CM: Intro to Male Repro

Question 1

thick, fibrous plaques palpable deep w/i base of penile shaft
significant penile deformity during erection

Answer 1

Peyronie’s dz

Question 2

painless, firm masses of testicular parenchyma

Answer 2

testicular cancer

Question 3

What is testicular torsion?

Answer 3

spermatic cord twists - testicle ischemic - surgery!

Question 4

painful mass of gradual onset originating from outside testicle

Answer 4

epididymitis

Question 5

soft homogenous scrotal mass that transilluminates

Answer 5

hydrocele

Question 6

dilated and engorged testicular veins easily palpable in spermatic cord

Answer 6

varicocele (usually on left) - surgically correctable cause of male infertility

Question 7

irregular contour, firmness, nodules on prostate exam

Answer 7

prostatic cancer

Question 8

What is the role of FSH in spermatogenesis?

Answer 8

essential for initiation at puberty

stimulates normal levels in adult

Question 9

What is the role of the seminiferous tubules during spermatogenesis?

Answer 9

lined by sertoli cells - tight jxns between divide into basal and adluminal compartments
blood testes barrier allows spermatogenesis to occur in immunologically privileged site

Question 10

What are the roles of sertoli cells in spermatogenesis?

Answer 10

nurse cells
undifferentiated spermatogonia near BM
more advanced spermatids and spermatocytes near luminal surface

Question 11

What is the order of differentiation of cells during spermatogenesis?

Answer 11

gonocytes –> spermatogonia –> spermatocytes (pre-meiotic) –> spermatids (post-meiotic) –> spermatozoa (mature)

Question 12

What is the role of the epididymis in sperm production?

Answer 12

sperm transport and storage
sperm fertilizing ability (to penetrate zona pellucida)
motility maturation
transit about 12 days

Question 13

What is the role of PSA?

Answer 13

to liquefy seminal coagulum

Question 14

What is the normal physiology of an erection?

Answer 14

stimulus –> NO release –> cGMP formation –> vascular smooth muscle relaxation –> filling of sinuisoids w blood
PDE5 breaks down cGMP to reverse process

Question 15

What are psychogenic causes of ED?

Answer 15

anxiety, loss of attraction, stress, relationship problems

Question 16

What are psychiatric causes of ED?

Answer 16

depression

Question 17

What are neurogenic causes of ED?

Answer 17

trauma, myelodysplasia, multiple sclerosis, DM, alcohol, pelvis surgery

Question 18

What are endocrine causes of ED?

Answer 18

primary or secondary hypogonadism, hyperprolactinemia

Question 19

What arteriogenic causes of ED?

Answer 19

HTN, smoking, diabetes, hypercholesterolinemia, peripheral vascular dz

Question 20

What are venous causes of ED?

Answer 20

impairment of veno-occlusive mechanisms, peyronie’s dz

Question 21

What are drug induced causes of ED?

Answer 21

antihypertensives, antidepressants, hormones

Question 22

What findings suggest psychogenic ED?

Answer 22

sudden onset, situational, normal nocturnal erections

Question 23

What findings suggest organic ED?

Answer 23

gradual in onset, progressive, reduced nocturnal and early morning erections, normal libido and dev during puberty

Question 24

What are the contraindications for PDE5 inhibitors?

Answer 24

pts taking nitrates

unstable angina or recent MI

Question 25

What is priapism?

Answer 25

painful, unwanted, persistent erection which may produce ischemic damage to cavernous tissue if left untreated for >6hrs