Usmle Step 1 Dit: Reproduction

Front 1

Most common testicular tumor

Back 1

Seminoma

Front 2

Large cells with watery cytoplasm and a "fried egg" appearance

Back 2

Seminoma

Front 3

Malignant, painless, homogenous testicular englargement

Back 3

Seminoma

Front 4

What is the common age onset of a seminoma?

Back 4

15-35 years old

Front 5

Most common testicular tumor in boys <3 years old

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Yolk sac tumor

Front 6

Tumor of the endodermal sinus

Back 6

Yolk sac tumor

Front 7

Schiller-Duval bodies

Back 7

Yolk sac tumor

Front 8

Yellow, mucinous with aggressive malignancy of testes

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Yolk sac tumor

Front 9

Malignant, increased hCG with disordered syncytiotrophoblastic and cytotrophoblastic elements

Back 9

Choriocarcinoma

Front 10

Hematogenous metastes to lung and brain

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Choriocarcinoma

Front 11

Malignant in males, benign in children and women. Multiple tissue types

Back 11

Teratoma

Front 12

Increased hCG

Back 12

Choriocarcinoma

Teratoma (50%)

Front 13

Increased AFP

Back 13

Yolk sac tumor, Teratoma (50%)

Front 14

Malignant, hemorrhagic mass with necrosis, painful

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Embryonal carcinoma

Front 15

Alveolar/tubular appearance with papillary or glandular convulsions

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Embryonal carcinoma

Front 16

Germ cell tumor with normal AFP and increased hCG when pure and increased AFP when mixed

Back 16

Embryonal carcinoma

Front 17

95% of all testicular tumors are ________

Back 17

testicular germ cell tumors

Front 18

A testicular mass that does not transilluminate

Back 18

testicular CA

Front 19

Risk factors for testicular germ cell tumors?

Back 19

cryptorchidism

Front 20

5% of all testicular tumors are _______

Back 20

Non-cell cell tumors. Mostly benign.

Front 21

Contains reinke crystals

Back 21

Leydig cell tumor

Front 22

Angrogen producing tumor that produces, gynecomastia in men and precocious puberty.

Back 22

Leydig cell tumors

Front 23

Golden brown color appearance

Back 23

Leydig cell tumors

Front 24

Most common non-germ tumor

Back 24

Leydig cells

Front 25

Why does leydig cell tumors produce gynecomastia?

Back 25

Because excess androgen forms estrogen

Front 26

Androblastoma from sex cord stroma

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Sertoli cell tumor

Front 27

What conditions are associated to sertoli cell tumor?

Back 27

Peutz-Jeghers sx, Carney sx

Front 28

Non-germ cell tumors that produce gynecomastia

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Leydig cell*, Sertoli cell tumor

Front 29

Most common testicular cancer in older men

Back 29

Testicular lymphoma

Front 30

Non-germ cell tumor that is not primary, aggressive

Back 30

Testicular lymphoma

Front 31

Lesions in the serous covering the testis that presents as a testicular mass that can be transilluminated

Back 31

Hydrocele, speratocele

Front 32

Increased fluid secondary to incomplete obliteration of processus vaginalis

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Hydrocele

Front 33

Dilated epididymal duct

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Spermatocele

Front 34

Precursors of squamous cell carcinoma

Back 34

Bowen disease, erythroplasia of Queyrat, bowenoid papulosis

Associated to: HPV, lack of circumcision

Front 35

Painful sustained erection, not associated with sexual stimulation or desire

Back 35

Priapism

Front 36

Associated to spinal cord traumas and sickle cell disease

Back 36

Priapism

Front 37

Angulation of the penis, due to inflammation and fibrous tissue formation of tunica albuginea. Very painful.

Back 37

Peyronie disease

Front 38

Benign genital warts caused by HPV 6 and 11

Back 38

Condyloma acuminatum

Front 39

Inflammation of the glans penis, common in uncircumcised and diabetics.

Back 39

Balanitis

Front 40

Most common cause of balanitis

Back 40

40% due to candida

Front 41

Common onset for BPH?

Back 41

present in 80% of men over 80 years old

Front 42

Dysuria, frequency, urgency, low back pain. Caused by bacteria

Back 42

Prostatitis

Front 43

Prostatitis in <35 year olds is caused by

Back 43

Gonorrhea, Chlamydia

Front 44

Prostatitis in >35 year olds is caused by

Back 44

E. Coli, Klebsiella, serratia, enterobacter, proteus

Front 45

Causes of BPH

Back 45

Androgens; increased DHT mostly, can be seen in increased testosterone

Front 46

Nodular enlargement of the periurethral (lateral and medial) lobes, which compresses the urethra into a vertical slit.

Back 46

BPH

Front 47

BPH symptoms

Back 47

increased frequency of urination (every 2h), nocturia (2-3x a night), difficulty starting and stopping the stream, dysuria

Front 48

Complications of BPH

Back 48

Distention and hypertrophy of the bladder, hydronephrosis, UTIs

Front 49

Treatment with nonselective alpha antagonists

Back 49

Cause relaxation of smooth muscle:

CTerazosin, prazosin, doxazosin, prazosin

Front 50

Tamsulosin (flomax

Back 50

BPH Tx

selective alpha-1AD receptor blocker. Fewer SE than non-selective because alpha-1B receptors in blood vessles

Front 51

5-alpha-reductase inhibitors

Back 51

BPH Tx

Finasteride, dubasteride

Slowly reduces DHT levels-> decrease in prostate volume over 3-6mm

SE: decreased libido, ejaculatory disorder, impotence

Front 52

What might you find during a prostate exam of a patient with BPH?

Back 52

Probably not palpable because it is in the anterior lobe and when you introduce finger its opposite to that direction

Front 53

What might you find during a prostate exam of a patient with prostatic adenocarcinoma?

Back 53

Very palpable, hard nodule.

Front 54

Palpable prostate size in BPH

Back 54

Does not correlate with symptom severity

Front 55

What lab is increased in BPH?

Back 55

Increased free prostate specific agent

Front 56

Symptoms of prostatic adenocarcinoma

Back 56

Urinary symptoms same as BPH

Front 57

Common age onset of prostatic adenocarcinoma

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men >50

Front 58

Most common location for prostatic adenocarcinoma

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Poster lobe

Front 59

Diagnosis of prostatic adenocarcinoma is mostly done by:

Back 59

Palpable during exam--> needle core biopsy

Front 60

How is PSA in prostatic adenocarcinoma?

Back 60

Increased total PSA, decreased free PSA

Front 61

Lower back pain in patient with prostatic adenocarcinoma:

Back 61

Think of osteoblastic metastases in bone: also increases ALP and PSA

Front 62

Undescended testis (1 or both)

Back 62

Cryptoorchidism

Front 63

Impaired spermatogenesis (since sperm develop best at temperatures <37degrees), normal testosterone levels (bc leydig cells are unaffected by temperature)

Back 63

Cryptoorchidism

Front 64

How are inhibin, FSH, LH, testosterone levels in cryptoorchidism?

Back 64

Decreased inhibin, increased FSH and LH. Testosterone decreased if its bilateral, normal if its unilateral

Front 65

Dilated veins in pampiniform plexus as a result of increased venous pressure

Back 65

Varicocele

Front 66

"Bag of worms" appearance, can cause infertility

Back 66

Varicocele

Front 67

Diagnosed by ultrasound with doppler

Back 67

Varicocele

Front 68

Inflammation of the epididymis; swollen, tender.

Back 68

Epididymitis

Front 69

Clinically, how do you confirm diagnosis of epididymitis?

Back 69

Elevate testes and there is relief

Front 70

Treatment of epididymitis?

Back 70

<35 years old: think gonorrhea/chlamydia

- ceftriaxone IM then doxycycline for 10 days

>35 years or history of anal intercourse: enterobacteriaecea. Treat with fluoroquinolone for 10-14 days

Front 71

Twisting spermaticord, can lead to isquemia and necrosis of testicle.

Back 71

Testicular torsion

Front 72

Very painful, high riding testes, potential emergency, absent cremasteric reflex.

Ultrasound: absence of circulation to testes

Back 72

Testicular torsion

Front 73

Treatment of testicular torsion

Back 73

Surgical detorsion is preferable*: orqueopexy within 6 hours to prevent permanent lesion.

Manually untwist if surgery is unavailable

Front 74

Treatment for post puberty cryptorchidism

Back 74

Orqueopexy or orqueoectomy

Front 75

Grey, crusty plaque on shaft or gland of penis that appears in 5th decade of life

Back 75

Bowen disease

Front 76

Red, velvety plaque usually on the glands

Back 76

Erythroplasia of queryvat

Front 77

Multiple papular lesiones which do not become invasive, affects young individuals

Back 77

Bowenoid papulosis