Male patho 0514FA

Question 1

prostatitis

Answer 1

dysuria.
frequency.
urgency.
low back pain.
WBC in secretions.

Question 2

cause of acute prostatitis

Answer 2

bacterial (E.coli)

Question 3

cause of chronic prostatitis

Answer 3

bacterial.

Abacterial (more common).

Question 4

BPH commonly affects?

Answer 4

men > 50 yo

Question 5

cause of BPH

Answer 5

(maybe) age-related increase in estradiol.

possible sensitization of prostate to growth-promoting effects of DHT.

Question 6

what parts of prostate are affected by BPH?

Answer 6

nodular enlargement of periurethral lobes (LATERAL and MIDDLE), which compress urethra into vertical slit

Question 7

presentation of BPH

Answer 7

increased freq urination.
nocturia.
difficulty starting/stopping.
dysuria.

Question 8

BPH may lead to…?

Answer 8

distention and hypertrophy of bladder.
hydronephrosis.
UTI.

Question 9

BPH and malignancy

Answer 9

NOT considered premalignant.

does have increase free PSA.

Question 10

BPH TX

Answer 10

alpha 1 antagonists (terazosin, tamsulosin) -cause relaxation of smooth muscle.

finasteride - 5 alpha reductase inhibitor.

Question 11

prostatic adenocarcinoma affects what age group?

Answer 11

men > 50 yo

Question 12

where does prostatic adenocarcinoma arise?

Answer 12

posterior lobe (peripheral zone)

Question 13

how is prostatic adenocarcinoma diagnosed?

Answer 13

DRE (hard nodule palpated)

and prostate biopsy

Question 14

tumor markers in prostatic adenocarcinoma

Answer 14

prostatic acid phosphatase (PAP).

PSA (increase total PSA, decrease fraction of free PSA).

Question 15

what bone changes may develop in late stages of prostatic adenocarcinoma?

Answer 15

OSTEOBLASTIC mets in bones - indicated by lower back pain, increase serum alk phos and PSA

Question 16

cryptorchidism

Answer 16

undescended testis (one or both).
results in impaired spermatogenesis (sperm develops best at < 37C).
normal testosterone levels (Leydig not affected by temp)

Question 17

cryptorchidism assoc with increased risk of?

Answer 17

germ cell tumors

Question 18

risk of cryptorchidism increased by?

Answer 18

prematurity

Question 19

bilateral cryptorchidism

Answer 19

decrease inhibin
increase FSH
increase LH
decrease testosterone

Question 20

unilateral cryptorchidism

Answer 20

decrease inhibin
increase FSH
increase LH
normal testosterone*

Question 21

varicocele

Answer 21

dilated veins in PAMPINIFORM PLEXUS due to increased venous pressure (impaired drainage).

most common cause of SCROTAL ENLARGEMENT in adult males.

Question 22

varicocele occurs most on which side?

Answer 22

LEFT due to increased resistance to flow from left spermatic vein draining into left renal vein (vs. right spermatic vein draining directly into IVC)

Question 23

how does varicocele cause infertility?

Answer 23

due to increased temp

Question 24

how does varicocele appear?

Answer 24

bag of worms

Question 25

DX of varicocele

Answer 25

ultrasound

Question 26

TX of varicocele

Answer 26

varicocelectomy. | embolization by interventional radiologist.

Question 27

testicular germ cell tumor

Answer 27

95% of all testicular tumors. most often MALIGNANT. may be mixed germ cell.

Question 28

ddx for testicular mass that does NOT transilluminate

Answer 28

cancer

Question 29

seminoma

Answer 29

testicular germ cell tumor. most common. age 15-35. painless, homogenous enlargement.

Question 30

seminoma appearance

Answer 30

large cells in lobules with watery cytoplasm and FRIED EGG appearance

Question 31

seminoma prognosis

Answer 31

radiosensitive. late mets. excellent prog.

Question 32

embryonal carcinoma

Answer 32

testicular germ cell tumor painful. worse than seminoma. often MIXED with other types.

Question 33

morphology of embryonal carcinoma

Answer 33

glandular or papillary

Question 34

tumor markers in embryonal carcinoma

Answer 34

increase hCG, normal AFP when pure. | increased AFP when mixed.

Question 35

yolk sac (endodermal sinus) tumor

Answer 35

``` testicular germ cell tumor. yellow, mucinous. analogous to ovarian yolk sac tumor. glomerus-like SCHILLER DUVAL BODIES. increased AFP. ```

Question 36

choriocarcinoma

Answer 36

testicular germ cell tumor. disordered syncytiotrophoblastic and cytotrophoblastic elements. hematogenous mets to lungs.

Question 37

tumor markers in choriocarcinoma

Answer 37

increase hCG - may produce gynecomastia since hCG is LH analog

Question 38

teratoma

Answer 38

testicular germ cell tumor. unlike in females, mature teratoma in males is MALIGNANT. 50% have increased hCG and/or AFP.

Question 39

testicular non-germ cell tumor

Answer 39

50% of all testicular tumors. | most are benign.

Question 40

Leydig cell tumor

Answer 40

testicular non-germ cell tumor. androgen-producing. golden brown color. REINKE CRYSTALS.

Question 41

effects of androgen prod in Leydig cell tumor

Answer 41

precocious puberty in BOYS. | gynecomastia in MEN.

Question 42

Sertoli cell tumor

Answer 42

testicular non-germ cell tumor. | androblastoma from sex cord stroma.

Question 43

testicular lymphoma

Answer 43

testicular non-germ cell tumor. most common testicular cancer in older men. NOT PRIMARY - arise from lymphoma mets to testes.

Question 44

hydrocele

Answer 44

tunica vaginalis lesion. testicular mass that can be transilluminated. increased fluid second to INCOMPLETE FUSION of processus vaginalis.

Question 45

spermatocele

Answer 45

tunica vaginalis lesion. testicular mass that can be transilluminated. dilated epididymal duct.

Question 46

penile SCC

Answer 46

more common in Asia, Africa, S.Am. | assoc with HPV and lack of circumcision.

Question 47

Peyronie's disease

Answer 47

bent penis due to acquired fibrous tissue formation

Question 48

priapism

Answer 48

painful sustained erection NOT assoc with sexual stim or desire

Question 49

priapism assoc with?

Answer 49

trauma. sickle cell disease. medications.

Question 50

meds assoc with priapism

Answer 50

``` anticoags. PDE5 inhibitors. antidepressants. alpha blockers. cocaine. ```