A&P, Urologic Imaging, Diagnostic Testing

Question 1

Testis-Determining Factor (TDF)

Answer 1

Promote conversion to testes in utero

Seminiferous tubules appear 43-50 days

Question 2

Stages of Testicle Descent

Answer 2

7-12 weeks utero - AMH prevents development of uterus and fallopian tubes

7-9 months utero - Testosterone causes testicular descent encased in spermatic cord

Late descent increases risk testicular cancer

Question 3

Dartos and Cremaster Muscles

Answer 3

Dartos: smooth muscle under fascia - changes with temperature changes to control surface area/wrinkle #

Cremaster: skeletal muscle from internal oblique - elevates testes

Question 4

FSH and LH cell influence

Answer 4

FSH - act on Seminiferous tubules to undergo spermatogenesis

-seminiferous tubules secrete inhibin which prevents FSH release

LH - acts on Leydig cells which release testosterone

-Testosterone inhibits hypothalamus and anterior pituitary

Question 5

Determining factor for male/female genital development

Answer 5

Embryonic testosterone

Placental hCG stimulates testosterone secretion in fetal testes

Question 6

Most common cause of intersex in males and females

Answer 6

Males: testicular feminizing syndrome

Female: congenital adrenal hyperplasia

Question 7

Effects of FSH and LH on spermatogenesis

Answer 7

FSH stimulates spermatogenesis in seminiferous tubules

LH stimulates spermatids maturation into spermatozoa (testosterone does this)

Question 8

Erection and Ejaculation mechanisms

Answer 8

Erection - PNS: locally produced nitric oxides cause smooth cell relaxation - blood flow increases

Ejaculation - SNS: contraction of vas deferens and ampulla causes sperm expulsion

Question 9

Retrograde Urethrogram (RUG) Indications

Answer 9

Indicated w/ blood at the meatus

Can identify urethral diverticulum and fistulas

Question 10

CT Indications with and without contrast

Answer 10

Renal stone - No contrast CT is gold standard

Hematuria - IVP with IV contrast

• evaluates collecting system, ureters, and bladder
• optimal for renal tumor identification

Question 11

Gonadal Function

Answer 11

Testosterone is the single most important diagnostic test for male hypogonadism

Normal = 300-800

Levels highest at 8 am

Need 2-3 abnormal tests to confirm

-get FSH and LH to determine primary or secondary hypogonadism

Question 12

Testosterone level indications

With SHBG and FSH/LH

Answer 12

SHBG high and free T low = aging, hyperthyroidism, increased estrogen, liver dx, HIV, antiseizure drugs

SHBG low and free T high: obesity, hypothyroidism, increased GH, exogenous androgens

T low and LH/FSH high = primary hypogonadism

T low and LH/FSH low = secondary hypogonadism

Question 13

Elevated and Decreased PSA

Answer 13

Elevated: BPH, prostate cancer, inflammation, infection, perineal trauma

Decreased: obesity - worse outcome w/ /prostate cancer, meds - 5-alpha reductase, NSAIDs, statins, thiazide

Question 14

PSAD, PSAV, Free/Total PSA

Answer 14

PSAD - adjust PSA level for men w/ BPH by predicting the prostatic volume responsible for that level

-Determine w/ TRUS

PSAV - rate of PSA change over time, determine with transrectal prostate biopsy

Free/Total - Free%

-Free>total = more likely BPH

Question 15

Azospermia

Oligospermia

Answer 15

Azospermia: no measureable sperm in semen

-Klinefelters

Oligospermia:

-Genetics, anatomic, endocrine, heat