Male Genital and Rectal

Question 1

Irregular lymph nodes

Answer 1

hard or immobile; suggest cancer

Question 2

What to palpate in the scrotum

Answer 2

Testes,
epididymis
spermatic cord (vas deferens)

Question 3

Testicles should feel like

Answer 3

an eraser or a hard-boiled egg

Question 4

Highest incidence of testicular cancer

Answer 4

15-35

Question 5

Where is the epididymis located? What does it feel like?

Answer 5

Superiorly and posterolaterally on the testicle; feels like a bag of worms

Question 6

Spermatic cord

Answer 6

bilateral firm cords that feel like “the inside of a bic pen”; palpate from the epididymis to the inguinal ring using thumn and index finger

Question 7

Hernia exam

Answer 7

Use scrotum skin and stick finger in inguinal canal; ask patient to turn their head and cough

Question 8

Prostate size

Answer 8

about the size of a walnut

Question 9

Shape of prostate

Answer 9

almond w/ 2 lobes

Question 10

Consistency of the prostate

Answer 10

firm, like tip of nose or thenar area of palm

Question 11

Condyloma acuminata

Answer 11

caused by HPV (most common); multiple lesions, grow together and spread to perineum and anal area; variably sized soft papules and plagues in anogenital regions

Question 12

Genital Herpes

Answer 12

HSV2; begins with PAINFUL vesicles on erythematous base; vesicles can ulcerate; incurable w/ recurrent outbreaks

Question 13

What causes syphilitic chancre

Answer 13

treponema pallidum

Question 14

Syphilis

Answer 14

painless papule that erodes into a painless ulcer; may become secondarily infected; heals w/o treatment in 4-8 weeks

Question 15

Urethritis

Answer 15

infection or inflammation of urethra; gonococcal (caused by N. gonorrhoeae) or non-gonococcal (cause by chlamydia trach); male with c/o dysuria and urethral d/c; may see inflamed meatus

Question 16

Peyronie’s Disease

Answer 16

idiopathic condition resulting in fibrosis in the tunica albuginea; firm plague in penile shaft are palpable; may develope penile curvature, painful erections, and occasionally erectile dysfunction

Question 17

Carcinoma of the penis

Answer 17

begins as firm nodule or ulcer that DOES NOT HEAL; average age is 50; usually nontender; more common in uncircumsized males, inguinal adenopathy often present

Question 18

Sx with carcinoma of penis

Answer 18

inguinal LAD

Question 19

Indirect inguinal hernia

Answer 19

most common in all ages, both sexes; above inguinal ligament, near internal inguinal ring; often extends into scrotum; palpable as impulse down canal

Question 20

Direct Inguinal Hernia

Answer 20

less common; usually in men over age 40; above inguinal ligament, RARELY IN SCROTUM; bulges anteriorly

Question 21

Femoral hernia

Answer 21

least common; more common in WOMEN; below inguinal ligament; more lateral than inguinal hernias; may mimic lymph node; never into scrotum

Question 22

Varicocele

Answer 22

Varicose veins of scrotal vessels; develops slowly; feels like a soft “bag of worms,” may slowly collapse if scrotum elevatd while patient supine; associated w/ infertility

Question 23

Hydrocle

Answer 23

soft non-tender hemi-scrotal swelling that TRANSILLUMINATES; size of swelling may wax and wane; check for concurrent indirect hernia or testicular masses

Question 24

Spermatocele/epididymal cyst

Answer 24

painless, mobile mass just above the testis; smaller than hydrocele usually; may transilluminate

Question 25

Acute epididymitis

Answer 25

infection of epididymis via the vas deferens; fever/chills; acute and unilateral, dull to severe scrotal pain radiating to ipsilateral flank; hemi-scortal swelling and tenderness which may progress to erythematous, fluctuant mass; PREHN'S SIGN (elevation of the scrotum providing relief)

Question 26

Acute orchitis

Answer 26

inflammation or infection of the testis; testicular swelling and tenderness; similar in appearance to epididymitis; complication of epididymitis and mumps

Question 27

PREHN's sign

Answer 27

Epididymytis

Question 28

Testicular torsion

Answer 28

ACUTE onset of scrotal pain, UNILATERAL with hemiscrotal swelling; often hours after vigorous physical activity/minor trauma; pain on palpation without relief w/ elevation; ABSENT CREMASTERIC REFLEX; most common in neonates and adolescents

Question 29

Cause of testicular torsion

Answer 29

Twisting of the testes and spermatic cord causes ischemia

Question 30

test for testicular torsion

Answer 30

(-) Cremasteric reflex | Dopplar U/S shows decreased blood flow

Question 31

Tx for testicular torsion

Answer 31

SURGICAL EMERGENCY

Question 32

Bell-clapper deformity

Answer 32

Testical in horizontal plate

Question 33

Testicular tumor

Answer 33

painless, SOLID testicular swelling or nodule; inguinal LAD or para-aortic LAD; +/- abdominal pain or with pulmonary symptoms or neuro deficits

Question 34

Inguinal LAD associated with

Answer 34

penile carcinoma | Testicular tumor

Question 35

(-) Cremasteric reflex

Answer 35

Testicular torsion

Question 36

Cause of acute orchitis

Answer 36

complication of epididymitis and mumps

Question 37

Associated w/ infertility

Answer 37

Varicocele

Question 38

Internal hemorrhoid

Answer 38

enlargements of normal vascular cushions above pectinate line; can cause BRIGHT RED BLEEDING WITH DEFECATION; can prolapse and appear as red moist mass

Question 39

External hemorrhoid

Answer 39

Dilated veins covered covered with skin; tender, swollen, BLUISH mass at anal margin; asymptomatic unless thrombosed

Question 40

Anal fissure

Answer 40

tear in the inside lining of the wall of the anus; caused by stretching of anal mucosa; SEVERE PAIN W/ PASSAGE OF STOOL AND SCANT BLEEDING; pain causes spasm, worsens fissure;

Question 41

Dx of anal fissure

Answer 41

hx and anoscopy

Question 42

Anorectal abscess

Answer 42

from an infected anal crypt gland; severe pain in the anal or rectal area; fevere and malaise; perianal erythema and a palpalble, often fluctuant mass; PURULENT RECTAL DRAINAGE MAY BE NOTED IF THE ABSCESS HAS BEGUN TO DRAIN SPONTANEOUSLY

Question 43

What can an anorectal abscess lead to

Answer 43

anorectal fistula

Question 44

Rectal polyps

Answer 44

Protuberance into the lumen above the surrounding colonic mucosa; may be pedunculated or sessile; soft, difficult to feel w/ finger

Question 45

Tx for rectal polyps

Answer 45

Bx to r/o malignancy

Question 46

Pedunculated

Answer 46

stalk

Question 47

Sessile

Answer 47

attached at base

Question 48

Rectal carcinoma

Answer 48

firm, nodular, rolled edge; often have blood per rectum; not typically dx'd by physical exam

Question 49

Prostatitis types

Answer 49

Acute vs. chronic

Question 50

Prostatitis acute

Answer 50

enlarged, tender prostate gland; UTI symptoms, often w/ fever and chills; perineal or abd pain; examine gently

Question 51

Tx for prostatitis acute

Answer 51

antibiotics

Question 52

Prostatitis- Chronic

Answer 52

presents with RECURRENT UTI's; prostate exam may be normal

Question 53

Tx for prostatitis chronic

Answer 53

abx for a lot longer than acute

Question 54

Benign prostatic hypertrophy prevalence

Answer 54

more common w/ increasing age

Question 55

BPH

Answer 55

symmetrical enlargement . of gland; SLOWING OF URINE STREAM WITH DIFFICULTY STARTING STREAM

Question 56

Carcinoma of prostate

Answer 56

enlarged, firm nodule or area of hardness; IRREGULAR CONTOUR and median sulcus is obscured; usually a slow-growing tumor; metastasizes locally and to bone

Question 57

Complaint with carcinoma of prostate

Answer 57

obstructive voiding symptoms

Question 58

Trouble peeing

Answer 58

BPH; carcinoma of prostate