General diagnosis - Rectal and urogenital exam Flashcards
Bacterial vaginosis
gynecologist referral
- fishy smelling watery discharge after sex or menstruation
- inflammatory condition of the vagina (associated w/: gardnerell species overgrowth)
- vagianl pH > 4.5, numerous clue cells, + amine test confirms Dx
Cancer of the penis
urologist referral
- non-healing ulcer or mass on the glans penis or foreskin with inguinal node spread
- neoplastic condition of the penis; associated w/ chronic HPV infection
- biopsy confirms Dx
Cancer of the vulva
gynecologist referral (biopsy confirm Dx)
- non-healing ulcer or mass in the vulva with spread to involve the inguinal nodes
- neoplastic condition of the vulva; associated w/: chronic HPV infection
candidiasis
gynecologist referral for treatment
- sever vulvar and vaginal itching with thick cottage cheese discharge
- infection of the vulva/vagina d/t candida albicans overgrowth; after use of broad-spectrum antibiotics and in diabetics
- labs: discharge have buds and branching hyphae (characteristic of candida albicans)
cervical cancer
gynecologist referral (PAP smear and follow up biopsy)
- post-coital (after sex), bleeding and non-healing erosion of cervix
- neoplasia of the cervix; MC associate w/ chronic HPV infection
chancroid
medical practitioner referral
- painful yellow genital ulcers, swollen tender inguinal lymph nodes
- seually transmitted disease cause by Hemophilus ducreyi
- tissue culture to confirm Dx
endometriosis
Co-manage with gynecologist
- severe dysmenorrhea, painful nodules in the adnexa, retroverted uterus and infertility
- deposition of endometrial tissue outside uterine cavity; commonly in broad ll., on the ovary and in the pelvis
- laproscopic biopsy of chocolate cysts in the pelvis confirm Dx
epididymo-orchitis
hospital referral
- tender swollen testis and epididymis, prehn’s sign (elevation of scrotum relive pain) may be present
- acute inflammation of the testes and epididymis; associated with gonorrhea and chlamydia
granuloma inguinale
medical practitioner referral
- painless beef-red ulcers in genital region
- STD d/t calymmatobaacterium (klebsiella) granulamatis
herpes genitalis
Co-manage with medical practitioner
- painful recurrent multiple vesicles and shallow ulcers in the genital region
- STD d/t herpes simplex type 2 infection
lymphogranuloma venereum
medical practitioner referral for antibiotics
- fleeting rash, followed by swollen painful draining inguinal lymph nodes (buboes), and rectal strictures
- uncommon STD d/t chlamydia tachomatis types L1-3
- sin of groove may be present in inguinal region
pelvic inflammatory disease
hospital referral
- fever, lower abdominal pain, cervical motion tenderness, mucopurulent cervical discharge
- inflammatory disease of uterus, fallopian tubes and surrounding pelvic connective tissue; d/t gnorrhea or chlamidia
prostatic cancer
urologist referral
- often asymptomatic
- symptomatic (cancer spread): hematuria, hard irregular prostate, LBP, fatigue, weight loss
- slow-growing malignancy of the prostate gland
- Labs: elevated PSA, alakaline phosphatase, hypercalcemia occurs with metastases
ovarian cancer
gynecologist referral
- bloating, abdominal disconfrt adn ascites; 1 ovary enlarged
- malignancy of ovary (MC after 50yo)
- US confirm presence of mass
syphilis
Medical practitioner referral
- painless hard nodule or genital ulcer
- STD d/t treponema pallidum
- VDRL, FTA-abs needed to confirm Dx
Testicular cancer
urologist referral
- dull ache in scrotum with an enlarged irregular testis and gynecomastia
- US confirms ECHOdensity of mass, biopsy confirms Dx
Trombosed external hemorrhoid
proctologist referral (if, conservative care with sitz baths and preparation H are not helpful)
- vary tender blue swollen nodule at he anal orifice arising below the pectinate line
- painful thrombosed tributary of the inferior rectal vein; associated with constipation
Torsion of the testis
urgent referral to confirm and do surgery
- sudden onset of testicular/scrotal pain, refered to the periumbilical region, n/v, prehn’s sign is negative, affected testis will be higher than the other
- uncommon twisting of the testis d/t long mesorchium
Trichomonas
gynecologist referral
- vulvar itching, malodorus frothy yellow-green vaginal discharge female (asymptomatic in males)
- STD d/t protozoan called trichomonas vaginalis
- Lab: motile flagellates in discharge
Uterine leiomyoma (fibroids)
gynecologist referral
- polymenorrhagia (frequent periods w/ prolonged bleeding), irregularly enlarged uterus, anemia
- benign smooth mm tumors of the uterus (related to estrogen stimulation)
- may be: microcytic hypochromic anemia d/t prolonged bleeding
Varicocele
urologist referral
- dragging sensation in scrotum, bag of worms’ sensation on palpation
- vericose veins in pampiniform plexus of veins (MC on left)
- doppler US confirms Dx
bag of worms’ sensation on scrotum
varicocele
buboes in groin (draining lymph nodes)
lymphogranuloma venereum
cheesy white curds in the vagina
candidiasis
craggy hard irregular nodule in prostate
prostatic cancer
erosion on the cervix
cervical cancer
irregular painless testicular enlargement
testicular cancer
irregular uterine enlargement
uterine fibroids
froth malodorous vaginal discharge
trichomaonas
multiple painful shallow genital ulcers
herpes genitalis
non-healing vulvar ulcer
carcinoma of the vulva
non-healing penile ulcer
carcinoma of the penis
painful bluish mass protruding from the anal orifice
thrombosed external hemorrhoid
painful nodules in the adnexa
endometrosis
painless fleshy mass protruding form anal orifice
internal hemorrhoid
painful soft yellow genital ulcer
chancroid
painless soft red genital ulcer
granuloma inguinale
painless firm genital ulcer
syphilis
pelvic mass in a postmenopausal woman
ovarian cancer
regular uterine enlargement
pregnancy
sign of the groove (swollen inguinal nodes with groove)
lymphogranuloma venerum
smooth round prostate with median sulcus
normal prostate
strawberry cervix
trichomonas
swollen tender testis and epididymis
epididymo-orchitis
tender boggy prostate
prostatitsis
tenderness on motion of the cervix
pelvic inflammatory disease
transilluminable mass in the scrotum
hydrocele
watery fishy vaginal discharge
bacterial vaginosis
