ED

Question 1

Inability to obtain and/or maintain a penile erection sufficient for sexual activity

Answer 1

Erectile Dysfunction

Question 2

Erectile Dysfunction can be the first sign of underlying CVD (True or False)

Answer 2

True!! 4x the risk for a heart attack (MI)

Question 3

HTN
Diabetes
Dyslipidemia
Smoking
Obesity
Depression... are risk factors for

Answer 3

ED and CVD

Question 4

Pathogenesis for Erectile Dysfunction

Answer 4

Smoking/Diabetes/HTN –> oxidative damage to endothelial cells –> impaired vasorelaxation–> no erection (penis can’t fill with blood)

Question 5

The (Sympathetic/Parasympathetic) nervous system is responsible for erection

Answer 5

Parasympathetic

Question 6

The (Sympathetic/Parasympathetic) nervous system is responsible for emission

Answer 6

sympathetic

Question 7

The (Sympathetic/Parasympathetic/somatic) nervous system is responsible for ejaculation

Answer 7

All three but somatic (majorly!)

Question 8

_______ nerves cause sperm to be moved from the testes to the urethra, then the ________ nerves allow for the final ejaculation out of the Penis

Answer 8

Sympathetic; Somatic

Question 9

Nerve responsible for the SENSORY innervation of the penis

Answer 9

1. Dorsal penile nerve (branch of pudendal nerve)

2. Cavernous nerves (branch of pelvic plexus)

Question 10

Blood supply to the Penis

Answer 10

1. Dorsal penile artery
2. Bulbourethral artery
3. Cavernous artery
   * they are all branches of internal pudendal artery

Question 11

Order of molecular mechanism of Tumescence

Answer 11

1. parasympathetic release of NO
2. Increased intracellular cGMP
3. Inhibition of Ca+2 channels
4. Decreased intracellular Ca+2 (sequestration of ca+2 in ER)
5. Smooth muscle relaxation
6. increased blood flow to penis
7. Tumescence

Question 12

Order of molecular mechanism of Detumescence

Answer 12

1. adrenergic release of NE
2. Increased IP3 and DAG
3. Opening of Ca+2 channels
4. Increased intracellular Ca+2
5. Smooth muscle contraction
6. decreased blood flow to penis
7. Detumescence

Question 13

Connective tissue disorder characterized by the development of dense collagen in the _________ of the penis, resulting in curvature of the erection and sexual dysfunction is called ________. It causes ______ erectile dysfunction

Answer 13

tunica albuginea
peyronie’s disease
vascular leak

Question 14

Continuum of Treatments for Erectile Dysfunction

Answer 14

1. Initial tx:
   - Lifestyle modifications(quit smoking, drinking, lose weight)
   - Change BP meds
   - Treat underlying (DM, HTN, low testosterone)
2. 1st-3rd line tx:
   - PDE-5 inhibitors (oral)
   - IC/IU Injections
   - Penile prosthesis (implant)

Question 15

ED tx with the highest overall patient satisfaction is

Answer 15

penile implant (prosthesis)

Question 16

consider hypogonadism when serum testosterone is

Answer 16

300 ng/dL