genitourinary

Question 1

paraphimosis

Answer 1

foreskin becomes trapped behind the glans penis

Question 2

hypostadias

Answer 2

urethral opening is on underside of the penis

Question 3

chancre

Answer 3

painless ulceration formed during primary stage of syphilis

Question 4

condyloma

Answer 4

presence of warts caused by HPV

Question 5

peyronie disease

Answer 5

connective tissue disorder; chronic inflammation and scar tissue formation in the túnica albugínea

Question 6

hydrocele

Answer 6

collection of fluid in the scrotum

Question 7

spermatocele

Answer 7

benign, sperm-filled cyst at the head of the epiddidymis

Question 8

varicocele

Answer 8

enlargement of the veins within the scrotum

Question 9

epididymitis

Answer 9

inflammation of infection of the epididymis; generally caused by chlamydia, gonorrhea, or E. Coli

Question 10

testicular tumor

Answer 10

câncer that develops in the testicles

Question 11

epispadias

Answer 11

urethral deformity; can open on top, side, or be open along length of penis

Question 12

indirect inguinal hernia

Answer 12

through internal ring; most common type of hernia, pts often young males; pain on straining; touches fingertip on exam

Question 13

direct inguinal hernia

Answer 13

doesn’t go through internal inguinal ring; through external right; hernia bulges anteriorly, pushes against side of finger

Question 14

femoral hernia

Answer 14

bulging of intestines through the femoral ring

Question 15

cryptorchidism

Answer 15

undescended testicle

Question 16

what causes erection?

Answer 16

two corpa cavernosa engorged with blood (arterial dilation and decreased venous outflow produce increased blood supply)

• controlled by ANS
• occur due to local synthesis of NO

Question 17

ejaculation

Answer 17

• emission of secretions from vas deferens, epidiymides, prostate and seminal vesicles
• orgasm followed by contrition of vessels supplying blood to corpa cavernosa and gradual detumenscence (subsidence of erection)

Question 18

fecal occult blood test

Answer 18

screening for blood (cancer)

Question 19

genital exam: infants

Answer 19

• inspect/palpate
• congenital anomalies (hypospadias, epispacias, undescended testes, etc)
• urethral placement
• retractability of foreskin (should be able to reduce it)
• descent of testicles
• masses (if found, transilluminate!)

Question 20

genital exam: children

Answer 20

• inspection and palpation
• lesions
• malformations
• discharge
• masses
• hernias

Question 21

genital exam: adolescents

Answer 21

• alleviate anxiety
• protect privacy
• inspect/palpate (tanner staging)
• check knowledge of reprod. function, concern for sexual abuse, sex activity

Question 22

genital exam: adult (inspection)

Answer 22

much of inspection happens during palpation

• General appearance - lesions, chancres, pubic hair patterns, note circumcised or uncircumcised, position, meatus position/stenosis
• note: phimosis and paraphimosis (attempt manual reduction for paraphimosis - refer out if unsuccessful)

Question 23

genital exam: adult (palpation)

Answer 23

**GLANS:tenderness/nodularities/lesions - palpate top to bottom/side to side/strip the urethra looking for any abnormal discharge or blood at urethral meatus. Open meatus to inspect for discharge, lesions.

-cremasteric reflex - tongue blade stroked on inside of thigh - testicle on that side should rise voluntarily - tests T12-L1-L2 nerves

• Testis: need to be more gentle- good to isolate one testicle at a time - can ask pt to hold penis out of the way, roll testicle around in fingers - smooth - not overly tender
• note contours during palpation
• will find epididymis as a lump of tissue that is sitting on posterior/top of testicle compare sides of epididymus
• find spermatocord - follow it up to pelvis to inguinal ring

Question 24

how to palpate for hernia

Answer 24

follow spermatacord up to pelvis, toothpick feeling is the vas defrens, find the external inguinal ring - place tip of finger here and have pt cough/bear down.
-If bulge felt on tip of finger = indirect hernia, if bulge felt on side of finger = direct hernia

Question 25

tanner stage 1

Answer 25

Testes, scrotum, and penis are same size/shape as a young child; no pubic hair growth

Question 26

tanner stage 2

Answer 26

Enlargement of scrotum and testes, skin becomes redder, thinner, and wrinkled, no penile enlargement; slightly longer, straight, pigmented hair at base of penis, sometimes on scrotum, texture is still downy

Question 27

tanner stage 3

Answer 27

Enlargement of penis, especially in length, further enlargement of testes and scrotal descent occurs; dark pigmented, curly pubic hair at base of penis

Question 28

tanner stage 4

Answer 28

Continued enlargement of penis and sculpturing of glans, increased pigmentation of scrotum; atult type pubic hair but only to inguinal folds; “Not quite adult”

Question 29

tanner stage 5

Answer 29

Penis reaches to nearly bottom of scrotum; hair spreads to medial surface of thighs buts not upward; Adult distribution

Question 30

tanner stage 6

Answer 30

(Seidel/Mosby includes this extra stage for pubic hair growth, but no other resources online include it as a formal Tanner stage) Hair spreads to lenea alba (at midline from umbilicus down); occurs in 80% of men

Question 31

uncercumcised penis

Answer 31

● Retract foreskin - should retract easily
● Normal to see smegma (white, cheesy sebaceous matter that collects between glans penis and foreskin)
● Note ease of retractability (or lack of indicating paraphimosis or phimosis)
● Complete exam of glans and urethral meatus
● Always reduce foreskin back to normal when completing exam

Question 32

circumcised penis

Answer 32

● Glans should appear erythematous and dry

● No smegma.

Question 33

How to minimize patient anxiety during exam?

Answer 33

● Chaperone: especially for opposite sex
● Anxiety: can be most difficult for teenagers, but important to assess in all patients
○ Answer questions ahead of time
○ Thorough communication before exam starts
● Position: describe the positioning they will go through prior to begining exam
● Equipment: assemble ahead of time to minimize time and confusion that will provoke anxiety
● Instruction: while doing exam on patient you can instruct them how to do the self-exam

Question 34

describe steps of male self exam

Answer 34

● Be sure to educate and demonstrate the self exam procedure to your patients. Also, give them the chance to perform a GSE with your guidance.
● Step 1: Patient should hold penis in hand
○ Inspect head of penis for lesions or masses (if not circumcised, pull back foreskin)
○ Palpate head of penis feeling for bumps, sores, warts or blisters.
Step 2: Inspect urethral meatus, squeeze to see if there is any discharge.
Step 3: Patient should examine entire shaft.
● Evaluate for any lesions, asores or masses.
● Use a mirror to visualize the underside.
Step 4: Patient should then examine the base of the penis by moving pubic hair out of the way.
Step 5: Scrotum evaluation
● Patient should hold each testicle gently while inspecting and palpating using lighter then firmer pressure.
● Recommended to do this while taking a bath. The warmth will make the skin less thick and easier to access for abnormalities.