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Fall Y3 > Repro Exam 5 > Flashcards

Repro Exam 5 Flashcards

1
Q

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

A

urinary sx

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2
Q

Which of the following is NOT part of the PE for penile and scrotal lesions?
a. color
b. configuration
b. size
c. transillumination

A

transillumination

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3
Q

What is NOT part of the work up for penile and scrotal lesion?
a. skin biopsy
b. UA
c. skin scraping
d. STI testing

A

UA

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4
Q

What is the DDX for penile and scrotal lesions?

A

inflammatory or papulosquamous
infectious
neoplastic

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5
Q

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

A

painful or painless

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6
Q

What is the PE for penile discharge ?
a. palpate inguinal lymph node
b. cremaster reflex
c. discharge
d. a and c

A

a and c

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7
Q

What are the ddx for penile discharge?

A

Gonococcal urethritis
Non-gonococcal urethritis
Urethral irritation (soaps, detergents, lubricants)
Hematospermia

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8
Q

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

A

all

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9
Q

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

A

all

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10
Q

What is the ddx of scrotal masses and swelling?

A

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

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11
Q

What is the work up for scrotal masses and swelling?
a. UA
b. STI testing
c. US
d. biopsy
e. all of the above

A

all

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12
Q

Which of the following is not a PE of prostatitis?
a. DRE
b. genital exam
c. abdominal exam
d. skin exam

A

skin

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13
Q

What are the ddx of prostatitis?

A

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

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14
Q

What is the work up for acute prostatitis?
a. UA
b. STI
c. CBC
d. a and b

A

a and b

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15
Q

What is the work up for chronic prostatitis?
a. PSA
b. UA
c. US
d. all of the above

A

all

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16
Q

What are the PE of erectile dysfunction?
a. genitalia exam
b. abdominal exam
c. cardiovascular exam
d. a and c

A

a and c

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17
Q

What is not part of the erectile dysfunction work up?
a. hormone testing
b. lipid panel and ASCVD
c. DM testing
d. UA

A

UA

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18
Q

What is included in the PE for gynecomastia?
a. breast
b. abdominal
c. genital
d. a and c

A

a and c

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19
Q

What is NOT included in the work up of gynecomastia?
a. hormone testing
b. US
c. mammography
d. MRI

A

MRI

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20
Q

What is the ddx of gynecomastia?

A

Congenital hypogonadism
Medications
Anabolic steroids
Alcohol, cannabis
Cirrhosis (+estradiol, +SHBG)
Cushing’s disease (low T)
Renal disease (low T)

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21
Q

What is bioethics?

A

advancments in medicine due to new technology

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22
Q

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

A

all

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23
Q

What are the ethical issuse around fertility?
a. ferility drugs
b. surrogacy
c. gamete donors
d. all of the above

A

all

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24
Q

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

a period of time before a patient reaches 12 continous months without having a cycle

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25
Q

When do hot flashes normally occur?
a. early perimenopause
b. late perimenopause
c. menopause
d. post-menopause

A

late perimenopause

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26
Q

What are the ovarian follicle changes in perimenopause?

A

oocytes undergo atresia each month and eventually deplete the amount of ovarian follicles resulting in hypoestreogenemia and high FSH

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27
Q

What are the endocrine changes in menopause?

A

dec in antral follicle count dec inhibin inc FSH
dec estradiol

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28
Q

What is the average age of perimenopause?
a. 47
b. 50
c. 51
d. 40

A

47

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29
Q

What is the average menopause?
a. 47
b. 50
c. 51
d. 40

A

51

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30
Q

What is the MOA of physiologic menstural irregularity?

A

dec in functional follicles shortened follicular phase causing cycles to shorten in length to 25 days or less,

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31
Q

What is the hallmark sxs that indicates perimenopause transition has started?

A

Hot flashes
Insomnia
Weight gain and bloating
Mood changes
Irregular menses (perimenopause)
Mastodynia
Depression
Headache
Sexual function changes & vulvovaginal atrophy (VVA)
Joint pain

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32
Q

When is urogenital atrophy most significant?
a. early perimenopause
b. late perimenopause
c. menopause
d. post-menopause

A

post-menopause

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33
Q

STRAW staging system

A
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34
Q

What is the general approach to evaluation of a menopausal patient?

A

history
pelvic exam
FSH sometimes

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35
Q

What test maybe useful but not necessary for dx with the exception of special circumstances?
a. FSH
b. inhibin
c. AMH
d. estradiol

A

FSH

36
Q

What factors can affect the onset of menopause?

A

smoking
genetics
ethnicity
partial hysterectomy
type 1 DM
DES exposure
Galactose consumption
fragile X carrier
exposure to certian chemotherapeutic agents or radiation

37
Q

What are diseases linked to estrogen deficiency?

A

osteoprosis
cardiovascular disease
cognitive impairment
impaired vison/macular degeneration
asthma
polymetabolic syndrome

38
Q

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

A

FSH

39
Q

How do you test for menopause in those takinf oral contraceptives?
a. FSH
b. inhibin
c. AMH
d. estradiol

A

FSH

40
Q

How do you test for menopause in posthysterectomy or endometrial ablation?
a. FSH
b. inhibin
c. AMH
d. estradiol

A

FSH

41
Q

What FSH level indicates menopause?
a. 4
b. 14
c. >25
d. <25

A

> 25

42
Q

What are the risk factors for developing hot flashes (VMS)?

A

obesity
cigarette smoking
reduced physical activity
hormone concentration
black pt
those with tachykinin receptor 3 (TACR3) gene

43
Q

What is the physiology of hot flashes?

A

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

44
Q

What dosen’t brings on hot flashes?
a. alcohol
b. spicy or hot food/drinks
c. difficult emotions
d. cold drinks/food

A

cold drinks/food

45
Q

What should be included in the hot flash assessment when taking a hx with a pt?

A

frequency, duration, severity

46
Q

List some DDX’s for hot flash presentation.

A

menopause
hot drinks
alcohol
cancer
infections
hyperthyroidism

47
Q

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?

A

stress managment, mindfulness, yoga, plant-based diet, dec alcohol, acupuncture, sleep hygeine, homeopathy, undas, botanicals,

48
Q

List the non-hormonal pharmaceutical options for hot flashes.

A

SSRIs
SNRIs
Paroxetine
Citalopram
Gabapentin
Bazedaxifene

49
Q

What treatment options are available for insomnia?

A

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

50
Q

For a menopausal pt presenting with vulvovaginal changes what exam must be performed?

A

pelvic

51
Q

What treatment options are available for vulvovaginal changes?

A

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

52
Q

What treatment options are available for depression and anxiety?

A

mind-body medicine (CBT, MBSR, yoga, Tai Chi, Qi Gong)
magnolia bark
b vitamins
Vitamin d
5HTP, GABA
hypericum, maca
homeopathy
undas
SSRI
MHT

53
Q

Why does CVD increase in menopause, the underlying MOA?

A

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

54
Q

What are the treatment options available for CVD related to menopause?

A

lifestyle
diet
stress managment
excercise
smoking cessation
intimacy and quailty social support

55
Q

What is the effect of hormones on the breast tissue?

A

estrogen and progestin: node + breast cancer and inc mortality, HER2 +
estrogen alone: no risk for breast cancer

56
Q

What health maintenance and screening should be included for the menopausal patient?

A

BMI/waist cicrumferance
pap & HPV testing
CBE
pelvic exam
lipids
glucose
mamogram
colon cancer screening
DEXA
Vit D testing

57
Q

Describe the difference on a physiological level between transdermal and oral estrogen.

A

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,

58
Q

What delivery system of progesterone protects the uterus?

A

OMP

59
Q

When is it not safe to prescribe HMT for a pt?

A

no risk of hormone senstive cancer, breast cancer, CVD, clotting disease

60
Q

What do you need to do before starting menopause hormone therapy?

A

lipid panel
mammogram
Gail model
ASCVD
rule out contraindications

61
Q

What ethical issues do genetic testing pose?
a. none
b. sexual selection
c. expensive
d. explotation

A

sexual selection

62
Q

What population tends to get physiologic phimosis?
a. older
b. middle aged
c. young
d. teenagers

A

young

63
Q

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

A

redness, swelling, and decreased blood flow

64
Q

Which of the following is a RF for phimosis?
a. poor hygeine
b. sexual activity
c. drug use
d. smoking

A

poor hygeine

65
Q

What are some methods to prevent phimosis?
a. frequent hygeine and diaper changes
b. hydrotherapy
c. healthy diet with fiber
d. quit smoking

A

frequent hygeine and diaper changes

66
Q

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

A

phimosis is tight forseskin cannot be retracted from the glans penis and paraphimosis is when foreskin is trapped in the retracted positons

67
Q

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

A

penile trauma

68
Q

What are treatment options for phimosis?
a. antibiotics
b. topical creams either steroids or callendula/centella
c. ice
d. sitz baths

A

topical creams either steroids or callendula/centella

69
Q

Which of the following is NOT a cause of paraphimosis?
a. patholigcal phimosis
b. balanitis
c. sexual activity
d. heart disease

A

heart disease

70
Q

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

A

all

71
Q

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

A

balanitis is inflammation of the glans penis and balanoposthitis is inflammation of both the glans penis and the foreskin

72
Q

What is the most common cause of balanitis and balanoposthitis?
a. bowenoid papulosis
b. psoriasis
c. candidia
d. reactive arthritis

A

candidia

73
Q

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

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

74
Q

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

a and c

75
Q

Which is not a causes of balantits/balanoposthitis?
a. infectious
b. dermatological
c. pre/malignant
d. tramua

A

trauma

76
Q

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

A

balantits/balanoposthitis involves topical antifungals, corticosteriods, and antibiotics while paraphimosis involves topical pain managment

77
Q

What is circinate balanitis associated with?
a. chlamydia
b. squamous cell carcinoma
c. reactive arthritis
d. balanitis xerotica obliterans

A

reactive arthritis

78
Q

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

A

glans and forseskin atrophies and appears white

79
Q

what dermatological conditons is NOT are associated with balanits?
a. psoriasis
b. eczema
c. lichen planus
d. contact dermatitis
e. acne

A

acne

80
Q

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

A

sexual sensation

81
Q

which of the following is a benefit of circumsion?
a. procedural complications
b. easier hygiene
c. sexual dissatisfaction and stress
d. potentially unethical

A

easier hygiene

82
Q

Which of the following is NOT a way to remove pearly penile papules?
a. liquid nitrogen
b. excison
c. laser surgery
d. radiosurgery

A

excison

83
Q

what are RF for tumors of the penis?

A

poor hygeine, smoking, hx of HPV, UTIs, penile injury, phimosis, HIV infx, HSV, psoriasis, uncircumcised

84
Q

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

A

pearly penile papules

85
Q

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

A

erythroplasia of queyrat

86
Q

What is the most common penile cancer?
a. basal cell carcinoma
b. kaposi sarcoma
c. melanoma
d. squamous cell carcinoma

A

squamous cell carcinoma

Fall Y3 (10 decks)

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