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(DIT) Rapid Fire + 4/5 Stars > Male Reproductive > Flashcards

Male Reproductive Flashcards

1
Q

Erection

A

PNS - cavernous nerves
release NO –> increased cGMP –> sm.m. relaxation

cGMP broke down by phosphodiesterase 5

  • use PDE5 inhibitors to block and maintain erection
  • Sildenafil, tadalafil

Pudendal N.
-contract muscles at base of penis to maintain erection

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2
Q

Emission and ejaculation

A

Emission: sperm into urethra mix w/ fluid from seminal vesicles and prostate gland –> semen

Ejaculation: semen expelled from penis

Mediated by sympathetic n.
Some pudental n. - base of penis muscles

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3
Q

“Point and Shoot”

A

PNS for erection

SNS for emission and ejaculation

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4
Q

Spermatogenesis

A 
Spermatogonium (one 2N) --> interphase -->
primary spermatocyte (one 2N) --> meiosis I -->
secondary spermatocyte (two 1N) --> meiosis II -->
Spermatid (four 1N) --> spermiogenesis --> mature spermatozoon

Failure of meiosis I –> accumulation of primary spermatocytes

Failure of meiosis II –> accumulation of secondary spermatocytes

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5
Q

Regulation of spermatogenesis

A

Hypothalamus –> GnRH –> anterior pituitary

AP:

  1. LH –> Leydig Cells = T
  2. FSH –> Sertoli cells
    a. inhibin
    b. ABP (androgen binding protein) –> sperm production
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6
Q

Aromatase

A

T –> estrogen

produced by sertoli cells, bone, brain, skin, adipose tissue

obese patients become T deficient d/t estrogen conversion in fat tissue

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7
Q

5 alpha reductase inhibitors

A

finasteride
dutasteride

tx BPH, male pattern baldness

blocks conversion of T to DHT

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8
Q

Flutamide

A

non steroidal competitive inhibitor at T receptor

used in prostate cancer

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9
Q

Seminoma

A

Germ cell tumor

Most common - 50%
15-35 yo
malignant
painless homogenous testicular enlargement

Histo: large cells, lobules, watery cytoplasm, “fried egg” appearance

Radiosensitive
Late mets
Good prognosis

homologous to dysgerminoma in females

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10
Q

Embryonal carcinoma

A

Germ cell tumor

malignant
worse prognosis
PAINFUL palpable mass in scrotum

Histo: glandular, papillary morphology
-can differentiate into other tumors

AFP normal (increased in mixed germ cell)
high hCG
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11
Q

Yolk sac (aka endodermal sinus tumor)

A

Germ cell tumor

most common under 3 yo
yellowish, mutinous
Schiller-Duval body - primitive glomeruli

high AFP

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12
Q

Choriocarcinoma

A

Germ cell tumor

malignant
HIGH hCG

disordered synctiotrophoblasts and cytotrophoblasts

hematogenous mets

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13
Q

Teratoma of testis

A

Germ cell tumor

mature - malignant
multiple tissue types
high hCG
high AFP in 50%

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14
Q

Leydig cell tumor

A

benign, non-germ cell tumor

Most common - adults

Reinke crystals - lipofusion pigment in odd shapes

androgen producing - may produce estrogens –> virilizing or feminizing sx

Endo sx: decreased libido, ED, infertility

Kids: precocious puberty in boys

Golden brown tumor

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15
Q

Sertoli cell tumor

A

90% benign, non-germ cell tumor

secrete estrogen –> gynecomastia

assoc w/ Peutz-Jegher’s and Carney syndromes

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16
Q

Testicular lymphoma

A

met to testes

most common tumor in older men

17
Q

Hydrocele

A

increased fluid d/t incomplete fusion of processes vaginalis

common in newborns

18
Q

Spermatocele

A

dilated epidermal duct

19
Q

Varicocele

A

bag of worms

dilated v. in pampiniform plexus

infertility

20
Q

Epididymitis

A

Painful testicle

inflammation of epididymis

dx: support of testes –> some relief

Tx: GC/Chlamydia - ceftriaxone IM then doxycycline x10 d

tx older 35 yo or hx of anal intercourse = Ecoli, enterobacteriaceae - fluoroquinolone x 10-14 d

21
Q

Testicular torsion

A

high riding testis oriented longitudinally
absent cremasteric reflex on side of torsion

twisting of spermatic cord –> ischemia

dx: support of testis = no relief, US
tx: surgical detorsion w/ b/l orchiopexy w/in 6 hours

22
Q

Cryptorchidism

A

increased risk in premature

failure of testis to descend into scrotum
usually u/l
descent complete in first year of life
increased risk of testicular concern - germ cell tumor, increased in contralateral testicle too

higher body temp = low spermatogenesis

tx: early orchiopexy - anchor to scrotum
or orchiectomy

R/O CAH - may have ovaries

23
Q

Mechanisms of ED

A

failure to initiate - psychogenic, endocrinologic or neurogenic

failure to fill - atherosclerosis - DM, drug related - 80% in older men

Failure to store adequate blood volume w/in lacunar network - DM

24
Q

Phosphodiesterase Inhibitors

A

block PDE5 - don’t break down cGMP –> decreased Ca2+ = sm.m. relaxation

Sildenafil
Vardenafil
Tadalafil - BPH

Uses: ED, raynaud dz, primary pulmonary HTN

Side effects:
HA, flushing, dyspepsia
Impaired blue/green color vision

Risk of life threatening hypotension w/ nitrates

25
Q

Bowen disease

A

Gray, solitary, crusty plaque on penile shaft, scrotum (or female genitalia)

occasionally progress to invasive squamous cell carcinoma - 5th decade

26
Q

Erythroplasia of Queyrat

A

Red, velvety plaque involving the glans

type of bowen disease

27
Q

Bowenoid papulosis

A

multiple papular lesions, do not become invasive

younger adults

28
Q

Squamous cell carcinoma of penis

A

Asia, Africa, S. America

95% of penile cancers

Ass oc w/ HPV, lack of circumcision

29
Q

Peyronie disease

A

Angulation of the penis leading to painful erections

Due to inflammation and fibrous tissue formation of the tunica albuginea

30
Q

Priapism

A

Persistent penile erection - painful

Can lead to ischemia and clotting of the blood retained in the penis

Assoc w/ sickle cell disease and spinal cord injuries

31
Q

Condyloma acuminatum

A

Benign genital warts

HPV 6, 11

tx: chemical/physical destruction
immunologic tx
surgical excision

32
Q

Balantitis

A

Inflammation of glans penis

Causes: candida 40%, local trauma, bacteria, viruses, STDs

More common in uncircumcised and DM

33
Q

Prostatitis

A

Inflammation of prostate

Sx: dysuria, frequency, urgency, low back pain

Under 35: G/C
Over 35: E coli, Klebsiella, Sebratia, Enterobacter, Proteus

Tx: Fluoroquinolone (levofloxacin), TMP/SMX x 4 weeks

34
Q

Benign prostatic hyperplasia (BPH)

A

Too much DHT

80% over 80 have it

Sx: incomplete voiding, urinary frequency, straining to void, intermittent or weak urine stream, urgency, nocturia at least 2-3 times/night

palpable prostate size (posterior lobe) does not correlate w/ obstruction or sx severity - nodular enlargement of periurethral - lateral and middle lobes

35
Q

Tx of BPH

A

nonselective a1-blockers: doxazosin, prazosin, terazosin

  • decrease prostate sm.m. tone –> IMMEDIATE improvement in urine flow
  • SE: dizziness, POSTURAL HYPOTENSION, fatigue, asthenia

Selective alpha 1A,D blocker - tamulosin
-fewer SE than nonselective, no antihypertensive effects

5alpha-reductase inhibitors: finasteride, dutasteride
-SLOWLY reduce DHT levels = 20% decrease in prostate volume over 3-6 mo

Surgical intervention - can lead to permanent ED

36
Q

Prostate Adenocarcinoma

A

95% from glands/ducts of prostate

Slow growing
over 50 yo

sx: urinary frequency, nocturia, weak stream (same as BPH)

Develops in posterior lobe - rectal exam

Screen w/ PSA - confirm with bx

May met to bone: LBP, increased alkaline phosphatase

Histo: obliteration of orderly glands, dense darker, little cytoplasm

Tx: flutamide (inhibit T at receptor level), resection

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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