Male Path Flashcards
Old man with signs of bladder outlet obstruction (urinary hesitancy, need to strain, weak flow, incomplete voiding) most likely due to
benign prostatic hyperplasia (BPH)
digital rectal examination shows a smooth, homogenously enlarged prostate
benign prostatic hyperplasia (BPH)
a sedating antidepressant used off-label most often as a hypnotic to treat insomnia associated with depression or antidepressant treatment.
Trazodone
Trazzz o bone
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).
Trazodone
*contraindicated in Sickle Cell Anemia
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 (______).
buserelin
bicalutamide
Prostate cancer is an _____-dependent tumor, patients with advanced disease are generally treated with surgical or medical orchiectomy.
androgen
Patient with acute, severe, progressive scrotal pain with a HIGH-riding scrotal mass is concerning for
testicular torsion
Scrotal edema and an absent cremasteric reflex (testicular elevation when stroking the ipsilateral inner thigh) is highly suggestive of
testicular torsion
Twisting of spermatic cord
Venous congestion, hemorrhagic infarction & necrosis of testis
testicular torsion
↑ Risk of Testicular Torsion with poor fixation of testis to ____
tunica vaginalis
scrotal mass that increases in size when standing as compared with supine positioning. This dilation of the pampiniform plexus may cause a dull ache
Varicocele
presents with acute scrotal pain that is relieved with manual elevation of the testicle and dysuria
Epididymitis
Neisseria gonorrhoeae
Hydrocele is a fluid collection within the ____ that transilluminates on examination and causes scrotal enlargement
tunica vaginalis
non-fusion of the urethral folds would most likely result in
Hypospadias
urethra opens on ventral shaft
For Heart Failure. It has significant antiandrogenic effects and can cause gynecomastia, decreased libido, and impotence.
Potassium sparing Diuretic
Laboratory testing shows elevated serum thyroxine and triiodothyronine levels. Scrotal ultrasonography demonstrates a hypoechoic mass within the right testicle. Hyperthyroid Symptoms
Germ Cell tumor
hCG marker
Abrupt onset, clear precipitating event or stressor Impaired erections with a partner Normal nocturnal/Morning erections Normal masturbation Impaired or premature orgasm
Sexual Performance Anxiety
Serum testosterone is normal or elevated. However, spermatogenesis (sperm count) is decreased.
anabolic steroids
excessive doses of _____ include acne, gynecomastia, azoospermia, decreased testicular size, and increased aggression
anabolic steroids
Sertoli cells produce ___ in response to FSH from the anterior pituitary.
inhibin
Inhibin suppresses ___ production in the pituitary.
FSH
____ cells facilitate spermatogenesis within the seminiferous tubules.
Sertoli
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.
processus vaginalis
Peyronie disease, excess collagen formation within the ____ can cause significant pain and curvature of the penis.
tunica albuginea
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.
Gleason
staging via spreading to LNs
Prostatectomy or injury to the prostatic plexus
(inferior hypogastric, pelvic, sacral splanchnic nerves)
can cause .
erectile dysfunction
Patients with congenital bilateral absence of the vas deferens (Cystic Fibrosis) have azoospermia and infertility with ___ levels of FSH, LH, and testosterone.
normal
____ is a 5-alpha reductase inhibitor and it inhibits the conversion of testosterone to dihydrotestosterone that acts on epithelium of prostate.
Finasteride
alpha-1 blockers act on _____ of prostate and bladder base.
smooth muscles
The ___ gonadal vein drains directly into the inferior vena cava.
right
The __ gonadal vein drains into the __ renal vein.
left
left
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.
urethral
pelvic
If urethral injury is suspected, placement of a _____ is contraindicated.
Foley catheter
The ____ urethra is further divided into the prostatic and membranous segments
posterior
the _____ urethra is divided into bulbous and penile segments.
anterior
Trauma to the pelvis severe enough to cause fracture often results in disruption of the posterior urethra at the ______ junction
bulbomembranous
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).
bulbous
Primary hypogonadism can be confirmed with __ serum testosterone associated with ___ LH.
Management of male hypogonadism includes testosterone therapy
low
elevated
For the treatment of erectile dysfunction
Phosphodiesterase 5 inhibitors (eg, sildenafil)
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.
osteoblastic
Secondary (hypogonadotropic) hypogonadism
___ testosterone
___ FSH, LH
Low
Low/normal
Androgen insensitivity syndrome (AIS) is caused by loss-of-function mutations of the androgen receptor (AR) gene on the __ chromosome
X
___ receptor dysfunction leads to decreased facial, axillary, and pubic hair; oligospermia; gynecomastia;
Androgen
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
3
This patient’s acute testicular pain, posterior testicle tenderness, and pyuria raises suspicion for acute ____.
epididymitis
Acute epididymitis
Epidemiology
Age <35: sexually transmitted (chlamydia, gonorrhea)
Age >35: _________
bladder outlet obstruction (coliform bacteria)
The finding of impaired sperm motility raises concern for _______.
primary ciliary dyskinesia (PCD)
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.
elevated
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
Testicular Cancer
95% percent of testicular cancers are
Germ cell tumors:
seminomatous or nonseminomatous (embryonal carcinoma, yolk sac, choriocarcinoma, teratoma, mixed)
During embryogenesis it is responsible for development of the internal male genitalia.
Testosterone (Leydig cells)
is responsible for regression of the paramesonephric (müllerian) ducts that normally give rise to the internal genitalia in the female fetus.
müllerian inhibiting factor (MIF).
can be used to treat both the BPH symptoms and hypertension.
alpha-1 blocker (doxazosin, prazosin, terazosin)
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.
bladder neck and prostate
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.
superficial inguinal
Lymph from the testes drains to the ____ lymph nodes.
para-aortic
Lymph from the glans penis drains into the _____ lymph nodes.
deep inguinal
___ cells suppress female internal reproductive organ development by producing anti-Müllerian hormone (AMH)
Sertoli
Sertoli cells produce ______, which concentrates testosterone in the seminiferous tubules to enable spermatogenesis.
androgen-binding protein
___ cells secrete testosterone, which stimulates the Wolffian (mesonephric) ducts to develop into internal male
Leydig
The SRY gene on the Y chromosome codes for the ______, which differentiates the primitive gonads into testes.
testes-determining factor
Testosterone is ____ converted into dihydrotestosterone, which transforms the genital tubercle, urogenital folds, and labioscrotal swelling into the external male reproductive organs.
peripherally
Testicular torsion causes decreased _____ leading to hemorrhagic infarction
Venous drainage
↑ risk of cryptoorchidism
Prematurity
In BILATERAL cryptoorchidism testosterone levels
decrease
In UNILATERAL cryptoorchidism testosterone levels
remain normal
In cryptoorchidism _______ is impaired
spermatogenesis
In cryptoorchidism
___ Inhibin B
___ FSH/LH
↓
↑
↑ of GERM cell tumors associated with
cryptoorchidism, Klinefelter syndrome
Scrotal enlargement
↑ with Valsalva (squatting)
↓ when Laying down
does NOT transilluminate
Varicocele
Dilated veins in Pampiform plexus cause
Varicocele
*more common on the LEFT side due to venous drainage to left renal vein
Hematocele is a bloody scrotal fluid collection that does NOT
transilluminate
infection, trauma
Scrotal Cyst due to dilated EPIDIDYMAL duct or rete testis
Spermatocele
fluctuant nodule
Do NOT biopsy a suspected testicular germ cell tumor due to risk of
seeding scrotum
Leydig and Sertoli cell tumors are mostly
Benign
Rare (5%)
Sertoli cell tumors ____ Estrogen
Increase
Leydig cell tumors ____ Estrogen & ___ Testosterone
Increase both
Painless testicular mass
MOST COMMON
Excellent Prognosis
↑ Placental ALP (PALP)
Seminoma (germ cell)
*phenotypic features of spermatogonia
Painful testicular mass
Bloody, Necrotic mass
Gladular/Papillary
↑hCG
Embryonal Carcinoma (germ cell)
- if also ↑AFP/ LDH = mixed
Yellow Mucinous
Look like Glomeruli (Schiller-Duval bodies)
↑AFP/LDH
Aggresive AF
Endodermal Yolk Sac tumor
germ cell
Hyperthyroidism symptoms (high yield)
+/- Gynecomastia
Lung/ Brain metastasis
↑↑ hCG
Choriocarcinoma
Testicular mass with no elevations in:
AFP
hCG
PALP
Teratoma
Localized pain over posterior testis
+ Prehn sign (pain relief with scrotal elevation)
Epididymitis
- E.coli/Pseudomonas in Older men
- Chlamydia/ Gonorrhea in young men
- possibly caused by autoimmune (granulomas)
Inflammation of testis
Orchitis
- E.coli/Pseudomonas in Older men
- Chlamydia/ Gonorrhea in young men
- possibly caused by autoimmune (granulomas)
Dysuria, urgency, lower back pain
Warm, tender, swollen prostate
Prostatitis
- E.coli in Older men
- Chlamydia/ Gonorrhea in young men
Prostatic adenocarcinoma arises most often from ___ lobe
posterior
peripheral zone
Prostatic adenocarcinoma
__ total PSA
__ free PSA
↑
↓
Prostatic adenocarcinoma metastasize where?
Lower Back vertebrae
Osetoblastic lesion
Prostatic adenocarcinoma metastasis to the spine occurs via _____ venous plexus
Batson (vertebral) venous plexus
May lead to distention and hypertrophy of bladder, hydronephrosis, & UTIs
BPH
Inhibit conversion of testosterone to dihydrotestosterone
Reduce prostate gland size
Adverse effects: decreased libido, erectile dysfunction
5-alpha-reductase inhibitors (finasteride, dutasteride)
Usual first-line therapy for BPH
Adverse effects: orthostatic hypotension, dizziness
Alpha-adrenergic antagonists
(terazosin, tamsulosin)
Relax smooth muscle in bladder neck, prostate capsule & prostatic urethra
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
Effects of Androgen deprivation in men or Orchiectomy
a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors.
Flutamide
Flutamide is used in combination with ___ for the treatment of prostate cancer.
long-acting gonadotropin-releasing hormone agonists (Leuprolide)
Secondary hypogonadism occurs in _____ due to deposition of iron in the pituitary gland.
Hemochromatosis
*also at risk for deficiencies in other pituitary hormones (eg, central hypothyroidism).
The penile flaccid state is maintained by tonic alpha-adrenergic (norepinephrine) sympathetic activity, causing high vascular and trabecular ____, preventing corporal engorgement with blood.
smooth muscle tone
Priapism can be treated with penile injections of ____, which induce smooth muscle contraction, leading to detumescence.
alpha-adrenergic agonist (phenylephrine)
The penile flaccid state is maintained by tonic ___ activity
alpha-adrenergic (norepinephrine) sympathetic
Priapism can be treated with penile injections of alpha-adrenergic agonist (phenylephrine), which induce ____, leading to detumescence.
smooth muscle contraction
inhibitors block the generation of androgens in the adrenal glands, testes, and tumor cells.
This reduces systemic androgen levels, which limit prostate cancer growth.
17-alpha-hydroxylase
abiraterone
