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140 Cards in this Set

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What kind of problem is Erectile Dysfunction?
A functional Disorder
What really is the description of erectile dysfunction?
Inability to achieve and maintain erection
What are the two main causes of erectile dysfunction?
psychogenic or organic organ is most common
What kind of problem is Erectile Dysfunction?
A functional Disorder
What really is the description of erectile dysfunction?
Inability to achieve and maintain erection
What are the two main causes of erectile dysfunction?
psychogenic or organic organ is most common
When the cause of erectile dysfunction is neurogenic, what does it mean?
That there is a nerve problem. Decreasing libido or preventing initiation of erection
Give an example of a nerogenic cause of erectile dysfunction. Remember this is an organic cause
Parkinsons's disease, stroke, cerebral trauma
When the cause of erctile dysfunction is hormonal, what does it mean?
that there is a decrease in androgen levels
When the cause of erectile dysfunction is vascular, what does that mean?
There is arterial insufficiency
Give an example of vascular cause of erectile dysfunction
hypertension, hyperlidipdemia, diabetes, smoking...
When the cause of erectile dysfunction is neurogenic, what does it mean?
That there is a nerve problem. Decreasing libido or preventing initiation of erection
Give an example of a nerogenic cause of erectile dysfunction. Remember this is an organic cause
Parkinsons's disease, stroke, cerebral trauma
When the cause of erctile dysfunction is hormonal, what does it mean?
that there is a decrease in androgen levels
When the cause of erectile dysfunction is vascular, what does that mean?
There is arterial insufficiency
Give an example of vascular cause of erectile dysfunction
hypertension, hyperlidipdemia, diabetes, smoking...
When discussion hyptertension as a vascular cause of erectile dysfunction, what is the pathway for this cause?
Not an increase in blood pressure. It causes lesions that lead to erectile dysfunction.
Most causes of erectile dysfunction in older men relate back to .....
Metabolic syndrome
The treatment for erectile dysfunction includes...
careful history

lab tests to rule out organic causes (cuz they can fix the organic causes)

Psychosexual counseling

Androgen replacement

Vascular devices

Surgery
Where is the Tunica Albuginea?
It is the envelope that holds the corpora cavernosa
What is erythema?
Redness on skin from inflammation...capulary congestion
What is balanitis?
Inflammation and infection of the tip of the penis
What kind of inflammation can you have with Balanitis?
Acute or Chronic
Where is the inflammation with balanitis?
on the glans penis (the tip)
What is balanoposthitis?
inflammation of glans and prepuce
What is the physcial chacteristic that is a common companion to a person who suffers from balanitis?
Phimosis (tight foreskin...)
What are some causes of balanitis?
Poor Hygiene
Bacteria
Smegma
Glandular Secretions
Other than having phimosis, what other physical condition would predispose one to balanitis?
a redundant prepuce that is difficult to clean
What is smegma?
debris from desquamated epithelia that gets stuck under the prepuce and gets infected...causing balanitis
When the causative agents get under the prepuce and get infected, what does it cause? And what does that lead to?
Causes ulcerations of mucosal surface of glans...that lead to scarring of phimosis which further causes balanitis and balanoposthitis
What are some common bacteria that are related to balanitis?
chlamydiae & mycoplasms...could be fungal or yeast too!!!
How do you tx for balanitis?
there is non specific inflammation, so you need to have correct lab id...then abx
What is different about acute superficial balanitis?
has exudate with smell
What is balanitis xerotica obliterans?
a disorder of penis
inflammation and infection
a specific type of balanitis
What is physical problem in balanitis xerotica obliterans?
chronic white pathcy lesion that originates on the glans and progresses to involve the meatus
What is balanitis xerotica obliterans similar to in females?
Lichen Sclerosus
What type of male is a common person to have balanitis xerotica obliterans ?
diabetic, middle aged men
What is tx for balanitis xerotica obliterans?
topical or intralesional injections of corticosteroids
What has localized progressive fibrosis of tunica albuginea?
Peyronie's disease
Where is the tunica albuginea?
surrounds the corpus cavernosum
How does Peyronie's Disease get the fibrous issue?
Inflammatory process...cause is unknown
Where is the fibrous plaque with Peyronie's Disease located?
On Dorsal midline of shaft
What is cause of Peyronie's Disease?
cause unknown...but it looks like severe vasculitis
What are some mans of Peyronie's disease?
painful, bent erection. presence of hard mass at site of fibrosis....hard mass may resolve itself in beginning stages of disease because of remodeling
What is dx for Peyronie's Disease?
ultrasound, physical exam with history
What is tx for Peyronie's disease?
Surgery sometimes, but it is self limiting...antioxidants, or corticosteroids
Where is the fibrous plaque with Peyronie's Disease located?
On Dorsal midline of shaft
What is cause of Peyronie's Disease?
cause unknown...but it looks like severe vasculitis
What are some mans of Peyronie's disease?
painful, bent erection. presence of hard mass at site of fibrosis....hard mass may resolve itself in beginning stages of disease because of remodeling
What is dx for Peyronie's Disease?
ultrasound, physical exam with history
What is tx for Peyronie's disease?
Surfery sometimes, but it is self limiting...antioxidants, or corticosteroids
What can happen if you have Peyronie's Disease?
Erectile Dysfunction ---(vascular organic cause)b/c of veno occlusive dysfunction...failure of veins to close
What does veno occlusive dysfunction mean?
failure of veins to close
What is priapism?
involuntary, prolonged, abnormal painful erection not associated with sexual excitement
Why is priapism a medical emergency?
b/c of ischemia and fibrosis with risk of subsequent impotence
What type of person can get priapism?
Occurs at any age, but it is also common in Sickle Cell anemia sufferers
What is the cause of Priapism?
impared blood flow in corpora cavernosa
What are the mechanisms for impared blood flow in corpora cavernosa (in priapism)?
1) Ischemic (low flow)

2) Non Ischemic (continued arterial flow)
What are some of the characteristics of priapism that is caused by ischemic mechanism? (characteristics that would distinguish it from non ischemic)
more painful & more rigid
When the mechanism of priapism is considered non ischemic, what does that mean?
Continued arterial flow.
With non ischemic priapism, what are some characteristics of it?
no fear of hypoxia of tissue and not a lot of permanent damage
What is cause of the impared blood flow with priapism?
Two ways: Primary (idiopathic) or Secondary
What are some examples of primary cause for priapism?
trauma, infections, neoplasms
What are some examples of secondary cause for priapism?
sickle cell anemia, leukemia, viagara, and testosterone steroids
What are the tx for priapism?
analgesics, hydration, sedation, irrigation of corpus cavernosum with saline shunt
What is a hydrocele?
excess fluid between the tunica vaginalis and the testes
Where does a hydrocele actually appear on the scrotum?
unilateral or bilateral
What are the kinds of causes that hydrocele can come from?
primary or secondary
What do they describe a hydrocele as when they do an examination?
palapable cystic mass
Hydroceles are considered....
benign
What is tx for hydrocele?
surgical correction to alleviate pain or for cosmetic reasons
What is a hematocele?
accumulation of blood in tunica vaginalis
What is a visual manifestation of hematocele?
scrotal skin is dark red
What causes a hematocele?
abdominal surgery, scrotal trauma, bleeding disorder or testicular tumor
What is a spermatocele?
painless, sperm cyst at end of epididymis
What is dx of spermatocele?
transilluminates and is moveable
What is a varicocele?
varicosites of pampiniform plexus (a network of veins in testes)
What is cause of varicocele?
incompetent valves
What is dx of varicocele?
feels like a bag of worms....
What can a varicocele cause?
impotence if not corrected. low sperm concentration and motility reduced
What are testicular torsions?
twisting of the spermatic cord
What are the two types of testicular torsions?
extravaginal torsion & intravaginal torsion
What population gets extravaginal testicular torsions?
neonates
What population gets intravaginal testicular torsions?
most common type....18-30 yrs old
Where is the problem with intravaginal testicular torsions?
testes rotate on long axis in tunica vaginalis...flips up like a light switch
Where is the problem with extravaginal testicular torsions?
testicle and the fascial tunicae that surrounds it rotate around the spermatic cord at the level ABOVE the tunicae vaginalis...twist around cord
What causes testicular torsions?
Usually there is developmental or congenital abnormalities.....so the problem would present bilaterally
How does pt present with testicular torsion?
severe distress, swollen scrotum
What is important in dx of testicular torsion?
must differentiate between epididymitis, orchitis and trauma
What is a defining manifestation of testicular torsion?
Usually testicle is high and in weird place, but ***cremasteric reflext is absent****
Why is testicular torsion a medical emergency?
to save the testicle
What is epididymitis?
Inflammation of the epididymitis (the sack that connects the testicle to the vas deferens...where sperm are born)
Whar are the two types of epididymitis?
sexually transmitted and primary non sexually transmitted
Sexually transmitted epididymitis is associated with this condition
urethritis
Sexually transmitted epididymitis is usually caused by these bacteria
chlamydia trachomatis & neisseria gonorrhoeae
Primary non sexually transmitted epididymitis is associated with these two conditions
UTI and prostatis
How do bacteria get to the epididymus in primary epididymitis? How do they get all the way up there??
Straining, lymphatics of sperm cord or rarely (by the blood)
What are the mans of epididymitis?
unilateral acute pain and swelling with erythema (24-48 hrs)

Maybe pus if the bacteria produce pus
What is dx for epididymitis?
leukocytosis, bacteriuria and pyuria

(increase in WBC due to bacterial infection) pus in urine, bacterial in urine
What is orchitis?
infection of the testes
How does orchitis usually start?
with an infection in genitourinary tract, blood or lymph
What can orchitis be a complication of?
systemic infection (mumps, scarlet fever or pneumonia)
Can babies get orchitis?
No, it does not happen in prepubescent boys
What are mans of orchitis?
fever, painful enlargment of testes with small hemorrhages in tunica albuginea
After acute phase of orchitis, what do you get?
****hyalization of seminoferous tubules & atrophy of testicles
What can happen after you get orchitis?
impared spermatogenesis (from hyalization of seminoferous tubules)

Can become sterile if both testes involved
What is prostatis?
Inflammation of prostate gland
What is primary cause of prostatis?
caterization or instrumentation
What else can cause prostatis?
Secondary.....other diseases
What are the four kinds of prostatis?
asymptomatic inflammatory prostatis

acute bacterial prostatis

chronic bacterial prostatis

chronic prostatis/pelvic pain syndrome
What are the symptoms of asymptomatic inflammatory prostatis?
No symptoms...detected on biopsy or examination of prostatic fluid
What is closely related to acute bacterial prostatis?
UTI...it is a subtype of UTI
What is most common cause of acute bacterial prostatis?
e-coli
What are mans of acute bacterial prostatis?
uti, fever, malaise, myalgia, thick prostrate discharge with lots of wbc and grows pathogens on culture ******
How do you remember the chronic bacterial prostatis?
that it is from recurrent UTI, from g-negs
What is tx for chronic bacterial prostatis?
difficult to treat because abx don't penetrate chronically inflammed prostate
What are the two kinds of chronic prostatis (pelvic pain syndrome)
inflammatory & noninflammatory
Another name for: inflammatory (chronic prostatis/pelvic pain syndrome)
non bacterial prostatis
Another name for:
noninflammatory (chronic prostatis/pelvic pain syndrome)
prostatodynia
What is leukocyte count in inflammatory chronic prostatis?
elevated
What is leukocyte count in noninflammatory chronic prostatis?
normal
What is the cause of inflammatory chronic prostatis?
unknown cause, but maybe an autoimmune disorder
Where is the pain in inflammatory chronic prostatis?
all over your body
What is the cause of prostatic cancer?
Unknown, but many many risk factors
What are the cancers called in prostatic cancer?
prostatic adenocarcinomas
Where are the prostatic adenocardinomas in prostatic cancer?
in the PERIPHERAL zones of the prostate
What is the bladders involvement with prostatic cancer?
b/c of location, the bladder is not involved
Where does prostatic cancer masticisze to ?
bones and lungs..b/c lymphatic spread thru thoracic duct
What are the first symptoms of prostate cancer?
asymptomatic. If you have symptoms than it is advanced
How do you screen for prostatic cancer?
psa and digital rectal exam
What is PSA?
It is a glycoprotein secreted around benign & malignant cells in the prostate. so high psa could mean cancer or not
What type of grading do they do for prostate cancer?
Gleason Grading system. PSA and Serum Acid phosphatase
What is Benign prostatic Hyperplasia? (BPH)
non malignant enlargment of prostate gland
What is physically present with benign prostatic hyperplasia?
large nodular lesions on periurethral region of prostate (area right around urethra)
What do these nodular lesions on the periurethral region of the prostate cause?
they compress the urethra and produce symptoms of dysuria
What is cause of BPH benign prostatic hyperplasia?
unknown cause
What is the dx for benign prostatic hyperplasia?
history, physical exam, symptoms with index rating PSA and serum creatine
What is phimosis?
tightening of prepuce that prevents its retraction over the glans
When is phimosis a urological emergency?
urinary stream obstructed
hematuria
preputial pain is present
Paraphimosis is...
entrapement of retracted foreskin behind coronal sulcus....can lead to ischemia & necrosis