Pharmacology of Erection
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Questions and Answers

What is the next step in the treatment of a patient with scrotal edema and erythema?

  • Empiric therapy with ceftriaxone and doxycycline (correct)
  • Scrotal ultrasound
  • Percutaneous epididymal biopsy
  • Testing for hepatitis B and C

    • Why is culture of expressed prostatic secretions not recommended?

  • The patient has a history of urinary tract infections
  • The patient has a history of hepatitis B and C
  • The patient presented with symptoms of prostatitis
  • The patient did not present with symptoms of prostatitis (correct)

    • What is often detected as crepitus on physical examination?

  • Subcutaneous emphysema (correct)
  • Urethral Gram stain
  • Subcutaneous edema
  • Scrotal erythema

    • What is the next step in the treatment of a patient with a 1 cm stone within the ileal conduit?

    <p>Endoscopy and basket removal of the stone</p> Signup and view all the answers

    Why is the patient asymptomatic?

    <p>He is afebrile</p> Signup and view all the answers

    What is not recommended in the treatment of the patient?

    <p>Culture of expressed prostatic secretions</p> Signup and view all the answers

    What is the dose of ceftriaxone in the empiric therapy?

    <p>250 mg IM in a single dose</p> Signup and view all the answers

    What is the duration of doxycycline treatment?

    <p>For 10 days</p> Signup and view all the answers

    What is the dose of doxycycline in the empiric therapy?

    <p>100 mg orally twice a day</p> Signup and view all the answers

    What is the location of the stone in the patient with the ileal conduit?

    <p>Within the ileal conduit</p> Signup and view all the answers

    Study Notes

    Male Sexual Function and Dysfunction

    • Erection is maintained by post-ganglionic sympathetic adrenergic nerves, which release norepinephrine as their primary neurotransmitter.
    • Parasympathetic stimulation causes erection through non-adrenergic, non-cholinergic neuronal release of nitric oxide, leading to relaxation of penile smooth muscle.
    • Acetylcholine, vasoactive intestinal polypeptide, cyclic GMP, and prostaglandin would result in tumescence rather than detumescence.

    Urology

    • In the evaluation of nongonococcal urethritis, erythromycin (500 mg four times daily) or ofloxacin (300 mg twice daily) is indicated for 10-14 days.
    • Spectinomycin, ceftriaxone, amoxicillin-clavulanic acid, and penicillin are not indicated for the treatment of nongonococcal urethritis.

    Metabolic Stone Evaluation

    • A urine pH of 5.45 and total urinary uric acid of 368 mg/day (normal < 650 mg/day) are notable findings.
    • Potassium citrate therapy can increase urinary uric acid levels.

    Case Studies

    • A 16-year-old phenotypic girl with primary amenorrhea and testes found on laparoscopic examination has a karyotype of 46,XY.
    • The tumor most likely to develop is a gonadoblastoma if the gonads are not removed.

    Erectile Dysfunction

    • Vascular assessment evaluates peak systolic velocity, end-diastolic velocity, and resistive index.
    • A peak systolic velocity of < 25-30 cm/sec suggests arterial insufficiency, while an end-diastolic velocity of >5 cm/sec suggests veno-occlusive dysfunction.
    • A resistive index of < 0.80 suggests veno-occlusive dysfunction.

    Adrenal Gland and Nerve Supply

    • The nerve supply of the adrenal gland is sympathetic to medulla.
    • The adrenal gland receives sympathetic innervation.

    Testicular Sperm Extraction

    • Assay of testosterone, LH, and FSH is not needed in a patient with a diagnosis of Kallmann syndrome.
    • Testicular sperm extraction requires hormonal treatment to stimulate spermatogenesis.

    Uroflow and Urodynamic Studies

    • Uroflow represents the combined dynamics of the outflow tract and detrusor contractility.
    • A decrease in peak uroflow may be due to either obstruction of the outflow tract, poor detrusor contractility, or both.
    • There is minimal to no correlation between peak uroflow and IPSS.

    Radiation Safety

    • The maximum yearly dose recommended by the National Council on Radiation Protection and Measurements is 5,000 mrem or 5 rem to the entire body.
    • The maximum recommended dose to a fetus is 0.5 rem, and 50 rem to an individual body organ.

    Orthotopic Diversion

    • CIS in the bladder, tumor at the bladder neck, and positive pelvic lymph nodes are not contraindications for orthotopic diversion.

    Clitoral Anatomy

    • The nerves at the mid-portion of the clitoral body are found dorsally.
    • The clitoral neural anatomy is similar to that of the normal male penis.

    Endocrine Neoplasia and Hypertension

    • A 50-year-old man with multiple endocrine neoplasia type 2, hypertension, and an adrenal mass requires treatment for hypertension and further evaluation.

    Urinary Tract Infections and Scrotal Edema

    • Empiric therapy with ceftriaxone and doxycycline is indicated before laboratory test results are available.

    Ileal Conduit and Stone Management

    • A 1 cm stone within an ileal conduit requires further evaluation and management.
    • The next step is likely endoscopy and basket removal of the stone.

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    Related Documents

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    Description

    This quiz covers the pharmacology of erection, including the role of sympathetic and parasympathetic nerves, and the antibiotics used to treat related disorders.

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