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Men's Health > Day 1 > Flashcards

Day 1 Flashcards

1
Q

the term verumontanum is also referred to as:

A

ejaculatory duct

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2
Q

List the path of sperm from where it is made to ejaculation..

A

made in the seminiferous tubules, into Rete testes, to the efferent ductules, to the epididymis, to the vas deferenens, enters ejaculatory duct along with fluid from seminal vesicles(alkaline secretion) which travels through prostate (acidic secretion), the membranous urethra and spongy urethra (which gets secretions from bulbourethral glands) out meatus

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3
Q

At what age does the prostate start to enlarge

A

40 y/o

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4
Q

why does the prostate cause obstruction problems with the urethra when enlarged?

A

Due to it’s fibrous capsule limiting it’s external growth…

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5
Q

In what zone does the urethral passage go through

A

the transition zone

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6
Q

which zone is cancer most often found??

A

in the peripheral zone

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7
Q

Which is more likely palpable on a DRE?

A

the cancer in the peripheral zone

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8
Q

How would you treat a mild symptomatic AUA score?

A

observation

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9
Q

You suspect BPH based on sx/DRE/age/AUA score… which lab are you going to order?

A

Serum creatinine and UA looking for infxn & hematuria…

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10
Q

Patient presents with hematuria, which image are you going to order?

A

CT urogram

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11
Q

Patient presents with elevated creatinine, which image are you going to order?

A

Renal/Bladder US b/c contrast is nephrotoxic

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12
Q

What is the 1st line tx of pt with moderate/severe sx of BPH

A 
alpha-blocker nonselective:
-Terazozin or Doxazosin
Selective alpha-receptor blockers: 
-Tamsulosin (Flomax)
-Alfuzosin (Uroxatrol)
-Silodosin (Rapaflo)
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13
Q

What is the MOA of Terazozin?

A

smooth muscle relaxant..

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14
Q

What’s the time difference to see effects btw alpha blockers and 5alpha-reductase inhibitors…

A

alpha blockers only 2-4 wks compared to 5a-reductase inhibitors take up to 6 months

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15
Q

whats the MOA of 5alpha-reductase inhibitors

A

blocks conversion of testosterone to DHT.

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16
Q

At what size Prostate would you consider initiating the 5alpha-reductase inhibitor?

A

> 40cm

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17
Q

What are some examples of a 5alpha-reductase inhibitor?

A

Dutasteride (Avodart)

Finasteride (Propecia/Proscar)

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18
Q

what’s the most promininent ADR of Finasteride or Dutasteride

A

gynecomastia, sexual dysfxn, ca risk

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19
Q

What are the 4 absolute indications for surgery in a pt w/ BPH

A
  1. urinary retention refractory to tx
    2 recurrent UTI’s
  2. recurrent gross hematuria
    4 renal insufficiency
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20
Q

Surgery of choice for a pt with BPH

A

TURP

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21
Q

what are the 2 most common RF’s for a urethral stricture

A

trauma and infxn

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22
Q

What r pts at risk for with phimosis?

A

squamous cell carcinoma under foreskin.

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23
Q

How are we tx a pt with paraphimosis?

A

squeeze gland for 5 minutes, retract the skin forward & Abx

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24
Q

what is Peyronie’s Dz

A

curvature of the penis & painful erection… a fibrous plaque involving the tunica albuginea

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25
Q

when do you refer a patient with Peyronie’s Dz aka curved penis

A

when unable to have sex

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26
Q

what is the worst consequence of priapism?

A

impotence

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27
Q

which type of priapism would need emergent surgery?

A

ischemic

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28
Q

which comorbidity is most associated with priapism especially in kids?

A

sickle cell crisis

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29
Q

what are some causes of nonischemic priapism?

A

penile or perineal trauma, pelvic AVmalformations, acute spinal cord injury

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30
Q

which drug is most associated with ischemic priapism?

A

trazadone (psuchotropic drug)

31
Q

How do you tx an ischemic priapism?

A

aspiration and irrigation…
(give adrenergic agonist-terbutaline) narcotics for pain; also tx sickle cell (O2, hydration, alkanization, transfusions)

32
Q

where is the fluid from a hydrocele found?

A

btw tunica vaginalis

33
Q

how do we work up and treat hydroceles?

A

U/S, transilluminate… if simple-observe, but if u c septations-refer i.e. complex

34
Q

why do u NOT want to aspirate a hydrocele?

A

it will re-accumulate

35
Q

how do we tx a epididymal cyst or spermatocele?

A

observe unless bothersome to the pt.

36
Q

How do you want to work up a varicocele?

A

U/S and semen analysis

37
Q

In what positions do you want to examine a pt w/ varicocele? (“bag of worms”)

A
  • supine is should be decreased

- upright & valsalva increased

38
Q

what anatomical differences exist that requires a CT scan of the abdomen when a pt presents w/ right sided varicocele vs. left (US/ semen analysis only)

A

right side empties into vena cava with less resistence than left side which empties into renal vein…therefore it should be less common in rt.

39
Q

how would u account for the bellclapper deformity

A

a congenital malformation of the tunica vaginalis that not only covers the teste & epididymis but the spermatic cord as well

40
Q

what will you find/perform on PE that will help dx testicular torsion

A

absent cremaster relex…

41
Q

How are you to tx the pt with teste pain that has a “blue dot sign”

A

reassurance, as its mostly a result of appendix testis twisted

42
Q

what time frame is ideal for saving testicular torsion?

A

< 6 hrs.

43
Q

which way would u attempt to twist the testes manually if a torsion had occurred/

A

away from midline..

44
Q

How would you differentite hypogonadism? Find cause…

A

order LH/FSH levels… if high=primary testes failure. If low=secondary either at hypothalamus or anterior pituitary…

45
Q

What are some causes of hypogonadimsm at the teste level?

A
  • klinefelters syndrome (XXY)-95% azospermia
  • cryptorchidism
  • trauma/torsion
  • infectious orchitis (mumps)
  • radiaiton
46
Q

what are some other causes of gonadal deficiency

A

illness (HIV/liver/kidney dz, Ca, hemochromatosis)

  • obesity
  • normal aging (andropause)
  • drugs(spironolactone/ketoconazole/steroids/ETOH, marijuana, opiods)
  • pituitary tumor
47
Q

What are the 4 major findings of hypogonadism?

A
  • erectile dysfxn
  • low libido
  • depression
  • fatigue
48
Q

When do you tx for hypogonadism

A

Testosterone <300

3 sx present

49
Q

What r some Contraindications to testosterone replacement therapy?

A 
Hematocrit > 50% 
severe OSA
poorly controlled CHF
recent MI or unstable angina
Hx of prostate Ca
50
Q

when do u want to monitor testosterone therapy?

A

at 3-6 months, should be in range 500-700 watch for increased hematocrit & PSA levels.

51
Q

What are the key features of androgen insensitivity syndrome?

A

Normal testosterone and LH levels, but failure of male secondary sex charecteristics. (female body in genetically male XY)

52
Q

What’s one major concern for precocious puberty?

A

bones maturation w/ early closure of epiphyseal leading to short stature.

53
Q

What’s a few tx for precocious puberty which is also a cause for the gonadal deficiency…

A

spironolactone (androgen agonist)

Ketoconazole (inhibits androgen synthesis)

54
Q

whats a major cause of gynecomastia

A

androgen deficiency; an increased estrogen/androgen ratio

55
Q

whats the biggest cause of male infertility…

A

sperm problems..

56
Q

How is the anterior pituitary connected to the hypothalamus?

A

hypothalamic-hypophyseal portal system delivers hormones in very high concentrations.

57
Q

what two signals act to negative feedback on hypothalamus/pituitary

A

testosterone and inhibin made by the sertoli cells

58
Q

why is the scrotum important in sperm formation?

A

allows testes to lie outside body cavity about 3 degrees cooler as temperature is important for production

59
Q

What does the Gubernaculum testis refer to & what is it’s fxn

A

scrotal ligament; prevents testis from moving too much…. defect can lead to torsion

60
Q

what are the contents of the spermatic cord

A

testicular artery, vein, lymphatics, nerves, and vas deferens…

61
Q

What cells does FSH act upon?

A

sertoli cells and germ cells to produce spermatogenesis

62
Q

what does the sertoli cells make that acts to negatively feedback to the pituitary

A

inhibin

63
Q

What hormone works on the leydig cells to make testosterone

A

LH

64
Q

How long does it take for spermatogenesis to occur?

A

about 74 days followed by 21 days maturation in epididymis

65
Q

How is prostate size estimated on DRE? what is typical for a 50 y/o

A

in grams

40 grams in a 50 y/o

66
Q

what two substances do testosterone bind to….

A

sex hormone-binding globulin and albumin…

67
Q

where does the conversion of testosterone to DHT occur?

A

tissues sensitive to androgens- hair follicles, prostate, testes, and muscles…

68
Q

what do we use to tx BPH

A

alpha-blockers

69
Q

how do we prevent testosterone to DHT

A

5-alpha reductase inhibitors (Finasteride aka Proscar/Propecia) & dutasteride aka Avodart

70
Q

what is DHT necessary for

A

external genitalia in boys

71
Q

why are obese men more likely to have gynecomastia?

A

testosterone converted to estradiol in adipose tissue.

72
Q

The syndrome seen as a female body habitus with genetic XY sex chromosome is referred to as…

A

testicular feminization or androgen insensitive…

73
Q

how does Viagra work to help males have an erection?

A

inhibits phosphodiesterase acitivty leaving more cGMP in tissues and hence longer vasodilation time.

74
Q

What the signaling molecule that stimulates cellular production of cGMP

A

NO Nitric Oxide.

Men's Health (3 decks)

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