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Male CK > UW and FA > Flashcards

UW and FA Flashcards

1
Q

Leyding cells (endocrine cells) - function

A

secrete testosterone in the presence of LH

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2
Q

Leyding cells (endocrine cells) vs temperature

A

testosterone production unaffected by temperature

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3
Q

vasectomy?

A

remove of ductures deferens (vas deferens) –> birth control

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4
Q

prostate location

types of obstruction in BPH

A

between pubic symphisis + + anal canal

  1. static obstriction (androgen-mediated)
  2. dynamic obstriction (α adrenoreceptor mediated)
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5
Q

Benign prostatic hyperplasia - treatment (and mechanism)

A
  1. a1 antagonists (terazosin, tamsulosin) –> relaxation of SMC
  2. 5α-reductase inhibitors (eg. finasteride
  3. tadalafil (PDE-5 inhibitor)
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6
Q

Prostatitis - divided to/due to

A
  1. acute: bacterial (eg. E.coli)

2. chronic (bacterial or abacterial)

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7
Q

Prostatitis - symptoms / PE

A
  1. dysuria
  2. frequency
  3. urgency
  4. low back pain
    - warm, tender, enlarged prostate
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8
Q

PSA - in Prostatic adenocarcinoma

A

increased total with decreased fraction of free

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9
Q

PSA - normal range

A
  • increases in age by BPH
  • under 2.5 ng/ml in 40-49
  • under 7.5 ng/ml in 70-79
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10
Q

Penile pathology - 4 diseases

A
  1. Peyronie disease
  2. iscemic priapism
  3. SCC
  4. penile fracture
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11
Q

Peyronie disease - definition/mechanism

A

abnormal curvature of penis due to fibrous plaque within tunica albuginea (goes up)

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12
Q

Peyronie disease - symptoms / treatment

A
  1. pain
  2. anxiety
  3. erectile dysfunction
    - surgical repair once curvature stabilizes
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13
Q

Ischemic priapism - definition / etiology

A

painful sustained erection lasting more than 4 hours

etiology: 1 sickle cell anemia (trapped RBCs in vascular channels)
2. drugs (sildenafil, trazodone, prazosin,methylfainidate, cocaine)
3. cauda equina syndrome

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14
Q

ischemic priapism - management

A

treat immediately with corporal aspiration, intracavernosal phenylephrine, or surgical decompression to prevent ischemia

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15
Q

SCC of penis - epidimiology

A

more common in Asian Africa, South America

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16
Q

SCC of penis - precursor in situ lesions/and their definition

A
  1. Bowen disease –> leukoplakia in penile shaft
  2. erythroplasia Queyrat –> in situ carcinoma of glans, presents as erythroplakia
  3. Bowenoid papulosis –> carcinoma in situ of unclear malignant protention, presenting as redish papules
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17
Q

SCC of penis - risk factors

A
  1. HPV

2. lack of circumcision

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18
Q

Cryptorchidism - sperm vs testosterone - mechanism

A
  • impaired spermatogenesis: sperm develops best at less than 37. sertoli are Q sensitive
  • normal Testosterone levels (Leyding unaffected to Q)
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19
Q

Cryptorchidism - complication / RF

A

high risk of germ cell tumors
RF: 1. prematurity
2. Hypospandias

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20
Q

Cryptorchidism - endocrine profile

A

low inhibin B, High FSH and LH

testosterone low in bilateral, normal in unilateral

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21
Q

MCC of scrotal enlargement in adult males

A

Varicocele

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22
Q

Varicocele - complication

A

infertility because of high temperature

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23
Q

Varicocele - diagnosis

A
  1. standing clinical exam (distention on inspection and bag of worms
  2. US with Doppler (retrograde flow, dilation of pampiniform, tortuous anechoic tubules)3. does not transilluminate
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24
Q

Varicocele - treatment

A

gonadal vein ligation (boys _ young men with test atrophy)

2. scrotal support + NSAID (older who do not desire additional childrenfffff

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25
Q

Testicular tumors are divided to (proportions and behavioural)

A
  1. germ cell (95%) –> Mostly malignant, children mature teratoma benign
  2. non-germ cell (5%) –> mostly benign, but lymphoma is aggressive
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26
Q

Testicular non-germ cell tumors - types and aggressiveness

A

Mostly benign
1. Leydig cells
2 Sertoli cells
3. Testicular lymphoma (aggressive)

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27
Q

Leydig celll tumor - presentation mechanism)

A

produce androgens or estrogens –> gynecomastia in men. precosious puberty in boys

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28
Q

MC testicular cancer in older men

A

Testicular lymphoma

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29
Q

Testicular lymphoma - characteristics

A
  • Not 1ry –> arises from metastatic lymphoma to testes

- Aggressive

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30
Q

Testicular germ cell tumors - risk factors

A
  1. Cryptorchidism

2. Klinefelter syndrome

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31
Q

Testicular germ cell tumors - characteristics

A
  • can resent as a mixed germ cell tumor

- does not transilluminate

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32
Q

Testicular germ cell tumors - types (mc?)

A
  1. Seminoma (MC)
  2. Yolk sac (endodermal sinus) tumor
  3. Chroriocarcinoma
  4. Teratoma
  5. Embryonal carcinoma
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33
Q

seminoma - clinical characteristic / prognosis / marker

A
  • painless, homogenous testicular enlargment
  • excellent –> 1. Radiosensitive 2. late matastasis
  • high placental ALP
  • mildly elevated HCG
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34
Q

tests - Yolk sac (endodermal sinus) - behavioral / appearance / marker

A

aggressive malignancy

  • yellow mucinous
  • Schiller Duval bodies resemble primitive glomeruli
  • high AFP is highly characetristic
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35
Q

MC testicular in boys under 3

A

yolk sac

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36
Q

male teratoma - behaviour

A

unlkie in females. mature teratoma in adults males may be maligntn. Benign in children

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37
Q

testicular choriocarcinoma - marker

A

high HCG

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38
Q

testicular cancer that is painful

A

Embryonal carcinoma

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39
Q

Embryonal carcinoma - markers

A 
if pure (rare) --> high hCG, normal AFP
if mixed with other tumors --> high hCG, increased AFP
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40
Q

Scrotal masses?

A

benign scrotal lesions presents as testicular maasses thatn cen be transilluminated

41
Q

Scrotal masses - types

A
  1. congenital hydrocele
  2. Acquired hydrocele
  3. Spermatocele
42
Q

congenital hydrocele?

A

Common cause of scrotal swelling in infants due to incomplete obliteration of processus vaginalis

43
Q

Acquired hydrocele?

A

scrotal fluid collection usually 2ry to infection, trauma, tumor (if bloody –> hematocele)

44
Q

Spermatocele?

A

cyst due to dilated epididymal duct or rete testis –> paratesticular fluctuant nodule

45
Q

Extragonadal germ cell tumors - location

A

MIDLINE location:

  • adults –> MC retroperitoneum, ediastinum, pineal, suprasellar regions
  • young childrens: sacroccygeal teratomas are MC
46
Q

Paratesticular fluctant nodule

A

Spermatocele

47
Q
  1. Leyding tumor produces
  2. Yolk sac produces
  3. choriocarcinoma produces
  4. seminoma
A
  1. estrogens, testosterone
  2. AFP
  3. HCG
  4. placental ALP, mildly HCG
48
Q

clinical suspicion of testiuclar tumor - next step

A

U/S

49
Q

diagnosis of testicular tumor - next

A

orchiectomy –> then check under the microscope to assess the further treatment
(usually: radiation if local, chemo if widespread)

50
Q

testicular cancer - treatment - seminoma vs nonseminoma

A

seminoma: sensitive to chemo and radio
nonseminoma: sensitive to chemo

51
Q

prostate cancer presents with

A
  1. Obstructive symptoms on voiding (similar to BPH)
  2. palpable lesion on examination
    MOST ARE ASYMPTOMATIC
52
Q

prostate cancer best initial / most accurate test

A

biopsy for both

53
Q

prostate cancer - complications of radiation

A
  1. like prostatectomy (erectile dysfunction is much less common)
  2. diarrhea
54
Q

prostate cancer - hormonal manipulation

A

Flutaminde, GNRH agonists, ketoconazole, and orchiectomy help control the size and progesion of metastases once they have occurred. They are not like tamoxifen in breast cancer. THEY DO NOT PREVENT RECURRENCES. They shrink the lesions that are already present

55
Q

prostate cancer - chemotherapy

A

only if hormonal theray fails

56
Q

prostate cancer - lumpectomy

A

never

57
Q

prostate cancer - US as a screening and other uses

A

it is not a screening test –> it is used to localize lesions to biopsy after a high PSA

58
Q

prostate cancer - PSA

A

controversial:

  1. No clear mortality benefit
  2. Not routinely offered
  3. Normal PSA does not exclude ca
  4. above age 75, do not do even if asked
  5. higher the PSA, the greater the risk (volume of cancer)
59
Q

elevated PSA - NEXT STEP

A
  1. palpable mass –> biopsy
  2. no palpable mass –> transrectal US:
    if mass –> biopsy
    if no mass –> multiple blind biopsies
60
Q

absent of achilles reflex in eledery with difficulty to void

A

may be normal in elderly

61
Q

Mytonoci dystrophy - levels of hormones

A

low test

high LH, FSH, GNRH

62
Q

Common causes of erectile dysfunction

A
  1. vascular (smoking, CAD etc)
  2. neurologic (DM, MS, spinal injury/surgery)
  3. Psychogenic
  4. endocrine
  5. medications
  6. hypogonasisms
63
Q

erectile dysfunction due to neurologic causes - clinical manifestation

A

loss of bulbocavernosus reflex

64
Q

medications that causes erectile dysfunction

A

antihypertensives (esp b-lockers and thiazides), SSRIs, anti-androgen

65
Q

diagnosis of prostatitis - next step

A

culture of mid-stream urine sample

66
Q

acute vs chronic prostatitis regarding treatment

A

acute: TMP-SXM, fluoroquinolones (-6 wks)
chronic: fluoroquinolones

67
Q

when to suspect prostate abscess? next step

A

acute prostatitis continues to fave fever despite antibiotics
–> do an CT

68
Q

metastatic symptoms of testicular cancer

A

back pain, cough, dyspnea, neck mass

69
Q

metastiatic symptoms of testicula cancer - back pain?

A

due to retroperitoneal lymphadenopathy

70
Q

best initial treatment of BPH

A

a1-blocker

finasteride takes months to work

71
Q

treatment of BPH - antimuscarinics?

A

to treat overeactive bladder

72
Q

BPH with atypical presentation (under 50 years old) or no response to medications - next step

A

urodynamic studies

73
Q

transrectal U/S for prostate cancer as screening

A

NO –> low sensitivity

74
Q

do or not PSA for screening

A

discuss it with the patient

75
Q

chronic prostatitis / chronic pelvic pain syndrome - symptoms

A
  1. pain in pelvis, perineum, genitalia
  2. irritateive voiding symptoms (urgencym hesitancy)
    hematospermia, pain with ejaculation
    MORE THAN 3 MONTHS
76
Q

chronic prostatitis/cronic pelvic pain syndrome - diagnosis

A
  1. no or mild prostate teenderness
  2. sterile urine culture
    NORMAL PSA
77
Q

chronic prostatitis / chronic pelvic pain syndrome - management

A
  1. a-blocker
  2. antibiotics (cipro) esp if history of UTI
  3. 5a-reductase inh
78
Q

chronic prostatitis/chrnonic pelvic pain syndrome - = chronic BACTERIAL prostatitis ???

A

no it is different

79
Q

epididymitis presentation

A

irriattative voiding symptoms

scrotal pain, swelling, tenderness, purulent urethral discharge

80
Q

sildanefil - SE?

A
  1. cardiovascular: Hypotenstion (esp with nitrates, a-blockers)
  2. ocular: blue vision, nonarteritic anterior iscemic optic neuropathy
  3. genitourinary: priapism
  4. other: flushing, headache, HEARING LOSS
81
Q

a new SE of sildanefil

A

hearing loss

82
Q

sildanefil is contraindicated with

A

nitrates

a blockers

83
Q

CAD patients under metoprolol has erectile dysfunction - nect step

A

sildanefil (dont stop the b-blocker)

84
Q

indications for cytoscopy

A
  1. gross hematuria with no evidence of glomerular disease or infection
  2. microscopic hematuria wiht no evidence of glomerular disease or infection but increased risk for malignancy
  3. recurrent UTIs
  4. obstructive symptoms with suspicion for stricture, stone
  5. irritative symptoms without urinary infection
  6. abnormal bladder imaging or urine cytoogy
85
Q

BPH vs cancer regarding RF

A

BPH: older than 50
cancer: older than 40, African american, family history

86
Q

penile fracture - test?

A

retrograte urethrogram

87
Q

urinary Stress incontinence - treatment

A
  1. pelvic floor muscle strengthening (Kegel) exercise
  2. weight loss
  3. pessaries ( a plastic device inserted into the vagina)
88
Q

urinary Urgency incontinence - treatment

A
  1. pelvic floor muscle strengthening (Kegel) exercise
  2. bladder training (timed voiding, distraction and relaxation techniques)
  3. antimuscarinics
89
Q

Overflow incontinence - treatment

A 
catherterization
relieve obstruction (α-blockers for BPH)
90
Q

Bladder cancer RFs

A
  1. smoking (until up to 20 years after cessation)
  2. occupational exposures
  3. chronic cystitis
  4. iatrogenic causes (cyclophosphamide)
  5. pelvic radiation exposure
91
Q

cryptorhidism - treatment

A

irchiopexy before age 1 to avoid complications

- if not descent until 6 months is unlikely to descent

92
Q

special characteristics of psychogenic erectile dysfunction

A
  1. sudden
    onset
  2. situational (eg. problem with partner, normal durin masturbation)
  3. normal nonsexual nocturnal erections
93
Q

hydrocele - surgery

A

only after 1 year

94
Q

varicocelle - translumination?

A

no

95
Q

finasteride - SE

A

low libido, erectile dysfunction

- effectiveness after 6-12 months

96
Q

age to start offer PSA

A

40

97
Q

acute vs chronic prostatitis regarding fever

A

not in chronic

98
Q

acute prostatitis with urinary rention –> ….

A

suprapubic catheterization of the bladder

Male CK (2 decks)

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