Genitourinary exam & common complaints

Question 1

When palpating a male scrotum area, you find a hard ferm modal that seems fixed. What is the probably Dx?

Answer 1

Testicular cancer.

The scrotum & testes should be firm but not hard, symmetric & non-tender when palpating.

Question 2

How should the prostate feel in examination?

Answer 2

Normally rubbery & firm with a smooth surface & a palpable sulcus between right & left lobes. Normal prostate size 3.5cm wide, protruding about 1cm into the lumen of the rectum. Absent of tenderness & nodularity.

Question 3

How to perform a prostate exam?

Answer 3

1. Keeping the Pt draped. Ask him to lie on the left side with his buttocks close to the edge of the table with his knees & hips flexed.
2. Placing the pad of a gloved & lubricated index finger on the anus, gradually insert the examining finger in the anus as the sphincter relaxes.
3. Palpate the prostate gland

Question 4

What are the Risk Factors for breast cancer?

Answer 4

Asymptomatic Pt: Done annually, beginning at the age of 40, which coincides with the time of increased risk for the development of breast cancer.

Symptomatic Pt: The goal of the examination is to characterize the abnormality better, identify the etiology, & direct additional evaluation & treatment. Breast-related symptoms may include any of the following:
1. Discrete masses detected by the skin
2. Pain
3. Unusual nipple discharge
4. Discoloration or change in the quality of the skin

Question 5

What will you document when you find a mass or something concerning in the breast?

Answer 5

Describe what it looks like, its size, location using a clock face (12, 6, 3, 9), & where it is in relation to the nipple

Question 6

What is the 1st thing you will suspect when you have Pt complain of dysuria?

Answer 6

UTI because most pt has an infectious etiology.

Question 7

Which organs are palpating when doing Bimanual Examination?

Answer 7

We palpate the uterus 1st, then try to feel the ovaries.
Bimanual exam: The uterus and adnexal structures should be outlined between the 2 fingers of the gloved hand in the vagina and the flat of the opposite hand, which is placed on the lower abdominal wall. Gentle palpation and manipulation of the structures will delineate position, size, shape, mobility, consistency, and tenderness of the pelvic structures—except in the obese or uncooperative patient or in a patient whose abdominal muscles are taut as a result of fear or tenderness.

Question 8

What are the Symptoms of vaginitis?

Answer 8

1. Itchy or sore vagina
2. Vaginal discharge that’s a different color, smell, or thickness than usual vaginal dryness
3. Pain when peeing or having sex
4. Light vaginal bleeding or spotting
5. Sore, swollen, or cracked skin around the vagina

Question 9

What is the difference between Primary & secondary amenorrhea?

Answer 9

Primary amenorrhea—This is when a girl does not get her first period by age 15.

Secondary amenorrhea—This is when a woman who already menstruates does not get her period for 3 months or more.

Question 10

What type of Pt would you screen for UTI & STDs?

Answer 10

Sexually active or with symptoms

Question 11

What are the alarming symptoms for dysuria?

Answer 11

1. Fever or chills
2. Flank pain (with or without hematuria)
3. Hematuria
4. Urethra discharge or genital lesions
5. Inability to urinate or fully empty bladder
6. Severe suprapubic pain

Question 12

Is it alarming when an older male complains of dysuria, associated with can not empty his bladder?

Answer 12

Yes, because the dysuria is associated with an inability to urinate which can indicate UTI or blockage from implant prostate

Question 13

Breast cancer risk factors?

Answer 13

Question 14

What are the alarming symptoms for scrotal pain?

Answer 14

1. Sudden onset severe pain with or without swelling
2. Recurrent episodes of pain
3. Pain after physical or sexual activity
4. Pain after truma
5. Abdominal pain
6. Fever
7. Severe edema, necrosis

Question 15

What is Fournier gangrene?

Answer 15

It is a acute necrotic infection of the scrotum, penis, or perineum. It is characterized by scrotum pain and redness with rapid progression to gangrene and sloughing of tissue. Fournier gangrene is usually secondary to perirectal or periurethral infections associated with local trauma, operative procedures, or urinary tract disease.

Question 16

Inguinal hernia?

Answer 16

It occurs when tissue, such as part of the intestine, protrudes through a weak spot in the abdominal muscles.

Question 17

List the symptoms for Pelvic Inflammatory Disease (PID)?

Answer 17

1. Pain in your lower abdomen;
2. Fever
3. Unusual discharge with a bad odor from your vagina
4. Pain and/or bleeding when you have sex;
5. Burning sensation when you urinate; or
6. Bleeding between periods