Repro Exam 5 Flashcards
Which of the following is NOT a history question to ask about a penile and scrotal lesions?
a. pruritis
b. painful or painless
c. recurrence
d. urinary sx
urinary sx
Which of the following is NOT part of the PE for penile and scrotal lesions?
a. color
b. configuration
b. size
c. transillumination
transillumination
What is NOT part of the work up for penile and scrotal lesion?
a. skin biopsy
b. UA
c. skin scraping
d. STI testing
UA
What is the DDX for penile and scrotal lesions?
inflammatory or papulosquamous
infectious
neoplastic
Which of the following is NOT a history questions to ask when pt presents penile discharge?
a. systemic sx
b. urinary sx
c. painful or painless
d. sexual hx and practices
painful or painless
What is the PE for penile discharge ?
a. palpate inguinal lymph node
b. cremaster reflex
c. discharge
d. a and c
a and c
What are the ddx for penile discharge?
Gonococcal urethritis
Non-gonococcal urethritis
Urethral irritation (soaps, detergents, lubricants)
Hematospermia
What is the work up of penile discharge?
a. complete UA with culture and sensitivity
b. STI testing
c. semen analysis and discharge analysis
d. all of the above
all
What is the PE for diagnosing scrotal masses and swelling?
a. palpate and ascultate
b. transilluminaion
c. cremaster reflex
d. hernia
e. all of the above
all
What is the ddx of scrotal masses and swelling?
Hydrocele – will transilluminate
Hematocele – may not transilluminate
Varicocele – feels like “bag of worms” on palpation
Edema – from systemic conditions
Indirect inguinal hernia – bowel sounds, positive hernia exam
Orchitis – very tender to palpation
Testicular cancer – firm to palpation
Testicular torsion – sudden pain
Torsion of appendix testis – blue dot sign (~20% of cases)
Epididymitis – painful, acute or chronic, usually STI in younger men
Spermatocele – painless
What is the work up for scrotal masses and swelling?
a. UA
b. STI testing
c. US
d. biopsy
e. all of the above
all
Which of the following is not a PE of prostatitis?
a. DRE
b. genital exam
c. abdominal exam
d. skin exam
skin
What are the ddx of prostatitis?
Acute bacterial prostatitis
Prostatic abscess
Cystitis
Epididymitis
Proctitis
Diverticulitis
Pelvic floor dysfunction
IBS, colon cancer
Interstitial cystitis, bladder cancer, STI
Chronic prostatitis
BPH
Prostate cancer
Chronic pelvic pain syndrome
What is the work up for acute prostatitis?
a. UA
b. STI
c. CBC
d. a and b
a and b
What is the work up for chronic prostatitis?
a. PSA
b. UA
c. US
d. all of the above
all
What are the PE of erectile dysfunction?
a. genitalia exam
b. abdominal exam
c. cardiovascular exam
d. a and c
a and c
What is not part of the erectile dysfunction work up?
a. hormone testing
b. lipid panel and ASCVD
c. DM testing
d. UA
UA
What is included in the PE for gynecomastia?
a. breast
b. abdominal
c. genital
d. a and c
a and c
What is NOT included in the work up of gynecomastia?
a. hormone testing
b. US
c. mammography
d. MRI
MRI
What is the ddx of gynecomastia?
Congenital hypogonadism
Medications
Anabolic steroids
Alcohol, cannabis
Cirrhosis (+estradiol, +SHBG)
Cushing’s disease (low T)
Renal disease (low T)
What is bioethics?
advancments in medicine due to new technology
What are some ethical issues within the reproductive block?
a. genetic testing for unborn babies
b. advancments in fertility technology
c. contraceptive technology
d. all of the above
all
What are the ethical issuse around fertility?
a. ferility drugs
b. surrogacy
c. gamete donors
d. all of the above
all
What is the definiton of perimenopause?
a. a period of time before a patient reaches 12 continous months without having a cycle
b. varying cycle length greater than 7 days different from normal
c. the day after 12 months and from then on
d. when a patient has no menstural cycle for 12 months
a period of time before a patient reaches 12 continous months without having a cycle
When do hot flashes normally occur?
a. early perimenopause
b. late perimenopause
c. menopause
d. post-menopause
late perimenopause
What are the ovarian follicle changes in perimenopause?
oocytes undergo atresia each month and eventually deplete the amount of ovarian follicles resulting in hypoestreogenemia and high FSH
What are the endocrine changes in menopause?
dec in antral follicle count dec inhibin inc FSH
dec estradiol
What is the average age of perimenopause?
a. 47
b. 50
c. 51
d. 40
47
What is the average menopause?
a. 47
b. 50
c. 51
d. 40
51
What is the MOA of physiologic menstural irregularity?
dec in functional follicles shortened follicular phase causing cycles to shorten in length to 25 days or less,
What is the hallmark sxs that indicates perimenopause transition has started?
Hot flashes
Insomnia
Weight gain and bloating
Mood changes
Irregular menses (perimenopause)
Mastodynia
Depression
Headache
Sexual function changes & vulvovaginal atrophy (VVA)
Joint pain
When is urogenital atrophy most significant?
a. early perimenopause
b. late perimenopause
c. menopause
d. post-menopause
post-menopause
STRAW staging system
What is the general approach to evaluation of a menopausal patient?
history
pelvic exam
FSH sometimes
What test maybe useful but not necessary for dx with the exception of special circumstances?
a. FSH
b. inhibin
c. AMH
d. estradiol
FSH
What factors can affect the onset of menopause?
smoking
genetics
ethnicity
partial hysterectomy
type 1 DM
DES exposure
Galactose consumption
fragile X carrier
exposure to certian chemotherapeutic agents or radiation
What are diseases linked to estrogen deficiency?
osteoprosis
cardiovascular disease
cognitive impairment
impaired vison/macular degeneration
asthma
polymetabolic syndrome
How do you test folx with underlying menstural cycle disorders to see if they are in menopause?
a. FSH
b. inhibin
c. AMH
d. estradiol
FSH
How do you test for menopause in those takinf oral contraceptives?
a. FSH
b. inhibin
c. AMH
d. estradiol
FSH
How do you test for menopause in posthysterectomy or endometrial ablation?
a. FSH
b. inhibin
c. AMH
d. estradiol
FSH
What FSH level indicates menopause?
a. 4
b. 14
c. >25
d. <25
> 25
What are the risk factors for developing hot flashes (VMS)?
obesity
cigarette smoking
reduced physical activity
hormone concentration
black pt
those with tachykinin receptor 3 (TACR3) gene
What is the physiology of hot flashes?
the thermoneutral zone is narrowed w/ less estrogen causing the hypothalamus to trigger the feeling of warmth or cold easier, thermoregulatory area are close to GnRH containing neruons so could be crossing over from high FSH
What dosen’t brings on hot flashes?
a. alcohol
b. spicy or hot food/drinks
c. difficult emotions
d. cold drinks/food
cold drinks/food
What should be included in the hot flash assessment when taking a hx with a pt?
frequency, duration, severity
List some DDX’s for hot flash presentation.
menopause
hot drinks
alcohol
cancer
infections
hyperthyroidism
Discuss treatment options for hot flashes; when is it safe to use MHT and when is it not safe to prescribe it for a pt?
stress managment, mindfulness, yoga, plant-based diet, dec alcohol, acupuncture, sleep hygeine, homeopathy, undas, botanicals,
List the non-hormonal pharmaceutical options for hot flashes.
SSRIs
SNRIs
Paroxetine
Citalopram
Gabapentin
Bazedaxifene
What treatment options are available for insomnia?
stress management
mindfulness
tai chi, Qi Gong
alcohol
acupuncture
pine bark extract 20 mg daily
unda 30, 9, 22, 210
melationin 0.5-3 mg
botanicals- valerian, passiflora, avena, skullcap, kava, leonorus. magnolia bark
For a menopausal pt presenting with vulvovaginal changes what exam must be performed?
pelvic
What treatment options are available for vulvovaginal changes?
moisturizers, lubricants,
lactobacillus and vitamin E suppositories
suppositories hyaluronic acid, vit A, vit d, Vit E nightly
topical ginseng, menthol, l-arginine
local estrogen options
ospemifen
black cohosh, dong quai, maca, tribulus, soy
holistic pelvic floor
What treatment options are available for depression and anxiety?
mind-body medicine (CBT, MBSR, yoga, Tai Chi, Qi Gong)
magnolia bark
b vitamins
Vitamin d
5HTP, GABA
hypericum, maca
homeopathy
undas
SSRI
MHT
Why does CVD increase in menopause, the underlying MOA?
dec estrogen effects endothelila functions and tone, inc risk of HTN, negative change in lipids and glucose, in levels of coagulation markers,
inc adipose, inc leptin and PAI-1, dec ghrelin and adiponectin, inc clotting, inflammation, and atherosclerotic plaquing
What are the treatment options available for CVD related to menopause?
lifestyle
diet
stress managment
excercise
smoking cessation
intimacy and quailty social support
What is the effect of hormones on the breast tissue?
estrogen and progestin: node + breast cancer and inc mortality, HER2 +
estrogen alone: no risk for breast cancer
What health maintenance and screening should be included for the menopausal patient?
BMI/waist cicrumferance
pap & HPV testing
CBE
pelvic exam
lipids
glucose
mamogram
colon cancer screening
DEXA
Vit D testing
Describe the difference on a physiological level between transdermal and oral estrogen.
transdermal: dec fibrinogen, dec factor VII, promotes postive effect on ednothelial function, dec CRP, amyloid A procoagulant factors, or acute inflammation
oral: goes first pass-metabolism, cuases upregulation of plaque inflammatory processes and increase plaque instability, increase acute inflammation, increase CRP, dec ghrelin,
What delivery system of progesterone protects the uterus?
OMP
When is it not safe to prescribe HMT for a pt?
no risk of hormone senstive cancer, breast cancer, CVD, clotting disease
What do you need to do before starting menopause hormone therapy?
lipid panel
mammogram
Gail model
ASCVD
rule out contraindications
What ethical issues do genetic testing pose?
a. none
b. sexual selection
c. expensive
d. explotation
sexual selection
What population tends to get physiologic phimosis?
a. older
b. middle aged
c. young
d. teenagers
young
What indicates pathological phimosis?
a. nontender, swelling, and increased blood flow
b. redness, swelling, and decreased blood flow
c. white and decreased blood flow
d. none of the above
redness, swelling, and decreased blood flow
Which of the following is a RF for phimosis?
a. poor hygeine
b. sexual activity
c. drug use
d. smoking
poor hygeine
What are some methods to prevent phimosis?
a. frequent hygeine and diaper changes
b. hydrotherapy
c. healthy diet with fiber
d. quit smoking
frequent hygeine and diaper changes
What is the difference between phimosis and paraphimosis?
a. phimosis is more sevre than paraphimosis
b. phimosis is tight forseskin cannot be retracted from the glans penis and paraphimosis is when foreskin is trapped in the retracted positons
c. phimosis is due to infection and parahimoiss is not due to infection
d. phimosis can cause gangrene/necrosis and parahimosis can not
phimosis is tight forseskin cannot be retracted from the glans penis and paraphimosis is when foreskin is trapped in the retracted positons
Which of the following is NOT a RF of phimosis?
a. diaper rash and poor hygeine
b. condome catheter
c. balanitis xerotica obliterans
d. penile trauma
penile trauma
What are treatment options for phimosis?
a. antibiotics
b. topical creams either steroids or callendula/centella
c. ice
d. sitz baths
topical creams either steroids or callendula/centella
Which of the following is NOT a cause of paraphimosis?
a. patholigcal phimosis
b. balanitis
c. sexual activity
d. heart disease
heart disease
Which of the following is a treatment for paraphimosis?
a. ice
b. topical pain managment
c. slowly attempt to reduce the foreskin over the glans
d. all of the above
all
What is the difference between balanitis and balanopostitis?
a. they are the same thing
b. balanitis is more sever than balanoposthitis
c. balanitis is inflammation of the glans penis and balanoposthitis is inflammation of both the glans penis and the foreskin
d. balanitis is due to poor hygiene and balanoposthitis is not
balanitis is inflammation of the glans penis and balanoposthitis is inflammation of both the glans penis and the foreskin
What is the most common cause of balanitis and balanoposthitis?
a. bowenoid papulosis
b. psoriasis
c. candidia
d. reactive arthritis
candidia
What is the difference between the presentation of balanits/balanoposthitis and phimosis?
a. phimosis presents as redness, swelling, and blockage of flow but balanits/balanoposthitis is pain during or after urination, discharge from painful inflammed tissue, local erythema and edema
b. balanits/balanoposthitis presents as redness, swelling, and blockage of flow but phimosis is pain during or after urination, discharge from painful inflammed tissue, local erythema and edema
c. phimosis presents as snapping, sound, sudden pain and balanits/balanoposthitis resents as redness, swelling, and blockage of flow
d. none of the above
phimosis presents as redness, swelling, and blockage of flow but balanits/balanoposthitis is pain during or after urination, discharge from painful inflammed tissue, local erythema and edema
Which of the following is RF is specific to balanoposthitis but not balanitis?
a. poor hygeine
b. antibiotic use
c. phimosis
d. a and c
a and c
Which is not a causes of balantits/balanoposthitis?
a. infectious
b. dermatological
c. pre/malignant
d. tramua
trauma
how dose treatment for balantits/balanoposthitis compare to treatment of paraphimosis?
a. balantits/balanoposthitis and paraphimosis have the same treatment
b. balantits/balanoposthitis involves topical antifungals, corticosteriods, and antibiotics while parphimosis only involves topical antifungals
c. balantits/balanoposthitis involves topical pain managment while parahimosis involves topical centella, Vit E, and callendular
d. balantits/balanoposthitis involves topical antifungals, corticosteriods, and antibiotics while paraphimosis involves topical pain managment
balantits/balanoposthitis involves topical antifungals, corticosteriods, and antibiotics while paraphimosis involves topical pain managment
What is circinate balanitis associated with?
a. chlamydia
b. squamous cell carcinoma
c. reactive arthritis
d. balanitis xerotica obliterans
reactive arthritis
what dose balanitis xerotica obliterans look like?
a. glans and forseskin atrophies and appears white
b. redness and erythema
c. muliple little papules
d. alll of the above
glans and forseskin atrophies and appears white
what dermatological conditons is NOT are associated with balanits?
a. psoriasis
b. eczema
c. lichen planus
d. contact dermatitis
e. acne
acne
which of the following is NOT a benefit of circumcison?
a. easier hygeine
b. reduction in UTI, HPV, HIV, HSV
c. sexual sensation
d. reduction in penile inflammation and phimosis
sexual sensation
which of the following is a benefit of circumsion?
a. procedural complications
b. easier hygiene
c. sexual dissatisfaction and stress
d. potentially unethical
easier hygiene
Which of the following is NOT a way to remove pearly penile papules?
a. liquid nitrogen
b. excison
c. laser surgery
d. radiosurgery
excison
what are RF for tumors of the penis?
poor hygeine, smoking, hx of HPV, UTIs, penile injury, phimosis, HIV infx, HSV, psoriasis, uncircumcised
which of the following is not a pre-cancerous lesion of penis cancer?
a. leukoplakia
b. pearly penile papules
c. balanitis xerotica obliterans
d. condyloma accuminata
pearly penile papules
Which of the following is a carcinoma in situ associated with HPV 8?
a. bowen disease
b, erythroplasia of queyrat
c. bowenoid papulosis
d. all of the above
erythroplasia of queyrat
What is the most common penile cancer?
a. basal cell carcinoma
b. kaposi sarcoma
c. melanoma
d. squamous cell carcinoma
squamous cell carcinoma
