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repo med tes 2 > the BALLS!!!!!! > Flashcards

the BALLS!!!!!! Flashcards

1
Q

low testosterone

< 150-200 ng/dL

A

Hypogonadism

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2
Q

Hypogonadism etiology

A

Primary: testicular failure
Mumps orchitis
Secondary: hypogonadotropic hypogonadism
Age-related (ADAM), chronic opiates

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3
Q

Hypogonadism epidemiology

A

increasingly diagnosed

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4
Q

Hypogonadism presentation

A

decreased energy/fatigue, ED, decreased force of ejaculation, decreased libido

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5
Q

Hypogonadism work - up

A

Free and total testosterone
Exam
If low – DEXA scan (< 100 ng/dL)

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6
Q

Hypogonadism tx

A

Androgen (testosterone) supplementation

Gels, injections, pellets

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7
Q

Hypogonadism follow up monitoring

A

PSA, hemogram (H&H), testosterone, review of urinary symptoms, DRE
3, 6 and 12 months after initiating, then annual
Counsel prostate Ca monitoring; CV risks, infertility.

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8
Q

basic questionnaire can be very useful for men to describe the kind
and severity of their low testosterone symptoms.

A

ADAM Questionnaire

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9
Q

testis (testes) not in scrotum

Possibly absent; possibly non-palpable (20%); if palpable, won’t come down

A

Cryptorchidism

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10
Q

Cryptorchidism etiology

A

not well understood

Normal descent is androgen-independent, mediated by “descendin;” passage through inguinal canal begins 28 weeks

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11
Q

Cryptorchidism epidemiology

A

rare

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12
Q

Cryptorchidism work up

A

good physical exam (don’t forget penis), possible scrotal U/S, urologist may pursue further studies (MRI, diagnostic laparoscopy)

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13
Q

Cryptorchidism tx

A

hormonal manipulation (GnRH injection); orchidopexy

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14
Q

testi at Inguinal canal -

A

between internal and external rings

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15
Q

testi Intra-abdominal (10%) -

A

proximal to inguinal ring

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16
Q

Absent testis (20%)-

A

truly absent, probable vascular event

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17
Q

Ectopic testis -

A

below the internal ring but out of normal path

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18
Q

Retractile testis -

A

reflects exuberant cremasteric reflex

Follow patient until puberty

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19
Q

Most descend spontaneously in first __ months

A

3

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20
Q

If undescended at __months, descent is unlikely

A

6

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21
Q

what percent of term infants have cryptorchidism

A

3

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22
Q

what percent of premes have cryptorchidism

A

30

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23
Q

what percent of Cryptorchidism is bilateral

A

10

3 percent have one or both missing

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24
Q

Cryptorchidism risk factors

A

Twins, low birth weight, pre-term delivery, family history, Prune Belly syndrome

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25
Q

Cryptorchidism cancer risk

A

Increased risk of testicular cancer (1/2500 versus 1/100,000)
Cancer risk may be reduced by orchidopexy, certainly facilitates examination
Contralateral testis at increased risk also, even if descended (10-25% of cancers on this side)

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26
Q

Cryptorchidism fertility effect

A

decreased

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27
Q

t/f torsion risk is 10 x higher

A

t

28
Q

benign accumulation of serous fluid between layers of tunica vaginalis

A

Hydrocele

29
Q

infant Hydrocele presentation

A

infant/toddler with hemiscrotal enlargement; volume/size waxes and wanes during day

30
Q

infant Hydrocele etiology

A

patent processus vaginalis (communicating hydrocele)

31
Q

infant Hydrocele work up

A

clinical diagnosis; scrotal sonogram may be helpful

32
Q

infant Hydrocele tx

A

if persistent after one year, repair via inguinal incision

33
Q

Adult Hydrocele presentation

A

scrotal discomfort; scrotal enlargement; possible h/o trauma or infection

34
Q

Adult Hydrocele etiology

A

idiopathic; post-traumatic; post-infectious

35
Q

Adult Hydrocele work-up

A

careful physical examination; transillumination; possible scrotal sonogram

36
Q

Adult Hydrocele tx

A

Expectant management if asymptomatic
Aspiration/sclerosis associated with recurrence
Scrotal excision (hydrocelectomy)

37
Q

congestion of veins around the testis

A

Varicocele

38
Q

Varicocele etiology

A

reflects valvular anomaly exacerbated (or caused?) by gonadal venous anatomy; rare malignant etiology (consider if right-sided, or in man > 40 years)

39
Q

Varicocele presentation

A

asymptomatic; dull ache; infertility; scrotal enlargement; majority on left

40
Q

Varicocele work up

A

Clinical diagnosis; “bag of worms” due to dilatation of veins in pampiniform plexus; examine both standing and supine; generally no need for imaging; ?SA

41
Q

Varicocele tx

A

varicocelectomy; embolization; 2/3 surgically treated have fertility improvement

42
Q

Varicocele epidemiology

A

age 15-30 years; rarely over 40 years

43
Q

careful dissection of spermatic cord, with ligation of veins (preserve the artery, lymphatics, vas deferens)

A

Varicocelectomy

44
Q

twisting of spermatic cord causing ischemia of testis

A

Testicular Torsion

45
Q

Testicular Torsion epidemiology

A

bimodal distribution

Neonatal (extravaginal) v. pubertal (intravaginal)

46
Q

Testicular Torsion etiology

A

anatomic predisposition (Bell-clapper deformity; cryptorchidism); trauma; sex

47
Q

Testicular Torsion presentation

A

Sudden severe onset unilateral scrotal pain; nausea/emesis; abdominal pain; symptoms may be intermittent (intermittent torsion)

48
Q

Testicular Torsion work up

A

Difficult exam; high-riding testis; ?negative cremasteric reflex on affected side; scrotal edema and tenderness; pain unrelieved by scrotal elevation
Sonogram often equivocal or may be misleading, could delay treatment
High index of suspicion

49
Q

Testicular Torsion tx

A

Scrotal exploration, with untwisting of cord and orchidopexy; ?contralateral orchidopexy
High salvage rate if treated within 6 hours

50
Q

Inflammation/infection ball mow hawk

A

Epididymitis

51
Q

Epididymitis etiology

A

Ascending infection from urethra, prostate, bladder
<35 years - C. trachomatis, N. gonorrhoeae
>35years - E.coli
Surgery (vasectomy)
Other trauma

52
Q

Epididymitis

A

Scrotal pain, scrotal enlargement, fever

53
Q

Epididymitis

A

Good history and exam; UA C&S; ?penile swab/probe for STI, ?scrotal sonogram

54
Q

Epididymitis

A

Antibiotics (empiric by age, i.e. doxycycline or ciprofloxacin)
Palliatives (scrotal support, NSAIDs, ice, narcotics)

55
Q
  • acute inflammatory reaction of testis secondary to infection
A

Orchitis

56
Q

Orchitis etiology

A

Most common – viral mumps infection in children
Bacterial orchitis - most commonly associated with epididymitis in sexually active males and men >50 with BPH
C. trachomatis, N. gonorrhoeae, E. coli

57
Q

Orchitis presentation

A

Scrotal pain (mild-severe) and swelling
Exam can reveal impressive induration and edema
Overlying skin frequently thickened
Testicle won’t move freely in the scrotum, seems “stuck”

58
Q

Orchitis work up

A

Good history and exam; UA C&S; ?penile swab/probe for STI, ?scrotal sonogram

59
Q

Orchitis tx

A

Viral (mumps orchitis) - no medications; may lead to infertility
Bacterial - treat suspected organism, exclude/address abscess

60
Q

Highly curable cancer in young to middle-aged men

A

Testis Cancer

61
Q

Testis Cancer histology

A 
Germ cell (95%)
Seminoma
Non-seminoma (NSGCT)
Mixed (managed as NSGCT) 
Non germ cell (5%)
Rare secondary tumors (lymphoma, leukemia)
62
Q

Testis Cancer epidemiology

A

8,500 new cases/year; 350 deaths/year

Trimodal: Up to 10 years (yolk sac); 20-40 years (seminoma); > 60 years (spermatocytic seminoma)

63
Q

Testis Cancer presentation

A

painless testicular mass
Usually incidental by partner or after trauma
Cough or dyspnea secondary to lung metastases
GI symptoms secondary to retroperitoneal metastases
Gynecomastia

64
Q

Testis Cancer work up

A

Scrotal sonogram
Tumor markers (AFP, beta-hCG, LDH);
CT to assess the lymph nodes of retroperitoneum
Radical inguinal orchiectomy

65
Q

Testis Cancer tx

A

guided by histology (seminoma v. NSGCT) and staging (markers + imaging)
Surveillance
Adjuvant chemotherapy
Adjuvant radiotherapy
Retroperitoneal lymph node dissection (RPLND)

66
Q

Testis Cancer prognosis

A

Cure rate 90% for seminoma (all stages combined)

Cure rate approaches 100% for low-grade NSGCT

repo med tes 2 (3 decks)

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