Male Genitourinary and Prostrate exam Flashcards
vascular erectile tissue
Corpus spongiosum – containing the urethra.
Corpora cavernosa – two.
glans
cone shaped end of the penis.
prepuce/foreskin
present on uncircumcised males, covers the glans
urethral meatus
vertical slit like opening at the tip of the glans.
scrotum
pouch that contains the testes
tunica vaginalis
serous membrane covering the testes
epididymis
tightly coiled spermatic ducts on the posterior-lateral surface of each testicle. Storage of sperm.
Vas deferens
cordlike tube, transports sperm from epididymis to urethra
Spermatic cord
contains vas deferens, blood vessles, nerves and cremaster muscle fibers (pulls testicle outwards, helps to maintain testicle position in order to regulate temperature)
Prostate gland: where is cancer most common?
- sits along backside of bladder, divided into five lobes.
- posterior lobe is most common for cancer: prostate is like hole of doughnut, as prostrate grows larger, hole of doughnut gets smaller, difficulty with urination
- posterior lobe is what can be felt on examination
Indirect hernia
- most common for both sexes
- occurs above inguinal ligament
- often occurs into the scrotum
- comes through internal ring and slides through the canal
Direct hernia
- less common, usually seen in men
- occurs above the inguinal ligament
- rarely moves into the scrotum
- comes through external ring
femoral hernia
- least common, more common in women than men
- occurs below the inguinal ligament
- never moves into the scrotum
dysuria
painful urination
hematuria
red urine
components of male GU examination
penis scrotum and its contents hernias prostate exam special techniques
Inspection of penis
- look at skin (lesions and rashes)
- hair (distribution, lesions, infections)
- prepuce/foreskin (retract if present)
- glans (ulcers, scars, rashes, inflamm.)
- meatus (lesions or inflammation,discharge), milk or strip the penis and put the sample on a glass slide
STD’s
Chlamydia - WBC
Gonorrhea - WBC with Gm(-) intracellular diplococcic
Trichomonas - WBC with moving organisms
GEN Probe – Chlamydia & GC
Palpation of penis
- Palpate from the glans to the base.
- Note any tenderness, nodules, masses,
inflammation. - Palpate the inguinal areas for lymph
nodes, masses, hernias or tenderness. (will see enlarged lymph nodes with gonorrhea and syphilis)
scrotum examination
- inspection of the skin and scrotal contours
- palpation of the testes and epididymis (should be smooth)
- palpation of the spermatic cord (feels like rope, roll gently between fingers)
hernia palpation:
- finger slides up into the inguinal canal
- have patient bend down and cough, will feel hernia bounce
prostate gland
bi-lobed, heart shaped, consistency of a rubber ball. The inferior aspect of the posterior lobe is best palpated on DRE. Note size (walnut), tenderness, consistency, nodules, etc.
Testicular self-exam
- Best performed during or after a bath or shower. - Examine each testicle with both hands. Gently roll the testicle between the thumbs and fingers. - Locate the epididymis on the posterior surface of the testicle. - Follow up with a physician if you find any lumps or tenderness. - Educate your patients.
Prostate Cancer
- most common non-skin cancer
- 2nd cause of death in males
- screening tests: DRE and PSA
- PSA can detect some cases of prostate cancer, but can also result in false positives (prostatitis, prostatic hypertrophy)
- US government recommends against screening in patients older than 75 (should be looking at it in patients at 50 years old)
- if pain, then send them for an ultrasound
hypospadias
- congenital displacement of the urethral meatus on inferior surface of penis along the urethral groove.
- important in a newborn exam, associated with congenital renal abnormalities
- epispadias = urethral opening on dorsal shaft
Phimosis
- the foreskin cannot be retracted over the penis
- painful with erection
- can be due to lack of poor hygiene
- treatment = circumcision
paraphimosis
- foreskin cannot be retracted back over the glans, stuck behind the corona
- treatment = circumcision
hydrocele
fluid filled mass within tunica vaginalis
- transilluminates with a light
cryptorchidism
- undescended testicle
- usually atrophied
- increased risk for cancer
syphilis
- syphilitic chancre: painless round or oval erosion or ulcer, non-tender enlarged inguinal lymph nodes are common.
- RPR and VDRL are positive, screening test, many false positives.
- FTA- ABS is positive or Dark Field Microscopy, confirmatory test.
secondary syhpilis
- unexplained rash on palms of hands, back, soles of feet
non-treponemal tests for syphilis
- common false positives
RPR (Rapid Plasma Regain)
VDRL (Venereal Disease Research Lab)
confirmatory test for syphilis
- FTA-ABS (fluorescent treponemal antibody absorbed)
- TP-PA (T. pallidum particle agglutination)
- Dark field microscopy
Genital herpes
- cluster of small vesicles.
- Burning and painful.
- Progress to ulcers on a erthymic base.
- Dx – viral culture of the fluid in the vesicle.
Herpes simplex virus 1 and 2 - Virus: Herpes simplex 1 and Herpes simplex 2.
- Primary infection – painful lesions, lymphadenopathy, fever, malaise.
- Recurrent infections – localized lesions and less symptoms.
- Viral shedding is usually asymptomatic.
- Pregnant women can vertically transmit HSV to the infant during birth.
- Viral culture of vesicle fluid can confirm active infection.
- Treatment – acute and suppressive therapy. (not curative)
venereal warts
- Venereal warts (Condyloma acuminatum) - caused by HPV (human papillomavirus. Grow in cauliflower like clusters.
Difficult to treat – cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara(imiquimod), surgery.
genital scabies
- Contagious disease caused by a mite (Sarcoptes scabiei)
- Direct skin contact.
- Nocturnal pruritus is very characteristic progressing to intense pruritus.
- Linear, curved or s-shaped burrows.
- Diagnosis: clinical suspicion, slide mount preparation.
- Treatment: Permethrin cream (Elimite), Lindane; oral steroids or antihistamines for pruritus.
gonococcal vs nongonococcal urethritis
- purulent discharge of gonorrhea
nongonoccoal = chlamydia
sample on slide for chlamydia?
WBC
sample on slide for gonorrhea
WBC and Gm- intracellular diplococcic
Trichomonas on slides?
WBC with moving organisms
What are three positions to examine prostate?
- Sim’s position/left lateral decubitus: laying on left side
- modified lithotomy: similar to female GU
- standing position and leaning forward (gives best access to posterior lobe anteriorly.)
testicular cancer
USPSTF recommends against routine screening for testicular cancer and against testicular self-exam
- it has low incidence and favorable outcome - most cancers are found by patients and their partners
- seen often in young men: most common cancer of young men between the ages of 15 and 35
treponema pallidum
organism causing syphilis
Herpes simplex virus 1 and 2
causes genital herpes
condyloma acuminatum
HPV virus causing venereal warts
sarcoptes scabiei
scabies mite
niesseria gonorrheoea
gram- bacteria causing gonorrhea
causes gonococcal urethritis
nongonococcal urethritis?
caused by chlamydia. Chlamydia trachomatis bacteria.
What does prostatic cancer feel like?
hard, irregular nodules and asymmetric gland
what does BPH feel like?
benign prostatic hyperplasia
- symmetrical, enlarged, soft gland that may bulge into the rectal lumen
prostatitis palpation?
feels tender, boggy and fluctuant gland
see chapman’s reflex in lateral thigh
