02b: Prostate Flashcards
Majority of blood to prostate comes from (X) artery off of (Y) artery.
X = inferior vesical Y = internal pudendal
Most common malignancy in males 15-35 years old:
Testicular cancer
T/F: No major genetic factors for testicular cancer.
True
Which aspect of history would put patient at risk for testicular cancer?
Undescended testis
Diagnosis of testicular cancer via:
Hx, PE, and scrotal ultrasound
Rx for testicular cancer:
- Surg excision of testicle (inguinal approach)
2. Chemo (super effective, even with metastasis)
Which tumor markers can be followed to assess efficacy of Rx for testicular cancer?
- AFP
- bHCG
- LDH
BPH treatment regimen:
- Alpha blockers (terazosin, doxazosin, tamsulosin, Alfuzosin)
- 5a-reductase inhibitors (Finasteride, Dutasteride)
Function of alpha blocker Rx in BPH:
Relax smooth muscle at bladder neck
Pt being treated for BPH: PSA will decrease by as much as (X)% due to (Y) meds.
X = 50 Y = 5a-reductase inhibitors
T/F: BPH Rx regimen will not affect sexual function.
False - 5a-reductase inhibitors have potential sexual side effects (can be irreversible!)
T/F: No major genetic factors for prostate cancer.
False - positive FHx and HPC1 gene are risk factors
(High/low) (X) diet is risk factor for prostate cancer:
High
X = fat
Why is PSA high in prostate cancer?
Cancer cells have destabilized basement membrane, so more leaks out
“Med castration” for prostate cancer can include which hormonal treatments?
- GnRH agonist (Lupron)
- Estrogen
- Antiandrogens
What’s the next step in Rx for patients with metastatic prostate cancer who have failed hormonal therapy?
Chemo (with goals to contain cancer and alleviate pain)
Standard chemo Rx for prostate cancer includes (X). What’s the mechanism of action?
X = Abiraterone (in combo with prednisone)
Inhibits 17a hydroxylase (thus inhibiting androgen synthesis)
Predominant blood supply to penis:
Internal pudendal a
Which a predominantly responsible for blood supply to erectile tissue of penis?
Cavernosal a (runs through corpus cavernosa)
T/F: Urethra runs through corpus cavernosa.
False - corpus spongiosum
55 yo M smoker presents with complaints of erectile dysfunction. What do you suspect is the cause? What would you test for?
Arteriogenic (atherosclerotic);
DM, CAD, cholesterol, etc.
Check for distal pulses
What are some endocrine diseases that cause erectile dysfunction?
- DM
- Thyroid disease
- Testosterone deficiency
Basic workup for erectile dysfunction includes which labs?
- T, LH
- TSH
- Lipid/cholesterol panel
- HbA1c
- Prolactin
Which PDE5 inhibitor would you recommend for patient with ED that is already paying for multiple meds?
Tadalafil (longest half-life, fewer doses; insurance won’t cover)
Common side effects of viagra:
HA, flushing, dyspepsia; maybe transient/mild visual effects
List the injectable meds for ED:
3 Ps:
- Papavarine (PDE inhibitor)
- Prostaglandin E1 (vasodilator)
- Phenoxybenzamine/phentolamine (alpha-R blockade)
T/F: Penile prostheses are last-resort for erectile dysfunction.
True
Priapism: (painless/painful) prolonged erection indicates arterial problem. Is this an emergency?
Painless
No; uncontrolled arterial flow
Priapism: (painless/painful) prolonged erection indicates venous problem. Is this an emergency?
Painful
Yes, low-flow priapism (blood trapped in erection chambers); penis can become ischemic
Rx options for priapism:
Oral meds (sympathomimetics), irrigation, shunts (extreme case)
Condyloma on penis caused by:
HPV
T/F: Circumcision essentially eliminates risk of penile cancer.
True
RFs for penile cancer:
- Smoking
- Poor hygiene
- HPV infection/sex partners
Sequence of spermatogenesis:
Spermatogonium, spermatocyte, spermatid, spermatozoan
T/F: Exogenous testosterone decreases sperm production.
True
Histo: endometrium in (X) phase has multiple simple, tubular glands in stroma with abundant mitotic activity.
X = proliferative
Endometrium has (X) epithelium.
X = pseudostratified
Day (X) of menstrual cycle begins change from proliferative to secretory endometrium.
X = 16
Histo: endometrium in (X) phase has glands with prominent subnuclear vacuoles. There is (high/low) mitotic activity.
X = early secretory
No mitoses
Day (X) of menstrual cycle: sub- and supra-nuclear vacuoles are seen with apical discharge.
X = 18
Histo: endometrium in (X) phase has “saw-toothed” glands and (Y) in gland lumen.
X = late secretory Y = secretions
Max stromal edema in endometrium is seen on day (X) of menstrual cycle.
X = 22
Predecidual changes in endometrium include:
Indistinct perviascular aggregates of cells with eosinophilic cytoplasm
Stromal granulocytes in endometrium is classic for day (X) of menstrual cycle and represents preparation for:
X = 26
Menstruation (predecidual change; inflammatory cells enter stroma, ready to mop up debris from menstruation)
Most common cause of dysfunctional uterine bleeding is:
Anovulatory breakdown (endometrium right around menopause loses ability to respond properly to hormones)
Anovulation: excess (progesterone/estrogen) leading to disordered (X)
Estrogen, relative to progesterone
X = gland proliferation (super large grands with relative scarcity of stroma)
Endometrial hyperplasia is related to abnormally high, prolonged level of (X). Which diseases/situations might cause this?
X = estrogen
- Menopause/persistent anovulation
- PCOD
- Granulosa cell tumors
- Estrogen replacement Rx
- Obesity
Key histo characteristic that distinguishes high grade from low grade endometrial hyperplasia:
Presence of atypia
20% of endometrial cancer is (X) type with (Y) cells. This type is (less/more) aggressive and (dependent/non-dependent) on estrogen.
X = non-endometrioid
Y = serous, clear
More
Non-dependent
Endometrioid Adenocarcinoma grade depends on % of:
Solid growth pattern (non-squamous/non-morular);
G1 is up to 5%, G2 is 6-50%, G3 is over 50%
Presence of plasma cell in endometrial stroma is pathognomonic for:
Chronic endometritis
List some etiologies for chronic endometritis:
- Chronic PID
- Postpartm (retained gestational tissue)
- IUD
- TB or other infections (chlamydia)
A(n) (X) cyst is also called a “chocolate cyst”.
X = endometriotic (filled with degenerated blood products)
A mass of benign endometrial glands/stroma projecting into endometrial cavity.
Endometrial polyp
Hydatidiform moles tend to occur in (older/younger) women.
Two ends of spectrum (below 20 and over 45)
Which classic symptom would a woman with hydatidiform mole present with?
Bleeding in either late 1st T or early 2nd T
T/F: Hx of hydatidiform mole puts woman at higher risk of having future incidence of moles.
True
p57 staining will be positive in (complete/partial) hydatidiform mole.
Partial (imprinted gene is maternally expressed)
T/F: Choriocarcinomas are highly malignant but also highly responsive to chemo.
True
