GENITOURINARY Flashcards
Genitourinary history
MALE GU HISTORY
MALE GU EXAM
(Inspection)
- Skin – any lesions, inflammation or wounds
- Prepuce - retract to inspect glans if prepuce in place
- Glans
- Base of penis
- Location of urethra meatus and any notable discharge
- Scrotum
* Lift scrotum to inspect posterior surface.
* Again, observe any lesions. Epidermoid cysts are common, benign
MALE GU EXAM
( palpitation)
- Begin with the penis, note any areas of tenderness or
induration. Note any discharge that may be expressed through the meatus during palpation. - Scrotum & testes – should be firm but not hard, symmetric and nontender.
- Evaluate for inguinal hernias – this is best done with
the patient standing
EXAMINATION OF THE PROSTATE
For some male GU complaints, it may be necessary to complete a prostate exam. Inform the patient and, again, explain what will be required and obtain their consent:
- Keeping the patient draped, ask him to lie on his left side with his buttocks close to the edge of the table with his knees and hips flexed.
- Placing the pad of a gloved and lubricated index finger on the anus, gradually insert the examining finger in the anus as the sphincter relaxes.
- Palpate the prostate gland
Prostate gland ( size, consistency, normal finding)
- Normal size is 3.5 cms wide, protruding about 1 cm into the lumen of the rectum.
- Consistency: it is normally rubbery and firm with a smooth surface and a palpable sulcus between right and left lobes.
- There should not be any tenderness.
- There should be no nodularity.
FEMALE GU COMPLAINTS
Menstrual History
Psychosexual history
GYN and Obstetric history
FEMALE PELVIC EXAMINATION
- Screen exams do not need to start prior to age 21.
- As part of cervical cancer screening, which involves a PAP smear.
- In the setting of lower abdominal or vaginal symptoms (e.g. vaginal bleeding or discharge, lower abdominal pain, vaginal based
masses/ulcers, and several other symptoms or exposures). - For pregnancy
- Prior to a gynecological procedure or surgery, to further understand the size and shape of the uterus (e.g. prior to IUD placement).
PAP smear
this is offered starting at age 21, and is
repeated every 3 years if the findings are normal. Beginning at age 30, adding testing for HPV can allow the interval to be extended to every 5 years.
Blood discharge
Most commonly from menstruation (in correct age population). Other considerations: infection, cancer, fibroids,
pregnancy
Candida discharge
white, cottage cheese consistency. Causes itching, soreness and sometimes pain with intercourse.
Trichomonas discharge
yellowish/green, frothy, malodorous discharge. Can cause itching and pain with intercourse
Bacterial vaginosis discharge
Thin, grayish, malodorous discharge. Can cause pain with intercourse
Cervicitis/PID
yellowish discharge. Cervix may appear red/inflamed. Pain on manipulation of cervix may also be present.
Anteverted
(tipped towards the abdominal wall), in which case
the fundus will be palpated along the abdominal wall.
Retroverted
in which case the fundus will be palpated behind
the cervix in the posterior fornix.
Bimanual exam abnormalities
Pain on palpation/movement of the cervix might indicate
cervical infection.
Large fibroids can sometimes be identified during palpation of the uterus.
Large uterine cancers may also be palpable and may alsocause vaginal bleeding.
Ovarian masses (e.g. cysts, cancer) can sometimes be
identified during palpation of the adnexal region.
EXAMINATION OF BREAST COMPLAINTS
(Nipple discharge)
If the patient reports unusual discharge from the nipple, gently palpate the breast near the nipple, with a goal of trying to express and examine any abnormal fluid. Bloody discharge is particularly concerning for cancer. Most discharge, however, will be secondary to benign conditions.
EXAMINATION OF BREAST COMPLAINTS
(Puckering/Dimpling)
This can suggest an underlying mass which is distorting the skin above it. In this setting, careful palpation around the dimpling is often revealing. In addition, if it’s unclear if there is dimpling or asymmetry, observe the breasts while the patient sits up (with hands placed on hips). This may help clarify differences between the 2 sides and accentuate asymmetry.
EXAMINATION OF BREAST COMPLAINTS
( nipple retraction)
This is concerning for a mass growing underneath the nipple. In this case, carefully palpate the tissue around and underneath the nipple.
EXAMINATION OF BREAST COMPLAINTS
( Redness/Pain )
Suggestive of inflammation and/or infection. Carefully note the extent of redness as well as temperature differences. Assess for any focal swelling or fluctuance that might suggest underlying abscess.
1 - dysuria
Dysuria is defined as pain, burning, or discomfort
experienced during or immediately after urination.
1 - dysuria ( alarm symptoms)
Most causes of dysuria are benign and easily treated. Nonetheless, clinicians should ask about symptoms that
portend a more serious diagnosis.
Fever or chills
Flank pain (with or without hematuria)
Hematuria
Urethra discharge or genital lesions
Inability to urinate or fully empty bladder
Severe suprapubic pain
1 - dysuria ( narrowing differential)
For women with dysuria who have a prior history of UTIs, it is usually enough to ask about consistency with prior
symptoms and assess risk for STIs. If risk is low, UTI is usually the diagnosis, and no testing is required.
For male patients or women with alarm symptoms or symptoms that are different from any prior UTI, diagnostic
testing is usually required.
