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STEP 1 > Male Path > Flashcards

Male Path Flashcards

1
Q

Old man with signs of bladder outlet obstruction (urinary hesitancy, need to strain, weak flow, incomplete voiding) most likely due to

A

benign prostatic hyperplasia (BPH)

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2
Q

digital rectal examination shows a smooth, homogenously enlarged prostate

A

benign prostatic hyperplasia (BPH)

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3
Q

a sedating antidepressant used off-label most often as a hypnotic to treat insomnia associated with depression or antidepressant treatment.

A

Trazodone

Trazzz o bone

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4
Q

associated with the rare but serious side effect of priapism (ie, persistent erection of the penis for >4 hours that is not associated with sexual excitement).

A

Trazodone

*contraindicated in Sickle Cell Anemia

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5
Q

Medical orchiectomy uses continuous GnRH analogues (____) to reduce LH production, which subsequently reduces androgen production in the testes.

Because there is an initial SURGE in androgens at the start of therapy (due to stimulation of the GnRH receptor),

GnRH therapy is usually treated with a few weeks of androgen-receptor inhibitors (______).

A

buserelin

bicalutamide

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6
Q

Prostate cancer is an _____-dependent tumor, patients with advanced disease are generally treated with surgical or medical orchiectomy.

A

androgen

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7
Q

Patient with acute, severe, progressive scrotal pain with a HIGH-riding scrotal mass is concerning for

A

testicular torsion

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8
Q

Scrotal edema and an absent cremasteric reflex (testicular elevation when stroking the ipsilateral inner thigh) is highly suggestive of

A

testicular torsion

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9
Q

Twisting of spermatic cord

Venous congestion, hemorrhagic infarction & necrosis of testis

A

testicular torsion

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10
Q

↑ Risk of Testicular Torsion with poor fixation of testis to ____

A

tunica vaginalis

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11
Q

scrotal mass that increases in size when standing as compared with supine positioning. This dilation of the pampiniform plexus may cause a dull ache

A

Varicocele

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12
Q

presents with acute scrotal pain that is relieved with manual elevation of the testicle and dysuria

A

Epididymitis

Neisseria gonorrhoeae

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13
Q

Hydrocele is a fluid collection within the ____ that transilluminates on examination and causes scrotal enlargement

A

tunica vaginalis

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14
Q

non-fusion of the urethral folds would most likely result in

A

Hypospadias

urethra opens on ventral shaft

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15
Q

For Heart Failure. It has significant antiandrogenic effects and can cause gynecomastia, decreased libido, and impotence.

A

Potassium sparing Diuretic

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16
Q

Laboratory testing shows elevated serum thyroxine and triiodothyronine levels. Scrotal ultrasonography demonstrates a hypoechoic mass within the right testicle. Hyperthyroid Symptoms

A

Germ Cell tumor

hCG marker

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17
Q 
Abrupt onset, clear precipitating event or stressor
Impaired erections with a partner 
Normal nocturnal/Morning erections
Normal masturbation
Impaired or premature orgasm
A

Sexual Performance Anxiety

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18
Q

Serum testosterone is normal or elevated. However, spermatogenesis (sperm count) is decreased.

A

anabolic steroids

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19
Q

excessive doses of _____ include acne, gynecomastia, azoospermia, decreased testicular size, and increased aggression

A

anabolic steroids

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20
Q

Sertoli cells produce ___ in response to FSH from the anterior pituitary.

A

inhibin

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21
Q

Inhibin suppresses ___ production in the pituitary.

A

FSH

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22
Q

____ cells facilitate spermatogenesis within the seminiferous tubules.

A

Sertoli

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23
Q

A communicating hydrocele results when the ____ remains patent and allows peritoneal fluid to accumulate in the tunica vaginalis.

Common in newborns
Presents as a painless scrotal swelling that transilluminates.

A

processus vaginalis

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24
Q

Peyronie disease, excess collagen formation within the ____ can cause significant pain and curvature of the penis.

A

tunica albuginea

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25
Q

The highest ____ grade of 5 is assigned to poorly differentiated tumors; these tumors do not resemble normal prostatic tissue and are generally arranged into sheets of invasive cells with no glandular elements.

A

Gleason

staging via spreading to LNs

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26
Q

Prostatectomy or injury to the prostatic plexus
(inferior hypogastric, pelvic, sacral splanchnic nerves)
can cause .

A

erectile dysfunction

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27
Q

Patients with congenital bilateral absence of the vas deferens (Cystic Fibrosis) have azoospermia and infertility with ___ levels of FSH, LH, and testosterone.

A

normal

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28
Q

____ is a 5-alpha reductase inhibitor and it inhibits the conversion of testosterone to dihydrotestosterone that acts on epithelium of prostate.

A

Finasteride

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29
Q

alpha-1 blockers act on _____ of prostate and bladder base.

A

smooth muscles

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30
Q

The ___ gonadal vein drains directly into the inferior vena cava.

A

right

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31
Q

The __ gonadal vein drains into the __ renal vein.

A

left

left

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32
Q

Inability to void with a full bladder sensation, a high-riding boggy prostate, and blood at the urethral meatus are suggestive of ____ injury, particularly in the presence of a ____ fracture.

A

urethral

pelvic

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33
Q

If urethral injury is suspected, placement of a _____ is contraindicated.

A

Foley catheter

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34
Q

The ____ urethra is further divided into the prostatic and membranous segments

A

posterior

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35
Q

the _____ urethra is divided into bulbous and penile segments.

A

anterior

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36
Q

Trauma to the pelvis severe enough to cause fracture often results in disruption of the posterior urethra at the ______ junction

A

bulbomembranous

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37
Q

Although the _____ urethral segment is reinforced by the surrounding corpus spongiosum, it is susceptible to crushing injuries when the perineum is struck forcefully (ie, straddle injury).

A

bulbous

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38
Q

Primary hypogonadism can be confirmed with __ serum testosterone associated with ___ LH.

Management of male hypogonadism includes testosterone therapy

A

low

elevated

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39
Q

For the treatment of erectile dysfunction

A

Phosphodiesterase 5 inhibitors (eg, sildenafil)

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40
Q

Prostate cancer causes ___ lesions that result in new bone growth.

Biopsy would show disordered trabeculae and signs of prostate cancer such as irregular glands with enlarged nuclei and prominent nucleoli.

A

osteoblastic

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41
Q

Secondary (hypogonadotropic) hypogonadism

___ testosterone
___ FSH, LH

A

Low

Low/normal

42
Q

Androgen insensitivity syndrome (AIS) is caused by loss-of-function mutations of the androgen receptor (AR) gene on the __ chromosome

A

X

43
Q

___ receptor dysfunction leads to decreased facial, axillary, and pubic hair; oligospermia; gynecomastia;

A

Androgen

44
Q

Following vasectomy, viable sperm remain in the portion of the vas deferens distal to the transection. Patients can still have viable sperm in the ejaculate for up to __ months and at least 20 ejaculations after the procedure

A

3

45
Q

This patient’s acute testicular pain, posterior testicle tenderness, and pyuria raises suspicion for acute ____.

A

epididymitis

46
Q

Acute epididymitis
Epidemiology
Age <35: sexually transmitted (chlamydia, gonorrhea)
Age >35: _________

A

bladder outlet obstruction (coliform bacteria)

47
Q

The finding of impaired sperm motility raises concern for _______.

A

primary ciliary dyskinesia (PCD)

48
Q

Patients with Klinefelter syndrome (47,XXY) have primary hypogonadism characterized by low testosterone and elevated gonadotropin (FSH, LH) levels. In addition, ____ estradiol/ estrogen results in the common finding of gynecomastia.

A

elevated

49
Q 
Age 15–35
solid, firm, or fixed testicular mass 
in the tunica albuginea 
ovoid in shape
painless to palpation

Dull ache in lower abdomen
Does NOT transilluminate

A

Testicular Cancer

50
Q

95% percent of testicular cancers are

A

Germ cell tumors:

seminomatous or nonseminomatous (embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed)

51
Q

During embryogenesis it is responsible for development of the internal male genitalia.

A

Testosterone (Leydig cells)

52
Q

is responsible for regression of the paramesonephric (müllerian) ducts that normally give rise to the internal genitalia in the female fetus.

A

müllerian inhibiting factor (MIF).

53
Q

can be used to treat both the BPH symptoms and hypertension.

A

alpha-1 blocker (doxazosin, prazosin, terazosin)

54
Q

Alpha-1 blockers work by relaxing smooth muscle in the ___ & ____, opening up the bladder outlet and decreasing the resistance to the flow of urine. They also relax smooth muscle tone in arterial walls, thus decreasing blood pressure.

A

bladder neck and prostate

55
Q

The _____ lymph nodes drain nearly all cutaneous structures inferior to the umbilicus, including the external genitalia (scrotum) and the anus up to the pectinate line.

A

superficial inguinal

56
Q

Lymph from the testes drains to the ____ lymph nodes.

A

para-aortic

57
Q

Lymph from the glans penis drains into the _____ lymph nodes.

A

deep inguinal

58
Q

___ cells suppress female internal reproductive organ development by producing anti-Müllerian hormone (AMH)

A

Sertoli

59
Q

Sertoli cells produce ______, which concentrates testosterone in the seminiferous tubules to enable spermatogenesis.

A

androgen-binding protein

60
Q

___ cells secrete testosterone, which stimulates the Wolffian (mesonephric) ducts to develop into internal male

A

Leydig

61
Q

The SRY gene on the Y chromosome codes for the ______, which differentiates the primitive gonads into testes.

A

testes-determining factor

62
Q

Testosterone is ____ converted into dihydrotestosterone, which transforms the genital tubercle, urogenital folds, and labioscrotal swelling into the external male reproductive organs.

A

peripherally

63
Q

Testicular torsion causes decreased _____ leading to hemorrhagic infarction

A

Venous drainage

64
Q

↑ risk of cryptoorchidism

A

Prematurity

65
Q

In BILATERAL cryptoorchidism testosterone levels

A

decrease

66
Q

In UNILATERAL cryptoorchidism testosterone levels

A

remain normal

67
Q

In cryptoorchidism _______ is impaired

A

spermatogenesis

68
Q

In cryptoorchidism
___ Inhibin B
___ FSH/LH

A

↓

↑

69
Q

↑ of GERM cell tumors associated with

A

cryptoorchidism, Klinefelter syndrome

70
Q

Scrotal enlargement
↑ with Valsalva (squatting)
↓ when Laying down
does NOT transilluminate

A

Varicocele

71
Q

Dilated veins in Pampiform plexus cause

A

Varicocele

*more common on the LEFT side due to venous drainage to left renal vein

72
Q

Hematocele is a bloody scrotal fluid collection that does NOT

A

transilluminate

infection, trauma

73
Q

Scrotal Cyst due to dilated EPIDIDYMAL duct or rete testis

A

Spermatocele

fluctuant nodule

74
Q

Do NOT biopsy a suspected testicular germ cell tumor due to risk of

A

seeding scrotum

75
Q

Leydig and Sertoli cell tumors are mostly

A

Benign

Rare (5%)

76
Q

Sertoli cell tumors ____ Estrogen

A

Increase

77
Q

Leydig cell tumors ____ Estrogen & ___ Testosterone

A

Increase both

78
Q

Painless testicular mass
MOST COMMON
Excellent Prognosis
↑ Placental ALP (PALP)

A

Seminoma (germ cell)

*phenotypic features of spermatogonia

79
Q

Painful testicular mass
Bloody, Necrotic mass
Gladular/Papillary
↑hCG

A

Embryonal Carcinoma (germ cell)

  • if also ↑AFP/ LDH = mixed
80
Q

Yellow Mucinous
Look like Glomeruli (Schiller-Duval bodies)
↑AFP/LDH
Aggresive AF

A

Endodermal Yolk Sac tumor

germ cell

81
Q

Hyperthyroidism symptoms (high yield)
+/- Gynecomastia
Lung/ Brain metastasis
↑↑ hCG

A

Choriocarcinoma

82
Q

Testicular mass with no elevations in:
AFP
hCG
PALP

A

Teratoma

83
Q

Localized pain over posterior testis

+ Prehn sign (pain relief with scrotal elevation)

A

Epididymitis

  • E.coli/Pseudomonas in Older men
  • Chlamydia/ Gonorrhea in young men
  • possibly caused by autoimmune (granulomas)
84
Q

Inflammation of testis

A

Orchitis

  • E.coli/Pseudomonas in Older men
  • Chlamydia/ Gonorrhea in young men
  • possibly caused by autoimmune (granulomas)
85
Q

Dysuria, urgency, lower back pain

Warm, tender, swollen prostate

A

Prostatitis

  • E.coli in Older men
  • Chlamydia/ Gonorrhea in young men
86
Q

Prostatic adenocarcinoma arises most often from ___ lobe

A

posterior

peripheral zone

87
Q

Prostatic adenocarcinoma
__ total PSA
__ free PSA

A

↑

↓

88
Q

Prostatic adenocarcinoma metastasize where?

A

Lower Back vertebrae

Osetoblastic lesion

89
Q

Prostatic adenocarcinoma metastasis to the spine occurs via _____ venous plexus

A

Batson (vertebral) venous plexus

90
Q

May lead to distention and hypertrophy of bladder, hydronephrosis, & UTIs

A

BPH

91
Q

Inhibit conversion of testosterone to dihydrotestosterone
Reduce prostate gland size
Adverse effects: decreased libido, erectile dysfunction

A

5-alpha-reductase inhibitors (finasteride, dutasteride)

92
Q

Usual first-line therapy for BPH

Adverse effects: orthostatic hypotension, dizziness

A

Alpha-adrenergic antagonists
(terazosin, tamsulosin)

Relax smooth muscle in bladder neck, prostate capsule & prostatic urethra

93
Q 
Decreased lean body weight
Increased total weight & subcutaneous fat
Decreased body hair
Breast enlargement
Decreased bone density
Decreased prostate volume
Decreased libido
Erectile dysfunction
Decreased sperm count
A

Effects of Androgen deprivation in men or Orchiectomy

94
Q

a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors.

A

Flutamide

95
Q

Flutamide is used in combination with ___ for the treatment of prostate cancer.

A

long-acting gonadotropin-releasing hormone agonists (Leuprolide)

96
Q

Secondary hypogonadism occurs in _____ due to deposition of iron in the pituitary gland.

A

Hemochromatosis

*also at risk for deficiencies in other pituitary hormones (eg, central hypothyroidism).

97
Q

The penile flaccid state is maintained by tonic alpha-adrenergic (norepinephrine) sympathetic activity, causing high vascular and trabecular ____, preventing corporal engorgement with blood.

A

smooth muscle tone

98
Q

Priapism can be treated with penile injections of ____, which induce smooth muscle contraction, leading to detumescence.

A

alpha-adrenergic agonist (phenylephrine)

99
Q

The penile flaccid state is maintained by tonic ___ activity

A

alpha-adrenergic (norepinephrine) sympathetic

100
Q

Priapism can be treated with penile injections of alpha-adrenergic agonist (phenylephrine), which induce ____, leading to detumescence.

A

smooth muscle contraction

101
Q

inhibitors block the generation of androgens in the adrenal glands, testes, and tumor cells.

This reduces systemic androgen levels, which limit prostate cancer growth.

A

17-alpha-hydroxylase

abiraterone

STEP 1 (88 decks)

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