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133 Cards in this Set

  • Front
  • Back
what is it called when the male urethra forms on the inferior vs superior surface?

inferior- hypospadias
superior- epispadia

hypo= below, epi= above
spadias- like a spade digging a hole
show pics of the spadias. is the regular urethra missing?
yes, disregard 1st aid
yes, disregard 1st aid
how does hypospadias come about?
failure of the urethral folds to seal during development
draw what the sealing of the urethral fold look like? where is the genital tubercle?
how does the genital tubercle move as the urethral folds colse up?
it goes up and out to extend to be te penis
what goes wrong in epispadias embryologically?

what other presentation of the penis is often associated with epispadias?
the genital tubercle goes down below the urethral folds and they close up top

incomplete urethral fold closure (from the gential tubercle splitting it) will cause bifid penis
show pic of epispadias
besides te penis, wat else can be malformed in epispadias? ow so?
bladder exstrophy- bladder in front is also not sealed properly and you can see it from te outside
sow bladder exstropy
wat would appen if males got HPV 6 or 11? histology?
condyloma accuminatas- koilocytic changge
what causes lymphogranuloma verereum?
chlamydia trachomatis
where does chlamydia grow? must it?
an obligate intracellular bacteria

it clams up inside the cells
why does chlamydia have to be inside of cells?
it can't make it's own ATP so it must steal it
What are the 3 serotypes of Chlamydia trachomatis?

which one can cause lymphogranuloma verereum?
what is a serotype?
a different receptor on the surface of the same microorganism
what does lymphogranulosum verereum look like? 2 components
swollen inguinal lymph nodes that may ulcerate
ulcers on the genitals
swollen inguinal lymph nodes that may ulcerate
ulcers on the genitals
dissect lymphogranulosum venereum
lympho- affects the lymph nodes
granulosum- will see granulomas
verereum- relating to the sexual organs
can woemn get lymphogranulosum venereum too?
what are the swollen lymph nodes called?
are the genital ulcers and inguinal lymph node enlargements painful.
not the genital ulcers, but the nodes are
Mnemonic for aspects of serotypes A-C for Chlamydia trachomatis.
A, B, C
Chronic infection
what disease does chlamydia trachomatis A-C cause?
so what is the pathphysiology of trachomas?
the lymphoid follicles and papillae of the inner eyelid start to enlarge and fibrose

the eyelids get so large that the eyelashes double back to the eye and cause corneal abrasions and blindness
What does chlamydia trachomatis D-K cause? 3
PID- fallopian tube scarring --> ectopic pregnancy

pnemonia, trachoma (conjunctivitis)
How do infants contract all the things in chlamydia?
via passage through the birth canal
what is the presentation of neonatal pneumonia here?
staccato cough
what is a staccato? staccato cough?
notes played in music that are separate from each other

short bursts of sudden coughing
treatment for chlamydia trachomatis?
picmonic mnemonic for chlamydia trachomatis/
PIC OF THE conjunctivitis trachoma
so what is chlamydia trachomatis named for?
the type of bacteria and then then conjunctival condition of trachoma
which types are capable of cuaseing trchoma?
A-C and D-K (neonatal)
What should you think is happening if you find vaginall bleeding early in pregnancy 1 vs later on 2?
early- spontaneous abortion
late- placenta previa, placenta abruption
how does chlamydia spread in youir body? mnemonic?
enters mucosa as elementary bodies (young and entering elementary school)

enters endosome once taken in by cells and germinates into reticulate bodies
what forms when the lymphogranuloma venereum heals?
where else can lymphogranuloma venereums spread? why here?
it is in the superficial perineal pouch (superficial iguinal node domaiin) which has no separation from the perianal area
so what can happen when the perianal area heals from the ulcers and inflmmation of lymphogranuloma venereum?
perianal strictures
what is the leading cause of penile squamous cell carcinoma?

how often?
high risk HPV- 2/3rd of the time
what is a risk factor for sqamous cell carcinoma and why?
lack of circumcision because the foreskin can harbor microorganisms and can be more easily irritated and inflammed.
how many WBC's would you see in a male vs female urinalysis?
male- none
female- trace
how would you remove the trace WBC's in women?
pee, stop mid stream, clean with alcohol wipe, collect pee sample
what is the effect of estrogen vs androgens on growth plates?
androgen- closes them
estrogen- inhibits closing
leading 2 causes of prostatitis?
chlamydia and gonorrhea (STD's)
What does BPA function as? how do yyou know?
estrogen- they are blamming the earlier and earlier periods on BPA
Back to penile pathology: penile squamous cell carcinoma.

What are the 3 precursor lesions? name as describe appearance of each.
Bowen disease- leukoplakia on shaft
Erythroplakia of Querat- erythroplakia on glans
Bowenoid papulosis- reddish papules
what is this?
what is this?
erythroplakia of Querat
What is this?
What is this?
bowen's disease
what is this?
what is this?
bowenoid papulosis
So what can cause all these superficial penile lesions?
What do they have in common?
HPV and chronic irritation from things hding under the foreskin

they can all progress to squamous cell carcinoma
Comment on the metastatic potential of each of the 3 lesions/

what is their histology classified as
Bowen and erythroplasia are carcinoma in situ, but will eventually invade the plasma membrane

Bowenoid papulosis is like bowen, but with no capacity to invade
So what should you be most alarmed to see on a penis?
red on the glands or white on the shaft.
or anything with large plaque lesions ahter than papules.
WHat is the most common congenital male reproductive abnormality?
When does the testes usually descend?
before the 1st year
how prevalent is cryptorrchidism?
1% of baby boys
recommended approach to cryptorchismisn? why?
wait to see if it will correct itself

if it doesn't y age two, then you need to perform an orchipexy
Why must you do it by age 2?

2 possible complications
because then the increase heat will increase your risk of testicular atrophy and seminoma
What are the bacterial causes of orchitis in younger adults? be specific. why?
chlamydia trachomatis D-K
neisseria gonorrhea

they are STD's
What are the bacterial causes of orchitis in older adults? be specific. why?
e. coli and pseudomoas- these are things that hang out there and create UTI's. older adults have less sex and less defenses against these ordinary things.
what virus can cause orchitis?
mumps virus
do all males have the capacity to get orchitis?
no, only those greater than 10
who is most dangerous to get mumps and why?
adolescent boys because this can lead to lifelong inferility
What is the remaining cause of orchitis?
What would you see histologically with autoimmune orchitis?

what else does this look like?

also looks like TB
What are 2 ways you can differentiate TB from atoimmune granulomatous orchitis?
TB will have positive acid-fast baccili stain and have necrotizing granulomas
what goes wrong in testicular torsion?

what is the name of the resulting pathology?
the spermatic cord twists on itself, clamping down the thin vein, but leaving the artery open.

you get a hemorrhagic infarction as blood keeps coming in, but can't leave.
2 reasons why it is a hemorrhagic infarction?
blood goes into the tissue and it is a looselyorganized tissue
cause of testicular torsion?
congenital failure of testes to attach to the inner lining of the scrotum or some other twisting of the cord
what is supposed to attach the testes to the scrotum?
a covering called the tunica vaginalis
I though that was just a closed up flap in front?

what is that?

no, that is the processes vaginalis

tunica- tunic = covering
process- like a digit/finger
is it always the fault of the tunica vaginalis not attching? how often is it?
90% it is the tunica's fault, but it can also twist within the tunica
90% it is the tunica's fault, but it can also twist within the tunica
2 presentations of testicular torsion? why for each?
testicular pain- sensitive tissue is dying
loss of cremasteric reflex- nerve is cut off
how do you test for the cremasteric reflex?
scrape a tongue deressor along inner thigh and see if the scrotum lifts up
show what the hemorrhagic infarction of testicular torsion looks like
what is the defintiion of a testicular varicocele?
when the testicular veins are heavily dilated
what do varicoceles look like and why?
bag of worms because all the superficial veins are dilated
bag of worms because all the superficial veins are dilated
what side is varicocele usually on and why?
left because the left testicular vein drains into the renal vein and so has 1 more step to be blocked
most common cause of varicocele?
renal cell carcinoma (not nutcracker syndrome)
where does renal cell carcinoma love to invade?
the renal veins
what condition is highly associated withvaricoceles? why do we THINK this is?
infertility- the heat from all the blood may cause damage to the sperm and the sex cord cells.
which 2 demographics are most prine to testicular torsion and why?
anytime the testes is moving aorund a bunch

right after borth- descending
puberty- growting
describe the diagram of the tunica vaginalis.

does it surround the whole testes? is there a visceral and parietal? how is the process related?
what is the cause of hydrocele in infants vs adults?
infants- failure of process vagialis to close
adults- their process has sealed, but if they have impaired lymph drainage then it can fill with fluid
is there normally fluid in the tunica vaginalis?
how does hydrocele present?

physical exam finding?
scrotal swelling than cannot be transilluminated
scrotal swelling than cannot be transilluminated
what categor of ovarian tumor is absent in testicular tumors and why?
surface epithelial tumors because this layer doesn't exist in men
what will you find on PE of testicular tumors?

texture? pain?
firm, painless mass that cannot be transiluminated
how do we treat testicular tumors different than other tumors?
we don't biopsy
why don't we biopsy? 2 reasons
1. the testicle can leak out stuff afterwards and seed to the scrotum
2. 95% of tumors are germ cell and malignant anyways
two risk factors for germ cell tumors?
cryptorchidism and Klinefelter syndrome?
what is the usual age demographic for testicular tumors?

think lance armstrong
think lance armstrong
what are the two major divisions of testicular tumors? why? 3
seminoma and nonseminoma
seminomas are easily treated and have good prognosis and metastasize late while all the others do the opposite
ovarian analog to seminoma?
histological sign of seminoma?
uniform cells that are large with clear cytoplasm and central nuclei
what is a hormone that seminomas can produce? is this common?
b-hCG and no it is rare
what kind of cancer treatment should we use for seminoma?
what does seminoma look like grossly? mnemonic?
large homgenous mass with no hemorrhage or necrosis - it is the best of the tumors so it looks pretty darn good
large homgenous mass with no hemorrhage or necrosis - it is the best of the tumors so it looks pretty darn good
decribe what an embryonal carcinoma is
what type of cells are there? 2
is it malignant?
a malignant tumor of immature, primitive cells that may also form glands
is embryonal carcinoma malignant? how do yoiu know?

yes, these are embryo-like cells that are designed to grow really fast because embryos grow really fast
can embryonal carcinoma spread to other areas? readily? ewhat route?

yes, quite aggressively because embryos like blood like the placenta and will seek it out right away
What can happen to embryonal carcinoma if you treat with chemotherapy? why?
they can differentiate into more mature cells (like a teratoma)

they are pluripotent and use external signals to know when to differentiate
what things in the blood may be elevated in embryonal carcinoma? Why? 2
AFP- embryos will produce alpha feto protein
b-hCG- it is probably part placenta too (likes to spread hematogenously)
what tumor classically secretes AFP? b-hCG?
AFP- yolk sac
b-hCG- choriocarcinoma
what is this? what is in the red?
what is this? what is in the red?
embronal carcinoma- very purple
red is the glands
what does embryonal carcinoma look like grossly?
Why? mnemonic?
hemorrhagic and necrotic tissue- so agressive that it outgrows blood vessels and breaks them too.
hemorrhagic and necrotic tissue- so agressive that it outgrows blood vessels and breaks them too.
a boy gets a testicular tumor. what is it most likely?
yolk sac tumor
what is this?
what does it look like?
what is this?
what does it look like?
schiller-duval body
looks glomeruloid
schiller-duval body
looks glomeruloid
what two cells are malignant in choriocarcinoma?

which produces b-hCG?
cytotrophoblasts and synctiotrophoblasts (b-hCG)
what are two other conditions that elevated b-hCG can lead to and why?
it is similar in structure to FSH, LH, and TSH
TSH- hyperthyroidism
FSH and LH- gynocomastia
are there villi in choriocarcinoma?
what does choriocarcinoma do that is aaginst regular convention of cancer?
there is just a tiny lesion in the testes/ovary, but massive amounts everywhere else

usually it is the opposite
what is this?
what is this?
choriocarcinoma- larger cells are the synctiotrophoblasts
differences 1 and similaities 2 between teratomas in males and females?
differences- it is malignant in males
similarities- they are composed of mature fetal tissues and are derivved from 2-3 embryonic layers
what things may be raised in the blood with teratomas in males?
AFP or b-hCG
do most germ cell tumors fit into nice little boxes of these categories?
no, most garm cell tumors are mixed
how do you make a prognosis of a mixed germ cell tumor?
you go off of the most malignant tumor type
can seminoas be mixed with non seminomas?
are sex cord tumors usually benign or malignant?
what is this?
what is this?
normal testes histology
normal testes histology
what is the product of leydig cell tumors?
what is the presentation of leydig cell tumors in children vs adults? why?
children- precocious puberyt- too much androgen
adults- gynocomastia - I THINK...
adrostenedione --> peripheral conversion to estrogen --> increase sex hormone binding globulin --> decrease testosterone relative to estrogen
characteristic histology of some leydig cell tumors?

reinke crystals

Reike and crystals are big hoaxes that LIE to people.
what happens histologically to the testes in sertoli cell tumors? why?
tumors increase in side and number because sertoli cells are the lining of the tubules essentially
usual presentation of sertoli cells? why do you think this is?
clinically silent because it is benign and also doesn't produce any hormones
the 15-40 age range is for what kind of testicular tumor?

mnemonic? how do you figure this?
lance armstrong was in this range- and the most common type is germ cell
what should you think of when you find a testicular mass in a man greater than 60 years old?
are germ cell tumors and lymphomas each usually bilateral or iunivlareral? why?
lymphoma- bilateral because the lymph is everywhere
germ cell tumor- unilalteral like most primary cancers
what kind of lymphoma is it usually in the testicles?
B cell
Let's sum it up!
What are the penile pathologies? 5
count thing separately
1. epispadias
2. hypospadias
3. condyloma accuminatas
4. squamous cell carcinoma
5. Lymphogranuloma Venereum
3 precursor lesions to squamous cell carcinoma of the penis?
bowen disease
erythroplakia of Querat
bowenoid papulosis
mnemonic for bowen and querat?
White Bowflex, Red Quaran
Imagine a penis with cancer that just watched "sexy crazy cancer" who is now working out on a white bowflex and adpting religion bby dipping it's tip into a red quaran
What are the testicular pathologies (non tumor) 5
1. orchitis
2. testicular torsion
3. varicocele
4. hydrocele
5. cryptorchidism
What are the testicular tumors? divide into 2 types
5 for germ cell
2 for sex cord
Germ cell
1. seminoma
2. embryonal carcinoma
3. teratoma
4. choriocarcinoma
5. yolk sac tumor

Sex Cord
1. Leydig cell tumor
2. Sertoli cell tumor
what other testicular mass can be present that isn't a tumor?