men's reproductive

Question 1

risk factors of testicular cancer

Answer 1

Family history
Caucasian
Cryptorchidism
HIV infection

Question 2

Germ Cell Tumors: Seminomas

Answer 2

Arise from immature germ cells
Slow growing, nonaggressive
Easily cured with radiation

Question 3

Germ Cell Tumors: Nonseminomas

Answer 3

Arise from mature germ cells
More aggressive
Usually treated with surgery

Question 4

Early CM of testicular cancer

Answer 4

Enlargement of testicle
Painless mass noted
If discomfort present: Ache in groin, Sensation of heaviness

Question 5

Late CM of testicular cancer

Answer 5

Possible frank pain
Manifestations based on metastatic spread: Cough, Hemoptysis, Swelling of lower extremities, Back pain, Dizziness

Question 6

BPH: Definition & Risk Factors

Answer 6

Nonmalignant enlargement of prostate: ↑ epithelial cells, ↑ smooth muscle cells, Stromal cells.

RF: Age, Family history, Race/Ethnicity
LUTS: Lower urinary tract symptoms

Question 7

BPH Etiology

Answer 7

1. Hormone Imbalance: Testosterone and estrogen (estradiol)
2. DHT Accumulation

Question 8

What is DHT

Answer 8

Testosterone + 5 alpha-reductase = DHT

Question 9

Why is DHT important in development of BPH?

Answer 9

Acts on skin: acne
Acts on hair follicles: hair on chest BUT off scalp
Stimulates growth of prostate cells

Question 10

BPH: Clinical Manifestations

Answer 10

Frequency and urgency
Delay in initiation
Reduction in force
Increased urination time
Dribbling

Question 11

BPH: Complications

Answer 11

Obstruction
UTI
Renal problems

Question 12

treatment of BPH

Answer 12

Mild symptoms = watchful waiting
Moderate symptoms = drug therapy: 5-alpha reductase inhibitors, Alpha1-adrenergic antagonists
Severe symptoms = invasive options

Question 13

Finasteride

Answer 13

class: 5-alpha-reductase inhibitors
Indication: Mechanical obstruction of urethra
MOA: Blocks conversion of testosterone to DHT; Decreases epithelial tissue in prostate
SE: Impotence, Decreased libido (5-10%), Gynecomastia
Side note: Decreases prostate specific antigen (PSA) levels, Used for male-pattern baldness.
Caution in Handling

Question 14

Will finasteride work in someone with a smaller prostate?

Answer 14

not really, works best on very enlarged prostates

Question 15

When will the patient see results for finasteride?

Answer 15

6-12 months & have to take this for the rest of their lives.

Question 16

Dutasteride

Answer 16

class: 5-alpha-reductase inhibitors
Indication: Mechanical obstruction of urethra
MOA:Blocks conversion of testosterone to DHT; Decreases epithelial tissue in prostate
Adverse Effects: Similar to finasteride

Question 17

Tamsulosin

Answer 17

class: Alpha1-Adrenergic Antagonists
MOA: Relaxes smooth muscle cells, Selective for alpha receptors in the prostate
Indication: Dynamic obstruction of urethra
Adverse effects: Well tolerated
Abnormal ejaculation

Question 18

When will the patient see the results of tamsulosin?

Answer 18

works quickly and is taken for life.

Question 19

which race has the highest and lowest rate of prostate cancer?

Answer 19

African-American men = highest
Asians and Native American men = lowest

Question 20

what age do incidence increase rapidly for prostate cancer?

Answer 20

Incidence increases rapidly after 50.
> 80% of all cases in men > 65 yo.

Question 21

risk factors for prostate cancer

Answer 21

Age
Familial tendency
High fat diet

Question 22

CM for prostate cancer

Answer 22

Early: asymptomatic
Later: BPH type presentation, Metastasis: Bone, Lungs
Prognosis: Stage dependent, Early diagnosis

Question 23

what are the benefits of using PSA?

Answer 23

Small survival benefit with PSA screening in randomized trials.
Use of the PSA test was associated with a 50% drop in prostate cancer deaths in the U.S.

Question 24

what are the harms of using PSA?

Answer 24

Would take 48 diagnoses of prostate cancer to prevent 1 death.
Only 1 in 3 men with a positive PSA will have prostate cancer.
Many unnecessary biopsies.
Side effects of unnecessary treatment include erectile dysfunction, urinary incontinence, bowel problems.

Question 25

prognosis of prostate cancer

Answer 25

Low, intermediate, and high-grade CA.
Severity depends on a couple things: Gleason score (higher = worse), Tumor volume: PSA Level (higher and rapid rise = worse), Number of “cores” positive (more = worse)

Question 26

definition of erectile dysfunction

Answer 26

Inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse

Question 27

another word of erectile dysfunction

Answer 27

impotence

Question 28

primary ED (rare)

Answer 28

Life-long inability to have a normal erection d/t Severe psychiatric problems & Early vascular trauma

Question 29

secondary ED (most common)

Answer 29

ED in someone with a history of normal erections

Question 30

organic causes of Secondary ED

Answer 30

Peripheral vascular disease: Arterial insufficiency, Excessive venous drainage, Sedentary lifestyle (risk factor)
Medications: Antidepressants, Antihypertensives
Endocrine problems
Trauma, Surgery (Radical prostatectomy)

Question 31

psychogenic causes of Secondary ED

Answer 31

Depression
Low desire
Performance anxiety
Strained relationship

Question 32

Physiology of a Normal Erection

Answer 32

Sexual arousal
increased PNS and nitric oxide release
Activation of cGMP
Relaxation of arteries and smooth muscles
Increased inflow and reduced outflow
Engorgement and erection

Question 33

PNS =

Answer 33

parasympathetic nervous system

Question 34

cGMP =

Answer 34

cyclic guanosine monophosphate

Question 35

PDE-5 =

Answer 35

phosphodiesterase type 5

Question 36

sildenafil

Answer 36

class: PDE-5 inhibitor
MOA: Inhibits PDE5, Increases and preserves cGMP levels, Only enhances the normal response to sexual stimuli
Indications: Relief of ED, Pulmonary arterial hypertension, BPH
Timing of drug: up to 4hrs before sexual activity (onset 30-60 minutes)
SE: HA, flushing, dyspepsia
Caution: Preexisting CV disease, if on nitrate Rx, Hypotension
If you have chest pain or other signs of a heart attack during sex, stop and call 911
Sudden loss of vision in one or both eyes, sudden loss of hearing.
no more than once per day

Question 37

priapism

Answer 37

erection is painful or lasts more than 4hrs- medical emergency