Male GU

Question 1

Opening of urethra on inferior surface of penis due to failure of urethral folds to close

Answer 1

Hypospadias

Question 2

Epispadias is the opening of urethra on superior surface of the penis. What is the difference in etiology between hypospadias and epispadias?

Answer 2

Hypospadias = failure of urethral folds to close

Epispadias = abnormal positioning of genital tubercle

Question 3

Additional clinical feature associated with epispadias

Answer 3

Bladder exstrophy

Question 4

Necrotizing granulomatous inflammation of inguinal lymphatics and LNs caused C.trachomatis L1-L3; eventually heals with fibrosis; perianal involvement may result in rectal strictures

Answer 4

Lymphogranuloma venereum

Question 5

2 major risk factors for SCC of the penis

Answer 5

High risk HPV (2/3 of cases)

Lack of circumcision

Question 6

3 Precursor lesions of SCC of the penis (shaft vs. glans vs. reddish papules)

Answer 6

Bowen disease = shaft

Erythroplasia of Queyrat = glans

Bowenoid papulosis = reddish papules; similar to bowen disease but does not tend to invade

[these are all considered in situ carcinoma]

Question 7

Most cases of cryptoorchidism resolve spontaneously by the age of 2. If they do not, complications include testicular atrophy with infertility and increased risk for what type of cancer?

Answer 7

Seminoma

Question 8

Causes of orchitis

Answer 8

Chlamydia trachomitis (D-K) or N.gonorrhoeae

E.coli and Pseudomonas (older adults with UTI)

Mumps virus

Autoimmune orchitis (granulomatous inflammation of tubules — ddx includes TB which can be differentiated with AFB stain)

Question 9

Testicular torsion is twisting of the spermatic cord leading to _____ infarction. It is due to congenital failure of testes to attach to the inner lining of the scrotum. Presents in adolescents with sudden testicular pain and absent ______ reflex

Answer 9

Hemorrhagic; cremasteric

Question 10

A varicocele is a dilation of the spermatic vein due to impaired drainage; presents as scrotal swelling with bag of worms appearance. Usually left sided, seen in a large population of infertile males, and is associated with what malignancy?

Answer 10

Left-sided renal cell carcinoma

[RCC loves to invade the renal vein]

Question 11

Hydrocele = fluid accumulation within the _____ _____; presents as scrotal swelling that can be transluminated

Answer 11

Tunica vaginalis

Question 12

Etiology of hydrocele in infants vs adults

Answer 12

Infants — incomplete closure of processus vaginalis

Adults — blockage of lymphatic drainage

Question 13

The 2 basic types of testicular tumors arise from germ cells or sex-cord stroma. Typical presentation is a firm, painless testicular mass that cannot be transilluminated.

T/F: gold standard for testicular tumor diagnosis is biopsy

Answer 13

False — not biopsied due to risk of seeding scrotum; instead they are just removed via radial orchiectomy

Question 14

Most common type of testicular tumors

Answer 14

Germ cell tumors

Question 15

Germ cell testicular tumors usually occur between ages of 15-40 and are divided into seminoma and non-seminoma. Risk factors include ______ and _______ ______

Answer 15

Cryptorchidism; Klinefelter syndrome

Question 16

Malignant tumor of large cells with clear cytoplasm and central nuclei; composed of a homogenous mass with no hemorrhage or necrosis and rare cases may produce beta hCG

Answer 16

Seminoma

[similar to dysgerminoma of ovary]

Question 17

Prognosis of seminoma

Answer 17

Good prognosis; responds to radiotherapy

Question 18

Malignant tumor of immature, primitive cells that may form glands; composed of hemorrhagic mass with necrosis

Answer 18

Embryonal carcinoma

Question 19

Embryonal carcinomas are non-seminomas that are considered aggressive with early ______ spread. Chemotherapy may result in ________. In addition, increased _____ or _____ may be present

Answer 19

Hematogenous; differentiation; AFP; beta hCG

[differentiation to something like teratoma]

Question 20

Most common testicular tumor in children; AFP is characteristically elevated

Answer 20

Yolk sac tumor

[similar to yolk sac tumors in females — have schiller duvall bodies that appear as glomeruloid-like structures]

Question 21

Choriocarcinoma of the testicle is a malignant tumor of _____ and ______ that spreads early via the ______ route. Of note is that there is characteristic ABSENCE of villi

Answer 21

Syncytiotrophoblasts; cytotrophoblasts; hematogenous

Question 22

_______ is characteristically elevated in choriocarcinoma due to production from syncytiotrophoblasts, which may lead to symptoms of ______ or ______

Answer 22

Beta hCG; hyperthyroidism; gynecomastia

[beta hCG can activate TSH receptors leading to hyperthyroidism, or it can activate FSH/LH receptors leading to gynecomastia]

Question 23

T/F: Teratomas in males are composed of mature fetal tissue derived from 2-3 embryonic layers, may produce AFP or beta hCG, and are ALWAYS considered malignant

Answer 23

True

[benign in females, malignant in males]

Question 24

T/F: The vast majority of germ cell tumors are usually mixed; the prognosis is based on the worst component

Answer 24

True

Question 25

Sex cord-stromal tumors of the testicle are usually benign. Which type of sex cord-stromal tumor usually produces androgen and presents with precocious puberty in children or gynecomastia in adults with characteristic Reinke crystals seen on histology?

Answer 25

Leydig cell tumor

Question 26

Sex cord stromal tumor of the testicle comprised of tubules; usually clinically silent

Answer 26

Sertoli cell tumor

Question 27

Most common cause of testicular mass in males > 60; often bilateral

Answer 27

Lymphoma [usually diffuse large B-cell type]

Question 28

Acute prostatitis etiologies in young adults vs. older adults

Answer 28

Young adults = C trachomatis; N gonorrhoeae Older adults = E coli; Pseudomonas [same as orchitis!]

Question 29

Acute prostatitis presents as dysuria with fever and chills; the prostate will be tender and boggy on DRE. Prostatic secretions show _____ and culture reveals ______

Answer 29

WBCs; bacteria

Question 30

Chronic prostatitis presents as dysuria with pelvic or low-back pain. How do the prostatic secretions in chronic prostatitis differ from acute prostatitis?

Answer 30

Chronic = prostatic secretions show WBCs but cultures are negative Acute = prostatic secretions show WBCs and bacteria on culture

Question 31

BPH is hyperplasia of prostatic ____ and _____. It is an age-related change with no increased risk of cancer. It is primarily related to the hormone _______ and occurs in the ______ zone of the prostate

Answer 31

Glands; stroma DHT; periurethral

Question 32

Clinical features of BPH include problems starting and stopping urine stream, impaired bladder emptying, dribbling, _______ of bladder wall smooth muscle and possible associated diverticuli, microscopic hematuria, and slight elevation in ______

Answer 32

Hypertrophy; PSA (4-10)

Question 33

3 possible pharmacologic treatments for BPH

Answer 33

Alpha 1-antagonist (terazosin) to relax smooth muscle Selective alpha 1a-antagonists (tamsulosin) in normotensive individuals 5 alpha-reductase inhibitors (finasteride) — only one that decreases size of prostate because this is the enzyme that converts testosterone to DHT - the hormone driving prostate enlargement

Question 34

Most common cancer in men; 2nd most common cause of cancer death

Answer 34

Prostate adenocarcinoma (malignant proliferation of prostatic glands)

Question 35

3 major risk factors for prostate adenocarcinoma

Answer 35

Increasing age Race — african americans > caucasians > asians Diet high in saturated fats

Question 36

T/F: prostatic adenocarcinoma typically presents early with urinary symptoms

Answer 36

False — since it arises at the posterior periphery of the prostate, it does not affect the urethra until very late

Question 37

Screening for prostate cancer begins at age 50 with DRE and PSA. Normal serum PSA increases with age, but a PSA > _____ ng/dL is worrisome at any age. A ______ (increased/decreased?) percent free-PSA in the serum is suggestive of cancer

Answer 37

10; decreased [a decreased percent free PSA is suggestive of cancer because cancer makes bound PSA]

Question 38

T/F: A prostatic biopsy is required to confirm the presence of prostatic adenocarcinoma

Answer 38

True [cannot confirm carcinoma just based on DRE and/or PSA]

Question 39

How is prostate adenocarcinoma graded?

Answer 39

Gleason grading system — based on architecture, NOT nuclear atypia [requires looking at multiple regions of prostate, since cancer varies across the prostate gland — higher score = worse prognosis]

Question 40

Prostate cancer often spreads to the lumbar spine, which is considered _______ metastasis, presenting as low back pain with increased alkaline phosphatase, PSA, and prostatic acid phosphatase

Answer 40

Osteoblastic [alkaline phosphatase is a marker of osteoblastic activity]

Question 41

3 treatment options for prostate cancer

Answer 41

Prostatectomy (local disease) Continuous GnRH analogs (leuprolide) Androgen receptor inhibitor (flutamide)