S. Reproductivo Hombre Flashcards
An otherwise healthy 26-year-old man comes to the physician for medication counseling after recently being diagnosed with schizophrenia. Risperidone therapy is initiated. This patient is at increased risk for which of the following adverse effects?
Gynecomastia
A 30-year-old man comes to the physician for evaluation of lump on his right testicle that he noticed 2 weeks ago while bathing. He has a history of bilateral cryptorchidism treated with orchidopexy at 8 months of age. Physical examination shows a firm, nontender nodule on the right testis that does not transilluminate. His serum alpha-fetoprotein, placental alkaline phosphatase, and beta-human chorionic gonadotropin concentration are all within the reference range. This patient’s testicular tumor is most likely of which of the following types?
Teratoma
Testicular germ cell tumors are divided into two groups: seminomas (most common) and nonseminoma tumors. Nonseminoma tumors include embryonal carcinomas, yolk sac tumors, testicular choriocarcinomas, teratomas, and tumors with mixed germ cell histology. Pure teratomas typically do not cause an elevation in testicular tumor markers (beta-hCG, AFP, PLAP), which is consistent with this patient’s laboratory studies.
A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months. He has had an active sexual life in the past. He reports that early morning erections are present every other day. He has a history of hypertension and diabetes mellitus. His wife recently filed for divorce. He has smoked one pack of cigarettes daily for 25 years. His only medications are enalapril and metformin. Physical examination shows no abnormalities. The underlying cause of this patient’s condition is best classified as which of the following?
Psychogenic ED classically manifests with consistent sexual dysfunction that develops acutely, often during a time of increased psychosocial stress (e.g., this patient’s impending divorce).
The Appendix testis is a vestigial remnant of the Müllerian duct system and one of the four main testicular appendages. There it tends to be torsion. What cells are involved in its formation?
Sertoli cells produce Müllerian inhibitory factor (MIF), which causes the regression of the paramesonephric duct to the appendix testis. In the absence of MIF, the paramesonephric duct develops into female internal structures (i.e., fallopian tubes, uterus, proximal vagina).
This male newborn has epispadias, a condition that manifests with a urethral opening on the dorsal aspect of the penis. Epispadias is often associated with bladder exstrophy , which causes herniation of bladder mucosa through the lower midline abdominal wall, as seen in this patient. Which of the following is the most likely underlying cause of this patient’s findings?
Misdirected growth of the genital tubercle in the posterior (rather than superior) direction during the 5th week of gestation results in epispadias.
A 20-year-old male comes to the physician because of a 1-week-history of a painless ulceration on his penis. The patient is sexually active with multiple partners and does not use barrier protection. Physical examination shows a shallow, firm ulcer with a smooth base along the shaft of the penis and nontender bilateral inguinal adenopathy. Which of the following is most likely to confirm the diagnosis in this patient?
Darkfield microscopy is a diagnostic method that allows direct visualization of T. pallidum from the lesion’s serous exudate.
A 33-year-old man comes to the physician with his wife for evaluation of infertility. They have been unable to conceive for 2 years. The man reports normal libido and erectile function. He has smoked one pack of cigarettes daily for 13 years. He does not take any medications. He has a history of right-sided cryptorchidism that was surgically corrected when he was 7 years of age. Physical examination shows no abnormalities. Analysis of his semen shows a low sperm count. Laboratory studies are most likely to show which of the following?
Decreased inhibin B concentration
In this patient with a history of cryptorchidism, Sertoli cell dysfunction would be expected due to temperature-induced damage to the seminiferous tubules, which can result in infertility. Therefore, inhibin B concentration would be decreased and FSH concentration would be increased (due to the loss of the feedback inhibition by inhibin B).
A 52-year-old man comes to the physician for the evaluation of a painless right-sided scrotal swelling. The swelling started several weeks ago but is not always present. Physical examination shows an 8-cm, soft, cystic nontender right-sided scrotal mass that transilluminates. The mass does not increase in size on coughing and it is possible to palpate normal tissue above the mass. There are no bowel sounds in the mass, and it does not reduce when the patient is in a supine position. Examination of the testis shows no abnormalities. Which of the following is the most likely cause of the mass?
Since this patient has no signs of ongoing inflammation, no history of recent testicular trauma, and a normal testis on palpation, he most likely has a primary/idiopathic hydrocele, which is caused by an imbalance in the rate of fluid secretion and resorption by the tunica vaginalis.
A 47-year-old man is brought to the emergency department 1 hour after injuring his genital area when he fell astride his backyard fence. He was trimming a tree from the fence when he lost his balance (straddle injury). His vital signs are within normal limits. Examination shows blood at the urethral meatus, perineal ecchymoses, and a scrotal hematoma. An x-ray of the pelvis shows swelling of the soft tissue but no other abnormalities. Which of the following parts of the urinary tract is most likely damaged in this patient?
The bulbous urethra lies in close proximity to the pubic symphysis, is relatively immobile, and lacks the protection of the corpora cavernosa.
A 63-year-old man comes to the physician because of a 4-month history of urinary hesitancy and poor urinary stream. Digital rectal examination shows a symmetrically enlarged, nontender prostate. Serum studies show a prostate-specific antigen concentration of 2 ng/mL (N < 4). Pharmacotherapy with finasteride is initiated. Which of the following is the most likely effect of this drug?
Increased prostatic apoptosis is an effect of finasteride and other 5-alpha-reductase inhibitors (e.g., dutasteride), which inhibit the conversion of testosterone to dihydrotestosterone (DHT)
A 30-year-old man comes to the physician for evaluation of infertility. He does not smoke, drink, or take any medications. Physical examination shows no abnormalities. Serum analysis shows anti-sperm antibodies. What is the most likely cause of this patient’s serum finding?
A defect in Sertoli cell tight-junction proteins (claudins and occludins) can result in infertility due to impairment of the blood-testis barrier. This type of defect allows spermatozoa to enter the bloodstream, which are recognized by serum immune cells as foreign, and thus anti-sperm antibodies are created. The antibodies can lead to immobilization and agglutination of sperm or have a spermatotoxic effect.
A 62-year-old man with insomnia comes to the physician because of nocturia and several years of difficulty initiating urinary stream. He often has the sensation of incomplete bladder emptying. Urinalysis is normal. He is started on a medication that can be used for both benign prostatic hyperplasia and post-traumatic stress disorder. Which of the following sets of changes is most likely to occur in response to this drug?
α-1 blockers (e.g., prazosin) causes a decrease in blood pressure with compensatory fluid retention, miosis, and also decreased bladder sphincter tone, meaning it improves the obstructive symptoms of benign prostatic hyperplasia.
A 25-year-old man comes to the physician because he and his wife have been unable to conceive despite regular unprotected sex for the past 15 months without using contraception. His wife has been tested and is fertile. The patient began puberty at the age of 14 years. He was treated for Chlamydia trachomatis 6 years ago. He is a professional cyclist and trains every day for 3–4 hours. He feels stressed because of an upcoming race. His blood pressure is 148/92 mm Hg. Physical examination of the husband shows a tall, athletic stature with uniform inflammatory papular eruptions of the face, back, and chest. Genital examination shows small testes. Which of the following is the most likely underlying cause of this patient’s infertility?
Chronic anabolic steroid use can result in secondary hypogonadism due to the negative feedback of androgens on the hypothalamic-pituitary axis, which lowers LH and FSH levels. educed testosterone results in smaller testes as well. Uniform papular eruptions (steroid acne) and hypertension in this patient further support anabolic steroid use as the cause of his infertility. A low sperm count would also be expected.
Ten days after starting a new medication for major depressive disorder and insomnia, a 29-year-old man comes to the emergency department because of a 6-hour history of persistent, painful erection. Aspiration of fluid from which of the following is most likely to relieve this patient’s symptoms?
Vasodilation of the small vessels in the corpus cavernosum is part of the physiologic mechanism of a penile erection. Trazodone is an atypical antidepressant with alpha-1 receptor antagonistic effects that can lead to increased blood flow to the corpus cavernosum and priapism. When an erection is sustained for prolonged periods, as in low-flow priapism, high pressures within the corpus cavernosum prevent venous outflow. First-line treatment includes aspiration of blood from the corpus cavernosum and injection of phenylephrine to reduce blood flow to this compartment. Without treatment, this patient is at risk of irreversible ischemia and chronic erectile dysfunction.
A 55-year-old man comes to the physician because of difficulties achieving an erection for the past year. A medication is prescribed that inhibits cyclic GMP phosphodiesterase type 5. Which of the following is the most likely site of action of the prescribed drug?
PDE-5 inhibitors (e.g., sildenafil) are commonly used to treat erectile dysfunction.
By preventing the breakdown of cGMP, PDE-5 inhibitors cause smooth muscle relaxation in the penis and increased blood flow to the corpus cavernosum.
