Genitourinary Cases

Question 1

DDx for decreaesd force of stream when urinating

Answer 1

• Benign prostatic hyperplasia

• Urethral stricture
• Bladder atony
• Prostatitis acute v chronic
• Prostate cancer

Question 2

What symptoms would pt present with that would require surgery?

Answer 2

urinary retention, recurrent UTI, recurrent or persistant gross hemuria, bladder stones, renal insufficiency

Question 3

• Decreased FOS
• Hesitancy
• Incomplete emptying
• Nocturia
• Straining

Answer 3

All examples of lower urinary tract symptoms that are OBSTRUCTIVE

Question 4

• Urgency
• Frequency
• Dysuria

Answer 4

All LUTS related to Irritative

Question 5

• BPH is characterized by proliferation of :

Answer 5

benign stromal and glandular elements

Question 6

_____, an androgen derived from testosterone, is the major hormonal stimulus for proliferation in BPH

Answer 6

DHT

Question 7

BPH most commonly affects the______zone of the prostate, producing nodules that compress the prostatic urethra. On microscopic examination, the nodules exhibit variable proportions of stroma and glands.

Answer 7

inner periuretheral

Question 8

What is appropriate therapy for BPH?

anti-cholinergic

alpha-blocker therapy to shrink prostate

trans-urethral resection of prostate

alpha blocker to relax prostate smooth muscle

Answer 8

Alpha-blocker to relax the prostate muscle

Question 9

What are the two medical tx options for BPH

what about surgery?

Answer 9

Alpha-blocker therapy to relax smooth muscles or

5-alpha reductase inhibitors to decrease growth of gland

surgery: decrease gland size via transurethral surgery or open

Question 10

How can you tell the differnce between prostate cancer and BPH?

Answer 10

PSA will be much more elevated in cancer which often presents much later in pts. Cancer doesn’t present till its much more advanced

Question 12

Serine protease that functions to degrade semicoagulation produced by prostate cells of both benign and malignant

Answer 12

PSA

Question 13

If you have elevated PSA, what do you need to check for?

Answer 13

need to do transrectal ultrasound with 12 core biopsies

Question 14

Key for prostate cancer screening guidelines:

average at risk men screen at _____

men with baseline PSA or family hx start screening at ____

Answer 14

55

40

Question 15

What are the tx options for health men with low risk prostate cancer?

Answer 15

Active surveillance, radical prostectomy, external beam radiation therapy, brachytherapy and cryosurgery

Question 16

• 21 yo male complaining of right scrotal swelling x 2 weeks • PMHx: None
• PSHx: Right hernia repair
• SocHx: No tobacco, social EtOH
• Meds: None
• Allergies: none

Differntial Diagnosis?

Answer 16

• Epididymo-orchitis • Orchitis• Hydrocele• Spermatocele• Vericocele • Torsion• Hematoma • Hernia• Tumor

Question 17

• Exam:• GU 10cm firm mass right hemiscrotum, does not transilluminate

• Scrotal US:
• Right testes:10 cm heterogeneous echogenic mass • Left testes: normal

What are we concerened about?

Answer 17

testicular cancer

Question 18

• Most common cancer men ____
• Average age is 34
• 90% of testicular tumors are ________

Answer 18

20-39

germ cell cancers

Question 19

• Tumors with more than one subtype are considered ______

Answer 19

non-seminomas

Question 20

• Staging of testicular cancer is based on____________
• Classic presentation is a ______ but 30-50% present with pain

• 10% of patients present with _______

Answer 20

imaging and tumor markers

painless mass

metastatic symptoms

Question 21

3 weeks after an orchiectomy for pure seminoma,a 33 yo has a HCG of 0 and an AFP or 152. Pre op HCG was 22 and AFP was 152. Staging CT is negative. What is the next step?

Answer 21

Chemo with BEP bc the orchiectomy didn’t cure the cancer.

Question 22

tumor marker with a half-life 5-7 days
•Not present in pure seminomas or choriocarcinomas

Answer 22

Alpha-feto protein (AFP)

Question 23

Tumor marker Not detectable in normal males

Present in choriocarcinomas, embryonal and some seminomas

Half life is 24-36 hours

Answer 23

Beta human chorionic gonadotropin

Question 24

non specific tumor marker, correlates with volume of tumor

Answer 24

LDH

Question 25

What kind of tumor is a sertoli cell tumor?

Answer 25

stromal cell tumor

Question 26

Pure seminoma, teratoma, mixed embryonal and leydig cell tumor adn mixed seminoma and choriocarcinoma are all examples of

Answer 26

germ cell tumors

Question 27

What is used to diagnose testicular cancer?

Answer 27

• Exam and Ultrasound • Tumor Markers
• Inguinal Orchiectomy • CT abdomen/Pelvis• Chest Imaging

Question 28

Risk factor for testicular cancer

Answer 28

• 2.75-8x increased risk with history of undescended testes • History of atrophy
• DES exposure
• HIV/AIDS-increased risk of seminoma

Question 29

What is the tx for stage 2 NSGCT cancer (no lymph node mets)

Answer 29

2a: RPLND or chemo

2b or 2c; chemo

Question 30

tx for stage 3 testicular cancer

Answer 30

Chemotherapy

Question 31

• Stage 1 NSGCT (normal markers after orchiectomy) what do you do for treatment

Answer 31

observation

• Chemotherapy
• 2 cycles Bleomycin, etoposide, cisplatin

• Retroperitoneal Lymph Node Dissection (RPLND)

Question 32

61 yo male presents with painless swellig in left testicle for 2 months, see 5 cm mass. Pt has HCG= 25 and AFP=4. What is the likely dx?

Answer 32

Seminoma, d/t age group

often AFP less then 8 and in men in 60s

Question 33

Dx man with stage 1 seminoma, what is the treatment course?

Answer 33

<1% risk of dying, prefered is observation

otherwise 20-26gy radiation to retroperitoneium

Question 34

preferred tx for stage 2 seminoma

Answer 34

2a: radiation

2b or more: chemo