 1. prematurity
2. Hypospandias
20
Q
Cryptorchidism - endocrine profile
A
low inhibin B, High FSH and LH
testosterone low in bilateral, normal in unilateral
21
Q
MCC of scrotal enlargement in adult males
A
Varicocele
22
Q
Varicocele - complication
A
infertility because of high temperature
23
Q
Varicocele - diagnosis
A
- standing clinical exam (distention on inspection and bag of worms
- US with Doppler (retrograde flow, dilation of pampiniform, tortuous anechoic tubules)3. does not transilluminate
24
Q
Varicocele - treatment
A
gonadal vein ligation (boys _ young men with test atrophy)
2. scrotal support + NSAID (older who do not desire additional childrenfffff
25
Testicular tumors are divided to (proportions and behavioural)
1. germ cell (95%) --> Mostly malignant, children mature teratoma benign
2. non-germ cell (5%) --> mostly benign, but lymphoma is aggressive
26
Testicular non-germ cell tumors - types and aggressiveness
Mostly benign
1. Leydig cells
2 Sertoli cells
3. Testicular lymphoma (aggressive)
27
Leydig celll tumor - presentation mechanism)
produce androgens or estrogens --> gynecomastia in men. precosious puberty in boys
28
MC testicular cancer in older men
Testicular lymphoma
29
Testicular lymphoma - characteristics
- Not 1ry --> arises from metastatic lymphoma to testes
| - Aggressive
30
Testicular germ cell tumors - risk factors
1. Cryptorchidism
| 2. Klinefelter syndrome
31
Testicular germ cell tumors - characteristics
- can resent as a mixed germ cell tumor
| - does not transilluminate
32
Testicular germ cell tumors - types (mc?)
1. Seminoma (MC)
2. Yolk sac (endodermal sinus) tumor
3. Chroriocarcinoma
4. Teratoma
5. Embryonal carcinoma
33
seminoma - clinical characteristic / prognosis / marker
- painless, homogenous testicular enlargment
- excellent --> 1. Radiosensitive 2. late matastasis
- high placental ALP
- mildly elevated HCG
34
tests - Yolk sac (endodermal sinus) - behavioral / appearance / marker
aggressive malignancy
- yellow mucinous
- Schiller Duval bodies resemble primitive glomeruli
- high AFP is highly characetristic
35
MC testicular in boys under 3
yolk sac
36
male teratoma - behaviour
unlkie in females. mature teratoma in adults males may be maligntn. Benign in children
37
testicular choriocarcinoma - marker
high HCG
38
testicular cancer that is painful
Embryonal carcinoma
39
Embryonal carcinoma - markers
```
if pure (rare) --> high hCG, normal AFP
if mixed with other tumors --> high hCG, increased AFP
```
40
Scrotal masses?
benign scrotal lesions presents as testicular maasses thatn cen be transilluminated
41
Scrotal masses - types
1. congenital hydrocele
2. Acquired hydrocele
3. Spermatocele
42
congenital hydrocele?
Common cause of scrotal swelling in infants due to incomplete obliteration of processus vaginalis
43
Acquired hydrocele?
scrotal fluid collection usually 2ry to infection, trauma, tumor (if bloody --> hematocele)
44
Spermatocele?
cyst due to dilated epididymal duct or rete testis --> paratesticular fluctuant nodule
45
Extragonadal germ cell tumors - location
MIDLINE location:
- adults --> MC retroperitoneum, ediastinum, pineal, suprasellar regions
- young childrens: sacroccygeal teratomas are MC
46
Paratesticular fluctant nodule
Spermatocele
47
1. Leyding tumor produces
2. Yolk sac produces
3. choriocarcinoma produces
4. seminoma
1. estrogens, testosterone
2. AFP
3. HCG
4. placental ALP, mildly HCG
48
clinical suspicion of testiuclar tumor - next step
U/S
49
diagnosis of testicular tumor - next
orchiectomy --> then check under the microscope to assess the further treatment
(usually: radiation if local, chemo if widespread)
50
testicular cancer - treatment - seminoma vs nonseminoma
seminoma: sensitive to chemo and radio
nonseminoma: sensitive to chemo
51
prostate cancer presents with
1. Obstructive symptoms on voiding (similar to BPH)
2. palpable lesion on examination
MOST ARE ASYMPTOMATIC
52
prostate cancer best initial / most accurate test
biopsy for both
53
prostate cancer - complications of radiation
1. like prostatectomy (erectile dysfunction is much less common)
2. diarrhea
54
prostate cancer - hormonal manipulation
Flutaminde, GNRH agonists, ketoconazole, and orchiectomy help control the size and progesion of metastases once they have occurred. They are not like tamoxifen in breast cancer. THEY DO NOT PREVENT RECURRENCES. They shrink the lesions that are already present
55
prostate cancer - chemotherapy
only if hormonal theray fails
56
prostate cancer - lumpectomy
never
57
prostate cancer - US as a screening and other uses
it is not a screening test --> it is used to localize lesions to biopsy after a high PSA
58
prostate cancer - PSA
controversial:
1. No clear mortality benefit
2. Not routinely offered
3. Normal PSA does not exclude ca
4. above age 75, do not do even if asked
5. higher the PSA, the greater the risk (volume of cancer)
59
elevated PSA - NEXT STEP
1. palpable mass --> biopsy
2. no palpable mass --> transrectal US:
if mass --> biopsy
if no mass --> multiple blind biopsies
60
absent of achilles reflex in eledery with difficulty to void
may be normal in elderly
61
Mytonoci dystrophy - levels of hormones
low test
| high LH, FSH, GNRH
62
Common causes of erectile dysfunction
1. vascular (smoking, CAD etc)
2. neurologic (DM, MS, spinal injury/surgery)
3. Psychogenic
4. endocrine
5. medications
6. hypogonasisms
63
erectile dysfunction due to neurologic causes - clinical manifestation
loss of bulbocavernosus reflex
64
medications that causes erectile dysfunction
antihypertensives (esp b-lockers and thiazides), SSRIs, anti-androgen
65
diagnosis of prostatitis - next step
culture of mid-stream urine sample
66
acute vs chronic prostatitis regarding treatment
acute: TMP-SXM, fluoroquinolones (-6 wks)
chronic: fluoroquinolones
67
when to suspect prostate abscess? next step
acute prostatitis continues to fave fever despite antibiotics
--> do an CT
68
metastatic symptoms of testicular cancer
back pain, cough, dyspnea, neck mass
69
metastiatic symptoms of testicula cancer - back pain?
due to retroperitoneal lymphadenopathy
70
best initial treatment of BPH
a1-blocker
| finasteride takes months to work
71
treatment of BPH - antimuscarinics?
to treat overeactive bladder
72
BPH with atypical presentation (under 50 years old) or no response to medications - next step
urodynamic studies
73
transrectal U/S for prostate cancer as screening
NO --> low sensitivity
74
do or not PSA for screening
discuss it with the patient
75
chronic prostatitis / chronic pelvic pain syndrome - symptoms
1. pain in pelvis, perineum, genitalia
2. irritateive voiding symptoms (urgencym hesitancy)
hematospermia, pain with ejaculation
MORE THAN 3 MONTHS
76
chronic prostatitis/cronic pelvic pain syndrome - diagnosis
1. no or mild prostate teenderness
2. sterile urine culture
NORMAL PSA
77
chronic prostatitis / chronic pelvic pain syndrome - management
1. a-blocker
2. antibiotics (cipro) esp if history of UTI
3. 5a-reductase inh
78
chronic prostatitis/chrnonic pelvic pain syndrome - = chronic BACTERIAL prostatitis ???
no it is different
79
epididymitis presentation
irriattative voiding symptoms
| scrotal pain, swelling, tenderness, purulent urethral discharge
80
sildanefil - SE?
1. cardiovascular: Hypotenstion (esp with nitrates, a-blockers)
2. ocular: blue vision, nonarteritic anterior iscemic optic neuropathy
3. genitourinary: priapism
4. other: flushing, headache, HEARING LOSS
81
a new SE of sildanefil
hearing loss
82
sildanefil is contraindicated with
nitrates
| a blockers
83
CAD patients under metoprolol has erectile dysfunction - nect step
sildanefil (dont stop the b-blocker)
84
indications for cytoscopy
1. gross hematuria with no evidence of glomerular disease or infection
2. microscopic hematuria wiht no evidence of glomerular disease or infection but increased risk for malignancy
3. recurrent UTIs
4. obstructive symptoms with suspicion for stricture, stone
5. irritative symptoms without urinary infection
6. abnormal bladder imaging or urine cytoogy
85
BPH vs cancer regarding RF
BPH: older than 50
cancer: older than 40, African american, family history
86
penile fracture - test?
retrograte urethrogram
87
urinary Stress incontinence - treatment
1. pelvic floor muscle strengthening (Kegel) exercise
2. weight loss
3. pessaries ( a plastic device inserted into the vagina)
88
urinary Urgency incontinence - treatment
1. pelvic floor muscle strengthening (Kegel) exercise
2. bladder training (timed voiding, distraction and relaxation techniques)
3. antimuscarinics
89
Overflow incontinence - treatment
```
catherterization
relieve obstruction (α-blockers for BPH)
```
90
Bladder cancer RFs
1. smoking (until up to 20 years after cessation)
2. occupational exposures
3. chronic cystitis
4. iatrogenic causes (cyclophosphamide)
5. pelvic radiation exposure
91
cryptorhidism - treatment
irchiopexy before age 1 to avoid complications
| - if not descent until 6 months is unlikely to descent
92
special characteristics of psychogenic erectile dysfunction
1. sudden
onset
2. situational (eg. problem with partner, normal durin masturbation)
3. normal nonsexual nocturnal erections
93
hydrocele - surgery
only after 1 year
94
varicocelle - translumination?
no
95
finasteride - SE
low libido, erectile dysfunction
| - effectiveness after 6-12 months
96
age to start offer PSA
40
97
acute vs chronic prostatitis regarding fever
not in chronic
98
acute prostatitis with urinary rention --> ....
suprapubic catheterization of the bladder
