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
|
|
Term
| A prostate metastatic workup gives a bone scan if PSA is greater than _______ and abdominal CT if PSA is greater than ___________. |
|
Definition
|
|
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. |
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Definition
|
|
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
|
|
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 |
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|
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
|
|
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
|
|
Term
| BPH is the most common benign neoplasm in men putting pressure on what part of the urethra? |
|
Definition
|
|
Term
| In the prostate anatomy which part is most commonly obstructing and which is palpated on DRE? |
|
Definition
|
|
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 |
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|
Term
| Phytotherapy is used for BPH, what are the two supplements called? |
|
Definition
|
|
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
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|
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
|
|
Term
| ID this scrotal problem - Non-communicating most common in adults, Communicating common in newborns, Excess tunica vaginalis fluid production. |
|
Definition
|
|
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
|
|
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
|
|
Term
| T or F: the majority of prostate cancers are indolent. |
|
Definition
|
|
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
|
|
Term
| These 3 event s are required for what - arterial flow to corpora cavernosa, smooth muscle relas, decrease of venous outflow. |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
|
|
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
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|
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
|
|
Term
|
Definition
|
|
Term
| Magnesium deficiency is common in severely ill patients and develops from ____________ losses and/or ______ losses of magnesium. |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
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
|
|
Term
|
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
|
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
|
|
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
|
|
Term
| Which of the following can cause male infertility - Youngs, CF, CBAVD, Kartageners. |
|
Definition
|
|
Term
|
Definition
| False, can cause it; so can microdeletion of Y chrome |
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