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Advanced Health Assessment > GENITOURINARY > Flashcards

GENITOURINARY Flashcards

1
Q

Genitourinary history

A
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2
Q

MALE GU HISTORY

A
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3
Q

MALE GU EXAM
(Inspection)

A
  • 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
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4
Q

MALE GU EXAM
( palpitation)

A
  • 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
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5
Q

EXAMINATION OF THE PROSTATE

A

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
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6
Q

Prostate gland ( size, consistency, normal finding)

A
  • 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.
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7
Q

FEMALE GU COMPLAINTS

A

Menstrual History

Psychosexual history

GYN and Obstetric history

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8
Q

FEMALE PELVIC EXAMINATION

A
  • 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).
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9
Q

PAP smear

A

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.

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10
Q

Blood discharge

A

Most commonly from menstruation (in correct age population). Other considerations: infection, cancer, fibroids,
pregnancy

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11
Q

Candida discharge

A

white, cottage cheese consistency. Causes itching, soreness and sometimes pain with intercourse.

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12
Q

Trichomonas discharge

A

yellowish/green, frothy, malodorous discharge. Can cause itching and pain with intercourse

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13
Q

Bacterial vaginosis discharge

A

Thin, grayish, malodorous discharge. Can cause pain with intercourse

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14
Q

Cervicitis/PID

A

yellowish discharge. Cervix may appear red/inflamed. Pain on manipulation of cervix may also be present.

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15
Q

Anteverted

A

(tipped towards the abdominal wall), in which case
the fundus will be palpated along the abdominal wall.

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16
Q

Retroverted

A

in which case the fundus will be palpated behind
the cervix in the posterior fornix.

17
Q

Bimanual exam abnormalities

A

 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.

18
Q

EXAMINATION OF BREAST COMPLAINTS
(Nipple discharge)

A

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.

19
Q

EXAMINATION OF BREAST COMPLAINTS
(Puckering/Dimpling)

A

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.

20
Q

EXAMINATION OF BREAST COMPLAINTS
( nipple retraction)

A

This is concerning for a mass growing underneath the nipple. In this case, carefully palpate the tissue around and underneath the nipple.

21
Q

EXAMINATION OF BREAST COMPLAINTS
( Redness/Pain )

A

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.

22
Q

1 - dysuria

A

Dysuria is defined as pain, burning, or discomfort
experienced during or immediately after urination.

23
Q

1 - dysuria ( alarm symptoms)

A

 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

24
Q

1 - dysuria ( narrowing differential)

A

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.

25
Q

1 - dysuria ( differential diagnosis)

A
26
Q

2- scrotal pain

A
27
Q

2- scrotal pain ( alarm symptoms)

A

 Sudden onset severe pain with or without swelling

 Recurrent episodes of pain

 Pain after physical or sexual activity

 Pain after trauma

 Abdominal pain

 Fever

 Severe edema, necrosis

28
Q

2- scrotal pain ( narrowing differential)

A
29
Q

2- scrotal pain ( differential diagnosis)

A
30
Q

3 - breast complain in women

A

breast lumps, breast pain, and nipple discharge.

31
Q

3 - breast complain in women ( alarm symptoms)

A

 Palpable breast mass

 Ulcerated breast lesion

 Axillary mass

 Bloody nipple discharge

 Breast complaint plus new systemic alarm symptoms
such as unexplained weight loss, bone pain, dsypnea

 Breast complaint plus a strong family history of breast or ovarian cancer

32
Q

3 - breast complain in women ( narrowing differential)

A
33
Q

3 - breast complain in women ( differential diagnosis)

A
34
Q

4- vaginitis

A
35
Q

4- vaginitis ( alarm symptoms)

A

 Feculent or profuse watery discharge (especially after vaginal trauma – including home births)

 Severe pelvic pain

 Fever

 Confusion, dizziness

 Heavy bleeding

 Systemic rash

 Recent childbirth

36
Q

4- vaginitis ( narrowing differential)

A

For any other patient, take a careful history to narrow down the possible causes:
 Sexual practices
 History of yeast infections
 Discharge characteristics
 Associated symptoms: pain with intercourse, blisters or lesions

 A pelvic exam may be required to look for internal lesions or discharge not noted by the patient and to collect
samples for diagnostic testing.

37
Q

4- vaginitis ( differential diagnosis)

A

Advanced Health Assessment (9 decks)

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