Male Exam Flashcards
What are the scrotal contents to palpate?
Testes, epididymis and spermatic cord (vas deferens)
When is the highest incidence of testicular cancer?
15-35 yrs old
Where do you palpate the epididymis?
Located superiorly and posterolaterally on testicle
How do you palpate the spermatic cord?
Palpate from the epididymis to the inguinal ring using thumb and index finger
How would you know there is hernia in the inguinal canal?
When turn head and cough, feel sudden pressure at side or tip of finger
What do your check for when examining the perianal area?
Hemorrhoids, fissures, skin tags, other lesions
What do you feel when palpating prostate?
Size of a walnut but feels like an almond with 2 lobes, firm like tip of nose or thenar area of palm
What test do you do after removing your finger?
Hemoccult/guaiac test
Condyloma acuminata
Sexually transmitted (HPV)
Usually multiple, grow together and spread to perineum and anal area
Variable sized soft papule and plaques in anogenital regions
2 types of HSV
Type 1: lips, area around mouth
Type 2: genital infections
What is genital herpes?
Begins with painful vesicles on an erythematous case, vesicles can ulcerate
Incurable with recurrent outbreaks
What causes syphilitic chancre?
Due to spirochete treponema pallidum
What is syphilitic chancre?
Primary (acute) phase begins as a painless papule that erodes into a painless ulcer
May become secondarily infected
Usually self-limiting 4-8 wks
What is urethritis?
Infection of inflammation of the urethra
Male complains of dysuria and discharge (may have inflamed meatus)
2 types of urethritis
Gonococcal (by neisseria gonorrhoeae)
Non-gonococcal (by chlamydia trachomatis and others-usually more clear, less purulent discharge)
Peyronie’s disease
Idipathic condition resulting in fibrosis in the tunica albuginea
Firm plaques in penile shaft are palpable
May develop penile curvature, painful erection and occasional ED
What is a carcinoma of the penis?
Begins as form nodule or ulcer that doesn’t heal and is usually non tender
When in carcinoma of the penis most common?
Avg age is 50
More common in uncircumsized males
Indirect inguinal hernia
Above inguinal ligament, near the internal inguinal ring
Often extends into scrotum
Palpable as impulse down inguinal canal
When is a direct inguinal hernia seen?
Usually in men over 40
Direct inguinal hernia
Above the inguinal ligament, rarely into the scrotum
Bulges anteriorly through the abdominal wall
When is a femoral hernia most common?
In women
Femoral hernia
Below inguinal ligament and more lateral than an inguinal hernia
May mimic lymph node
Never into scrotum!!
Common description of varicocele
Soft bag of worms
Varicocele
Varicose veins of scrotal vessel that develops slowly
May slowly collapse if scrotum elevated while pt supine
Associated with infertility
Hydrocele
Soft, non-tender hemi-scrotal swelling that transilluminates because full of fluid
Size of swelling may wax and wane (check for concurrent indirect hernia or testicular masses)
Spermatocele/epididymal cyst
Painless, mobile mass just above the testis
Smaller than hydrocele usually and may transilluminate
Acute epididymitis
Infection of epididymis via vas deferens
Fever and chills
Acute and unilateral, dull to severe scrotal pain radiating to ipsilateral flank
Hemi-scrotal swelling and tenderness which may progress to erythematous, fluctuant mass
What sign is seen in acute epididymitis?
Prehn’s sign (elevation of scrotum providing relief)
What often occurs after epididymitis?
Acute orchitis (also complication of mumps)
Acute orchitis
Inflammation of infection of the testis
Testicular swelling and tenderness
Similar appearance to epididymitis
What is a pt complaint of testicular pain until proven otherwise?
Testicular torsion
Testicular torsion
ACUTE onset of scrotal pain, unilateral with hemi scrotal swelling
Often hrs after vigorous activity/ minor trauma
TTP without relief from elevation
Absent cremasteric reflex
When is testicular torsion most common?
Neonates and adolescents
What deformity is seen with testicular torsion?
Bell-clapper
Testicular tumors
Painless, solid testicular swelling or nodule
Inguinal LAD or para-aortic LAD
May have abdominal pain or pulmonary symptoms of neurologic deficits
Internal hemorrhoids
Enlargements of normal vascular cushions above pectinate line
Can cause bright red bleeding with defecation
Can prolapse and appear as red, moist mass
External hemorrhoids
Dilated veins covered with skin
Tender, swollen, bluish mass at anal margin
Asympomatic unless thrombosed
Anal fissure
Tear in inside lining of wall of anus Caused by stretching of anal mucosa Severe pain with passage of stool and scant bleeding Pain causes spasm that worsens fissure Diagnose with history and anoscopy
Anorectal abscess
Originates from an infected anal crypt gland
Severe pain in anal or rectal area
Fever and malaise common
Perianal erythema and palpable, fluctuant mass
Purulent rectal drainage if abscess begins to drain spontaneously
What can an anorectal abscess lead to?
Anorectal fistula
Rectal polyps
Protuberance into lumen above surrounding colonic mucosa
May be pedunculated (stalk) or sessile (at base)
Soft, difficult to feel with finger
Biopsy to rule out malignancy
Rectal carcinoma
Firm, nodular rolled edge
Often have blood per rectum
Not usually diagnosed with physical exam
Acute prostatitis
Enlarged, tender prostate gland
UTI symptoms, often with fever and chills
Perineal or abd pain
Examine gently!
How do you treat acute prostatitis?
Antibiotics
How does chronic prostatitis present?
With recurrent UTIs
Prostate exam may be normal
Treat with abx for longer
When is benign prostatic hypertrophy more common?
With increasing age
What is benign prostatic hypertrophy?
Symmetrical enlargement of the gland
Slowing of urine stream with difficulty starting stream
Carcinoma of the prostate
Enlarged, firm nodule or area of hardness
Irregular contour and median sulcus is obscured
Usually slow-growing tumor
Metastasizes locally and to bone
May have difficulty voiding
