8. Male Genital Exam

Question 1

When should a male genital exam be performed?

Answer 1

1. All pediatric well-visit exams and at a sick visit, if needed.
   
   1. • with guardian/parent or chaperone
2. All adolescent well-visit exams until patient reaches Tanner Stage 5
   
   1. • chaperone and parents outside of the room; pt can refuse chaperone but document
3. After Tanner stage 5 (late adolescent/men) => as needed with
   
   1. signs/symptoms
   2. specific needs
   3. PMH of germ cell tumor or cyptorchidism
   4. FH of testicular cancer

Question 2

_____ is associated with testicular cancer 7-`10% of the time.

Answer 2

Cryptochordism

Question 3

Testicular cancer

1. MC in ____ YO
2. Most testicular cancers are ______ tumors
3. Prognosis with treatment is generally ______.
4. How is screening performed and on who?
5. If no risk-factors, is self-exam recommended?

Answer 3

1. 15-35YO
2. Germ-cell
3. Excellent
4. Screening = PE, routinely ONLY on men who have risk-factors.
5. No

Question 4

Why don’t we perform a routine testicular exam in post-pubertal men with no risk factors for testicular cancer?

Answer 4

The low incidence and high cure rate of testicular cancer make it unlikely that screening for testicular cancer would decrease mortality rate.

• 2/3 are at stage 1 and can create false-+

Question 5

it is ALWAYS important to tell male patients to be seen if what?

Answer 5

they notice anything abnorlam in genital region

Question 6

GU exam

• GU exam occurs when during a head-to-toe exam?
• Before GU exam, obtain __________.
• Steps?

Answer 6

• at the end
• comprehensive GU and sexual history
• 1. Wash hands and put on gloves
• 2. Pt stands with feet shoulder length apart, next to something to stabilize themselves.
• 3. Doc sits on a stool in front of pt
• 4. Pt lifts gown, lowers/removes shorts
• 5. Check-in with pt often

Question 7

Order of the Male Genital Exam

Answer 7

Examine

1. Inguinal/pubic area
   
   1. inspect
   2. palpate inguinal/suprapubic area
2. Look for hernias
   
   1. inspect for visible hernia
   2. palpate
3. Penis
   
   1. inspect shaft (dorsal/ventral side), prepuce, glans, meatus (press glans to open)
   2. palpate ventral/dorsal and lateral sides shaft and glans
4. Scrotum
   
   1. inspect scrotum by stretching anterior/posteiror folds of sac
   2. palpate scrotal sac and all sides of testis and epididymis
   3. palpate spermatic cord and vas deferens (look for dilation/varicocele, edema, continuity)
5. Rectal/prostate if indicated
6. Breast (if needed)

Question 8

How do you examine for inguinal hernias?

Answer 8

1. Place index finger in the loose scrotal skin below the inguinal canal and directly alongside the spermatic cord (right finger, patient’s right, and vice-versa
2. Follow the spermatic cord through the neck of the scrotum at an angle coinciding with the inguinal canal…until the finger reached the opening of the external inguinal ring (1-2cm)
3. Tell patient to bear down or turn his head and cough
4. Knot at end of finger => indirect inguinal hernia
5. Knot at the side of the finger => direct inguinal hernia

Question 9

How do you palpate all sides of testis?

Answer 9

1. Thumb on anterior side, 2-3 fingers on posterior side with enough pressure to move testicle in fingers.
2. Note size, shape, consistency, nodule, tenderness
   
   1. L is usually lower
   2. R is usually larger

Question 10

If we feel a scrotal mass, what can helps us differentiate diagnosis of [hydrocele vs hernia vs solid mass]?

Answer 10

Trans-illumination => detects hydrocele

Question 11

What 2 things are important when palpating scrotal mass?

Answer 11

1. Is the testicle palpable separate from the mass?
2. If there is a swelling/mass in the scrotum, can you isolate it within the scrotum or does it seem to be continuous into the inguinal canal?

Question 12

When is a rectal and prostate exam indicated?

Answer 12

1. Blood in stool
2. Constipation
3. Pain w poop
4. Symptoms of prostate inflammation/infection/enlargement
5. Over 50YO and pt chooses prostate exam/PSA test

Question 13

Before starting rectal and prostate exam, what is important to do?

Answer 13

Explain purpose and procedure: pt may feel pressure or have urge poop/pee

Question 14

How to perform rectal exam.

Answer 14

1. Visually inspect [sacrococcygeal area => anus => perianal area]
2. DRE
   
   1. warn pt, use lube, place finger against anus to allow relaxation, slowly inserrt and follow up anterior wall as far as it will go: sweep top of prostate and palpate, sides of rectum
   2. remove finger
   3. remove lube
   4. if stool is on glove => test for occult blood

Question 15

what is a hydrocele?

• Diagnosed?
• Test?

Answer 15

• Fluid around testis in tunica vaginalis that causes painless swelling of scrotum.
• Usually dx at birth and resolves in a year, but can develop in adulthood
• Trans-illuminate

Question 16

what is cryptochrodism?

• What happens if not fixed?

Answer 16

• Absence of 1 or both testes in scrotum (undescended testes), often in inguinal canal.
• If not returned by 6 months => surgery bc will affect fertility and increase risk of testicular cancer

Question 17

which type of inguinal hernia can be present in testes?

Answer 17

indirect

Question 18

what problem is a surgical MRGNC and CANNOT wait until tomorrow?

Answer 18

Testicular torsion => spermatic cord, which provides blood to testicle, rotates and becomes twisted => super painful

Question 19

sx of testicular cancer?

Answer 19

1. lump in either testicle
2. heaviness
3. dull ache in abdomen/gruin
4. sudden fluid in scrotum
5. pain/discomfort in testicle/scortum
6. back pain
7. enlargement/tenderness or breasts