Female/Male Genitalia

Question 1

Masses and enlargement in male breast: How do you assess and what could this mean?

Answer 1

Breast tissue in adolescent males- may enlarge (gynecomastia) which may disappear on its own
May be drug related- certain meds, or recreational drugs (spironolactone can cause this)

Question 2

Uterus & adnexa & ovaries

Answer 2

Palpate the uterus- usually 2 fingers in the vaginal canal and palpate the uterus with the other hand/fingertips

Question 3

anal wink

Answer 3

everyone

checking the anal sphincter tone assessing sacral reflex

Question 4

Menopause what are normal occurrences and what are abnormal?

Answer 4

Post menopause = > 1 yr without bleeding

RED FLAG: bleeding post-menopause could mean endometrial/uterine cancer

Question 5

Breast Assessment

Answer 5

• Largest amount of breast tissue is in the upper outer quadrant (9 o’clock to 12 o’clock position) and the tail of spence
  > Common site for breast cancers

Need to inspect and palpate (there’s a difference)
INSPECT: A good way to inspect is patient sitting with hands on hips gown at waist
PALPATE: Supine with the arm above head usually under head for support, May put a town or roll under that shoulder.

-Document abnormalities of breast according to clock position

Question 6

Ovarian Cancer

Answer 6

Asymptomatic at first then presents as abdominal vague symptoms such as fullness and bloating

Or found by enlarged ovary

Question 7

Cervical Cancer

Answer 7

Asymptomatic usually found on pap smear

Question 8

Normal findings in male infants/toddlers

How to asses

Answer 8

• Male Assess penis and urethral meatus
• Foreskin if present is fully retractable by age 3-4

Testicles
Make sure you can palpate both in the scrotal sac-possible undescended testes-refer to pediatric surgeon
-Cremasteric reflex- when the scrotal contents retract in response to cold hands

Question 9

Normal findings in female infants/toddlers

How to asses

Answer 9

?

Question 10

Bacterial vaginosis (BV)

Answer 10

Overgrowth of bacteria naturally found in the vaginal canal

How to diagnose:

• Chief cause Gardnerella vaginalis- FISHY odor
• CLUE cells will be present on a wet mount PH maybe higher than 4.5 (normal pH is 3.8-4.5)
• KOH is added to wet mount and if there is a strong fishy odor most likely BV

Question 11

Chlamydia

Answer 11

may be asymptomatic or may have discharge with a slight odor

Urine or cervical/vaginal swab to diagnose

Question 12

Gonorrhea

Answer 12

dysuria, green or yellow vaginal discharge

Gonorrhea nucleic acid amplification (NAAT) is the optimal test, culture, urine

Question 13

Condyloma Acuminatum

Answer 13

(genital warts)

Question 14

Molluscum Contagiosum

Answer 14

IN CHILDREN not considered an STI

Question 15

Trichomoniasis

Answer 15

Caused by infection with a protozoan parasite

Sometimes asymptomatic may have vaginal discharge- white, grey yellow or green, possible dysuria or CMT

Question 16

Ectopic pregnancy

Answer 16

• any pregnancy outside the uterus
• low back pain, abdominal pain cramping, CMT
• Any rupture is a medical emergency
• they will have + HCG

Question 17

PID

Answer 17

Any infection and/or STI can lead to PID- infection of uterus and adnexa

• CMT a classic sign along with abdominal pain, fevers etc.

Question 18

Genital Herpes

Answer 18

Caused by HSV- herpetic lesions- vesicles

– Chiefly caused by HSV-2

• however HSV-1 which is oral to oral contact can cause genital infection

Question 19

HIV

Answer 19

burning in and around thevaginaandvulva, dyspareunia, dysuria thick, whitevaginaldischarge

Question 20

Varicocele

Answer 20

Torturous thickened spermatic cord- feels like a ”bag of worms”
Do not need treatment unless symptomatic-surgery can cause infertility issues

Question 21

Testicular Torsion

Answer 21

twisting of the testes twisting the spermatic cord

Sudden onset of sever pain to the affected side. MEDICAL emergency

Question 22

Epididymitis

What should Epididymis feel like?

Answer 22

Inflammation of the epididymis – painful, swollen red scrotum, dysuria. may have fever or urethral discharge
Common causes: STI or UTI- screen and treat with appropriate antibiotics

Epididymis – should be nontender (posterolateral aspect of testes)

Question 23

Testicular Cancer

What should Testes feel like

Answer 23

Lumps?

Testes should feel smooth and rubbery devoid of masses

Question 24

Hydrocele

Answer 24

Fluid accumulation in scrotum
Fluid will TRANSILLUMINATE! US to confirm
Usually disappears in the first year of life in infants. In adults usually does not require treatment but surgery may be an option

Question 25

Prostatitis

Answer 25

May be caused by UTI or STI in younger men. PROSTATE BOGGY and ENLARGED

Question 26

BPH

Answer 26

Very normal occurrence in older men. PROSTATE enlarged but smooth and rubbery

Question 27

Prostate Cancer

Answer 27

PROSTATE Hard irregular nodule(s) –median sulcus of prostate may be obliterated

Question 28

Know how to assess a prostate and what a normal and abnormal should feel like What does abnormal prostate suggest?

Answer 28

- Any enlargement of the prostate gland may cause hesitancy when starting a stream, decrease force of urine and may cause urinary retention, UTIs etc.

Question 29

Assess for inguinal hernia

Answer 29

Place one finger in the inguinal canal and ask patient to bear down or “turn and cough” If hernia present, you will feel a bulge against your finger

Question 30

Hypospadias Epispadias and Phimosis

Answer 30

Hypo (Urethral oriface below) Epi (Urethral orifice above) Phimosis if the foreskin cannot be retracted

Question 31

Tanner Stages

Answer 31

?

Question 32

Visualization of large proportion of "clue cells" on your wet mount slide examination suggests:

Answer 32

Bacterial Vaginosis

Question 33

The best way to inspect female breast tissue is to:

Answer 33

WRONG: raise 1 arm above head with towel behind back supine (look over email)

Question 34

The examiner can palpate the posterior surface of the prostate gland. Palpation of a normal prostate in an older adult is likely to feel:

Answer 34

Sooth and rubbery like the end of a pencil eraser

Question 35

While assessing testicles and scrotum of a 55-year-old patient, the examiner notes a thickened spermatic cord that feels like a "bag of worms". This most likely is:

Answer 35

Varicocele

Question 36

How would the examiner assess for an inguinal hernia?

Answer 36

1 finger in the inguinal canal

Question 37

Documentation of a breast mass location is:

Answer 37

in reference to a clock around the nipple

Question 38

The most emergent cause of testicular pain in a young adult male is:

Answer 38

Testicular Torsion

Question 39

When estimating the uterine size, which estimates fetal growth/gestational age:

Answer 39

Measure from the upper part of the symphysis pubis to the top, or the superior aspect of the fundus Fundal height in cm correlates fairly well with the gestational age of the fetus in weeks (ex: 22 cm= 22 weeks gestation)

Question 40

The largest amount of glandular tissues lies in (and is one of the most common sites for breast cancer):

Answer 40

Upper Outer Region