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05. Andro (1569) > Sexual Medicine > Flashcards

Sexual Medicine Flashcards

1
Q

Major arterial supply to penis

A

pudendal artery

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2
Q

Mechanism of erections

Release of _____
____ in cAMP & cGMP
____ in intracellular Ca++
smooth muscle ____

A

Release of NO
Increases cAMP & cGMP
Decreases Ca++
Smooth muscle relaxation

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3
Q

Duplex penile doppler u/s

Normal values

Peak systolic > ___
End diastolic < ___

A

Peak systolic > 30

End diastolic < 5

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4
Q

Venous leak ED leads to ____ end diastolic velocities

A

HIGH (>5)

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5
Q

PDE-5 mechanism

Inhibits degradation of ____

A

inhibits cGMP degradation into GMP

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6
Q

Take Viagra (sildenafil) ____ food

Take Cialis (tadalafil) ___ food

A

Viagra –> NO FOOD

Cialis–> okay for food

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7
Q

Duration of action for Cialis (tadalafil)

A

36 hrs

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8
Q

Duration of active for Viagra/Levitra (sildenafil/vardenafil)

A

4-6 hrs

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9
Q

Protease inhibitors increase the _____ of PDE-5is

A

concentration (2-3x as potent)

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10
Q

Separate alpha blocker & PDE-5i by ___ hrs to avoid cumulative hypotension

A

4 hrs

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11
Q

PDE-5i side effects

A 
Headache
Facial flushing
GERD
Nasal congestion
Diplopia, blurred vision, chromatopsia
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12
Q

Trimix components & mechanisms

___ : cAMP activator
___ : PDE inhibitor
___ : alpha blocker

A

PGE-1 : cAMP activator
Papaverine : PDE inhibitor
Phentolamine : alpha blocker

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13
Q

Psych med that is a contrindication to Trimix

A

MAOI

cannot give phenylephrine to reverse possible priapism*

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14
Q

Pain with ICIs is due to ___ hypersensitivity

A

PGE-1

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15
Q

Intra-urethral suppositories can cause ___ bleeding, priapism, and penile pain

A

urethral

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16
Q

Vacuum contraindications

A

Anti-coagulation

Poor penile sensation

Poor cognition

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17
Q

Infected IPP board answer for management

A

EXPLANT everything

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18
Q

During IPP, you must abort if _____ perforation

A

urethral

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19
Q

Ischemic priapism

___ flow
veno___

A

low flow

veno-occlusive (smooth muscle paralysis)

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20
Q

Non-ischemic priapism

___ flow
___

A

high flow

arterial (cavernous artery to cavernosal fistula)

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21
Q

Cause of Priapisms

A

ICI
Cocaine
Hematologic cancer

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22
Q

Cause of Priapisms

A

ICI
Cocaine
Hematologic cancer

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23
Q

1 diagnostic test for priapism

A

Corporal blood gas

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24
Q

Purpose of distal penile shunt in priapism

A

return oxygenated blood to penis

rigidity may not improve

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25
Q

Last line treatment of non-ischemic priapism

A

Embolization

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26
Q

Xiaflex

Curvature between ___ & ___
Must have intact ____

A

30-90 degrees

erectile function

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27
Q

Biggest risk of intralesional collagenase for peyronie’s

A

penile fracture

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28
Q

Treatment of patient with Peyronie’s & severe ED OR peyronie’s with hinging

A

IPP

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29
Q

___ nerve is responsible for ejaculate explusion

A

pudendal

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30
Q

Sensory stimulation of _____ nerve stimulates ejaculation

A

dorsal penile nerve

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31
Q

Majority of ejaculate is contributed by ___ & ____

A

epididymis & vas deferens

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32
Q

Process of ejaculation: Ejection

A
  • Forcel contractions of the bulbospongiosus and ischiocavernosus in coordinatino with the external urethral sphinter lead to expulsion of semen.

Tight coaptation of the bladder neck is needed to prevent retrograde ejaculation

Process is mediated by the Somatic NS S2- S4 (not the bladder neck contraction)

33
Q

Process of ejaculation: Emission

A
  • Sperm from vas is deposited in the posterior urethra along with seminal fluid form the prostate and SV.

Bladder neck closes tightly to prevent retrograde ejaculation.

Under control of the sympathetic nervous system T10 - T12extending to the pelvic plexus then to the hypogastric nerves.

34
Q

Part of brain that plays a central role in ejaculation in animal models

A

medial pre-optic area MPOA

stimulation induces ejaculation whereas ablation prevents it.

35
Q

Medications approved by the FDA in the management of PE

A

None.

All meds are classified as off-label and include SSRIs: paroxetine, sertraline, Fluoxetine, TCA, Clomipramine, topical anesthetics

36
Q

PDE5i MOA

A

PDE5i are competitive inhibitors of PDE5 by binding to the catalytic domain48 and hence promote high levels of cGMP in the penile vasculature

37
Q

When should Sildenafil or Vardenafil be taken

A

1-2 hours prior to a meal.

Both are pyrazolopyrimidine compounds. Absorption is lowed by dietary lipids.

Peak absorption is 30-60 mins and T1/2 = 3-5 hours

38
Q

PDE5i contraindications

A

The only strict contraindication to use of PDE5i is concurrent use of nitrate containing medications (e.g. sublingual nitroglycerin, isosorbide mononitrate or dinitrate)

PDE5i can also potentiate the hypotensive effect of alpha blockers

PDE5i are metabolized primarily by the cytochrome CYP3A4 system

39
Q

PDE5i Adverse Events

A

The most common adverse events (AE) associated with this class of medications include headache, facial flushing, dyspepsia/heartburn, nasal congestion, visual changes, and myalgia

40
Q

Phases of Male Sexual Response

A
  • excitement/arousal: tachycardia, increase in blood pressure, penile erection, testicular retraction, sexual excitement

*Plateau: tachycarda, increase in blood pressure, muscle contraction, increasing sexual excitement.

*Orgasm: Pelvic muscular contractions, ejaculation, intense pleasure or satisfaction

*Resolution: Loss of penile erection, decline in heart rate, blood pressure, decreasing sexual excitement, refractory period

41
Q

When is penile duplex doppler ultrasound indicated

A

i) patients with a high likelihood of psychogenic ED, to establish the absence of an organic etiology and provide reassurance to the patient,

(ii) men with the possibility of arteriogenic ED, where cardiology evaluation may be indicated,

(iii) young men with a history of pelvic trauma who might be candidates for surgical revascularization,

(iv) men with Peyronie’s disease who are considering invasive intervention, and

(v) identification of men with severe veno-occlusive dysfunction who are unlikely to respond to medical therapy and should consider surgical intervention

42
Q

What values are considered as evidence of arterial insufficiency vs venous leak

A

PSV < 25-30 cm/sec is considered evidence of arterial insufficiency (arteriogenic ED) and EDV > 5 cm/sec is consistent with venous leak

43
Q

How can the dx of veno-occlusive dysfunction as cause of ED be confirmed?

A

cavernosography

44
Q

Describe the phases of an erection

A
  1. Flaccid: Arterial flow is low and corporal resistance is high d/t contraction of smooth msucle in the corporal arteries. pO2 is low at 35mmhg
  2. Filing: Increasing firmness of the penis from increased blood flow
  3. Full erection phase: erection of the penis to a non-dependent position. Partial pressure of O2 increase to 90 mmHg
  4. Rigid Erection: Engorgement of the coprus spongiosum occurs as blood is forced into the penis by contraction of the pelvic floor musculature, intra-penile pressure may exceed systolic blood pressure.
45
Q

Phases of penile detumescence

A
  1. Slight rise in intracoporal pressure related to construction of the cavernousus arteries against the engorged spongy tissues of the corpora cavernosa
  2. slow process of detumescence as partial venous drainage resumes
  3. Third and final phase of detumescence is rapid and associated with complete restoration of venous drainage.
46
Q

How does hyprolactinemia contribute to ED

A

Suppresses LH secretion

may be a/w prolactin secreting adenoma or medications that results in prolactin level increases

47
Q

How does hyperthyroidism contribute to ED

A

Hyper-estrogenism

48
Q

Medications a/w ED

A

-5-Alpha Reductase Inhibitors

Anti-androgens

LH-RH agonists/antagonists

Anti-hypertensives

H2 Blockers

Psychiatric Drugs

Digoxin

49
Q

Major arterial supply to penis

A

pudendal artery

50
Q

Mechanism of erections

Release of _____
____ in cAMP & cGMP
____ in intracellular Ca++
smooth muscle ____

A

Release of NO
Increases cAMP & cGMP
Decreases Ca++
Smooth muscle relaxation

51
Q

Duplex penile doppler u/s

Normal values

Peak systolic > ___
End diastolic < ___

A

Peak systolic > 30

End diastolic < 5

52
Q

Venous leak ED leads to ____ end diastolic velocities

53
Q

PDE-5 mechanism

Inhibits degradation of ____

A

inhibits cGMP degradation into GMP

54
Q

Take Viagra (sildenafil) ____ food

Take Cialis (tadalafil) ___ food

A

Viagra –> NO FOOD

Cialis–> okay for food

55
Q

Duration of action for Cialis (tadalafil)

56
Q

Duration of active for Viagra/Levitra (sildenafil/vardenafil)

57
Q

Protease inhibitors increase the _____ of PDE-5is

A

concentration (2-3x as potent)

58
Q

Separate alpha blocker & PDE-5i by ___ hrs to avoid cumulative hypotension

59
Q

PDE-5i side effects

A 
Headache
Facial flushing
GERD
Nasal congestion
Diplopia, blurred vision, chromatopsia
60
Q

Trimix components & mechanisms

___ : cAMP activator
___ : PDE inhibitor
___ : alpha blocker

A

PGE-1 : cAMP activator
Papaverine : PDE inhibitor
Phentolamine : alpha blocker

61
Q

Psych med that is a contrindication to Trimix

A

MAOI

cannot give phenylephrine to reverse possible priapism*

62
Q

Pain with ICIs is due to ___ hypersensitivity

63
Q

Intra-urethral suppositories can cause ___ bleeding, priapism, and penile pain

64
Q

Vacuum contraindications

A

Anti-coagulation

Poor penile sensation

Poor cognition

65
Q

Infected IPP board answer for management

A

EXPLANT everything

66
Q

During IPP, you must abort if _____ perforation

67
Q

Ischemic priapism

___ flow
veno___

A

low flow

veno-occlusive (smooth muscle paralysis)

68
Q

Non-ischemic priapism

___ flow
___

A

high flow

arterial (cavernous artery to cavernosal fistula)

69
Q

Cause of Priapisms

A

ICI
Cocaine
Hematologic cancer

70
Q

Cause of Priapisms

A

ICI
Cocaine
Hematologic cancer

71
Q

1 diagnostic test for priapism

A

Corporal blood gas

72
Q

Purpose of distal penile shunt in priapism

A

return oxygenated blood to penis

rigidity may not improve

73
Q

Last line treatment of non-ischemic priapism

A

Embolization

74
Q

Xiaflex

Curvature between ___ & ___
Must have intact ____

A

30-90 degrees

erectile function

75
Q

Biggest risk of intralesional collagenase for peyronie’s

A

penile fracture

76
Q

Treatment of patient with Peyronie’s & severe ED OR peyronie’s with hinging

77
Q

___ nerve is responsible for ejaculate explusion

78
Q

Sensory stimulation of _____ nerve stimulates ejaculation

A

dorsal penile nerve

79
Q

Majority of ejaculate is contributed by ___ & ____

A

epididymis & vas deferens

05. Andro (1569) (16 decks)

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