1 - Penile, Scrotal, Testicular Disorders

Question 1

Trazadone has been associated with this penile disorder.

Answer 1

• priaprism

Question 2

This is defined as a dilatation of the pampiniform plexus of spermatic veins.

Answer 2

• Varicocele

Question 3

Nonischemic priaprism results from what?

Answer 3

• a fistula between the cavernosal artery and corpus cavernosum

Question 4

23 y.o. African American male with sickle cell disease presents to your emergency department complaining of penile pain and sustained erection. What should you be concerned for?

Answer 4

• priaprism

Question 5

What is the difference between phimosis and paraphimosis?

Answer 5

• phimosis = tight foreskin that cannot be retracted

- paraphimosis = retracted foreskin in an uncircumcised patient that cannot be returned to normal position

Question 6

This is defined as a sustained erection lasting more than 4 hours.

Answer 6

• priaprism

Question 7

Balantitis can be the first sign of this systemic disease.

Answer 7

• diabetes mellitus

Question 8

This condition is defined as an acquired, localized fibrotic disorder of the tunica albuginea.

Answer 8

• Peyronie’s disease

Question 9

What is the difference between balantitis and balanoposthitis?

Answer 9

• balantitis = inflammation of the glans penis

- balanoposthitis = inflammation of the glans and foreskin

Question 10

If a patient presents with testicle torsion and is unable to have surgery in the next 2 hours what is the immediate treatment?

Answer 10

• manual detorsion

“open the book”

Question 11

A negative cremasteric reflex and Bell Clapper deformity should have you concerned for this emergency.

Answer 11

• Testicular torsion

Question 12

What is the treatment for phimosis? (3 options)

Answer 12

• manual stretching (with topical medicine)
• circumcision
• preputioplasty

Question 13

What lab test can help differentiate between ischemic and non-ischemic priaprism?

Answer 13

• cavernosum aspirate for blood gas

Question 14

this is defined as a painless, cyst arising from the head of the epididymis that is > 2 cm.

Answer 14

• spermatocele

Question 15

Ischemic priaprism is believed to be d/t what?

Answer 15

• defect in nitric oxide mediated pathway

Question 16

What is the main cause of balantitis?

Answer 16

• inadequate personal hygiene in uncircumcised males (candidal infection most common)

Question 17

How are hydroceles diagnosed?

Answer 17

• physical exam with transillumination

- u/s to confirm

Question 18

What is the first line treatment for Peyronie’s disease if the patient has moderate curvature for <12 months without compromising sexual function?

Answer 18

• pentoxifylline

Question 19

What is the definitive treatment for a hydrocele if it is necessary?

Answer 19

• hydrocelectomy

Question 20

What are the treatment options for ischemic priaprism? (3 options)

Answer 20

• phenylephrine injection (sympathomimetic)
• aspiration
• surgical shunt creation (last resort)

Question 21

This is defined as a collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis.

Answer 21

• hydrocele

Question 22

What are the infectious causes of epididymitis if the patient is under or over 40 years old?

Answer 22

• <40 = GC or chlamydia

- >40 = enteric bacteria (E. coli)

Question 23

What is the diagnostic criteria for varicoceles using ultrasound?

Answer 23

• veins > 3mm or reversal of flow with valsava

Question 24

What is a positive Phren’s sign? What does it indicate?

Answer 24

• relief of pain with elevation of the testicle

- sign for epididymitis

Question 25

What is the antibiotic treatment for epididymitis if the patient practices insertive anal intercourse?

Answer 25

• Ceftriaxone IM

- OR Levofloxacin

Question 26

What is the treatment for paraphimosis?

Answer 26

• manual reduction

or preputioplasty/circumsion if manual reduction is unsuccessful

Question 27

What is the antibiotic treatment for epididymitis if the patient is >35 and has a low STI risk?

Answer 27

• Levofloxacin

Question 28

What are the 2 empiric treatment options for candidal infection in a patient with Balantitis?

Answer 28

• clotrimazole

- miconazole

Question 29

What is the antibiotic treatment for epididymitis if the patient is <35 and has a STI risk?

Answer 29

• Ceftriaxone IM

- OR Doxycycline

Question 30

There is irreversible damage if a testicular torsion lasts longer than ____ hours.

Answer 30

> 12 hours

Question 31

What muscle contracts to regulate the temperature of the testes?

Answer 31

Cremasteric muscle

Question 32

What is the ideal temperature for the testes?

Answer 32

35-36 C

Question 33

Where is sperm stored and mature?

Answer 33

Epididymis

Question 34

This structure transports sperm from the epididymis to the ejaculatory duct and urethra.

Answer 34

Vas deferens

Question 35

This structure secretes a significant portion of fluid that ultimately becomes semen

Answer 35

Seminal vesicles

Question 36

These cells found adjacent to the seminiferous tubules in the testicle secrete hormones called androgens

Answer 36

Leydig Cells

Question 37

Leydig cells secrete androgens in response to what hormone?

Answer 37

LH

Question 38

The function of this cell is to nourish developing sperm through stages of spermatogenesis by providing nutrients.

Answer 38

Sertoli cells

Question 39

What hormone stimulates spermatogenesis and Sertoli cell function?

Answer 39

FSH

Question 40

The testes lack these 2 enzymes which results in them not being able to synthesize glucocorticoids or mineralcorticoids.

Answer 40

• 21 B hydroxylase

- 11 B hydroxylase

Question 41

The tests have this additional enzyme which allows the conversion of androstenedione to testosterone.

Answer 41

17 B Hydroxysteroid dehydrogenase