Andrology 🧔‍♂️ Flashcards

Question

How does hyperprolactenemia cause male infertility?

Answer 1

sexual & reproductive dysfunction.

Answer 2

both hypo and hyperthyroidism alter spermatogenesis.

Answer 3

Congenital adrenal hyperplasia, Addison's disease & Cushing's syndrome.

Answer 4

↓ gonadotropin secretion & ↓ spermatogenesis.

Answer 5

- genetic and chromosomal abnormalities - Developmental abnormalities - Defective androgen synthesis and action - Heat Exposure - Radiation - Testicular atrophy following trauma or infiction - Gonadal toxins - hypogonadism associated with systemic diseases

Answer 6

- Myotonia dystrophia - AZF microdeletion - Hermaphroditism - Klinefelter's syndrome (47, XXY karyotype).

Answer 7

- Bilateral anorchia - Varicocele - Sertoli-cell-only syndrome (germinal cell aplasia) - Cryptorchidism (undescended testis)

Answer 8

Leprosy and Mumps orchitis

Answer 9

- chronic renal, respiratory, liver, inflammatory, nutritional diseases as well as acute critical illness and severe burns - Non testicular diseases can disrupt different levels of the hypothalamic-pituitary-testicular axis.

Answer 10

Gonadal toxins such as drugs (e.g., Alkylating agents) and chemicals (e.g., Pesticide)

Answer 11

- severity, chronicity and the patho-physiological mechanisms involved in the underlying disease and its treatment.

Answer 12

- Inadequate sexual performance - Ductal obstruction - semen factors

Answer 13

- erectile and ejaculatory disorders

Answer 14

- **Congenital absence of the ductal system**, e.g., aplasia of the vasa deferentia. - **Acquired obstruction following infection** (e.g., bilateral gonococcal or tuberculous epididymitis) or vas ligation (voluntary or iatrogenic).

Answer 15

Idiopathic oligoasthenoteratozoospermia the commonest cause of male subfertility.

Answer 16

- may result from faulty maturation in the epididymis or biochemical abnormalities of seminal plasma due to genital tract infection or idiopathic.

Answer 17

- is a condition that includes oligozoospermia (low number of sperm), asthenozoospermia (poor sperm movement), and teratozoospermia (abnormal sperm shape)

Answer 18

- History - Examination - Investigations

Answer 19

- Personal history - Infertility history - Sexual history - Past history - Wife - Family history

Answer 20

- General Examination - Genital Examination - Rectal examination

Answer 21

- Semen analysis - Endocrine evaluation - Genetic & chromosomal evaluation - Testicular biopsy - Surgical exploration of scrotal contents - Radiologic evaluation

Answer 22

- Physical examination of semen - Microscopic examination of semen - Biochemical analysis of semen (markers of obstruction)

Answer 23

- volume - Color - Characteristic order - Liquefecation time - Viscosity (consistency) - pH

Answer 24

Normally: 2 – 6 mL.

Answer 25

absence of semen (no ejaculate).

Answer 26

grayish white color.

Answer 27

- Normally semen liquefies within 10 – 30 minutes at 37 °C. ⚠ - If Delayed → Seminal vesicle disease - The semen is ejaculated in a liquid form. Seminal vesicle protein is responsible for coagulation & prostatic proteolytic enzymes are responsible for liquefaction. Incomplete liquefaction can cause decreased motility.

Answer 28

⚠Greenish color: genital tract infection. ⚠ Red or Brown color: haemospermia & drugs. ⚠Yellow color: e.g., jaundice, drugs.

Answer 29

- Normally leaves pipette in drops

Answer 30

⚠ If, after one hour, it forms a thread more than 2 cm long on the pipette, this is referred to as Viscopathy. - High viscosity (the sample exits the pipette as a thread) may cause infertility.

Answer 31

- pH changes may be caused by acute & chronic inflammation of the prostate, epididymis or seminal vesicles (dysfunction of the accessory glands). ⚠↑ pH > 8 → Infection ⚠↓ pH → Seminal vesicle disease

Answer 32

- Sperm Concentration - Motility - Sperm morphology - Vitality (viability) - Sperm Antibodies - Cellular components other than sperms

Answer 33

The number of sperms per milliliter of semen.

Answer 34

multiplying sperm concentration by semen volume.

Answer 35

≥ 15millions/mL (average 20-200).

Answer 36

Zero (absence of spermatozoa from the ejaculate):

Answer 37

< 15 millions/mL

Answer 38

> 200 millions/mL

Answer 39

* Progressive motility (PR). * Non-progressive motility (NP) * Total motility (PR+NP) * Immotile sperms

Answer 40

✅ Progressive motility (PR): ≥ 32% ✅ Total motility (PR+NP): ≥ 40%

Answer 41

Progressive motility (PR) < 32%.

Answer 42

✅ The change in the evaluation method for sperm morphology by adopting “strict criteria” has lowered the threshold of normal to ≥ 4% morphologically normal sperms.

Answer 43

- We must differentiate between non-motile, living sperms from dead sperms by Eosin Negrosin (vital) stain. Only dead sperms will stain (Pink / Red).

Answer 44

≥ 58 %. ➥The test is therefore unnecessary if total sperm motility is ≥ 60 %.

Answer 45

sperm agglutinations (immune- mediated infertility).

Answer 46

Normally: Peroxidase-positive leukocytes < 1 million/ml.

Answer 47

peroxidase-positive leukocytes > 1 million/ml

Answer 48

Normally absent.

Answer 49

⚠ Haemospermia is the presence of RBCs in the ejaculate. Can be caused by: - Congestion - Prostatovesiculitis - Bilharziasis of the genital tract. - Idiopathic - Malignancy. - Haemorrhagic diathesis. - Tuberculosis of the genital tract.

Answer 50

- A number of in-vitro tests have been developed to assess various functional, biochemical & molecular markers of sperm health yielding information on the fertilizing capacity of spermatozoa as well as their ability to support normal embryonic development.

Answer 51

- Evidence from the patient’s history suggestive of hormonal abnormalities - Particular findings on physical examination.

Answer 52

(FSH, LH and Testosterone levels). - Serum FSH assesses → the state of the seminiferous epithelium - Serum LH reflects → the adequacy of Leydig cell function.

Answer 53

If the patient has: * signs and symptoms suggestive of pituitary tumour * sexual dysfunction * relevant drug history

Answer 54

If the patient has: gynecomastia

Answer 55

Assessment of other endocrine organ functions (adrenal, thyroid, ...) is recommended

Answer 56

- Buccal smear - Karyotyping - Y-chromosome microdeletion assay - PCR

Answer 57

- to demonstrate the presence or absence of sex chromatin (Barr body).

Answer 58

✅Normal males: Sex chromatin is absent ⚠Klinefelter's males: Sex-chromatin positive

Answer 59

Normal karyotype is 46,XY. - Karyotype may identify either numerical or structural chromosomal anomalies.

Answer 60

should be performed on all patients with azoospermia.

Answer 61

for detection of specific genes e.g.: - AZF (in non-obstructive azoospermia) - CFTR (cystic fibrosis genes in obstructive azoospermia due to CBAVD)

Answer 62

- Testicular biopsy is now reserved for therapeutic testicular sperm extraction for ICSI (intracytoplasmic sperm injection). - A thorough understanding of the histological appearance of a testis biopsy in normal and diseased patients is crucial.

Answer 63

- Trans-rectal US - Scrotal US & Duplex examination - Vasography - Abdomino-pelvic US - CT & MRI

Answer 64

- Evaluation of SV, ED, prostate - Particularly valuable in obstructive amospermia

Answer 65

Scrotal US & Duplex examination

Answer 66

- Diagnosis of varicocele, hydrocele, testicular volume - Measures early testicular masses

Answer 67

- Absent or obstructed vas and ejaculatory ducts

Answer 68

- For cases of undescended testis

Answer 69

- Undescended testis - Pituitary tumors

Answer 70

Varicolcele

Answer 71

no obstruction

Answer 72

- Medical treatment (hormonal and non-hormonal) - Surgical treatment - Assisted reproductive techniques

Answer 73

- Gonadotropin releasing hormone (GnRH) - Gonadotropins - Androgens - Antiestrogen therapy - Bromocryptine

Answer 74

− GnRH stimulates secretion of LH and FSH. − It can be used in hypogonadotropic hypogonadism.

Answer 75

- Can be used in hypogonadotropic hypogonadism. a) Human Chorionic Gonadotropin (HCG): Mainly LH activity. b) Human menopausal gonadotropin (HMG): Both LH & FSH activity, but mainly FSH.

Answer 76

a) Parenteral androgens: e.g., Testosterone propionate. b) Oral androgens, e.g., Testosterone undecanoate.

Answer 77

a) Clomiphene citrate. b) Tamoxifen. c) Testolactone. d) Anastrozole

Answer 78

for treatment of hyperprolactinemia

Answer 79

- antioxidants - Kallikrein - Nucleotides as ATP - Others

Answer 80

- stimulates sperm motility - enhances sperm transport - activates fructolysis.

Answer 81

↑ sperm motility.

Answer 82

- Repair of penile and urethral disorders - Orchiopexy - Varicocelectomy - Vasovasostomy (correction of vasal occlusion) - Epididymovasostomy - Artificial spermatocele

Answer 83

- such as hypospadias, chordee, urethral fistula or stricture.

Answer 84

- early in life to correct cryptorchidism, if trial of gonadotropin fails.

Answer 85

- in cases of varicocele

Answer 86

- vasal aplasia, long unbridgeable vasal stenosis, or failure of repeated reconstructive surgery on the seminal pathways.

Answer 87

- Intra Uterine Insemination - Semen processing - Gamete Intrafallopian Transfer (GIFT) - In Vitro Fertilization (IVF) - Microfertilization or Microinsemination for severe male factor infertility

Answer 88

- Artificial Insemination Husband IUI (AIH)

Answer 89

to improve sperm quality (before artificial insemination or in vitro fertilization)

Answer 90

- Subzonal insemination (SUZI) and Intracytoplasmic sperm injection (ICSI)

Answer 91

the quantity and quality of sperm isolated from the semen after processing.

Answer 92

- the Bulbous Urethra

Answer 93

- the External Urinary Meatus

Answer 94

a fusiform dilatation lined by stratified squamous epithelium

Answer 95

The external urinary meatus opens into the Fossa Navicularis

Answer 96

- The rest of the Anterior Urethra and the ducts of Littre's & Cowper's glands are lined by columnar epithelium.

Answer 97

- secrete mucus and their ducts open into the roof and sides of penile urethra. They are particularly numerous in the fossa navicularis.

Answer 98

- lie on either side of the membranous urethra, but their long ducts open into the floor of the bulbous urethra.

Answer 99

- are small blind channels in the substance of the glans penis that open near or within the lips of the external urinary meatus.

Answer 100

- The part adjacent to the bladder is lined by transitional epithelium, - The length is lined by stratified squamous epithelium with islets of columnar epithelium in the proximal part. - Many small mucous glands open into the urethra and their ducts are lined by columnar epithelium.

Answer 101

- are situated on either side of the lower end of the urethra. - Their ducts which open beside or just inside the urethral orifice are lined by columnar epithelium.

Answer 102

- lie in the posterior third of each labium majus (at 4 and 8 o’clock) and their ducts open on the inner surface of each labium minus just external to the hymenal ring. - The ducts are lined by columnar epithelium.

Answer 103

- Prostatorrhoea - Urethrorrhoea (Prosemen)

Answer 104

- An escape of prostatovesicular fluid from the external urinary meatus independent of orgasm.

Answer 105

- Its escape is noticed when the patient strains at stools or at urination. - It is an excess of secretion expressed by the pressure of hard stools on the prostate & the vesicles.

Answer 106

- It is clear, sticky, whitish discharge.

Answer 107

- Normally it doesn’t contain pus cells unless there is inflammation.

Answer 108

- An escape of normal urethral secretion from the external urinary meatus without coitus being indulged in. - It is an excess of secretion from the accessory sexual glands in the urethra like Cowper’s or Littre’s

Answer 109

- Its occurrence in some quantity at times of sexual excitement & before ejaculation is a normal event as it helps to alkalinize the urethra to receive the aftercoming semen.

Answer 110

- It is clear viscid fluid mucus, free of pus cells

Answer 111

- frequently mistaken for gonorrhoea by the laity.

Answer 112

common in young unmarried men.

Answer 113

- An acute infectious disease of the genitourinary mucous membrane caused by Neisseria gonorrhoeae.

Answer 114

- It is almost exclusively transmitted by sexual intercourse and may also cause local or metastatic complications. (More in females due to late diagnosis) 1) Sexual 2) Non-sexual 3) Perinatal transmission (mother to infant)

Answer 115

It is a fragile organism with only man as a host.

Answer 116

**O2:** Aerobe or Facultative Anaerobe **CO2:** 5%

Answer 117

- It can be cultivated on enriched media in the presence of moisture & 5% CO2. **Culture media:** - Ordinary Media - Transport Media - Growth Media - Growth-Transport Media

Answer 118

- Does NOT grow

Answer 119

- Non-nutritional, semisolid media that maintain a state of reduction during transport, e.g. Stuart's medium.

Answer 120

**Non-selective media** e.g. McLeod’s chocolate agar. **Selective media** - that eliminate the growth of common contaminants by addition of antimicrobial agents, e.g. Thayer-Martin medium.

Answer 121

- That provides both nutritional and transport requirements a) Nonselective as modified Thayer-Martin medium. b) Selective as Biological environment chamber.

Answer 122

- The gonococcus requires a mucosal surface to gain access to the body

Answer 123

columnar epithelium

Answer 124

- Subsequently the infection can spread to the other structures lined with columnar epithelium such as Littre’s glands, Cowper’s glands, Prostate, Seminal vesicles & Epididymis in the male, and Skene’s glands & Fallopian tubes in the female.

Answer 125

resolve by fibrosis

Answer 126

- The organism is able to infect the vulva and vagina of prepubertal girls, and the eye in both adults and neonates. In either sex it may gain entry to the blood stream with resultant disseminated disease

Answer 127

Dissemenated Diseases

Answer 128

- Genital gonococcal infections in men & women - Extragenital gonococcal infections in men & women

Answer 129

**Urethritis:** Inflammation of urethra **Epididymitis:** Inflammation of the epididymis

Answer 130

- urethritis

Answer 131

local complications of gonorrhoea are rare.

Answer 132

- Sexual intercourse is the principal mode of infection in adults

Answer 133

2-5 days (from last sexual intercourse).

Answer 134

- Dysuria - Urethral discharge: profuse (abundant), yellowish & usually purulent (contains pus). - Constitutional symptoms, e.g: fever, headache, malaise may occasionally develop. - The urinary meatus may appear red & oedematous. - Slight tender enlargement of inguinal lymph nodes occurs in some cases.

Answer 135

- Smear examination - Culture - Non-culture tests (DNA-based tests) - Two-glass test - Three-glass test - Serological tests

Answer 136

- These tests depend on detection of antibody against gonococci in the patient serum. ⚠ However, they do not show a high degree of specificity or sensitivity & cannot differentiate between past and present gonococcal infection.

Answer 137

- Complications tend to occur when symptoms and signs have been ignored and treatment delayed. Local Complications: - Balanoposthitis - Tysonitis - Paraurethritis - Littritis - Peri-urethral abscess - Urethral stricture - Cowperitis and Cowper’s gland abscess - Posterior urethritis - Cystitis (trigonitis) - Prostatitis and prostatic abscess - Seminal vesiculitis - Epididymitis

Answer 138

- inflammation of preputial sac & glans penis may occur in uncircumcised patient, severe phimosis then develops.

Answer 139

- alcoholism, physical exertion, trauma (instrumentation), vigorous prostatic massage, irrigation, and sexual indulgence.

Answer 140

- A tender swelling with a bead of pus next to the frenum - Abscess may develop. - May occur when the prepuce is long and hygiene is poor.

Answer 141

- spread of the infection into the submucous tissue of the urethra results in a boggy, painful swelling on the undersurface of the penis

Answer 142

paraurethral ducts present beads of pus at their openings on pressure.

Answer 143

threads appear in the first glass in the two-glass urine test.

Answer 144

- The abscess may open into the urethra or the surface of the penile shaft or the scrotum.

Answer 145

- a chronic sequel of peri-urethral inflammation which causes fibrous stricture

Answer 146

- The patient may complain of morning gleet, difficulty in passing urine and a narrow stream, subsequently retention of urine may occur.

Answer 147

- Best felt between the thumb on the perineum and a forefinger in the rectum.

Answer 148

- A painful swelling palpable on either side of the median raphe of the perineum

Answer 149

- if the infection is untreated, the posterior urethra may become involved in about 10-14 days.

Answer 150

- There is increasing dysuria, urgency, frequency and terminal haematuria. Both glasses of urine in the two-glass urine test are hazy in appearance.

Answer 151

- when the bladder is infected, the trigon is most often involved

Answer 152

- Acute prostatitis causes an exacerbation of the symptoms of urethritis together with perineal pain and suprapubic discomfort, fever and malaise. - On rectal examination the gland is found to be swollen and tender. - When prostatic abscess develops, the symptoms of acute prostatitis become even worse. The abscess may rupture into the urethra or rectum; or point to the perineum and a sinus or a fistula may form.

Answer 153

- This is usually associated with prostatitis

Answer 154

Manifested by haemospermia, frequent erections and ejaculations. The inflammed seminal vesicles may be felt per rectum as tender sausage-like structures above the prostate.

Answer 155

Epididymitis

Answer 156

- The condition is usually unilateral and presents as a painful, hot, red swelling. - If both epididymides are involved, sterility will result.

Answer 157

- In contrast to gonorrhea in men, gonococcal infection in women is often asymptomatic, but of far greater consequence because of the potential for serious complications (e.g., PID) from the infection.

Answer 158

- usually longer than 2 weeks.

Answer 159

- Endocervical canal & the Urethra.

Answer 160

- The condition is symptomless in almost 50% of cases. In some, symptoms may be related to the co-existing trichomoniasis or candidiasis. - The other 50% complains of symptoms of urethritis and/or cervicitis.

Answer 161

- Dysuria. - Frequency will indicate the presence of trigonitis or cystitis - In severe cases, there is terminal hematuria. - On examination (in lithotomy position) the external urinary meatus maybe reddened with edematous lips. On massaging the urethra with the index finger in the vagina (milking of the urethra), yellow purulent discharge can be expressed from the urethral orifice.

Answer 162

- On examination: a mucopurulent or purulent discharge is seen coming from the external os which appear congested. - There may be signs of acute cervical erosions.

Answer 163

- Skenitis - Bartholinitis

Answer 164

- Beads of pus seen or expressed from the Skene’s ducts, Paraurethral cyst or abscess of Skene’s glands rarely occur as a result of blockage of their ducts.

Answer 165

- Bartholin's glands may be infected unilaterally or bilaterally, causing pain & swelling of the vulva with discomfort and difficulty in sitting & walking.

Answer 166

- abscess of the gland develops and eventually this may rupture through the skin or mucous membrane.

Answer 167

- On examination, there will be swelling of the vulva on the affected side. - The abscess can be felt between the fingers with the thumb on the outer surface of the labium majus and the index finger in the vagina.

Answer 168

- Treated by drainage. However, simple incision and drainage can often lead to recurrence, so marsupialization is usually done for recurrent Bartholin’s cysts or abscesses.

Answer 169

- Extension of gonococci to the pelvis may result in salpingitis, pyosalpinx or parametritis. - Lower abdominal pain, pyrexia and general malaise are common manifestations that often occur during or within a week after menstruation.

Answer 170

- is a collective term for the involvement of the fallopian tubes, ovaries and adjacent peritoneum. It is a serious condition with agonizing sequelae such as chronic pelvic pain, dyspareunia (pain on intercourse), ectopic (tubal) pregnancy and infertility. - A Clinical syndrome associated with ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures.

Answer 171

- Gonococcal Proctitis (Anorectal gonorrhea) - Oropharyngeal Gonorrhoea - Gonococcal Conjunctivitis - Disseminated Gonococcal Infection (DGI) - Gonococcal Perihepatitis (Fitz-Hugh-Curtis Syndrome)

Answer 172

- The rectal mucosa may be infected by the gonococcus in either sex.

Answer 173

- The patient may have no symptoms. When present, they may include anal pain or irritation, a change in bowel habits, tenesmus, and mucoid, purulent, or blood-stained anal discharge

Answer 174

Rectal mucosa smear for Gram’s stain and culture may help in diagnosis.

Answer 175

orogenital contact.

Answer 176

- It is rare in adults

Answer 177

- Occurs from direct contamination of the eye with infectious discharge by fingers or towels.

Answer 178

Blood-borne dissemination of gonococci occurs mainly in women

Answer 179

7 - 30 days after mucosal infection, About 1-2% of mucosal infections → (DGI)

Answer 180

- Mild (benign gonococcaemia) presenting as a triad of fever, arthritis, & dermatitis. - The rarer but more serious manifestations include endocarditis, myocarditis, pericarditis, meningitis, osteomyelitis, and hepatitis.

Answer 181

- Terminal (C5-C9) complement deficiencies

Answer 182

- Mortality is very rare, even with disseminated infection

Answer 183

- skin lesions are generally found on the extremities as small macules, papules, pustules or vesicles that may be haemorrhagic or necrotic.

Answer 184

- Spontaneous resolution and relapses may occur

Answer 185

- meningococcal septicemia, pyoderma, and drug rash.

Answer 186

- Is always monoarticular - If polyarticular, it is additive (when another joint is affected, the previous affected joint remains affected).

Answer 187

- The condition occurs mainly in women

Answer 188

- There are usually associated symptoms of salpingitis, or the pelvic infection may have been asymptomatic.

Answer 189

The infection is believed to reach the subphrenic space by spread from the fallopian tube along the peritonium and paracolic gutters.

Answer 190

Ceftriaxone 250 mg IM single dose. This is the only option (spectinomycin not effective in this setting).

Answer 191

- Ceftriaxone 1 gm IM single dose. - Spectinomycin, 2 gm IM once.

Answer 192

N. gonorrhoeae, C. trachomatis, or Gram-negative bacilli.

Answer 193

- Gonorrhoea Can be transmitted from the mother’s genital tract to the newborn during birth, and can cause: 1. Gonococcal ophthalmia neonatorum. 2. Systemic neonatal infection **It can also cause endometritis and pelvic sepsis in the mother.**

Answer 194

- The Cephalosporins and Spectinomycin (2g IM once) are safe. - Azithromycin is safe and can be prescribed for chlamydia.

Answer 195

In prepubertal girls the vaginal mucosa is thin, immature and has alkaline pH. Thus, it is susceptible to gonococcal infection.

Answer 196

(Urethritis, vulvovaginitis, proctitis) 1- Dysuria, vulvovaginal itching or soreness and difficulty in walking 2- The underwear may be stained & the purulent discharge is often obvious 3- The vulva & vagina are swollen, red and discharging mucopurulent discharge

Answer 197

- Swabs for Gram stain and Culture. - Other members of the household should be investigated.

Answer 198

- Infection of the babys' eyes during parturition through the infected cervix.

Answer 199

2 - 5 days.

Answer 200

Sexually or nonsexually transmitted urethral inflammation which is NOT due to Neisseria gonorrhoea”

Answer 201

- Patients with postgonococcal urethritis in which the gonococcus disappears but symptoms of urethritis remain are included in this category (NGU).

Answer 202

- The syndrome results from a dual infection with N. gonorrhoea and other agents that cause NGU and the later are unmasked when the gonorrhoea is treated with drugs that are not effective for NGU.

Answer 203

- Sexually transmitted urethritis - Non-Sexually acquired urethritis: - Non-specific urethritis

Answer 204

Other STDs; Including: - Chlamydia - Syphilis - Gonorrhoea - Hepatitis-B - HIV ➥ For both patient and partner

Answer 205

- increased practice of orogenital contact

Answer 206

2 - 7 days.

Answer 207

- The genital infection may be asymptomatic or present with varying degrees of severity. 1. primary attack 2. Recurrent attacks

Answer 208

- Papillomatous growth found in the urogenital, perineal & perianal regions caused by infection with the Human papillomavirus (HPV).

Answer 209

- Prophylactic vaccines for genital HPV are currently under development.

Answer 210

- Blood, semen, vaginal fluids, and breast milk are the body fluids known to have the highest concentrations of HIV.

Answer 211

3 - 10 years

Answer 212

**Stage 1:** Acute viral infection, seroconversion **Stage 2:** Early disease, completely asymptomatic **Stage 3:** Intermediate phase, overt disease **Stage 4:** AIDS

Answer 213

(severe opportunistic infections & uncommon malignancy)

Answer 214

- HIV infection can have myriad manifestations **ranging from subclinical laboratory abnormalities to the opportunistic infections and malignancies** that define the acquired immunodeficiency syndrome **(AIDS)**. - The term **AIDS** has been used to describe the more **severe manifestations of this disorder, particularly opportunistic infections and unusual tumors associated with immunodeficiency**. The **other major clinical presentations of HIV** infection include **PGL** (persistent generalized lymphadenopathy) and **ARC** (AIDS-related complex). - It is **not known which patients will progress** from the asymptomatic seropositive state to the symptomatic phase of ARC or AIDS.

Answer 215

- In some cases, these features may disappear spontaneously. In others ARC may be an intermediate stage between the initial infection and AIDS, or a chronic manifestation of HIV infection.

Answer 216

- Severe opportunistic infections and uncommon malignancies occur on a background of profound immunosuppression (CD4 cell count below 200 cells/mm3) and the mortality is high. - The patients present in many ways

Answer 217

- Cutaneous manifestations of AIDS - Major noncutaneous clinical manifestations of AIDS

Answer 218

- The cutaneous manifestations may be divided into 3 large categories: infections, neoplastic and others. - Pre-existing diseases, such as psoriasis, may worsen in HIV-infected individuals and may present in atypical, exaggerated forms because of the underlying immunosuppression.

Answer 219

- A multicentric tumor arising from local hyperplasia of vascular endothelium. - It occurs as deep red to blue macular, plaque and nodular lesions on the skin, oral mucosa and internal organs.

Answer 220

The clinical manifestations of AIDS are protean and affect virtually every organ in the body. The clinical manifestations depend upon the particular secondary disease. A) Protozoal and helminthic infections B) Fungal infections C) Bacterial infections D) Viral infections E) Cancer

Answer 221

- Chest radiograph - Head CT scan

Answer 222

- Cough or dyspnea - Fever without a source - Night sweats, fever, or weight loss

Answer 223

- Diffuse bilateral interstitial infiltrates - Spontaneous pneumothorax

Answer 224

- Upper lobe infiltrates or cavitation - Hilar adenopathy - Pleural effusions - Miliary TB pattern

Answer 225

- Indicated for complaints of headache or focal neurologic deficit.

Answer 226

Toxoplasmosis, hypodense, multiple sclerosis and ring-enhancing lesions

Answer 227

- Laboratory evaluation of immune status - Smears, appropriate cultures and biopsy for more definitive diagnosis. - Testing for HIV infections

Answer 228

(white cell count and helper/suppressor T-cell ratio). ➥ There is immunosuppression if helper/suppressor ratio is < 1, and there are fewer than 500 helper T cells.

Answer 229

- HIV culture - Detection of HIV antibodies - Detection of HIV antigen

Answer 230

- Cultivation of host lymphocytes in presence of interleukin. ➥ It is the most accurate but difficult & expensive.

Answer 231

- Within 2 to 8 weeks (average of 25 days), but it can take from 3 to 6 months.

Answer 232

(P24 in the core of the virus) by ELISA and PCR.

Answer 233

- Serologic testing for HIV currently involves a screening test (ELISA) followed by a confirmatory test (Western blot) for all positives.

Answer 234

HIV antibody negative + have Normal T helper lymphocyte counts and Normal T helper : T suppressor ratios.

Answer 235

➥ Prevention of sexual transmission ➥ Prevention of non sexual transmission ➥ Prevention of vertical transmission

Answer 236

Reverse Transcriptase Inhibitors

Answer 237

- Immunomodulators to restore T cell functions as IF, IL-2, Isoprenosine.

Answer 238

- Subunit vaccines by recombinant DNA technology. - Liver recombinant microorganisms

Answer 239

Herpesviridae family

Answer 240

intimate contact with infected body fluids including semen

Answer 241

- Increases the risk of AIDS, possibly by activating CD4+ cells such that HIV-1 is produced.

Answer 242

- Hepadnaviridae family - DNA ds - HBV DNA was integrated into the DNA of spermatozoa and mononuclear cells

Answer 243

- Flaviviridae family - RNA ss+ - HCV-specific antigens and RNA have also been detected in semen and the supernatant of spermatozoa, cell pillet and spermatids with chronic hepatitis C. However, it may be absent after Percooll selection

Answer 244

- Maternal transmission of HCV could be observed in babies born to mothers with high level viraemia and infection through assisted reproduction and cryopreservation occurs.

Answer 245

Hepatitis G virus (HGV) and HGV RNA are present in semen, with HIV-1-infected homosexual men.

Answer 246

- It is the branch of medicine that deals with the sexual health and sexual dysfunctions.

Answer 247

- complex physiologic response that is dependent upon the integration of vascular, endocrine, psychological, and neurogenic mechanisms.

Answer 248

- This stage in which a man or a woman begins to want or “desire” sexual activity

Answer 249

- May last from a moment to many years

Answer 250

- sexual drive (libido) - an attractive partner - a suitable environment that provide freedom from distraction & anxiety

Answer 251

- Excitement phase - Plateau phase (full sexual excitement) - Orgasmic phase - Resolution phase

Answer 252

- Sexual stimuli can create sexual desire

Answer 253

- Occurs only in males,

Answer 254

- During which further erection & ejaculation are inhibited.

Answer 255

Sacral segments (S2 - S4) of the spinal cord (parasympathetic system).

Answer 256

- Relaxation of the smooth muscles of the incoming arterial walls. - Filling the erectile tissue to with blood.

Answer 257

1- Cavernosal artery dilatation leading to increased blood flow. 2- Relaxation of the smooth muscles of the blood sinusoids of corpora cavernosa. 3- Mechanical venous occlusion.

Answer 258

- Emission - Bladder Neck Closure - Ejaculation Proper

Answer 259

is an intracellular enzyme that degrades cGMP → The penis returns to its flaccid state.

Answer 260

Ejaculation is the process of semen expulsion from the sex organs to the outside, and this occurs through 3 rapidly successive phases which are reflex in nature

Answer 261

- expulsion of semen into the posterior urethra (sympathetic control from T10 - L2 through the hypogastric plexus).

Answer 262

- to avoid retrograde ejaculation with formation of posterior urethral chamber (sympathetic control from T10 - L2).

Answer 263

- Propulsion of semen out of the urethra. - This involves opening of external urethral sphincter, contraction of bulbourethral muscles and contraction of pelvic floor muscles (somatic control from S2 - S4 through pudendal nerve). - Ejaculation of the semen from the penis marks the height of orgasm.

Answer 264

A cortical sensory experience. It is the sum of the reactions and sensations in the body at climax that evokes feelings of release and pleasure.

Answer 265

- Consistent inability to achieve or sustain an erection of sufficient rigidity for sexual intercourse to the point of satisfaction of both partners.

Answer 266

- With the introduction of new diagnostic techniques, the old theory that 90% of ED cases are due to psychogenic causes has become obsolete. - It is now estimated that organic causes are present in approximately 70% of cases of ED. However, both organic and psychogenic factors are involved in many cases.

Answer 267

because the latter is a comprehensive label for disturbances which may occur in libido erection, ejaculation, or orgasm.

Answer 268

- Congenital penile deformities - Mechanical Causes - Endocrinal Causes - Metabolic Causes - Neurogenic Causes - Vasculogenic Causes - Exercise Intolerance - Iatrogenic Causes

Answer 269

- Is the name for a group of risk factors (obesity, overweight, ↑ blood pressure, ↑triglycerides, dyslipidaemia & ↑ fasting glucose) - that increase the chance for heart disease, diabetes, stroke & erectile dysfunction.

Answer 270

- Thorough sexual, medical and drug History - Examination - Investigations

Answer 271

**Onset, course, and duration:** - Organic impotence is of insidious onset and there is progressive loss of erectile capacity in all sexually arousing situations (many men cannot get an erection from time to time, and this is normal). **Presence of morning, nocturnal, psychogenic, and reflex erections** - (defective in organic impotence).

Answer 272

− History of systemic disease, e.g., diabetes, hypertension, peripheral neuropathy or organ failure. − Risk factors for atherosclerosis such as smoking, hypertension and hyperlipidemia. − History of marital troubles, drug intake, trauma or surgery.

Answer 273

1. Proper history and examination 2. International index of erectile function questionnaire (15 questions) 3. Intracavernous vasoactive drugs testing

Answer 274

1. Papaverine hydrochloride. 2. Prostaglandin E1 (Alprostadil) 3. Phentolamine Mesylate. 4. Atropine sulphate

Answer 275

exclude significant vascular lesion

Answer 276

- Priapism - Fibrosis - Injury - Pain - Transient hypotension

Answer 277

**Specialized methods for investigation**

Answer 278

- Psychological testing - Monitoring of nocturnal erections - Penile-brachial pressure index. - Doppler studies - Cavernosometry and Cavernosography - Internal pudendal arteriography: - Biothesiometry - Neurologic evaluation of afferent and efferent pathways of erection

Answer 279

for measurement of psychosexual functioning

Answer 280

- Occur during rapid eye movement sleep to differentiate organic from psychogenic impotence.

Answer 281

- This is done by Rigiscan device examination.

Answer 282

Vibration sense in penis

Answer 283

To study the venous drainage system of the penis (the veno-occlusive mechanism of the corpus cavernosum).

Answer 284

- Avoiding risk factors - Treatment of underlying causes - TTT of Psychogenic erectile dysfunction - TTT of Organic erectile dysfunction

Answer 285

Biothesiometry, Electromyography, Verve conduction studies, Thermal or Vibratory threshold and Bulbocavernosus latency.

Answer 286

drugs, smoking, weight reduction and alcohol

Answer 287

hypogonadism, surgical correction of correctable causes, control of diabetes, hypertension

Answer 288

- Psychotherapy, Behavior modification therapy, Sexual education & counseling and/or the use of a variety of medications. Such counseling is useful, even if the sexual dysfunction has a strictly organic basis.

Answer 289

- Hormonal pharmacotherapy - Non-hormonal pharmacotherapy - Hemodynamic treatment - Penile prosthesis - Other treatment options

Answer 290

- Androgens - Bromocriptine

Answer 291

- PDE5 inhibitors - Intracorporal pharmacotherapy - Systemic therapy

Answer 292

- Hypogonadism is the principal indication. - Most impotent men have normal testosterone levels; so, the administration of testosterone to these individuals provides no benefit.

Answer 293

sildenafil, avanafil, vardenafil and tadalafil

Answer 294

- erectile impotence secondary to hyperprolactinemia.

Answer 295

- These drugs inhibit PDE5 that degrades cGMP in the smooth muscle cells of the penis → accumulation of cGMP → good penile erection.

Answer 296

- Induction of artificial erection can be done, in selected cases, by injection of vasoactive drugs into corpora cavernosa to induce vasodilatation & erection. - Papaverine, phentolamine and prostaglandin E1 are commonly used for intracorporal injection.

Answer 297

yohimbine (alpha 2-adrenergic blocking agent).

Answer 298

For treatment of vasculogenic impotence). 1. Arterial reconstructive surgery. 2. Venous reconstructive surgery.

Answer 299

- Penile implants are reserved for erectile impotence that is not amenable to any other form of therapy. - They are divided into inflatable and noninflatable devices. - Noninflatable devices include rigid rods and malleable devices.

Answer 300

- vacuum-constriction devices and Electrostimulation therapy

Answer 301

- Uncommon disorder characterized by a painful prolonged and persistent (further than a time interval of 4 hours) penile erection in the absence of sexual interest or excitation.

Answer 302

So, there are 2 types of priapism depending on the cause: - Ischemic type: caused by: sickle cell disorders, leukemia & drugs - High flow type: caused by: Trauma

Answer 303

- Duplex examination and blood gas measurement of the blood from the penis.

Answer 304

conservative as ice packs, blood aspiration, drugs, or surgery

Answer 305

- Premature ejaculation - Delayed ejaculation - Retrograde ejaculation

Answer 306

- It is the inability to control ejaculation for a sufficient length of time during vaginal penetration before the man wishes to ejaculate. - It is ejaculation which always or nearly always occurs prior to or within about 1 minute (for primary PE) and 3 minutes of vagina penetration (for secondary PE).

Answer 307

- in younger men with a new partner but usually this is self-resolving with simple reassurance.

Answer 308

- Physiological PE - Psychological PE - Primary lifelong PE - Acquired or Secondary PE

Answer 309

- occurring from the 1st sexual experience & persists over life.

Answer 310

Can occur in association with anxiety. It was once thought that almost all PE was psychological.

Answer 311

characterized by -ve personal consequences (distress, bother, frustration and/or the avoidance of sexual intimacy).

Answer 312

- It is thought to be associated with diminished serotonergic neurotransmission & higher serum leptin levels. (neurobiologically - and possibly genetically- determined).

Answer 313

- Selective serotonin reuptake inhibitors (e.g., paroxetine) are effective in some cases.

Answer 314

- Occurring at some point during life after a period of normal ejaculatory functioning.

Answer 315

- It may occur 2ry to thyroid overactivity or neural or pelvic pathology and in association with prostatitis.

Answer 316

Neurobiologic defect (↓serotonin), Anxiety & Organic causes as erectile dysfunction, genital infections & hypogonadism

Answer 317

is a rare sexual disorder in which the man finds it difficult or impossible to ejaculate, despite the presence of adequate sexual stimulation, erection & conscious desire to achieve orgasm.

Answer 318

- Any underlying disease process should be corrected, and medications that may be causing the problem should be stopped, if possible, or substituted.

Answer 319

- A sexual act of normal duration, ending with orgasm, in the absence of antegrade ejaculation, but in the presence of postejaculatory urine containing sperm & fructose

Answer 320

- The emission enters the bladder rather than out of the penile shaft during ejaculation. It occurs when the bladder neck does not close following emission.

Answer 321

- It does not require intervention unless a pregnancy is desired. It can be distinguished from anejaculation by the finding of sperm in the post-orgasmic urine.

Answer 322

- It is a localized connective tissue disorder

Answer 323

- the tunica albuginea of the corpora cavernosa of the penis.

Answer 324

- Ultrasound & MRI images are helpful to confirm the diagnosis, determine the extent of the plaque and detect calcification.

Answer 325

There is a history of painful bending of the erect penis, the pain usually resolves after 6-18 months. Some men feel a lump and are concerned about the possibility of cancer.

Answer 326

- Minor degrees usually do not interfere with vaginal penetration, but reassurance is needed. - Surgery should be reserved for men with more severe deformity and should be deferred until the acute painful phase has settled.

Answer 327

Gonorrhoea

Answer 328

granuloma inguinale

Answer 329

genital herpes

Answer 330

molloscum Contagiosum

Answer 331

Genital candidiasis

Answer 332

pediculosis

Answer 333

Trichomoniosis

Answer 334

1- Chancroid (soft sore) 2- Granuloma inguinale (Donovanosis) 3- Lymphogranuloma venereum (LGV)

Answer 335

1- Chancroid (soft sore) 2- Granuloma inguinale (Donovanosis) 3- Lymphogranuloma venereum (LGV)

Answer 336

7 days (ranges from 3 days to 3 weeks)

Answer 337

- Direct smear stained with Gram's stain - Direct immunofluorescent test (sensitive & Specific) - Culture - PCR (Improces accuracy)

Answer 338

Donovanosis

Answer 339

9 - 90 days

Answer 340

- History of sexual contact. - Clinical appearance of the lesion. - Smears from scrapings obtained from the margin of the lesion are stained by Wright's, Giemsa's or Gram's stain. - PCR testing using swabs rather than biopsy or tissue sample

Answer 341

- Primary stage - Secondary stage - Late manifestations

Answer 342

- Characterized by acute proctocolitis and extension of inflammation to the perirectal lymphatics. - There are signs and symptoms of proctitis, with anal pruritis, rectal pain and tenesmus. - Perirectal abscesses and anal fissure may be the presenting feature.

Answer 343

- Anogenital and rectal syndrome - Genital elephantiasis - Malignant transformation

Answer 344

- Bowel perforation followed by acute peritonitis is the most common direct cause of death in LGV patients.

Answer 345

- Development of cancer following rectal strictures and/or genital elephantiasis may occur in these patients.

Answer 346

- Lymphatic obstruction may lead to elephantiasis of the external genitalia (vulva, penis and scrotum).

Answer 347

It is the various clinical conditions caused by Candida, mostly Candida albicans

Answer 348

Genital Candidosis

Answer 349

- It is a common infection of the female genitourinary tract, It is less often diagnosed in males and is rare in children and after menopause.

Answer 350

Trichomonas vaginalis (a flagellated protozoan)

Answer 351

- Mode of infection in the adults is usually Sexual contact. - Accidental infection from improperly sterilized instruments, gloves, moist towels, toilet seats and baths is possible.

Answer 352

- Males are often asymptomatic, but can transmit the infection. They may develop balanitis or balanoposthitis. - Trichomonal urethritis: symptoms and signs are indistinguishable from other causes of NGU.

Answer 353

- Metronidazole: 200 mg 3 times a day for one week. OR * Tinidazole: 2gm orally in a single dose. - Sex partners should be treated at the same time.