Gen Path - Class 24

Front 1

What is hypospadias?

Back 1

urethral meatus opens on ventral surface

Front 2

What is epispadias?

Back 2

urethral meatus opens on dorsal surface

Front 3

What is cryptochidism?

Back 3

incomplete descent of the testis into its normal scrotal position. Surgery required to be fixed.

Front 4

How do testes normally develop?

Back 4

Testes develop in the abdominal cavity. Slowly descend through inguinal canal. Permanently fixed in scrotum – by birth and inguinal canal closes.

Front 5

What is retractile testes?

Back 5

3-4% of newborns. Cremasteric muscle pulls testes back because the inguinal canal is open. Usually resolves by the 1st year of life.

Front 6

What are two clinical features of crytochidism?

Back 6

(1)Infertility – usually only if both testes are cryptorchid, (2)10x greater chance of testes tumour. Surgery reduces risk – but higher risk does remain

Front 7

What is hypogonadism?

Back 7

Puberty does not occur leaving testes in the infantile (undeveloped) state

Front 8

What is the pathogenesis of hypogonadism?

Back 8

body does not produce enough of the testosterone hormone

Front 9

What is primary hypogonadism?

Back 9

Also known as primary testicular failure – originates from a problem in the testicles.

Front 10

What is secondary hypogonadism?

Back 10

This type of hypogonadism indicates a problem in the hypothalamus or the pituitary gland – parts of the brain that signal the testicles to produce testosterone.

Front 11

What are two clinical manifestations of hypogonadism?

Back 11

(1)Infertility, (2)Eunuchoid body features (no body hair or pubic hair)

Front 12

What are five common causes of primary hypogonadism?

Back 12

(1)Klinefelter syndrome, (2)Undescended testicles, (3)Mumps orchitis, (4)Hemochromatosis, (5)Injury to the testicles (trauma/cancer treatments)

Front 13

What is Klinefelter syndrome?

Back 13

results from a congenital abnormality of the sex chromosomes, X and Y. The extra X chromosome that occurs in Klinefelter syndrome causes abnormal development of the testicles, which in turn results in underproduction of testosterone.

Front 14

What are undescended testicles?

Back 14

If not corrected in early childhood, it may lead to malfunction of the testicles and reduced production of testosterone.

Front 15

What is mumps orchitis?

Back 15

can lead to long-term testicular damage may occur. This may affect normal testicular function and testosterone production

Front 16

What is hemochromatosis?

Back 16

Too much iron in the blood can cause testicular failure or pituitary gland dysfunction affecting testosterone production.

Front 17

What are five causes of secondary hypogonadism?

Back 17

(1)Abnormal development of the hypothalamus (ex. Kallman’s Syndrome), (2)Pituitary disorders, (3)Infections affecting the hypothalamus or pituitary function, (4)Medications, (5)Obesity

Front 18

What is testicular torsion?

Back 18

Abnormal twisting of spermatic cord as the testis rotates within the tunica vaginalis. Medical emergency. Often congenital. Can also occur with heavy physical activity. Males 8 – 18 y. old.

Front 19

What is the pathology of a testicular torsion?

Back 19

Twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling.

Front 20

What are three clinical features of testicular torsion?

Back 20

(1)sudden onset of pain and swelling, (2)Tachycardia, (3)Nausea and Vomiting

Front 21

What are five infections of the male reproductive organs?

Back 21

(1)Orchitis, (2)Blanitis, (3)Urethritis, (4)Prostatis, (5)Epidydimitis

Front 22

What is orchitis?

Back 22

Complication of a lower urogenital tract infection. E. coli, Chlamydia. Blood infection – syphilis. Mumps – before immunization - 20%

Front 23

What are three clinical features of orchitis?

Back 23

(1)testicular pain and swelling, (2)low abdominal pain, (3)usually no urinary dysfunction

Front 24

What is balanitis?

Back 24

Inflammation of the glans penis. Viral or bacterial infection (Herpes Virus)

Front 25

What is a clinical feature of balanitis?

Back 25

Localized, diffuse redness, swelling or ulceration of the mucosa glans penis

Front 26

What is urethritis?

Back 26

Inflammation of the urethra. STD’s – Gonorrhoeae, Chlamydia.

Front 27

What is a clinical features of urethritis?

Back 27

purulent exudate, pain with urination

Front 28

What is prostatitis?

Back 28

Inflammation of the prostate. Generally affects older men. Bacterial infection – E. coli. Can be difficult to treat as it is difficult to get treatment to the area of infection.

Front 29

What are three clinical manifestations of prostatitis?

Back 29

(1)Pain with urination, (2)Urgency, not able to urinate, (3)Fever

Front 30

What is epididymitis?

Back 30

Inflammation of the epididymis. Ascending infection – a complication of urethritis or prostatitis. Younger men – STD’s. Older men – uropathogens d/t a complication from urinary obstruction or prostatic surgery.

Front 31

What are three clinical manifestations of epididymitis?

Back 31

(1)Gradual onset of scrotal pain and swelling, often developing over several days, (2)Usually located on 1 side, (3)Dysuria, frequency, or urgency

Front 32

What is the most common STI in Canada?

Back 32

Chlamydia

Front 33

What is the incidence of STI's in women and men?

Back 33

Young women ages 15–24

Young men ages 20–29

Front 34

What is genital herpes?

Back 34

Herpes Simplex Virus Type 2. Found of the glans, skin of the shaft or scrotum. Vesicles rupture and transform into shallow, painful ulcers. Heal with no scarring. Often reoccurs – activated when immunocompromised. Virus invades the ganglion cells that innervate the genital area. Genital herpes increases the risk of acquisition of HIV twofold.

Front 35

What is gonorrhea?

Back 35

Bacteria – N. gonorrhoeae. May lead to prostatitis or epididymitis if left. May cause Pelvic Inflammatory Disease in female partner -- infertility

Front 36

What are three clinical features of gonorrhea?

Back 36

(1)Symptoms present 2-5 days after exposure, (2)Results in purulent urethritis, (3)Burning on urination and yellow discharge

Front 37

What is chlamydia?

Back 37

Bacteria – Chlamydia trachomatis. Can only survive inside host cells. Most common cause of bacterial Urethritis in men. Also causes urethritis, endometritis and PID in women (many are asymptomatic). Infection may spread to prostate and epididymis and cause chronic inflammation and pain. Chlamydia infection may cause production of antibodies that cross-react with human antigens expressed on several organs (urethra, eyes, and joints) (Reiter's/Reactive arthritis)

Front 38

What are the clinical features of chlamydia in men and women?

Back 38

Men: Urethral pain, pain with urination, discharge (in some cases)

Women: Pain with urination, pain in the lower part of the belly, possibly with fever, vaginal discharge

Front 39

What is syphilis?

Back 39

Bacteria – T. pallidum. Primary and secondary syphilis are treatable. Tertiary is not.

Front 40

What are three clinical features of the primary stage of syphilis?

Back 40

(1)Painless ulcer – chancre – most often on the glans penis, (2)Local lymph node enlargement, (3)Heals spontaneously in 4-6 weeks ( heals in a few days with abx)

Front 41

What are five clinical features of the secondary stage of syphilis?

Back 41

(1)Systemic spread of the bacteria, (2)2 months to 2 years after initial infection!, (3)Fever, rash, papules (codyloma latum – typically seen on palms and soles), (4)Many other symptoms can occur: CNS irritation, KD sxs, hepatitis ect., (5)Disappears spontaneously

Front 42

What are three clinical features of the tertiary stage of syphilis?

Back 42

(1)Enters a latent phase, (2)2-20 yrs after primary infection, (3)Symptoms may reoccur, cardiovascular issues, CNS issues

Front 43

What is Human Papillomavirus (HPV)?

Back 43

The cause of 99.9% of cervical cancer; also genital warts common in men

Front 44

What are genital warts?

Back 44

AKA Condylomata Acuminata, venereal warts. More than 130 HPV types have been classified, 40 of which can infect the anogenital epithelium (most common is 6 and 11). Anogenital warts caused by HPV are transmitted sexually and have incubation period of 1-6 months. HPV infections are often acquired early (15–19 years of age), and the majority (>80%) of these infections clear spontaneously within 18 months.

Front 45

What are four signs/symptoms of genital warts?

Back 45

(1)Usually appear as soft, moist, pink or grey polyps, (2)Can become pedunculated and usually found in clusters, (3)Surface resembles surface of cauliflower, (4)The vulva, vaginal wall, the cervix and perineum can be involved; can also be found in perianal region and rectum

Front 46

How is HPV linked to cervical cancer?

Back 46

Almost all cases of cervical dysplasia and cancer caused by HPV. High risk types 16 and 18 account for 70% CA cases in N. America

Front 47

What are two types of testicular neoplasms?

Back 47

Germ cell tumours: (1)Seminomas, (2)Teratoma

Front 48

What are two types of prostate gland neoplasms?

Back 48

(1)Benign Prostatic Hyperplasia, (2)Carcinoma

Front 49

What is one type of penis neoplasm?

Back 49

Carcinoma

Front 50

What is testicular cancer?

Back 50

Rare, but the peak incidence is 25 to 45 yoa. 90% are germ cell tumours , 90% are malignant, 90% are curable with modern medicine.

Front 51

What is the etiology of testicular cancer?

Back 51

Unknown

Front 52

What are five risk factors for testicular cancer?

Back 52

(1)Cryptorchidism (10X higher risk), (2)Prenatal estrogen exposure, (3)Scrotal trauma, (4)High radiation exposure, (5)Klinefelter’s syndrome

Front 53

What is the pathology of testicular cancer?

Back 53

neoplastic transformation of germ cells

Front 54

What is seminoma?

Back 54

Most common. Epithelial cells. Peak age is 40 years old. Solid grey/white tumour. 90% cure rate.

Front 55

What are three clinical features of seminoma?

Back 55

(1)Enlargement of testes, solid mass, (2)Discomfort/dull scrotal pain, (3)No lab markers

Front 56

What are nonseminomatous germ cell tumours?

Back 56

Malignant stem cells. Most contain embryonal carcinoma cells alone or in combination with other cell types. 90% survival at 5 years.

Front 57

What are four clinical features of nonseminomatous germ cell tumours?

Back 57

(1)Testicular mass, (2)Peak age is 30 years old, (3)Metastasizes quickly, (4)Often produce HcG and AFP

Front 58

What are four other tumours seen in testicular cancer?

Back 58

(1)Yolk sac tumours – infancy and childhood, (2)Leydig cell tumours – produce excess testosterone, (3)Seritoli cell tumours – benign, (4)Teratoma – from embryonic layers – benign (teratocarcinoma = malignant) (Often have teeth and hair)

Front 59

What are four clinical features of general testicular cancer?

Back 59

(1)Enlargement of the testis with diffuse pain, swelling, and/or hardness, (2)If no pain, can go unnoticed, (3)May present with back pain – particularly if metastasis to retroperitoneal, cervical, and supraclavicular lymphatic chains, (4)+ HcG test – germ cell tumours

Front 60

What are three pathologies of the prostate gland?

Back 60

(1)Prostatitis, (2)Benign Prostatic Hyperplasia, (3)Prostate Cancer

Front 61

What is benign prostatic hyperplasia?

Back 61

BPH is a reactive , benign hyperplastic lesion related to the hormonal changes in the body that occur with aging. Age-related, non-malignant enlargement. 75% of men over 50.

Front 62

What are two risk factors of benign prostatic hyperplasia?

Back 62

(1)Over 50 years old, (2)Smoking

Front 63

What is the pathology of benign prostatic hyperplasia?

Back 63

Decreased cell death -- net increase of prostate cells (hypertrophy) - up to 10x normal size.

Not understood – may be hormonal – androgens and estrogens contribute to hyperplasia

Front 64

What is the pathogenesis of benign prostatic hyperplasia?

Back 64

enlarged prostate compresses the urethra

Front 65

What are eight clinical features of

Back 65

(1)Decreased urinary outflow (weak stream), (2)Forked stream, (3)Difficult initiation, (4)Difficult emptying, (5)Dribbling, (6)Nocturia, (7)Abdominal tenderness with full/distended bladder, (8)risk of UTI’s

Front 66

What is prostate cancer?

Back 66

Adenocarcinoma – 98% of prostate cancer. Most common Cancer in males. 3rd most common cause of cancer-related death in men. Etiology: unknown - may be androgen link

Front 67

What are six risk factors of prostate cancer?

Back 67

(1)Age (over 50), (2)African-American; U.S. and Scandinavia, (3)Family hx, (4)Cadmium?, (5)High-fat diet; high alcohol consumption, (6)Testosterone? – stimulates the growth, (7)Anti-testosterone drugs retard tumour growth

Front 68

What is the pathology of prostate cancer?

Back 68

Starts in periphery of prostate, moves inward. Stages I & II - encapsulated tumour

Stage III - breakdown of capsule -- adjacent spread

Stage IV - metastasis through lymph vessels -- affects nodes in pelvis, and up the thoracic duct -- main metastatic targets: bone & lung

Front 69

What are five clinical features of prostate cancer?

Back 69

(1)May be none, (2)May look like BPH, (3)Bone pain in later stages, (4)other cancer symptoms, (5)possible respiratory symptoms if spread to lungs

Front 70

What are six types of penile disorders?

Back 70

(1)Carcinoma, (2)Squamous cell carcinoma, (3)Bowen’s dz, (4)Phimosis, (5)Peyronle’s dz, (6)Priapism

Front 71

What is a penile carcinoma?

Back 71

Almost all are located on the glans. Thought to be associated with ‘smegma’ – product of penile coronal glands, desquamated cells and bacteria - carcinogen.

Front 72

What is a cause and risk factors of penile squamous cell carcinoma?

Back 72

Poor personal hygiene; RF: STD’s and HPV

Front 73

What is Bowen's disease?

Back 73

Single erythematous plaque, often on shaft (or scrotum) – carcinoma in situ. Mostly in uncircumcised men; peaks around 50 y.o. Incr’d risk of malignancy.

Front 74

What is phimosis?

Back 74

Abnormally tight foreskin; won’t retract. Physiologic phimosis occurs naturally in newborn males. Pathologic phimosis defines an inability to retract the foreskin after it was previously retractible or after puberty, usually secondary to distal scarring of the foreskin.

Front 75

What are three risk factors for phimosis?

Back 75

(1)Poor hygiene and recurrent episodes of balanitis or balanoposthitis lead to scarring of preputialorifices, (2)Forceful retraction of the foreskin leads to microtears at the preputial orifice that also leads to scarring and phimosis, (3)Elderly persons are at risk of phimosis secondary to loss of skin elasticity and infrequent erections.

Front 76

What is Peyronle’s dz?

Back 76

subcutaneous fibrosis over dorsum. Unknown cause – possibly associated with minor trauma. Men with Dupuytren's contractures -- scarring in the hand that affects fingers -- seem to be more likely to get Peyronie's.

Front 77

What is Priapism?

Back 77

intractable painful erection; occ. d/t venous thrombosis in corpuscarvernosa

Front 78

What is a vasectomy?

Back 78

Male sterilization. Vas deferens cut &tied off. Sperm production continues; sperm degenerate. 100% effective. 40% reversible.