Questions and Answers
What is a characteristic of psychogenic erectile dysfunction (ED)?
Which condition is most commonly associated with organic erectile dysfunction?
What change in morning erections is often observed in organic erectile dysfunction?
What role does history taking play in diagnosing erectile dysfunction?
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Which of the following is a focus during the local examination of a patient with erectile dysfunction?
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What is the typical course of organic erectile dysfunction over time?
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Which of the following is NOT a potential cause of erectile dysfunction?
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In the context of erectile dysfunction, a history of diabetes would most likely indicate what?
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What does the intracavernous injection (ICI) test primarily screen for?
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What is the recommended starting test for evaluating erectile dysfunction?
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How does nocturnal penile tumescence monitoring help in diagnosing erectile dysfunction?
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What factors may be assessed through laboratory investigations in erectile dysfunction patients?
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What happens during the nocturnal erections experienced during REM sleep?
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What indicates normal penile hemodynamics during the intracavernous injection test?
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What kind of tests may be required according to clinical suspicion in erectile dysfunction evaluations?
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What is typically the characteristic response in the case of a venous leak during the intracavernous injection test?
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What is the primary method used for evaluating penile arteries in cases of penile arteriogenic erectile dysfunction (ED)?
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Which of the following criteria indicates normal cavernosal arteries during the ICI test?
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What indicates a suspicion of venous leak in the evaluation of erectile dysfunction?
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What is the normal maintenance rate of saline infusion to achieve and maintain a rigid erection in cavernosometry?
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What characterizes neurogenic erectile dysfunction (ED) in terms of vasoactive agent responses?
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What abnormality would suggest a need for selective internal pudendal angiography?
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In patients with erectile dysfunction, increased end diastolic velocity greater than 5 cm/sec in duplex assessment is indicative of what?
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What is the initial criterion for determining arterial health during the ICI test in men with ED?
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Study Notes
Reflexes
- Cremasteric reflex: contraction of the cremaster muscle, elevating the scrotum in response to cold or arousal.
- Scrotal reflex: regulates the positioning of the scrotum based on temperature.
- Bulbocavernosus reflex: contraction of bulbocavernosus muscle during penile stimulation, indicating nerve function.
Diagnostic Procedures for Erectile Dysfunction (ED)
Laboratory Investigations
- Essential tests include fasting and post-prandial blood sugar, serum testosterone, and prolactin levels.
- Additional tests based on clinical suspicion: liver function tests, renal function tests, and thyroid profile (T3, T4, TSH).
Nocturnal Penile Tumescence (NPT) Monitoring
- Penile erections typically occur during REM sleep, averaging 4-5 times a night in adolescents.
- Frequency and duration of erections decrease with age.
- NPT monitoring differentiates organic from psychogenic ED; the Regiscan is the most precise method for tracking these erections.
Penile Vascular Studies
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Intracavernous Injection (ICI) Test:
- Screens for vasogenic ED using vasodilators (e.g., Prostaglandin E1).
- Normal response: full rigid erection within 10 minutes lasting over 30 minutes.
- Delay indicates arterial issues, while unsustained erections suggest venous leaks; in neurogenic ED, prolonged erection occurs with minimal doses.
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Confirmatory Tests for Penile Arteriogenic ED:
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Duplex Ultrasonography: evaluates penile arteries; normal shows:
- Peak systolic velocity >25 cm/sec.
- Diameter increase >75% post-ICI.
- Selective Internal Pudendal Angiography: invasive, performed before arterial surgery.
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Duplex Ultrasonography: evaluates penile arteries; normal shows:
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Confirmatory Tests for Venogenic ED:
- Indicated if venous leak is suspected; signs include:
- No or unsustained erection in ICI test, normal arteries but elevated end diastolic velocity >5 cm/sec.
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Cavernosometry: assesses intracavernous pressure; normal parameters include:
- Induction rate <40 ml/min.
- Maintenance rate <15 ml/min.
- Pressure drop <40 mm Hg in half a minute post-infusion.
- Indicated if venous leak is suspected; signs include:
Causes of ED
- Systemic disorders: liver, renal, and heart failures.
- Hyperprolactinemia: associated with various drugs including alcohol and marijuana.
- Myxedema: affects hormone levels, leading to dysfunction.
- Medications: estrogen and antiandrogens can contribute to ED.
Diagnosis of ED
History Taking
- Distinguishes between organic and psychogenic ED:
- Psychogenic: sudden onset, intermittent course, short duration, present morning erections, erections during non-coital occasions.
- Organic: gradual onset, progressive course, long duration, absent or weak morning erections.
Physical Examination
- General: assess blood pressure, pulse, and secondary sexual characteristics.
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Local:
- Penis: inspect for Peyronie’s disease, fibrosis, and size.
- Scrotum: evaluate testis size and consistency; assess prostate and seminal vesicles via rectal examination.
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Description
This quiz covers key diagnostic procedures for assessing erectile dysfunction (ED). Focus on understanding the necessary laboratory investigations and reflex tests associated with ED. It is essential for students and professionals in the medical field to familiarize themselves with these critical assessments.
