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33 Cards in this Set
- Front
- Back
Hyposadias
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Opening of urethra on inferior surface of penis
Due to failure of urethral folds |
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Epispadias
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Opening of urethra on superior surface of penis
Due to abnormal positioning of the genital tubercle Assoc with bladder extrophy |
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Condyloma Accuminatum
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HPV 6 or 11 = koilocytic change
Branching papillary, villous connective tissue stroma Epithelium with hyperkeratosis, acanthosis and koilocytosis No high grade dysplasia |
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Phimosis
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Orifice of prepuce too small to permit normal retraction
Anomalous More commonly due to repeated infection Increased risk of infection and carcinoma |
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Balanoposthitis
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Candida, anaerobes and Gardnerella Leads to smegma (Accumulation of desquamated epithelial cells, sweat and debris) |
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Peyronie disease
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Fibrous bands of corpus cavernosum (benign tumor)
Penile curvature and pain during intercourse |
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Bowen disease
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Type of carcinoma in situ (HPV16) of penile shaft or scrotum
>35 Presents as leukoplakia (solitary, thickened, gray-white plaque) |
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Bowenoid papulosis
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Type of carcinoma in situ (HPV16)
Occurs in sexually active adults, generally younger than Bowen Disease multiple red-brown papular lesions Does not progress to invasive carcinoma Regression with no therapy, just destruction of lesions |
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Invasive Carcinoma
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Poor hygiene + high risk HPV (16)
Papillary or flat lesions on glans or inner surface of prepuce near coronal sulcus Slowly growing and locally invasive Metastases to inguinal lymph nodes Negative lymph nodes – 66% 5 year survival Positivelymph nodes – 27% 5 year survival |
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Cryptoorchidism
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Failure of testicle to descend into scrotal sack
Most common congenital male repro abnormality Orchiopexy if it's not resolved by age of 2. Tack the testicle down to the scrotal sack because the high temperature of the testicle in the body leads to atrophy and infertility and seminoma Marked hyalinization and basement membrane thickening Leydig cells appear prominent May see same changes in other descended testis |
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Orchitis pathophysiology and causes
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Inflammation of the testicle
Causes 1) Chlamydia trachomatis (serotypes D-K) or Neisseria gonorrhea, young aduls. Risk of sterility, but libido is fine because Leydig are fine. 2) E. coli and Pseudomona = UTI, older adults 3) Mumps virus, increased infertility, usually not seen in <10yo 4) Autoimmune orchitis = granulomas in seminiferous tubules Congestion, edema and neutrophils Can progress to abscess Begins in epididymis then spreads to testis Can lead to scarring and sterility |
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Testicular torsion
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Twisting of the spermatic cord cuts off venous drainage, leading to congestion and hemorrhagic infarction
Usually due to congenital failure of tests to attach to inner lining of the scrotum. Manual untwisting within 6 hours may preserve viability Neonatal = shortly after birth Adult = adolescent males Sudden pain, lack of cremasteric reflex |
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Varicocele
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Dilation of spermatic vein due to impaired drainage
Scrotal swelling with bag of worms appearance Left sided vein drains into left renal vein, while right goes directly to IVC, so it's usually left-sided. ASSOCIATED WITH LEFT SIDED RENAL CELL CARCINOMA. Seen in a large percentage of infertile males |
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Hydrocele
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Fluid collection within the tunica vaginalis (serous membrane that covers testicle and internal scrotum)
Associated with incomplete closure of the vaginalis. Leads to peritoneal communication in infants or lymph obstruction in adults. Scrotal swelling that can be illuminated |
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Seminoma
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Malignant Germ cell tumor
50% of testicular tumors Large cells with clear cytoplasm and central nuclei, forming a homogenous mass with no hemorrhage or necrosis Sheets of polygonal cells with prominent nucleoli and a lymphoid infiltrate Resembles ovarian dysgerminoma Rare cases produce β-hCG Good prognosis, responds to radiotherapy |
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Embryonal carcinoma
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Malignant germ cell tumor
Immature, primitive cells that may produce glands. Hemorrhagic + necrosis (unlike seminoma) Varigatedwith foci of hemorrhage and necrosis Cells in alveolar, tubular, or papillary patterns or as sheets Large anaplastic epithelioid appearing cells with prominent nucleoli, tumor pleomorphism, tumor giant cells and mitoses Aggressive, early hematogenous spread Chemo may cause it to morph into teratoma Increased HFP or b-HCG |
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Endodermal sinus tumor (yolk sac tumor)
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Malignant germ cell tumor
Resembles yolk sac elements Most common testicular tumor in children SCHILLER-DUVAL BODIES (glomerulus-like structures) Cells arranged in a lace-like pattern with cells surrounding vessels and containing hyaline globules AFP ELEVATED |
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Choriocarcinoma
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Malignant germ-cell tumor
Multinucleated cells with large amounts of hemorrhage and necrosis Placenta-like tissue without villi Spreads early via blood (like embryonal carcinoma) b-HCG elevated and may lead to hyperthyroidism or gynecomastia due to similar structure to FSH, LH, TSH |
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Teratoma
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Germ cell tumor composed of mature tissue derived from two or three embryonic layers
MALIGNANT IN MALES (as opposed to females) |
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Behavior of seminoma vs non-seminoma germ cell tumors
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Seminomas
remain localized longer 70% present at Stage I Lymph spread Radiosensitive Non-Seminoma Germ Cell Tumor Hematogenous spread early 60-70% present at Stage II/III Overall more aggressive, worse prognosis 90% remission if you use aggressive chemo |
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Lymphoma
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Most common cause of testicular mass in males >60, often bilateral
Usually of diffuse large B-cell type |
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Prostatitis, causes, presentation, etc
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Acute inflammation of prostate.
Usually due to Chlamydia/Gonorrhea in young adults. E.coli and pseudomonas in older adults. Dysuria + fever and chills (low back pain = chronic) Tender, boggy prostate on DRE Prostatic secretions show WBC's, positive urine culture |
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BPH, pathophysiology, relation to DHT, presentation
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Hyperplasia of prostatic stroma and glands
Age-related change (usually after 60 years) DHT acts on the androgen receptor of stromal and epithelial cells leading to hyperstatic nodules central periurethral zone of prostate Starting/stopping issues Impaired emptying leading to infection Dribbling Hypertrophy of bladder, increased risk of diverticula PSA elevated |
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BPH treatment
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1) alpha1 antagonist (terazosin) relax smooth muscle. Also lowers BP. Selective alpha 1A antagonists (tamulosin) are used in normotensive
2) 5alpha-reductase inhibitor Blocks conversion to DHT. Takes months to produce results. ALSO used in male pattern baldness. |
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Prostate adenocarcinoma
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Most common cancer in men. 2nd most common cancer-deaths.
AA > Caucasian > Asian/ Usually arises in peripheral posterior region of prostate, so doesn't initially produce urinary symptoms. Screen beginning at 50 yo. Normal serum PSA increases with age due to BPH PSA > 10 is highly worrisome no matter age Decrease in % free-PSA (cancer is bound PSA) Increased alkaline phosphatase Small, invasive glands with prominent nucleoli Spreads to lumbar spine or pelvis commonly. Low back pain |
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Gleason grading stystem
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Multiple regions of tumor assessed
Score 1-5 is assigned for 2 areas then added together. 2-4 indolent 5-7 treatable 8-10 lethal Higher score = worse prognosis |
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Prostate adenocarcinoma treatment
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Prostatectomy if localized. Hormone suppression if it's advanced.
1) Continuous GnRH analogues (leuprolide) to shut down LH and FSH from anterior pituitary 2) Flutamide (androgen receptor competitive inhibitor) |
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Epidydymitis
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Holding urine for a long time in history (±)
Physical activity causing leakage or pain Prepubertal = E.coli or congenital <35 = Gonorrhea, Chlamydia >35 = E.coli, pseudomonas |
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Treatment for erectile dysfunction
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Phosphodiesterase-5-inhibitors (sildenafil, vardenafil, taladafil)
Vacuum constriction/devices Anti-depressants (SSRI's) |
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Indirect inguinal hernia pathophysiology
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Hernia passes through internal inguinal ring lateral to inferior epigastric artery, into canal with testicular A/V and vas deferens
MC in young men and women<5% strangulate |
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Direct inguinal hernia pathophysiology
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Hernia passes through abdominal wall medial to inferior epigastric artery in Hesselbach triangle
Elderly men Only 30% of inguinal hernias |
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Femoral hernia pathophysiology
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Hernia in upper medial thigh below inguinal ligament
FEMALE PREDOMINANCE High chance of strangulation |
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Treatment for Peyronie Disease
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Vitamin E (?)TamoxifenVerapamilInf a-2bColchicineAminobenzoate
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