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Endocrine / Reproduction > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Malformations of penis

A

Hypospadias (most common)- opening on ventral surface due to faulty closure of urethral folds
Epispadias (rarer)- opening on dorsal surface due to defect in genital tubercle
Phimosis- orifice of prepuce is too small to retract over head bc scarring from prior infxn

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2
Q

Inflammatory lesions of penis

A

Balanitis: glans infxn
Balanopothitis: glans and prepuce
More common in uncircumsized, accumulation of smegma
Candida, pyogenic bacteria, anaerobes

must be distinguished from ammoniacal dermatitis: normal redness seen in diapers

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3
Q

Peyronie’s disease

A

type of fibromatosis
painful contractures of the penis
may cause infirtility

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4
Q

squamous cell carcinoma in situ (CIS) of the penis

A

Bowen disease: leukoplakia involving shaft and scrotum, over 35yo, HPV16,18 assoc, sometimes precursor to invasive scc
Erythroplasia of Queyrat: erythroplakia of mucosal surface of glans and prepuce, HPV16 assoc, precursor to invasive scc
Bowenoid papulosis: pigmented reddish brown papules on external genetals, HPV16 assoc, NO risk of invasive scc

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5
Q

Invasive squamous cell carcinoma of penis

A 
most common cancer of penis
40-70yo
usually glans or prepuce
HPV16,18 assoc usually
smoking, no circumcision, CIS are risks
metastasizes to inguinal and iliac nodes
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6
Q

Varicocele

A

blockage of spermatic veins
usually left sided bc left renal vein, bag of worms appearance
very common cause of infertility

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7
Q

Hydrocele

A

accumulation of fluid around testes due to secretion into tunica vaginalis (peritoneum remnant)
common (bike riders)
dx: ultrasound
Tx: remove TV

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8
Q

Cryptorchidism

A

failure of testes to descend into scrotum (usually found in inguinal canal)
increased risk of infertility and germ cell tumors
Tx: orchidopexy (move testes down) doesnt decrease germ cell tumor risk

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9
Q

Orchitis

A

painful inflammation/swelling and frequent infection of testis
mumps (infertility rare, usually unilateral, usually adults)
congenital or acquired syphilis, HIV, acute epididymitis

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10
Q

Epididymitis

A

less than 35yo: Neisseria gonorrhoeae, chlamydia trachomatis
over 35yo: E coli, pseudomonas aeruginosa
also TB
Sx: scrotal pain, swelling, tenderness, urethral discharge(is sex transmitted)
Prehn’s sign: elevation of scrotum decreases pain

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11
Q

Torsion of testis

A

spermatic cord is twisted
predisposing: trauma, cryptorchid, atrophy
sudden onset of testicular pain
elevation of scrotum does NOT decrease pain
Tx: immediate surgery to prevent hemorrhagic infarction

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12
Q

Intratubular germ cell neoplasia, unclassified type (IGCNU)

A

seen in cryptorchidism
share many features with seminoma, may be precursor
has karyotypic abn, structural changes, PLAP+

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13
Q

testicular germ cell tumors

A

seminoma (most common, 40syo)
mixed
non-seminomatous (20-30syo): embryonal, yolk sac, choriocarcinoma, teratoma

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14
Q

Seminoma

A

40syo
AFP is normal, bHCG can be elevated, PLAP+
solid nests with fibrous septa, lymphoid infiltrate
Tx: surgery, radiation, carboplatin

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15
Q

Non-seminomatous germ cell tumors

A

chemo, but not radio sensitive
Embryonal ca: AFP is normal, hCG can be elevated, fleshy gray with prominant necrosis, gland-like
Yolk-sac: most common in infants, elevated AFP, white/tan masses with myxoid and cystic change, schiller-duval bodies
Teratoma: young kids, mixed in adults, can be mature or immature(worse)
Choriocarcinoma: bHCG is elevated, metastasizes to brain/lungs, multinucleated syncytioblasts

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16
Q

Sex-cord stromal tumors

A

Leydig cell: mostly adults, usually unilateral, usually benign but can be malignant, clear cytoplasm
Sertoli cell: can be malignant, estrogen production by tumor can cause gynecomastia and impotence, closely packed cords

17
Q

Lymphoma and plasmacytoma in testis

A

lymphoma is most common tumor over 60yo

usually diffuse large B-cell type

18
Q

Adenomatoid tumor (epididymis)

A

always benign

mesothelial origin, circumscribed nodule, spiderweb cytoplasm

19
Q

Vasitis Nodosa (spermatic cord)

A

usually after vasectomy, at blind end of vas deferens

resembles invasive adenocarcinoma, but sperm, inflammation, and NO atypia are present

20
Q

Prostatitis

A

acute: causes: intraprostate reflux of urine, pathogens (e coli, P aeruginosa, K pneumonia)
chronic: usually abacterial, recurrent acute prostatitis
Sx: fever, lower back, suprapubic pain, painful gland on rectal exam, dysuria, elevated PSA,, elevated WBCs or bacteria in end of urine specimen
granulomatous: due to prior instrumentation, other trauma, or TB, fungal

21
Q

Chronic Pelvic pain syndrome (CPPS)

A

a type of chronic nonbacterial prostatitis
prostatitis without UTI or positive cultures
chlamydia, ureaplasma urealyticum, trichomonal vaginalis

22
Q

Benign prostatis hyperplasia (BPH)

A

transition zone proliferation of glands and stroma
androgen-dependent process
sx: signs of urinary obstruction, hematuria, PSA mildly elevated
Tx: alpha-blockers to relax smooth muscle, 5a-reductase inhibitors to reduce growth of gland, surgery

23
Q

High grade prostatic intraepithelial neoplasia (HGPIN)

A

precursor to invasive cancer, does not on its own increase PSA
large nucleoli

24
Q

Prostate cancer

A

almost always in peripheral zone, thus accessable to rectal palpation
graded on gleason scale based on atypia
atypical small acinar proliferation (ASAP): a finding on biopsy indicative of cancer, needs to be followed up
Spread: seminal vesicles, external iliac lymph nodes, low back bones (via batson venous plexus)
5a-reductase inhibitor: dutasteride

25
Q

Linear model of sexual response

A 
desire
arousal/excitement
plateau
orgasm
resolution/ refractory period in men
26
Q

Sexual pain disorders

A

Vaginismus: recurrent or persistent involuntary contraction of perineal muscles when insertion is attempted
Dysparenunia: genital pain assoc with intercourse

27
Q

Treatments for sexual dysfunction

A

SSRIs: delay orgasm
Opioid antagonists and vasodilators: erectile disorders
PDE5 inhibitors: erectile dysfunction
Behavior therapy

28
Q

Sexual dysfunction

A

biological, psych, or interpersonal probs
primary: lifelong (rare)
secondary: acquired
must cause significant distress, and not better explained by another mental disorder
Causes: diabetes, adhesions, SSRIs, alcohol, hormonal probs, stress, depressions, etc
DO NOT assume anything

29
Q

Gender identity disorder

A

significant discomfort caused by disagreement with assigned gender
strong persistent cross-gender identification
must not be for reasons of advantages of other sex
must be persistent discomfort, significant distress
must not have another intersex physical condition
Tx: treat mood/anxiety, hormonal tx, sexual reassignment surgery

30
Q

Postpartum mood disorders

A

blues: normal, peaks at 3-5d, resolves in 2w
Depression: onset 2-12w, match sx of major depressive episode, lasts more than 2w, risks: hx, short inter-preg interval, health probs, younger mother

31
Q

Male vs female devo stuff

A

Male:
SRY gene on Y chrom, has TDF (testicular det factor) (week 6-7)
germ cells form spermatogonia
Sertoli cells express Sox9 and AMH
Leydig cells secrete testosterone (week 8)
Female: lack of SRY, so WNT4 expression instead

32
Q

Mesonephric duct stuff

A

Males: presence of testosterone- growth and diff of mesonephric ducts supported, makes semenial vessels,, AMH stimulates regression of paramesonephric ducts
Females: absence of testosterone- mesonephric ducts atrophy,, absence of AMH- paramesonephric ducts form uterus, oviducts, upper vagina

33
Q

46XX disorders of sex development (DSD)

A

excessive fetal androgen= CAH (21-OH def)- most common
also excessive maternal androgens, drugs, other congenital anomalies, ovotesticular dsd, XX males via SRY on X-chromosome

34
Q

46XY DSD

A 
mostly idiopathic
defect in testicular differentiation, sertoli cell fux, leydig cell fxn
defect in androgen taget tissues
gonadal dysgenesis
CAH
35
Q

Ovotesticular DSD

A

both ovarian and testicular tissue with normal responsiveness to hormones
spectrum from feminine to masculine
mostly 46XX, can be xy or mosaic
Tx: gonad biopsy as infant, surgical reconstruction and matching

36
Q

Complete androgen insensitivity (CAIS)

also: Complete testosterone biosynthetic defect

A

XY
testes develop, androgens are produced but body cannot respond
wolffian ducts regress, MIS is produced, mullerian ducts do not develop
ext genitals are female
feminizing puberty without menses
Tx: gonadectomy due to ca risk, HRT
identify as females

37
Q

Partial androgen insensitivity (PAIS)

A

very difficult to assign gender, 46XY
normal-high testosterone, normal MIS
surgical reconstruction often delayed until puberty
very variable, male or female identifications

38
Q

Congenital adrenal hyperplasia

A

21-OH deficiency usually
XX, ovaries develop
no testicular androgens, but excessive adrenal androgens
wolffian regress, mullerian develops, no MIS
ambiguous ext genitalia
feminizing puberty if tx with cortisol

Endocrine / Reproduction (7 decks)

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