1-14 Male GU and Prostate Exam Flashcards
What is the prepuce/foreskin?
Prepuce or foreskin – present on uncircumcised males, covers the glans.
What contains the urethra?
Corpus spongiosum
What is the urethral meatus?
Urethral meatus – vertical slit like opening at the tip of the glans.
What is the lobular division of the prostate gland?
Divided into five lobes. Anterior lobe Posterior lobe Middle lobe 2 Lateral lobes
What lobe of the prostate gland is most susceptible to cancer?
Posterior lobe
What 3 types of hernias are there? Which is the worst to have? What is more common in men?
Indirect - worst
Direct - more common in men
Femoral - least common in men, only hernia below inguinal ligament, and never proceeds into scrotum
What should the male GU Hx involve? What should you do to proceed?
Includes a sexual history of the patient.
Explain why you need to take this history and “ask permission”.
What are the 5 components of the male GU exam?
Penis Scrotum and its contents Hernias Prostate examination Special techniques
What involves the inspection component of the male GU exam?
Skin – lesions or rashes.
Hair – distribution. Lesions, infections,
parasites.
Prepuce or foreskin – if present, need to
retract.
Glans – ulcers, scars, rashes or signs of
inflammation.
Meatus – lesions or inflammation, discharge
How do you inspect the penis?
Gently compress the glans to express any discharge from the urethral meatus.
Also can “milk” or “strip” the penis.
Can put the sample on a glass slide or send for culture.
What STDs can be sampled directly from the penis? What cell types will be present?
STD’s
Chlamydia - WBC
Gonorrhea - WBC with Gm(-) intracellular diplococcic
Trichomonas - WBC with moving organisms
GEN Probe – Chlamydia & GC
How is the penis palpated?
Palpate from the glans to the base.
Note any tenderness, nodules, masses,
inflammation.
Palpate the inguinal areas for lymph
nodes, masses, hernias or tenderness.
How is the scrotum inspected and palpated?
Inspection of the skin and scrotal contours.
Palpation of the testes and epididymis.
Palpation of the spermatic cord.
How is a hernia palpated?
Proper technique for evaluating a hernia. Finger slides up the inguinal canal.
Also palpate the inguinal areas.
Ask the patient to cough or bear down.
How often are hernias bilateral?
direct - 55%
indirect - 30%
femoral - rarely
Where is the impulse location for the different types of hernias?
direct - at side of finger in inguinal canal
indirect - at tip of finger in inguinal canal
femoral - not felt by finger in inguinal canal, mass below canal
What positions can be used to examine the prostate?
Sim’s/lateral decubitus
Modified lithotomy
Standing and leaning forward
How do you do a rectal and prostate examination?
Palpation or Digital Rectal Examination (DRE)
Inform the patient of what is going to happen.
Lubricate your gloved index finger.
Place your finger pad on the external sphincter and ask the patient to relax the sphincter muscles.
Slowly roll and insert the finger as the sphincter relaxes as far as possible.
What should the prostate gland feel like?
Prostate Gland – bi-lobed, heart shaped, consistency of a rubber ball. The inferior aspect of the posterior lobe is best palpated on DRE.
Note size, tenderness, consistency, nodules, etc.
How is the testicular self exam done?
Best performed during or after a bath
or shower.
Examine each testicle with both hands.
Gently roll the testicle between the
thumbs and fingers.
Locate the epididymis on the posterior
surface of the testicle.
Follow up with a physician if you find any
lumps or tenderness.
What is the most common non-skin cancer?
Prostate Cancer
What is the 2nd leading cause of cancer death in men in the U.S.?
Prostate Cancer
What are the screening tests for prostate cancer?
Digital rectal exam (DRE).
PSA – more sensitive than DRE.
PSA screening can detect some cases of prostate cancer. False Positives.
What are some ratings from the USPTF regarding prostate cancer screening?
Rating : I recommendation
The current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than 75 years old.
Rating : D recommendation
Recommends against screening for prostate cancer in men 75 years or older.
What is the rating for testicular cancer screening from the USPTF?
Rating : D recommendation
Recommends against routine screening for testicular cancer.
USPSTF found no new evidence that screening with clinical examination or testicular self-exam is effective in reducing mortality from testicular cancer.
Why does testicular cancer screening have such a low recommendation from the USPTF?
Clinical considerations:
Low incidence of testicular cancer and favorable outcomes make it unlikely that clinical testicular screening would provide health benefits.
Most testicular cancers are discovered by patients or their partners, there is no evidence teaching young men how to examine themselves improves health outcomes.
Clinicians should be aware of testicular cancer as a possible diagnosis when young men present with suggestive signs and symptoms.
What is hypospadias?
Hypospadias – congenital displacement of the urethral meatus on the inferior surface of the penis along the urethral groove.
When is screening for hypospadias important? Why?
Important in a new born exam. Associated with congenital renal abnormalities.
What is phimosis? What is the treatment?
Phimosis – the foreskin cannot be retracted over the penis.
Very painful with an erection.
Hygiene issues.
Treatment – circumcision
What is paraphimosis?
Paraphimosis – Foreskin
cannot be retracted back
over the glans.
Treatment – circumcision
What is hydrocele?
Hydrocele – fluid filled mass within the tunica vaginalis.
Transilluminates with a light.
What is cryptorchidism?
Cryptorchidism – undescended testicle.
Usually atrophied. Increased risk for cancer.
What is a chancre?
Syphilitic Chancre – painless round or oval erosion or ulcer. Non-tender enlarged inguinal lymph nodes are common.
Treponema pallidum – causative organism
What screening tests are available for syphilitic chancres?
RPR and VDRL are positive, screening test, many false positives.
FTA- ABS is positive or Dark Field Microscopy, confirmatory test.
What is secondary syphilis characterized by?
Secondary Syphilis – Any unexplained rash on the body, palms of the hands and soles of the feet.
“Think Syphilis”
What is the incidence of syphilis?
Primary and secondary syphilis reported in the U.S. = 2.4 cases/100,000.
Congenital syphilis = 11.1 cases/100,000 live births.
What are the laboratory tests for syphilis?
Laboratory tests:
Non-treponemal tests (common false positives)
RPR (Rapid Plasma Regain)
VDRL (Venereal Disease Research Lab)
Confirmatory tests
FTA-ABS (fluorescent treponemal antibody absorbed)
TP-PA (T. pallidum particle agglutination)
Dark field microscopy
What are the UPSTF recommendations for syphilis for people at increased risk, pregnant women, and people not at risk?
Rating: A recommendation
Strongly recommends screening patients at increased risk for syphilis infection.
Rating: A recommendation
Strongly recommends screening all pregnant women for syphilis infection.
Rating: D recommendation
Recommends against routine screening of asymptomatic patients who are not at increased risk.
How is risk for syphilis assessed?
Assessment of risk: All sexually active persons 24 years old and younger. Previous history of other STD. New or multiple sexual partners. Inconsistent condom use. Exchanging sex for money or drugs. Early onset of sexual activity.
What is genital herpes characterized by? How is it Dx’ed?
Genital Herpes – cluster of small vesicles. Burning and painful. Progress to ulcers on a erthymic base. Dx – viral culture of the fluid in the vesicle.
What are the causative organisms for genital herpes?
Herpes simplex virus 1 and 2 – causative organism
What are some clinical considerations for genital herpes?
Clinical considerations:
- Virus: Herpes simplex 1 and Herpes simplex 2. - Primary infection – painful lesions, lymphadenopathy, fever, malaise. - Recurrent infections – localized lesions and less symptoms. - Viral shedding is usually asymptomatic. - Pregnant women can vertically transmit HSV to the infant during birth. - Serological testing can differentiate between HSV-1 and HSV-2. - Viral culture of vesicle fluid can confirm active infection. - Treatment – acute and suppressive therapy.
What is the UPSTF recommendations for genital herpes?
Rating: D recommendation
Strongly recommends against routine serological screening for herpes simplex virus (HSV) in asymptomatic adolescents and adults.
There is no evidence that screening asymptomatic adults with serological tests for HSV antibody improves the health outcomes or symptoms or reduces the transmission of the disease.
What are venereal warts? How are they treated?
Venereal warts (Condyloma acuminatum) - caused by HPV (human papillomavirus. Grow in clusters. Difficult to treat – cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara(imiquimod), surgery.
What are genital scabies caused by? Characterization, Dx and treatment?
Genital Scabies:
- Contagious disease caused by a mite (Sarcoptes scabiei)
- Direct skin contact.
- Nocturnal pruritus is very characteristic progressing to intense pruritus.
- Linear, curved or s-shaped burrows.
- Diagnosis: clinical suspicion, slide mount preparation.
- Treatment: Permethrin cream (Elimite), Lindane; oral steroids or antihistamines for pruritus.
What are 2 causes of urethritis?
Gonococcal vs Nongonococcal
What is nongonococcal urethritis characterized by?
Incubation period - 7-28 days onset - gradual dysuria - smarting feeling discharge - mucoid or purulent Gram stain - PMN leukocytes
What is gonococcal urethritis characterized by?
Incubation period - 3-5 days Onset - abrupt Dysuria - burning discharge - purulent Gram stain - gram negative intracellular diplococci
