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Repro. Med 2 > Male Pathology > Flashcards

Male Pathology Flashcards

1
Q

Review: layers of the spermatic cord

A

Some: Skin, SubQ
Damn: Dartos muscle (very fine, thin muscle layer)
Englishman: External spermatic fascia
Called: Cremaster muscle
It the: Internal spermatic fascia
Testis: Testes (V,A,N, lymph tissue, vas deferens) OR Testis Vaginalis

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2
Q

_____ is the twisting of the spermatic cord, causing compression of its blood supply

A

Testicular torision

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3
Q

What is the most common cause of testicular torsion?

A

Bellclapper’s deformity

No one is clapping for this deformity

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4
Q

How can an in-utero torsion manifest in a child once they are born?

A

They only have 1 testis

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5
Q

What are common sx of torsion?

A

Significant and acute pain

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6
Q

PE signs of testicular torsion…

A

Cremasteric reflex = typically absent

Testis = swollen, tender, high in scrotum, transverse lie

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7
Q

What are dx terms for testicular inflammation and what is it usually caused by?

A

(Orchitis) (Orchitis-Epididymitis)

INFECTION, often in combo w/ epididymal inflammation

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8
Q

What are the 2 possible paths for infxn that causes orchitis?

A

From the bloodstream

From the vas deferens to the epididymis to the testis (Retrograde)

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9
Q

What are the 3 types of pathogens that can cause orchitis? (provide examples)

A

Bacterial and non-sexually transmitted: Staph, Strep, E. Coli

Sexually transmitted: Gonorrhea, Chlamydia, Syphilis

Viral: Usually mumps, also coxsackie or parvovirus

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10
Q

What are s/s of orchitis? (Local and Systemic)

A

Rapid onset of pain, heaviness, pain w/ urination and pain w/ bowel movement

Blood in urethral discharge
(Discharge is a disturbing word)

Testes/Scrotum appear red, swollen
(You can paint them like a jacko lantern)

Systemic sx: Fever, N/V, Malaise

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11
Q

Tx for orchitis?

A

Abx

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12
Q

What kind of counseling may a pt w/ orchitis need?

A 
STD counseling 
(Please don’t have babies wild thang)

Fertilization counseling (both testes are affected, fertility can be affected)

  • Damage to Leydig cells– testosterone
  • Damage to seminiferous tubules
  • Especially concerning with mumps orchitis
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13
Q

What are the 2 cells testicular tumors can arise from?

What kind of markers do each provide?

A

Germ cells (seminoma) –> make tumor markers

Non-germ cells (sertoli, leydig) –> may release testosterone

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14
Q

T/F Testicular CA is a dz of old people

A

F, it is a dz of young people

50% dx 20-34 y/o

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15
Q

What is the most common testicular tumor?

A

Seminoma

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16
Q

What is the cure rate and 5 year survival for testicular CA

A

90% survival at 5 yrs

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17
Q

Where is testicular CA likely to spread?

A

Along the abdominal aorta and IVC

*think lymph nodes *

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18
Q

__% of people w/ testicular CA have an extra copy of a portion of chromosome 12

A

80%

**Most CA cells are triploid or tetraploid, so the genetic defect seems to affect proofreading of chromosomes at the pre-mitotic checkpoint

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19
Q

If the CA arises from germ cells, what can testicular CA secrete?

A

Embryonic proteins, like β-HCG, AFP, or LDH

**Markers can be followed to monitor tx

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20
Q

A varicocele is the dilation of veins in the ____

A

Pampiniform plexus

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21
Q

Which testicle is more likely to have varices?

A

Left

sharp turn the vein has to take at the renal vein to the IVC on the L side

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22
Q

What is the most common cause of a varicocele?

A

Poor blood return from pampiniform plexus → testicular vein → central circulation

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23
Q

How do you tx a varicocele?

A

Embolize the veins

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24
Q

___ is a fluid collection w/in the scrotum that can occur in adults or infants.
All are caused by fluid accumulation w/in the _____.

A

Hydrocele

Tunica vaginalis

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25
Q

What are they two type of Hydroceles?

A

Communicating

Non-communicating

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26
Q

Describe how a communicating hydrocele occurs?

A

Tunica vaginalis remains open to the peritoneal cavity (normally it closes by 3 weeks postpartum) –> called a funicular process

27
Q

A patent funicular process may increase the risk of developing a(n) ____ in men

A

Indirect hernia

28
Q

What intra-abdominal dz processes could cause a person with a patent funicular process to have scrotal swelling?

A

Intraperitoneal bleeding
Ascites
Abd CA

29
Q

How does a non-communicating occur?

A

Processus vaginalis has closed and is now a tunica vaginalis. Fluid accumulates in the tunica vaginalis before birth, and does not get reabsorbed

30
Q

What can cause a non-communicating hydrocele?

A

A process inside the scrotum (infxn, CA, or fluid production by the tunica itself) causes fluid to build up there.

31
Q

___ is an ↑ number, not size, of cells of the prostate.

Which cells are increasing in numbers?

A

BPH

Gland (secretory) and muscle cells

32
Q

The key to urinary sx that correlate with the increasing size of the prostate is due to the ____, which seems to contain the prostate laterally, transmitting pressure of the increased growth medially.

A

Prostate capsule

33
Q

T/F Prostate enlargement can compress the plexus branches to the bladder, or cause retrograde dysfunction of those nerves

A

T

34
Q

What is the main cause of prostate growth?

A

DHT (metabolite of testosterone)

**Testosterone and DHT are responsible for the growth of prostate cells, but T decreases as men age so DTH is left

***DHT is produced even when testosterone levels go ↓

35
Q

Prostate CA is most common in the what zone of the prostate?

A

The peripheral zone

36
Q

What are risk factors for prostate CA?

What prostate related dz is NOT a risk factor?

A

Multiple sex partners
HSV/HPV, especially HPV 16 and 18

BPH is NOT a risk factor

37
Q

Many prostate cancers ↑ production of transcription factors that eliminate ___ and ↑ odds of cellular _____.

A

Apoptosis

Immortality

38
Q

Prostate CA is also assoc. w/ ____ that ↑ cell turnover (↑ mitotic events)

A

Androgens

39
Q

What are histological signs of prostate CA?

A

↑ metastases
↓ organization
obliterated secretory spaces

40
Q

____ is an inability to completely retract foreskin that covers the head of the penis

A

Phimosis

Like a dog with his head stuck in a sweater sleeve

41
Q

What are the 3 types of phimosis?

A

Physiologic Phimosis
Pathologic Phimosis
Paraphimosis

42
Q

In physiologic phimosis….

At birth, glans is exposable in < __% of boys

At 3 y/o, __% of boys still do not have a retractable foreskin

Typically resolved by age __

A

4%
10%
7 y/o

43
Q

___ is a secondary phimotic condition where the glans either cannot be exposed at all or can only be exposed partially because adhesions and scar tissue prevent full exposure

What are common causes of this?

A

Pathologic Phimosis

Recurrent balanitis (infxn below the foreskin) 
improper hygiene
44
Q

____ is foreskin is partially retracted but “stuck” at that position and cannot return to covering the glans

A

Paraphimosis

45
Q

What makes Paraphimosis an emergency

A

Skin is so tight that venous congestion occurs distal to the ring of foreskin

Congestion causes compression of underlying penile tissue and hinders blood flow – uh oh!

46
Q

What is the tx for Phimosis?

A

Good hygiene
Gental manipulation

Circumcision for emergencies

47
Q

What are the types of penile tumors?

A

Papillomas (HPV: 16, 18 cause unregulated epithelial growth)

Squamous carcinoma

48
Q

What are the stages of penile CA?

A 
in situ
invasive
ulcerative 
Regional lymph nodes
Metastasizes widely
49
Q

____ is an acquired inflammatory condition of the penis

A

Peyronie’s Dz

Elbow macaroni dong

50
Q

The principal manifestation of Peyronie’s dz is formation of a ___(a segment of flat scar tissue) w/in the connective tissue (tunica albugenia) of the penis

This can be felt through the penile skin and may lead to serious problems such as curved and/or painful erections.

A

plaque

51
Q

Plaques reduce the elasticity of the penile connective tissue, which causes it to……..

(Brush your penis with crest 2x a day to reduce plaque)

A

bend towards the plaque region during erection

**Some men have more than one plaque, which may cause complex curvatures

(Lightning bolt penis)

52
Q

Where are Peyronie’s plaques most commonly located?

A

Top of the penis, but they may also occur on the bottom (ventral) or side (lateral) of penis

53
Q

Occasionally an extensive circumferential plaque develops→ these typically do not cause curvature but may cause a ___ deformity of the penile shaft

A

“wasting” or “bottleneck”

“Sir your penis looks like a bottle neck dolphin”

54
Q

In severe cases, the plaque may accumulate __ and become very hard, almost like a bone.
In addition to penile curvature, many patients also report ___ or ____ of their penis.

A

Ca++

shrinkage or shortening (nooooo!!!!!!)

55
Q

What is the cause of Peyronie’s plaques?

A

Unknown

Perhaps due to secondary to mild penile trauma

  • Vigorous sexual activity?
  • Injuries from sports or accidents?
56
Q

Risk factors for Peyronie’s plaques…

A 
DM
Tobacco use
Hx of pelvic trauma 
Poor wound healing
More traumatized tissue than normal
57
Q

How do you dx Peyronie’s plaques?

A

Sx = Pain w/ erection, abnormal appearing erection

PE: Hard plaques palpated

US or XR examination of the penis is used to characterize the plaque and check for the presence of calcification

58
Q

____ is painful erection lasting >4 hours
Uncommon, usually (not due to/due to) sexual stimulation
What are the two pathophysiological causes of this condition?

A

Priapism
Not due to
Has to do w/ increased flow into penis vs. decreased flow out

59
Q

What are the 2 types of priapism?

A

High-flow (non-ischemic): Result of overabundance of arterial flow

Low Flow (ischemic): Result of decreased venous drainage, usually due to vaso-occlusion

60
Q

Metabolic demands w/in the penile tissue are low, where the average temperature is _____ (lower/higher) than the body.

A

4 degrees lower

Probably why erection can be tolerated for up to 4 hours

61
Q

Metabolic needs cannot be met in (low/high) flow priapism bc of Elevated pCO2, low pO2, Acidic pH

A

low-flow priapism

62
Q

What populations are at risk for priapism?

A

Viscous or occlusive blood disorders: Sickle cell, Leukemia, Polycythemia

Those on certain Rx meds
Viagra, cialis, Zyprexa, wellbutrin, coumadin

Penile/ genital injury

Spinal cord injury, blood clots, spider venoms

63
Q

What is the tx for priapism?

A

Inhibitors of parasympathetic muscle relaxation

Intracavernous injections of vasoconstrictors

Shunting of venous blood

Repro. Med 2 (12 decks)

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