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AIM-Repro > Male Sex Function and Dysfunction, Prostate/Penis/Testes > Flashcards

Male Sex Function and Dysfunction, Prostate/Penis/Testes Flashcards

1
Q

neurogenic ED causes

A

central (parkinson’s, alzheimers, CVA, tumor, trauma)

spinal cord (trauma, disc, spina bifida, syringomyelia, tumor, MS)

peripheral (pelvic trauma - post surgical, EtOH, vitamin deficiency, DM)

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2
Q

Drugs leading to ED

A 
b-blockers
spironolactone
ketoconazole
cimetidine
antipsychotic meds
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3
Q

ED tx

A

PDE5 inhibitors
intraurethral PGE1
vacuum
intracavernosal injection (CCBs, alpha-blockers, vasodilators)

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4
Q

Injectables for ED tx

A

3Ps

papavarine
phenoxybenzamine/phentolamine
prostaglandin E1

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5
Q

papavarine

A

ED tx

  • inhibits phosphodiesterase
  • blocks Ca++ influx
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6
Q

phenooxybenzamine/phentolamine

A

ED tx

  • alpha-blockade
  • vasodilataion
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7
Q

PGE1

A

ED tx

vasodilation

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8
Q

Most ED is of which etiology

A

vasculogenic

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9
Q

ED tx begins with

A

oral agents (PDE5 inhibitors)

  • inc intracellular cGMP
  • inc intracavernosal smc relaxation
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10
Q

tx of low flow priapism

A

URGENT TX!!!!!!!

  • corporal aspiration
  • intracavernosal phenylephrine (sympathetic –> constriction)
  • surgery
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11
Q

BPH histo

A

inc epithelial and stromal cells in the periurethral area

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12
Q

BPH etiology

A

androgens/estrogens –> impaired apoptosis –> inc cellular accumulation

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13
Q

Type 2 5-alpha reductase primary location

A

stromal cells

play central role in androgen-dependent growth

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14
Q

90% of prostatic androgen is

A

DHT

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15
Q

bladder response to BPH obstruction

A
  1. detrusor instability or dec compliance –> freq/urgency

2. dec contractility –> dec flow rate, hesitancy, inc PVR –> detrusor failuresa

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16
Q

BPH complications

A

bladder decomposition/
urinary incontinence
upper tract deterioration/renal insufficiency
hematuria

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17
Q

clear indication for surgery for BPH

A

acute urinary retention

–> Transurethral resection of the prostate (TURP)

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18
Q

primary determinant of tx response or disease progression of BPH

A

Intl prostate sx score (IPSS)

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19
Q

medical therapy for BLH

A

alpha1-antagonists
5alpha-reductase inhibitors
aromatase inhibitors
plant extracts

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20
Q

BPH, bladder outlet obstruction assoc w/ _____ in prostate smc

A

alpha-adrenergic receptors

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21
Q

5alpha-reductase inhibitors for BPH

A

suppress DHT synthesis, dec prostate size

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22
Q

prostate cancer natural history

A

mostly death from other causes

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23
Q

PSA screening effects on dx of prostate cancer

A

declining age at diagnosis, diagnosis at earlier stages, decreased tumor volumes, and increased treatment rates

unclear effect on mortality

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24
Q

PSA

A

secreted in high concentrations into seminal guid and is involved in liquefaction of the seminal coagulum but it is found in low concentration in serum.

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25
Q

Transrectal ultrasound guided prostate biopsy indication

A

if a patient has a digital rectal exam that is suspicious for cancer and/or an elevated and rising PSA level.

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26
Q

gold standard for long term control of clinically localized prostate cancer in young healthy men

A

radical prostatectomy

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27
Q

prostatitis sx

A 
dysuria
dribbling/hesitancy
pain in abd, groin, lower back
pain in perineum 
painful ejaculation
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28
Q

prostatitis tx

A

alpha blockers
pain relievers
prostatic massage
lifestyle changes/home remedies

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29
Q

most common solid tumor in young adults

A

testicular cancer

*gern cell

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30
Q

testicular cancer, spread via

A

lymphatics, predictable fashion

retroperitoneal lymph node is most comm

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31
Q

testicular cancer non-normal mets

A

lung, liver, brain, bone, kidney, adrenal, GI, spleen

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32
Q

testicular carcinoma

more comm pure seminoma or non-seminoma?

A

non-seminoma 60-70%

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33
Q

bell clapper deformity

A

testicular torsion

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34
Q

premalignant penile lesions

A

bowenoid papulosis

carcinoma in situ

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35
Q

bowenoid papulosis

A

20-30 y/o
circumcised
HPV detected
rare risk of SCC devel

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36
Q

penile carcinoma in situ

A

50-60 y/o
uncircumcised
HPV detected
10%

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37
Q

premalignant penile lesions tx

A

topical 5-fluorouracil
laser ablation
partial penectomy

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38
Q

balanitis xerotica obliterans

A

inflammatory via chronic infection

flat, white patches on the glans and prepuse

39
Q

95% of penile cancers

A

squamous cell carcinoma

40
Q

squamous cell carcinoma risk fx

A

uncircumsized
premalignant lesions
light therapy to tx psoriasis
tobacco

41
Q

gold standard for invasive penile CA

A

partial or total penectomy 2cm neg margin

42
Q

phimosis

A

foreskin is tight and narrow, painful to retract

nml in infancy, if persists beyond 5 y/o –> med/surg

low potency steroids

circumcision

43
Q

priapism

A

persistent infection >4 hr

ischemic or nonischemic

44
Q

priapism ischemic tx

A

corporal aspiration and irrigation

penile corporal shunts

45
Q

Peyronie’s disease

A

inelastic scar in tunica albuginea of the corpora

unknown cause

penile pain, shortening, deformity

46
Q

Peyronie’s tx

A

meds - vitE, colchicine
intracorporal injection - verapamil
surgery - shorten corpora contralateral to plaque –> straighten penis

47
Q

cryptorchidism

A

undescended testes

complications: sterility, malignancy

48
Q

descent of testes is dependent on

A

mullein inhibiting substance and androgen

49
Q

ovarian tumors

mostly epithelial or germ cell?

A

epithelial

50
Q

testis tumors

mostly epithelial or germ cell?

51
Q

ovarian component of testicular seminoma

A

dysgerminoma

52
Q

peak age for most testicular tumors

A

25-35 years

53
Q

testicular tumor common >65 y/o

A

spermatocytic seminoma

54
Q

testicular tumor common <4 y/o

55
Q

testicular tumor common 4-13 y/o

56
Q

intratubular germ cell neoplasia

A

50% devel cancer in 5 years

57
Q

Intratubular Germ Cell Neoplasia (ITGCN)

A

Enlarged neoplastic germ cells w/ clear cytoplasm, centrally located BIG nuclei and nucleoli
Thicknened basement membrane
Absence of spermatogenesis
Almost no Sertoli cells

58
Q

extragonadal seminoma is a

59
Q

seminoma

A 
B-hCG
synctotrophoblasts
sheets of cells with clear cytoplasm
centrally located nucleus 
"FRIED EGG"
lymphocytes
60
Q

fried egg

61
Q

embryonal carcinoma histo

A 
poor diffrentiation
some gland formation 
mitosis
hyper chromic nuclei
hemorrhage, necrosis
--> MALIGNANT FEATURES

CD30+

62
Q

CD30+

A

embryonal carcinoma

63
Q

testicular germ cell tumor with BOTH syncytiotrophoplast AND cytotrophoblast

A

choriocarcinoma

64
Q

yolk sac tumor histo

A

hyaline globules
eos cytopasm
Schiller-Duvall body

65
Q

Schiller-Duvall body

A

capillary surrounded by cancer cells

seen in yolk sac tumors

66
Q

Mixed Germ Cell Tumor

A
  • comprises at least 2 types of germ cell tumors with or without ITGCN
  • 32-60% of all testicular tumors
  • in testis, extra-testicular sites in males
  • caucasians
  • postpubertal men, mean 30 y/o
  • present w/ testicular mass
67
Q

alpha feto protein

A

yolk sac tumor

68
Q

golden brown mass

A

Leydig cell tumor

69
Q

leydig tumors may produce

A

androgensestrogens

corticosteroids

70
Q

sertoli tumors may produce

A

no hormones

rarely produce androgen or estrogen

71
Q

back to back irregular glands with nuclei containing prominent nucleoli

A

adenocarcinoma/embryonal CA

72
Q

large monomorphic lymphoid cells with scant cytoplasm, large nuclei and prominent nucleoli

A

testicular NHL

73
Q

most common subtype of NHL involving testes

A

diffuse lg B-cell lymphoma

74
Q

diffuse suppurative inflammation with gram negative rods on gram stain

A

suppurative orchitis

75
Q

full thickness epithelial dysplasia with intact BM

A

seen on squamous/transitional epithelium

76
Q

islands of cartilage, squamous epithelial pearls and glands lined by tall columnar epithelium

77
Q

nests of large polyhedral cells with watery cytoplasm and large nuclei with prominent nucleoli, surr by lymphoid storm

78
Q

rounded cells w/ abundant granular eos cytoplasm containing crystalloid of Reinke

A

Leydig cell tumor

79
Q

synctiotrophoblast and cytotrophoblast arranged in sheets w/ extensive hemorrhage and necrosis

A

choriocarcinoma

80
Q

In which male age group are teratomas regarded as malignant?

A

all post-pubescent males

81
Q

spermatohytic seminoma

A

older men
very low malignanant potential
no ITGCN precursor

82
Q

PSA accepted threshold

83
Q

PSA is specific for prostate cancer

T/F

A

F

elevated also in BPH, prostatitis, etc

84
Q

BPH

A
  • stroma and gland involvement

- affects inner portion of prostate around urethral/transitional zone

85
Q

poorly differentiated glands packed back to back and lined by a single layer of epithelium

86
Q

most comm cancer in men

A

prostatic adenocarcinoma

87
Q

prostate adenocarcinoma location

A

peripheral zone of prostate posterior lobe

88
Q

TMPRSS2/ERG fusion

A

prostate adenocarcinoma

89
Q

prostatic adenocarcinoma histo

A

prominent nucleoli

single layer of cells, no basal layer

90
Q

grading of prostate adenocarcinoma

A

sum of tumor grade patterns
based on well vs poor differ cells
high grade 7-10
predicts prognosis

91
Q

prostate adenocarcinoma common spreads to

A

bones

**lumbar spine

92
Q

50% of patients with ___ will develop cancer in 5 yr

93
Q

which testicular tumor is highly radiosensitive?

94
Q

prostate carcinoma is the ____ leading COD in men

AIM-Repro (9 decks)

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