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Block 7 - Week 5
mens health
86
Chemistry
Post-Graduate
11/30/2009

Additional Chemistry Flashcards

 


 

Cards

Term
__________ __________ is where malignant prostate tumors arise, and ________ ________ is where BPH occurs.
Definition
Peripheral zone in posterior lobe, transitional zone in lateral/median lobes
Term
T or F: slow stream, frequency, nocturia, and urgency are associated with the presence of prostate cancer.
Definition
False, clinically localized cancer does not cause any symptoms because in peripheral zone however, lower back/hip/rectal pain signify metastasis
Term
What two tests can cause a ultrasound guided prostate needle biopsy pulling 10-12 cores of the peripheral zone to be a required follow up?
Definition
Abnormal PSA/PSA velocity or digital rectal exam
Term
Diagnosis of __________ ____________ requires a re-biopsy of prostate while _________ does not.
Definition
Atypical glands because of high rate of diagnosis change, HGPIN (high grade prostatic intraepithelial neoplasia)
Term
HGPIN (high grade prostatic intraepithelial neoplasia) is techinically not carcinoma insitu but it is a precursor to __________ grade and _________ grade cancer.
Definition
Intermediate, high; not low grade
Term
T or F: Adenocarcinoma arises from the peripheral zone of prostate and high volume on biopsy predicts low volume on pathology while low volume predicts high volume on path.
Definition
False, high=high, low does not equal small volume on final pathology
Term
What is the gleason grading system for prostate cancer based on?
Definition
Glandular pattern of tumor, not cytology
Term
What is the a low and high risk value for both PSA and Gleason Grading?
Definition
Low is less than 10 and stage 6; high is greater than 20 and stage 8-10
Term
T or F: >90% of men with prostate cancer have localized disease.
Definition
True
Term
A prostate metastatic workup gives a bone scan if PSA is greater than _______ and abdominal CT if PSA is greater than ___________.
Definition
10, 20
Term
Discuss the treatment of advanced prostate disease in locally advanced cases, metastatic, and hormone refractory cases.
Definition
External beam XRT +/- hormone deprivation; hormone dep and chemo; chemo, ketoconazole or clinical trials
Term
Localized prostate cancer can be treated with many different modalities like waiting, prostatectomy, external beam rads, and seed implants (brachytherapy) but which one is the best?
Definition
None is better than the other
Term
What are the signs and symptoms of testicular cancer?
Definition
Painless hard mass, lower extremity edema, weight loss, and dyspnea
Term
Testicular cancer is higher in _______ men and prostate is higher in ________ men.
Definition
White, black
Term
Germ cell tumors account for 95% of test cancers with one subtype that is the most slow growing and the most common while another is fast and spreads to the lymph and lungs, name them.
Definition
Seminoma, non-seminomas
Term
T or F: non-germ cell testicular tumors come from the stroma, account for 4% of cancer, and are rarely metastatic.
Definition
True; they come from sertoli and leydig cells
Term
It is known that seminomas can have elevated tumor markers like b-HCG but which non-seminoma subtypes show HCG or AFP?
Definition
Choriocarcinoma, yolk sac
Term
Treatment for testicular cancers includes orchiectomy plus ________ for seminoma, retroperitoneal lymph node dissection for _________, or __________ for metastatic disease.
Definition
XRT, non-seminomas, chemo; although many stages use a combination of all treatments
Term
Name these stages of testi cancer - confined to testes, retroperitoneal lymph nodes, supradiaphragmatic and visceral.
Definition
Stage 1,2,3
Term
T or F: BPH is a clinical diagnosis, not histological.
Definition
False, histo not clinical
Term
Lower urinary tract symptoms, that are either _____________ or ___________, increase with age and are not disease specific or diagnostic of _________.
Definition
Obstructive, irritative, BPH
Term
T or F: evaluation of lower urinary tract symptoms focuses on history, comorbidities, DRE, focused neurologic exam, and the AUA symptom index.
Definition
True
Term
BPH is the most common benign neoplasm in men putting pressure on what part of the urethra?
Definition
Posterior urethra
Term
In the prostate anatomy which part is most commonly obstructing and which is palpated on DRE?
Definition
Lateral, posterior
Term
The two drugs for BPH are alpha blockers and fnasteride, but how do they differ in mechanism and when to be used?
Definition
Alphas are used first and relax smooth muscle around vessels and bladder while working quickly over days; finasteride is most effective in men with large prostate or hematuria requires at least six months by shrinking the prostate and blocking DHT conversion
Term
Phytotherapy is used for BPH, what are the two supplements called?
Definition
Saw palmetto and pygeum
Term
Wqhat is the benefit of PVP laser versus transurethral resection?
Definition
Laser evaporates tissue and limits bleeding, while transurethral resect down to capsule and electrocautery can have more complications.
Term
ID this scrotal problem - Urologic emergency, Intravaginal (adults) versus extravaginal (neonatal), Must detorse within 6 hours of symptom onset or risk testicular death, Acute onset should raise index of suspicion, Scrotal exploration only way to definitively rule out.
Definition
Torsion
Term
ID this scrotal problem - Urologic emergency, Rupture of tunica albuginea leads to extrusion of seminiferous tubules and blood, Important to repair in order to preserve testicular function, decrease complications such as fistula formation and anti-sperm antibodies resulting in infertility.
Definition
hematocele
Term
ID this scrotal problem - Non-communicating most common in adults, Communicating common in newborns, Excess tunica vaginalis fluid production.
Definition
hydrocele
Term
ID this scrotal problem - Cystic dilation of epididymis, Spermatoceles have sperm present, Increased incidence with routine use of scrotal ultrasound.
Definition
Epididymal cyst/spermatocele.
Term
ID this scrotal problem - Acute infection can lead to sepsis, Chronic infection/inflammation can lead to chronic pelvic pain syndrome, Associated with urinary tract infection, STDs, BPH.
Definition
Epididymo-orchitis
Term
ID this scrotal problem - Pathologic dilation of the pampiniform plexus, Causes heavy, dull sensation, Can cause testicular atrophy, Found in 20% of normal men, Found in 40% of infertile men.
Definition
varicocele
Term
T or F: the majority of prostate cancers are indolent.
Definition
True
Term
What are the histo features of prostate cancer?
Definition
Relatively uniform proliferation of small round glands containing malignant tumor cells, Single layer of secretory type tumor cells and lack of basal layer, Some prominent nucleoli.
Term
Immunohisto study of prostate cancer biopsy reveals increased expression of racemase and a lack of basal cells via which two markers?
Definition
High molecular weight cytokeratin, p63
Term
T or f, CVD, venous leakage, and smooth muscle alterations can all be sources of problems for men with ED.
Definition
True
Term
These 3 event s are required for what - arterial flow to corpora cavernosa, smooth muscle relas, decrease of venous outflow.
Definition
Erection
Term
Vascular surgery has not stood the test of time for ED, but implants and inflatables have. What is a critical hormone for erectile function?
Definition
Test, which drops as we age
Term
T or F, Lab diagnosis of Test is via LC/MS/MS (gold standard), and free is measured by equilib dialysis or subtracted from total plus SHBG+T. Bioavailable test can be measured by precip SHBG test and gives albumin bound plus free.
Definition
True.
Term
Test downs bone resorption and increases density, but in older men with low test SHBG is but what happens to free serum T and bioavailable T?
Definition
they are low; old men with low T present the same a young men with low T
Term
T or f, Serum T in old men is correl to cognitive and spatial function, and decreases risk of metabolic syndrome and T2DM due to obesity.
Definition
True
Term
What are the absolute and relative contraindications of test replacemtn?
Definition
Absolute- protaste/breast cancer, hematocrit>55; relative - high hematocrit, BPH, CHF, sleep apnea; best are buccal and transdermal patch/gel
Term
What does test replacement due to lipid profile, coronary arterys, and hematocrit?
Definition
Nothing, benefit, increase via EPO in kidneys
Term
Serum calcium regulation is under the influence of primarily two systemic factors, ________ and ____________ and a number of local bone factors including ______ and __________ ligand which increase osteoclast numbers and osteoprotegerin which reduces osteoclast numbers.
Definition
1, 25 (OH)2D, PTH , M-CSF, RANK
Term
T or f, PTH, 1, 25 (OH)2D3 and local factors interact on the bone, intestine and kidney to maintain a normal serum calcium and calcium balance.
Definition
true
Term
PTH, is cleaved in the ___________ ________ to 84AA, stored in secretory granules and released in response to a fall in serum calcium. This is mainly mediated by the calcium receptor in the plasma membrane. Depletion of intracellular ________ can markedly impair PTH secretion because of its role with Ca receptor expression.
Definition
Endo Retic, Mg
Term
1,25 (OH)2D3, the circulating hormonal form of vitamin D3. 1,25 (OH)2D3 enhances intestinal absorption of _____ and _______ and thereby aids bone mineralization. It also participates in conversion of pre-osteoclasts to osteoclasts and decreases ______ synthesis and secretion.
Definition
Ca, phosphorus , PTH
Term
1,25 (OH)2D3 is produced locally in a diverse number of cells outside the kidney and influences cell differentiation, immunity, muscle function and glucose metabolism. These effects are __________/__________in nature and appear separate from those produced by 1,25 (OH)2D3 in the circulation.
Definition
Autocrine/paracrine
Term
Hypercalcemia may be associated with a large number of disorders; most commonly with ___________- _____________ or a malignancy.
Definition
primary hyperparathyroidism
Term
Measurement of serum ____ is the most useful test for evaluating the cause of hypercalcemia.
Definition
PTH; if high then parathyroidism, if low then other prob
Term
Serum PTH-related protein (PTHrP) is often elevated in hypercalcemic cancer patients, particularly with __________ __________ _______ and __________ _______.
Definition
squamous cell carcinoma, breast cancer;Intravenous bisphosphonate therapy can control the hypercalcemia of malignancy.
Term
T or f, Primary hyperparathyroidism is usually caused by a single parathyroid adenoma (80%).
Definition
true
Term
The classical bone pathology of hyperparathyroidism is termed osteitis fibrosa. What happens?
Definition
Numerous osteoclasts are resorbing bone while osteoblasts are repairing previously resorbed bone. The bone marrow is replaced in some areas by mononuclear cells, probably bone cell precursors, and fibrous stroma. Biopsy reveals severe osteitis fibrosa with some hemorrhage and hemosiderin deposits leading to the term
Term
_______ ______ to the face or neck may cause parathyroid adenomas.
Definition
Rad therapy
Term
Parathyroid hyperplasia (all 4 glands) may be part of multiple endocrine neoplasia syndromes type 1 and 2. Mutations in the _____ gene (type 1) and the ____________ (type 2) produce the syndromes.
Definition
Menin, RET-proto-oncogene
Term
The definitive treatment of primary hyperparathyroidism is ________.
Definition
surgery
Term
Cinacalcet is a drug which interacts with the __________ _________ in the parathyroid and can lower serum PTH and calcium, but is not yet approved for treatment of primary hyperparathyroidism except that caused by parathyroid carcinomas.
Definition
calcium receptor
Term
______________ is most commonly found postoperatively in patients who have had extensive parathyroid or thyroid surgery, and in patients with magnesium deficiency. It is also present in patients with severe vitamin D deficiency.
Definition
hypocalcemia
Term
A positive Trousseau
Definition
hypocalcemia
Term
Magnesium deficiency is common in severely ill patients and develops from ____________ losses and/or ______ losses of magnesium.
Definition
GI, renal
Term
Osteoporosis is defined by bone densitometry. Dual x-ray absorptiometry (DXA) is the most commonly used technique. Osteoporosis is defined by a T-score of ______ or less (indicates the density is 2.5SD below the average of young normal gender-matched individuals). Osteopenia is defined by a T-score of -1 to -2.4.
Definition
-2.5
Term
The overall activity of bone cells can be assessed biochemically. Osteoclast activity can be measured by serum or urine _______________ levels, specific markers for bone collagen degradation. Osteoblast activity can be measured by serum total ________ _________ activity.
Definition
N or C-telopeptide, alkaline phosphatase
Term
What is treat for osteopor?
Definition
These include estrogen, selective estrogen receptor modifiers, bisphosphonates and salmon calcitonin. The only agent which stimulates bone formation is human PTH 1-34 (teriparatide).
Term
The anti-resorptive agents increase bone _______ but not bone _____ to a variable degree and reduce fracture.
Definition
Density, mass; The anabolic agent, teriparatide, increases both bone density and bone mass and thereby reduces fracture risk.
Term
_____________ is characterized by an excess of unmineralized bone which results from an impairment of bone mineralization. Serum alkaline phosphatase is increased as a reflection of increased bone formation. Serum calcium and phosphorus are usually low when severe vitamin D deficiency is present. Hypophosphatemia alone may cause this.
Definition
Osteomalacia ;Impaired bone mineralization is usually due to inadequate calcium and/or phosphorus levels in the circulation, but may be also produced by certain drugs.
Term
_________ develops in children whose growth plates are not fused from similar disorders that cause osteomalacia. There is failure of epiphyseal function leading to impaired growth.
Definition
Rickets
Term
____________ and/or ____________ can result from disorders which cause a reduction of circulating vitamin D metabolites, from disorders which produce chronic hypophosphatemia and from peripheral resistance to 1,25 (OH)2D3.
Definition
rickets, osteomalacia
Term
_________ _________ is a localized disorder which evolves from an initial osteolytic lesion into a sclerotic phase over decades. Hearing loss is common with skull disease and secondary arthritis is common with pelvic or lower extremity disease.
Definition
Paget
Term
What is patho of paget
Definition
Numerous, often very large osteoclasts produce the initial lesion which leads to a secondary increase in osteoblasts and, over time, an increase in bone mass of chaotic structure.
Term
Tx of Paget
Definition
A considerable number of patients are asymptomatic and do not require treatment. The most effective treatments are oral and intravenous bisphosphonates. A single intravenous infusion of zoledronic acid can produce a biochemical remission for up to 6 years.
Term
The osteoclasts of Paget’s disease frequently harbor nuclear and _________ _________ identical in appearance to nucleocapsids of the _________ virus family.  Paget’s disease appears to be a familial, ________ __________  disorder in about 20% of patients.  The _________ gene encodes a protein which appears to control osteoclast activity, differentiation or survival. 
Definition
cytoplasmic inclusions , measles, auto dom, seuqestome 1
Term
Recent studies indicate that ____________ secreted by osteoblasts can stimulate insulin secretion and promote insulin responsiveness. Other recent studies have demonstrated that __________ secreted by osteocytes increases renal phosphate excretion and inhibits the 1 alpha hydroxylase which produces calcitriol.
Definition
Osteocalcin ,fibroblast growth factor 23 (FGF-23)
Term
Metformin is the drug of first choice for diabetes, what is mech, side effects?
Definition
Biguanide inhibits AMP kinase in liver halting glucose production, bad for GI, renal, liver.
Term
Name a sulfonylurea and a meglitinide, with mech, side effects.
Definition
Gliburide, bind SUR1 in beta cells induce insulin secretion, side effects of weight gain and hyhpoglyc, hepatic metab so bad in liver disease; Repaglinide same as other drug, with D-D interactions
Term
Thiazolidines have a delayed onset of action, name a drug, mech, side effects.
Definition
Glitazones, increase insulin senseitivity in fat/muscle via PPARy, effects are weight gain and fluid retention
Term
Name a alpha-glucosidase, with mech, side effects.
Definition
Acarbose, Miglitol, delay carb absorption via competitive inhib in GI, effects are GI
Term
Name a incretin mimetic, with mech, side effects.
Definition
Exenatide injectable, enhance insulin secretion and suppress glucagon in response to glucose load and preserve beta cells, effects are NVD and renal
Term
Name a dipeptidylpeptidase IV inhib, with mech, side effects.
Definition
Sitagliptin, prevents breakdown of GLP-1 and GIP to increase incretin, effects are limited.
Term
T or F, The method for insulin use is to start with long acting agent before bed then switch to basal bolus therapy if doesn
Definition
True
Term
Glargine/Detemir is a ________ acting insulin and NPH is an _________ acting one, which one has better basal rate?
Definition
Glargine has steady basal rate and is long acting, NPH is intermediate and has peak; detemir is also long acting which binds to albumin
Term
What type of insulin in Aspart, Lispro, and Glulisine?
Definition
They are rapid acting insulin analgous.
Term
Pramlintide is first amylin analgouge on market. What does it do?
Definition
Inihbi postprandial glucaon, inhibit gluconeo in liver, slows gastric emptying, effects are nausea
Term
a dilatation of the scrotal veins that can increase scrotal temperature and lead to impaired testicular and epididymal function.
Definition
Varicocele
Term
Which of the following can cause male infertility - Youngs, CF, CBAVD, Kartageners.
Definition
All
Term
T or f, Klenfelter
Definition
False, can cause it; so can microdeletion of Y chrome
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